Preventing interpersonal violence in Panama:is a parenting intervention developed in Australia culturally appropriate?

OBJECTIVES: To explore cultural appropriateness of a transported parenting intervention in Panama. METHODS: Panamanian parents (n = 25) were interviewed after participation in an Australian parenting intervention. A thematic analysis was conducted to interpret qualitative data. RESULTS: Three themes emerged; cultural context, appropriateness of the intervention, and development of support networks. In terms of cultural context, parents described economic difficulties, living in a dangerous world, struggling to balance parenting and work, and using aggressive communication patterns. In terms of appropriateness of the intervention, they rated materials as appropriate, although suggested modifications to its delivery by including children and teachers in the training. Finally, parents commented that the intervention prompted the development of social networks within their communities. CONCLUSIONS: Overall, parents considered a transported parenting intervention as appropriate to their local needs. This study might be useful to local governments and international funders in charge of deciding whether transporting parenting interventions North to South as a strategy for violence prevention would be respectful of local needs. Our findings cannot be generalized beyond Panama, but the methodology can be replicated to answer this question in other settings

Defining Quality of Life in the Children of Parents with Severe Mental Illness: A Preliminary Stakeholder-Led Model

Severe parental mental illness poses a challenge to quality of life (QoL) in a substantial number of children and adolescents, and improving the lives of these children is of urgent political and public health concern. This study used a bottom-up qualitative approach to develop a new stakeholder-led model of quality of life relevant to this population. Qualitative data were collected from 19 individuals participating in focus groups or individual interviews. Participants comprised 8 clinical academics, health and social care professionals or voluntary agency representatives; 5 parents and 6 young people (aged 13–18 yrs) with lived experience of severe parental mental illness. Data underwent inductive thematic analysis for the purposes of informing a population-specific quality of life model. Fifty nine individual themes were identified and grouped into 11 key ‘meta-themes’. Mapping each meta-theme against existing child-centred quality of life concepts revealed a multi-dimensional model that endorsed, to a greater or lesser degree, the core domains of generic quality of life models. Three new population-specific priorities were also observed: i) the alleviation of parental mental health symptoms, ii) improved problem-based coping skills and iii) increased mental health literacy. The identification of these priorities raises questions regarding the validity of generic quality of life measures to monitor the effectiveness of services for families and children affected by severe mental illness. New, age-appropriate instruments that better reflect the life priorities and unique challenges faced by the children of parents with severe mental illness may need to be developed. Challenges then remain in augmenting and adapting service design and delivery mechanisms better to meet these needs. Future child and adult mental health services need to work seamlessly alongside statutory education and social care services and a growing number of relevant third sector providers to address fully the quality of life priorities of these vulnerable families

Maternal understandings of postnatal depression

Paper one is a systematic literature review of qualitative studies examining postnatal depression in immigrant mothers using a metasynthesis approach. This review involved three phases: a systematic literature search of qualitative studies reporting on postnatal depression among immigrant mothers, critical appraisal of the studies from the literature search, and the metasynthesis of these studies. Fifteen studies met the inclusion, exclusion and quality criteria. The synthesis of the studies demonstrated that immigrant mothers are subjected to two overarching factors of migration and cultural influences that interact and give rise to psychosocial understandings of postnatal depression, healthcare barriers and views of potential remedies lying within the psychosocial domain. Mothers use self-help coping strategies in line with this. Social support appears to play an integral and mediating role for these immigrant mothers removed from their sociocultural context.A grounded theory approach was taken in the second paper to explore illness beliefs in mothers with postnatal depression. Eleven participants were interviewed using a semi-structured interview schedule and data was analysed in line with a grounded theory methodology. A theory of illness beliefs in PND was developed encompassing six core categories: 'unmet expectations', 'identifying stressors in their life context', 'conflict over label', 'antidepressants: the lesser of two evils', 'loss of time' and 'uncertain futures.' It was concluded that participants made multiple appraisals of their PND in light of their initial difficulties, following service involvement, their improvements, their consequences and the future. Participants' narratives were conflicting and uncertain with internal struggles evident as mothers were torn between their desire to be good mothers and their perceptions that PND meant that they were not good enough mothers. The final paper is a critical appraisal that outlines my personal journey through a grounded theory methodology in exploring illness beliefs in postnatal depression. This appraisal first discusses why a qualitative design was chosen and more specifically a grounded theory approach. The difficulties attached to using grounded theory are then considered. Finally in keeping with the need for transparency within the methodology, there is a reflective account of the challenges encountered, the knowledge and skills gained throughout the process and how this has been important for my learning and progression towards becoming a qualified Clinical Psychologist.EThOS - Electronic Theses Online ServiceLynne MacRaeGBUnited Kingdo

