Development and Evaluation of Acceptance and Commitment Therapy delivered by Psychologists and Non-Psychologists in an NHS Community Adult Mental Health Service: A Preliminary Analysis.

Background: Previous studies have demonstrated Acceptance and Commitment Therapy (ACT) is effective for depression and may be useful for complex transdiagnostic clients. Aims: To conduct a preliminary evaluation whether ACT is feasible and effective when delivered by psychologists and non-psychologists for complex clients in a National Health Service (NHS) community mental health service for adults. Method: Staff were trained in ACT and conducted one-to-one therapy with clients. Measures on general mental health, depression, fusion and values were given pre-therapy post-therapy and at three month follow-up. Results: Standardised measures showed significant improvements post-therapy for global mental health, depression, cognitive fusion and values post-treatment. These were partially maintained at follow-up and remained after an intent-to-treat analysis. There were no differences in outcomes between psychologists and non-psychologists, Conclusions: ACT may be delivered effectively with limited training for complex cases in secondary care, though further research is needed

Resilience and surgeons: train the individual or change the system?

We investigate both sides of the coin

Hypervigilance for faces, but typical gaze following in social anxiety. Abstract

A hypervigilance-avoidance theory has been proposed to explain early attentional biases towards faces followed by their subsequent avoidance, in social anxiety (SA) (Mogg et al., 1997). This theory has arisen from data obtained from dot probe-type tasks presenting static images which lack in ecological validity. Moreover, whilst the gaze of others is considered a threatening cue in SA and is typically avoided, the gaze following mechanism has not been examined in SA. We analysed eye movements, including gaze following in 39 participants, who were either high or low in SA (HSA and LSA respectively) as they watched an emotionally-neutral dynamic social scene. Contrary to the hypervigilance-avoidance hypothesis, whilst HSA participants directed significantly more early fixations towards the face than the LSA group, both groups fixated the face equally after this time. There were no group differences in gaze following. Results suggest that when viewing a neutral social scene, HSA individuals are initially biased towards the face but when threat is not perceived a typical viewing strategy is adopted. Furthermore, although direct gaze may be avoided in SA, the gaze following mechanism may be so automated that it is impervious to higher level socio-cognitive factors such as fear of social evaluation

Twitter journal clubs and continuing professional development: An analysis of a #MedRadJClub tweet chat

Introduction Online Twitter journal clubs are a recent and popular innovation with the potential to increase research awareness and inform practice. The medical radiation sciences' MedRadJournalClub (MJRC) is a Twitter-based event that attracts a global group of participants at the monthly chats. An analysis of a recent MedRadJournalClub discussion evaluated the perceived benefits and limitations of medical radiation practitioners participating in an online journal club. Methods The February 2017 chat used for analysis was based on the Journal of Medical Imaging and Radiation Sciences article by Currie et al. “Twitter Journal Club in Medical Radiation Science” that examines the educational theory behind learning and evidencing professional development through MRJC and social media. The data consisted of chat tweets which were collated using the Twitter advanced search function using the #medradjclub. An initial reviewed was performed to exclude irrelevant content. A second review was then undertaken to categorize the main theme of the tweet. The data were then subjected to thematic analysis which yielded seven different categories. Results The main benefits included global access due to the online nature of MRJC that has facilitated networking and collaboration. Open access to recently published research was another key benefit. The character limitation of a tweet was the most common constraint, and the dynamic nature of the twitter conversation requires multi-tasking that may be difficult. Conclusion Our analysis indicated that participants use MedRadJournalClub as a source of continuing professional development with some evidence that this is directly informing clinical and educational practice

Cognitive fusion as a candidate psychological vulnerability factor for psychosis: An experimental study of acute ∆9-tetrahydrocannabinol (THC) intoxication

Heavy cannabis use is associated with an increased risk of psychosis. However, the psychological mechanisms involved, and interactions with established risk factors for cannabis-related psychosis, remain unclear. This study examined the role of cognitive fusion, a candidate vulnerability factor for psychosis, during acute THC intoxication, and the interaction with key risk factors – developmental trauma and schizotypy. Twenty general population cannabis-using participants were administered THC or placebo in a within-participants, double-blinded randomised study. Developmental trauma, schizotypy and cognitive fusion were all associated with psychotic experiences during intoxication. Cognitive fusion accounted for increased psychotic experiences in those with developmental trauma and high schizotypy. Cognitive fusion may be a key mechanism by which developmental trauma and schizotypy increase risk of psychosis from cannabis use. This initial study is limited by a small sample and correlational design; a larger scale mediation study is now needed to support a causal argument. The findings have implications for psychological treatments and identifying those at risk of cannabis-related psychosis. Psychological interventions that target cognitive fusion may be more effective than generic approaches. People prone to cognitive fusion, particularly those with a history of developmental trauma and high in schizotypy, may be at higher risk for cannabis-related psychosis

Adults with higher social anxiety show avoidant gaze behaviour in a real-world social setting: A mobile eye tracking study.

