A feasibility study highlighting challenges in evaluating a structured, psychological treatment for self-harm in adult psychiatric inpatient settings

BACKGROUND: Despite being the most common reason for admission to psychiatric inpatient services, no evidence-based treatment currently exists for self-harm in this setting. Dialectical Behavioural Therapy (DBT) trials have found promising results in treating self-harm in outpatient settings; however findings for inpatient settings are still limited. METHOD: A single-arm feasibility trial was conducted examining a DBT-informed 'Coping with Crisis' (CwC) group protocol, which focused on self-harm and crisis management strategies. Twenty-four participants were recruited from an inpatient ward in a National Health Service (NHS) Trust in the UK. The Inventory of Statements about Self-Injury and Distress Tolerance Scale were administered at baseline and post-therapy. Data was collected on the rates of recruitment, retention, session attendance, outcome measure completion, adverse events and participant feedback, in order to inform the design of a main study. RESULTS: Findings indicated that it was feasible to run the CWC group and research study on an inpatient ward. However, there were several challenges in recruiting to target (80% achieved) and retaining participants (38% of consented participants completed). A number of implementation issues were identified and recommendations have been made to inform future group and study designs

Recovery from psychosis : physical health, antipsychotic medication and the daily dilemmas for mental health nurses

This paper considers some of the dilemmas experienced by Mental Health Nurses everyday when faced with the seemingly conflicting relationships that exist between recovery, antipsychotics and the physical health of people experiencing psychosis. We examine the role of antipsychotics in the process of recovery from psychosis and argue that Mental Health Nursing’s laudable shift away from the medical model towards the concept of self-defined personal recovery should not result in overlooking the importance of physical health and medication management. Mental Health Nurses have a responsibility to help services users make an informed choice about treatment; this exchange of information should be based on the best available evidence rather than philosophical values or personal opinion

A Qualitative Analysis of Experiential Challenges Associated with Meditation Practice

Although empirical interest in meditation has flourished in recent years, few studies have addressed possible downsides of meditation practice, particularly in community populations. In-depth interviews were conducted with 30 male meditators in London, UK, recruited using principles of maximum variation sampling, and analysed using a modified constant comparison approach. Having originally set out simply to inquire about the impact of various meditation practices (including but not limited to mindfulness) on men’s wellbeing, we uncovered psychological challenges associated with its practice. While meditation was generally reported to be conducive to wellbeing, substantial difficulties accounted for approximately one quarter of the interview data. Our paper focuses specifically on these issues in order to alert health professionals to potential challenges associated with meditation. Four main problems of increasing severity were uncovered: Meditation was a difficult skill to learn and practise; participants encountered troubling thoughts and feelings which were hard to manage; meditation reportedly exacerbated mental health issues, such as depression and anxiety; and in a few cases, meditation was associated with psychotic episodes. Our paper raises important issues around safeguarding those who practise meditation, both within therapeutic settings and in the community

Compassion-based approaches:a systematic review of their effectiveness and acceptability in schizophrenia spectrum disorders

The purpose of this systematic literature review is to provide an exhaustive summary of current research to explore the prospects of compassion-based approaches in treating persons with Schizophrenia Spectrum Disorders (SSD). Thereby, studies investigating the relationship between clinical parameters and self-compassion in SSD, as well as the acceptability, feasibility, and effects of compassion-based approaches for individuals with SSD were considered. The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Eight studies were included for qualitative synthesis. The results indicate an important role of self-compassion for several clinical parameters, including negative associations to positive symptoms, negative symptoms, cognitive disorganization, and emotional distress. All studies reported good acceptability and feasibility. Regarding the clinical effectiveness of compassion-based approaches, a variety of clinical benefits, such as improvements of mood, affect regulation, positive symptoms, negative symptoms, cognitive disorganization, and variables relating to psychological recovery were found in individuals with SSD. It is concluded that compassion-based approaches are a promising form of intervention in the treatment of SSD. However, further research, especially randomized controlled trials, in this field is needed to understand the full potential of compassion-based approaches for individuals with SSD.</p

Digital interventions for subjective and objective social isolation among individuals with mental health conditions: a scoping review

Background: Social isolation encompasses subjective and objective concepts. Both are associated with negative health consequences and are more prevalent among people with mental health problems than among the general population. To alleviate social isolation, digital interventions have potential as accessible alternatives or adjuncts to face-to-face interventions. This scoping review aimed to describe the types of digital interventions evaluated for feasibility, acceptability and effectiveness in alleviating social isolation among individuals with mental health problems, and to present an overview of the quantitative evidence yielded to inform future intervention design. // Methods: We searched five electronic databases for quantitative and mixed methods studies published between January 2000 and July 2020. Studies were included if they evaluated digital interventions for individuals with mental health conditions, had subjective and/or objective social isolation as their primary outcome, or as one of their outcomes if no primary outcome was specified. Feasibility studies were included if feasibility outcomes were the primary outcomes and social isolation was among their secondary outcomes. A narrative synthesis was conducted to present our findings. The protocol was registered on Open Science Framework (doi:https://doi.org/10.17605/OSF.IO/CNX8A). // Results: Thirty-two studies were included for our review: 16 feasibility studies, seven single-group studies and nine effectiveness trials. There was great variation in the interventions, study designs and sample populations. Interventions included web-based programmes, phone-based programmes, blended interventions, socially assistive robots and virtual reality interventions. Many were feasibility studies, or otherwise not fully powered to detect an effect if one were present, thus preventing clear conclusions about clinical effectiveness. Satisfactory feasibility outcomes indicated potential for future trials to assess these interventions. // Conclusion: Our scoping review identified a range of digital approaches utilized to alleviate social isolation among individuals with mental health disorders. Conclusions regarding clinical effectiveness cannot be reached due to variability of approaches and lack of large-scale randomized controlled trials. To make clear recommendations for digital social isolation interventions, future research needs to be based on rigorous methods and larger samples. Future studies should also focus on utilizing theory-driven approaches and improving existing approaches to advance the field