Sue Holttum

Cognitive Remediation in Anorexia Nervosa and Related Conditions: A Systematic Review

Research evidence for cognitive remediation therapys (CRT) effectiveness for anorexia nervosa (AN) has been gathering. This approach is also increasingly being implemented in other disorders including major depressive disorder, obsessive-compulsive disorder and autistic spectrum disorder that share commonalities with AN in neuropsychological profiles and clinical presentations. This systematic literature review identified and appraised the current evidence base to see whether evidence from related conditions could be integrated into the theoretical understanding of CRT for AN as well as future AN treatment developments and research. Overall, CRT studies in AN report promising findings, and CRT appears to be associated with improvements in set-shifting and in central coherence. Cognitive remediation approaches in other conditions also show promising evidence in associated improvements in areas of executive functioning and information processing; links are made between AN treatment and what future treatment developments could consider.

Cognitive Remediation in Anorexia Nervosa and Related Conditions

Research evidence for cognitive remediation therapys (CRT) effectiveness for anorexia nervosa (AN) has been gathering. This approach is also increasingly being implemented in other disorders including major depressive disorder, obsessive-compulsive disorder and autistic spectrum disorder that share commonalities with AN in neuropsychological profiles and clinical presentations. This systematic literature review identified and appraised the current evidence base to see whether evidence from related conditions could be integrated into the theoretical understanding of CRT for AN as well as future AN treatment developments and research. Overall, CRT studies in AN report promising findings, and CRT appears to be associated with improvements in set-shifting and in central coherence. Cognitive remediation approaches in other conditions also show promising evidence in associated improvements in areas of executive functioning and information processing; links are made between AN treatment and what future treatment developments could consider.

Compassion satisfaction, burnout, and secondary traumatic stress in UK therapists who work with adult trauma clients

Background Therapists who work with trauma clients are impacted both positively and negatively. However, most studies have tended to focus on the negative impact of the work, the quantitative evidence has been inconsistent, and the research has primarily been conducted outside the United Kingdom. Objectives This study aimed to assess the prevalence of, and identify predictor variables for, compassion satisfaction, burnout, and secondary traumatic stress in a group of UK therapists (N=253) working with adult trauma clients. Method An online questionnaire was developed which used The Professional Quality of Life Scale (Version 5) to assess compassion satisfaction, burnout, and secondary traumatic stress and collect demographics and other pertinent information. Results Whilst the majority of therapists scored within the average range for compassion satisfaction and burnout, 70% of scores indicated that therapists were at high risk of secondary traumatic stress. Maturity, time spent engaging in research and development activities, a higher perceived supportiveness of management, and supervision predicted higher potential for compassion satisfaction. Youth and a lower perceived supportiveness of management predicted higher risk of burnout. A higher risk of secondary traumatic stress was predicted in therapists engaging in more individual supervision and self-care activities, as well as those who had a personal trauma history. Conclusions UK therapists working with trauma clients are at high risk of being negatively impacted by their work, obtaining scores which suggest a risk of developing secondary traumatic stress. Of particular note was that exposure to trauma stories did not significantly predict secondary traumatic stress scores as suggested by theory. However, the negative impact of working with trauma clients was balanced by the potential for a positive outcome from trauma work as a majority indicated an average potential for compassion satisfaction.

The MATISSE Trial-A Critique: Does Art Therapy Really Have Nothing to Offer People With a Diagnosis of Schizophrenia?

U.K. national guidelines for the treatment of schizophrenia recommend art therapy among other approaches. However, a recent major trial called MATISSE (Multicenter evaluation of Art Therapy in Schizophrenia: Systematic Evaluation) suggests that art therapy may not be helpful. The purpose of the present study was to explore reasons for the MATISSE trial findings. A critical review of the MATISSE trial drawing on six papers reporting on the trial and its processes was performed. The MATISSE trial appeared to have weak conceptualization of the mechanisms for change, lack of piloting, incomplete process and subgroup analyses, and inappropriate assumptions about the generalizability of findings. The MATISSE trial’s conclusion that art therapy is of no value to people with a diagnosis of schizophrenia is unwarranted. More account should be taken of extant quality guidelines for complex interventions, including proposed change mechanisms, piloting, process analyses, variations in practice and contexts, and the effect of randomization on generalizability.

The relationship between acceptance and cognitive representations of pain in participants of a pain management programme

This study investigated the relationship between acceptance and cognitive representations of pain in participants on a pain management programme. Correlations between questionnaire measures of acceptance and five dimensions of health beliefs were examined in 116 participants attending for assessment for a pain management programme. Acceptance scores were inversely correlated with perceived severity and consequences of pain, and pain identity, but not correlated with beliefs about cause, expected duration of pain, or control and cure. Further research is needed to explore the nature of acceptance, and to identify the range and interplay of key dimensions of belief relevant to functioning and outcome of interventions in chronic pain populations.