A qualitative investigation into the experience of parenting with a severe mental illness

This thesis explores the experience of parenting with severe mental illness, using qualitative methodologies. It is presented in three parts: a literature review, a report of the empirical research, and a critical reflection of the process undertaken. The literature review provides both a systematic review of qualitative studies exploring the experience of parenting with a severe mental illness (SMI), and a meta-synthesis of the findings from the included studies. The findings demonstrated six overarching themes that were central to the parents' experience. The themes were interlinked and often conflictual in nature and a model of the relationship between the themes is provided. The synthesis revealed how the additional and conflicting pressures faced by parents with SMI can interact with their symptoms to affect parenting behaviours and decisions about engagement with services. The model of themes elicited by the synthesis provides a broad conceptual framework in which parenting with SMI can be considered across the age range of children, parental symptoms and parenting roles. The empirical research provides a specific focus on the views and experiences of parents with Bipolar Disorder (BD). Interpretative Phenomenological Analysis was used to explore the lived experience of parenting with BD, to provide insight into the parents' perspective and the influence that this may have on outcomes for parents as well as their children. The analysis resulted in six overarching themes, each of which consisted of a number of sub-themes. There were important interactions between the themes and these are illustrated for the reader. It was found that the parents identified a number of challenges in being a parent with BD and experienced feelings of inadequacy, guilt and worry relating to the impact that their illness had on their children and family. Strategies for managing these feelings and limiting the impact of BD could have an inadvertent negative effect on their own well-being, and that of their child. Learning to accept their diagnosis and developing strategies for managing their symptoms were crucial for positive parenting, although the changing needs of their children often presented new challenges. Contextual factors, including the stigma associated with mental illness, could also either mediate or exacerbate the challenge of parenting with BD. The clinical implications of these findings are discussed. The critical reflection provides a consideration of qualitative methodologies and a personal reflection on the qualitative process in relation to the empirical research. It details the critical debates around qualitative methodology, the application of qualitative methodologies, and the challenges this presented for the researcher. The report was written on completion of the investigation and reflects the process by which, as a novice, the author was able to develop an understanding of qualitative methodology and carry out an insightful piece of research.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The experience of non-epileptic attack disorder (NEAD) : a repertory grid study examining NEAD patients' construal of their disorder

Non-epileptic attack disorder (NEAD) is a disorder resembling epilepsy, but is caused by psychological processes rather than neurological disturbance. Approximately 15-30% of patients referred to specialist epilepsy centres have NEAD as opposed to epilepsy. Research into NEAD has largely focused on the differential diagnosis of NEAD and identifying risk factors, such as abuse and psychopathology. Whilst this is important, there remains a paucity of research exploring the processes involved in the development and maintenance of NEAD, which contributes to the lack of research investigating treatment effectiveness and prognosis. Furthermore, there remains a paucity of research investigating patient perceptions and experiences, despite such factors influencing prognosis. Subsequently, the current study used repertory grid methodology to explore the largely overlooked domain of how individuals with NEAD construe their world (i.e. how they perceive themselves, others and their disorder). Twelve individuals with a diagnosis of NEAD were recruited from a clinical neuropsychology department within North-West England. This study was an exploratory, cross-sectional study using the repertory grid technique to explore the participants' construals of themselves and others, including construals of their ideal self and self before NEAD. Based on personal construct theory, this method aimed to overcome some of the methodological limitations inherent within NEAD research, by minimising researcher bias, exploring implicit and explicit perceptions and exploring both individual and group perceptions.A case series of grids was presented. Individual and multiple analyses were used to explore participants' construct systems. A data driven approach enabled hypotheses to be developed from the individual grids, which were explored via a composite grid and SocioNet analysis. Despite some themes being identified, the findings revealed the uniqueness of the participants' ways of construing, including a lack of shared understanding amongst the participants. The participants were unhappy with their current self and no longer construed themselves to be the person they were before the onset of NEAD. They also construed themselves as being distinct and/or alienated from others, although some participants construed positive consequences as a result of their NEAD. Whilst most participants agreed with their NEAD diagnosis 'label', they were less accepting of the psychological factors that characterise the diagnosis. Finally, physical health difficulties were construed as being preferable to experiencing mental health difficulties. The findings were discussed in relation to previous research and theoretical implications were highlighted. Clinical implications were highlighted, particularly how the current diagnostic and treatment system for individuals with NEAD may threaten their self-identity. Methodological considerations and recommendations for future research were also suggested. The repertory grid technique was found to be a useful and effective method to investigate the subjective perceptions of individuals with NEAD.EThOS - Electronic Theses Online ServiceLisa MacRae, 3.53 Simon Building, The University of Manchester, Brunswick Street, Manchester, M13 9PLGBUnited Kingdo