Attentional biases are a core characteristic of social anxiety (SA). However, research has yielded conflicting findings and failed to investigate these biases in real, face-to-face social situations. Therefore, this study examined attentional biases in SA by measuring participants' eye gaze within a novel eye-tracking paradigm during a real-life social situation. Student participants (N = 30) took part in what they thought was a visual search study, when a confederate posing as another participant entered the room. Whilst all participants avoided looking at the confederate, those with higher SA fixated for a shorter duration during their first fixation on him, and executed fewer fixations and saccades overall as well as exhibiting a shorter scanpath. These findings are indicative of additional avoidance in the higher SA participants. In contrast to previous experimental work, we found no evidence of social hypervigilance or hyperscanning in high SA individuals. The results indicate that in unstructured social settings, avoidance rather than vigilance predominates, especially in those with higher SA

Ameliorating Patient Stigma Amongst Staff Working With Personality Disorder: Randomized Controlled Trial of Self-Management Versus Skills Training.

Background: Patients diagnosed with a personality disorder (PD) are often stigmatized by the healthcare staff who treat them. Aims: This study aimed to compare the impact on front-line staff of a self-management Acceptance and Commitment Therapy-based training intervention (ACTr) with a knowledge- and skills-based Dialectical Behaviour Training intervention (DBTr). Method: A service-based randomized controlled trial was conducted comparing the effects of 2-day ACTr (N = 53) and DBTr (N = 47) staff workshops over 6 months. Primary outcome measures were staff attitudes towards patients and staff-patient relationships. Results: For both interventions, staff attitudes, therapeutic relationship, and social distancing all improved pre- to postintervention, and these changes were maintained at 6-month follow-up. Conclusions: Although offering different resources to staff, both ACTr and DBTr were associated with an improved disposition towards PD patients. Future research could evaluate a combined approach, both for staff working with PD patients and those working with other stigmatized groups

The impact of complications and errors on surgeons

All surgical procedures carry with them the potential for adverse events. Dealing with the sequelae of the complications and errors that arise in the course of normal practice is therefore part and parcel of a surgeon’s working life. The challenges and stresses that this creates are now well recognised although surgical training has, until recently, done little to help surgeons prepare for such events and on-going professional and personal support is limited. This review shows that much of the research examining the impact of adverse events has been concentrated in healthcare systems outside of the UK, often markedly different to our own. With notable exceptions, sample sizes are often small and studies are often qualitative. While the latter provide rich and fascinating data, they may not always be representative, particularly if the focus is on serious errors where there is a risk of litigation. Despite the preponderance of complications, which are an acknowledged risk of surgical procedures, there is no research to date which has examined whether or not there are differences in the impact of complications versus errors on surgeons’ professional and personal lives. A national survey is currently planned to provide detailed information about the impact of adverse events – both complications and errors – which will map the way for better targeted support for surgeons to help them use their experiences to enhance their wellbeing and improve their practice

Attention to faces and gaze-following in social anxiety: preliminary evidence from a naturalistic eye-tracking investigation

Social attentional biases are a core component of social anxiety disorder, but research has not yet determined their direction due to methodological limitations. Here we present preliminary findings from a novel, dynamic eye-tracking paradigm allowing spatial–temporal measurement of attention and gaze-following, a mechanism previously unexplored in social anxiety. 105 participants took part, with those high (N = 27) and low (N = 25) in social anxiety traits (HSA and LSA respectively) entered into the analyses. Participants watched a video of an emotionally-neutral social scene, where two actors periodically shifted their gaze towards the periphery. HSA participants looked more at the actors’ faces during the initial 2s than the LSA group but there were no group differences in proportion of first fixations to the face or latency to first fixate the face, although HSA individuals’ first fixations to the face were shorter. No further differences in eye movements were found, nor in gaze-following behaviour, although these null effects could potentially result from the relatively small sample. Findings suggest attention is biased towards faces in HSA individuals during initial scene inspection, but that overt gaze-following may be impervious to individual differences in social anxiety. Future research should seek to replicate these effect