WAIS III UK: An extension of the UK comparability study

OBJECTIVES To correct and augment the sample on which a previous study, assessing the applicability of USA WAIS III norms to the UK population, was based. To repeat this study using the modified sample. DESIGN The WAIS III UK was administered to a supplementary sample, which was used to enhance and correct the original sample, allowing a better match to UK population demographics. METHOD WAIS III UK scores were processed using USA norms. RESULTS Distributions of UK IQ, Index, and subtest scores were consistent with USA norms. Means were significantly above USA values and did not show a flat profile. Correlational analysis suggested the presence of an age-related sampling bias, which was then statistically controlled for using analysis of covariance, with age as covariate, to give corrected means. These means, with the exception of two subtests (block design and picture arrangement), did not differ significantly from USA values. CONCLUSION With a minor proviso concerning the above subtests, it is probable that USA norms can be safely used with the UK population. Future UK samples need to ensure random sampling within demographic categories if sampling bias is to be avoided.

How Do “Mental Health Professionals” Who Are Also or Have Been “Mental Health Service Users” Construct Their Identities?:

“Mental health professionals” are increasingly speaking out about their own experiences of using mental health services. However, research suggests that they face identity-related dilemmas because social conventions tend to assume two distinct identities: “professionals” as relatively socially powerful and “patients” as comparatively powerless. The aim of this study was, through discourse analysis, to explore how “mental health professionals” with “mental health service user” experience “construct” their identity. Discourse analysis views identity as fluid and continually renegotiated in social contexts. Ten participants were interviewed, and the interviews were transcribed and analyzed. Participants constructed their identity variously, including as separate “professional” and “patient” identities, switching between these in relation to different contexts, suggesting “unintegrated” identities. Participants also demonstrated personally valued “integrated” identities in relation to some professional contexts. Implications for clinical practice and future research are explored. Positive identity discourses that integrate experiences as a service user and a professional included “personhood” and insider “activist,” drawing in turn on discourses of “personal recovery,” “lived experience,” and “use of self.” These integrated identities can potentially be foregrounded to contribute to realizing the social value of service user and other lived experience in mental health workers, and highlighting positive and hopeful perspectives on mental distress.

A grounded theory investigation of life experience and the role of social support for adolescent offspring after parental brain injury

Primary objective: The purpose of this study was to explore the experiences of adolescent offspring following parental acquired brain injury (ABI) and the role of supportive relationships in offspring coping. Design: The study was qualitative using grounded theory methodology. Methods and procedure: Nine adolescent offspring of parents with ABI were interviewed individually. For the purposes of triangulation, three of their noninjured parents were interviewed individually. Results: Findings indicate that following the shock of the ABI, adolescents appeared to go through a dynamic process of reevaluation of life priorities, a sudden realization of the fragility of life, and an increase in their appreciation of the familys needs. The studys findings also show that adolescent offspring can have a protective role in the family, assisting the family with the long-term challenges that ABI may present. Alternative parental figures and peer friendships appeared to have a central role for participants, providing a sense of normality and stability to their lives, and acted as an important connection with their lives prior to their parents’ ABI. Conclusions: Findings indicated that supportive relationships were crucial as a coping strategy for adolescent offspring. Assessment of adolescents’ coping strategies and support networks should be conducted by the best-placed clinician working with the family. Preventative interventions are recommended. A strength-based view of the adolescent may be beneficial.

Development of a measure of caregiver burden in paediatric chronic kidney disease: the Paediatric Renal Caregiver Burden Scale

To inform the development of a measure of caregiver burden for carers of children with chronic kidney disease, interviews were conducted with 16 caregivers and 10 renal healthcare professionals. A pool of 97 items generated from interviews was reduced to 60 items following review. A piloting exercise provided evidence for the usability, readability and relevance of items and informed further adaptations resulting in the 51-item Paediatric Renal Caregiver Burden Scale. Further to assessment of its psychometric properties, it is hoped that that the Paediatric Renal Caregiver Burden Scale will serve as a useful measure of caregiver burden in paediatric chronic kidney disease.

A discourse analysis of power in relation to PSYCHLOPS (Psychological outcome profiles) in the context of CBT for psychosis

Abstract Aims: Outcome measures (OMs) and routine change measurement have developed dramatically in psychological therapies over the last two decades and some therapists have expressed concerns that this, depending on how it is handled by the parties involved, can markedly affect the therapy. However, little research has investigated this. It therefore seemed timely to explore discourses of OMs drawn upon by both parties in the therapy room. Method: PSYCHLOPS (Psychological Outcome Profiles) is a client-centred measure which offered an opportunity to explore how therapists and clients receiving CBT for psychosis talked about OMs. A useful contrast was provided by the CORE-OM (Clinical Outcomes in Routine Evaluation-Outcome Measure). The discourses drawn upon by clients (n=4) and therapists (n=4) were analysed, informed by a Foucaultian framework. Results: OMs were constructed as empowering or disempowering of clients, as being able to do therapeutic work of engagement and containment, and as part of the a...