Attention training and traumatic stress symptoms : a controlled evaluation

Many of the symptoms characteristic of PTSD such as hypervigiliance towards threat, involve attentional processes. The first part of this thesis explored the role of attentional processes in the maintenance and treatment of PTSD. Although general models of anxiety give attentional processes central prominence cognitive models of PTSD (e.g., Foa & Riggs, 1993; Brewin, Dalgleish, & Joseph, 1996; Ehlers & Clark, 2000) assign an important role to trauma memory and place little or no emphasis on the role of attentional processes in maintaining symptoms. Models of anxiety have suggested that attentional bias is automatic (Mathews & Macleod, 2002) or strategic (Wells & Mathews, 1994). Wells' (2000) Metacognitive Model of PTSD is one of the few models to emphasis thinking style and attention rather then memory. In this model attentional bias is thought to be strategic in nature. The evidence reviewed supports a role of attention in PTSD and suggests it may be beneficial to modify this process. Two different attention techniques based on models of bias are reviewed.The second part of the thesis described a randomized controlled evaluation of attentional training technique (ATT; Wells, 1990) on traumatic stress symptoms in a sample of 60 university students, who had previously experienced a stressful life event. ATT is a technique used in metacognitive therapy to modify the control of attention. Participants were randomly assigned to either an ATT group (n = 29) or a control group (n = 31). An emotional attention set shifting task was included as an objective measure of attention. The results supported the hypotheses, ATT reduced intrusions and negative affect, increased self-report attention flexibility and modified performance on the attention set shifting task. The results are consistent with the metacognitive model of PTSD. Theoretical and clinical implications are discussed and the results add to studies suggesting positive effects of the technique across a range of disorders.The third part critically reflected on methodological and ethical issues from the above research study. The interpretation of the findings is limited by the student population. It is acknowledged that the results are preliminary in nature but it is believed that the study provides useful insights into the role of attentional processes in the development and treatment of traumatic stress symptoms and provides a basis for studies in the future.EThOS - Electronic Theses Online ServiceLynne MacRaeGBUnited Kingdo

An investigation of the relationship between bipolar disorder and cannabis use

Substance abuse is very common in Bipolar Disorder (BD) and can lead an individual having an increased range of difficulties. Studies have indicated that cannabis is used very frequently, but most research into substance use and BD has focused on either alcohol use or substance use disorders generally. The relationship between BD and cannabis use specifically has received far less attention. This thesis specifically explored the co-occurring relationship between BD and cannabis use. In the first section the author examines and critically evaluates studies that have reported on the relationship between BD and cannabis use. The initial phase included a literature search of the area and the identification of relevant papers. A total of 13 research studies were identified and included in the final review. The studies varied considerably in terms of their research questions, design and methodological quality. The findings from the studies were synthesised in relation to a number of existing hypotheses for why BD and substance use in general co-occur. On the whole, the 13 studies contributed sufficient evidence both for and against the existing hypotheses. The findings suggest that there are a number of factors that contribute towards the high co-occurrence of BD and cannabis use (e.g. the use of cannabis to self-medicate symptoms).The second section was designed to investigate a number of the factors derived from the literature which might explain the high co-occurrence of BD and cannabis use. The Experience Sampling Methodology (ESM) was utilised to provide a close investigation of a number of factors over the course of daily life. Twenty-three participants with BD type I and type II completed diary entries for 6 days using ESM. The procedure allowed a close investigation into the associations between cannabis, mood, BD symptoms and Behavioural Activation System (BAS) sensitivity. Self-reported BAS was also measured to indicate the extent to which this predicted changes in mood, BD symptoms and cannabis use. The findings indicate that cannabis use is associated with a number of psychological effects, although no evidence for the self- medication of mood and BD symptoms was revealed in the daily life of the participants. An association between BAS sensitivity and positive affect and manic symptoms was revealed and this is consistent with the findings in current literature. The final section provides a critical reflection of the research process. This includes a rationale for the development of the literature review and the main research paper. This is followed by a description of the study context and then a reflection on the methodological and ethical issues which were faced. Finally it discusses theoretical, clinical and future implications for research in this area.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The implementation of family‐focused practice in adult mental health services: A systematic review exploring the influence of practitioner and workplace factors

From Wiley via Jisc Publications RouterHistory: received 2020-06-16, rev-recd 2020-12-03, accepted 2020-12-17, pub-electronic 2021-04-01, pub-print 2021-08Article version: VoRPublication status: PublishedAbstract: There is increased recognition of the need for greater and more appropriate support to be offered to families in which a parent experiences mental illness and has dependent children. One way of meeting this need is for adult mental health services to take a more family‐focused approach. However, there are recognized difficulties in facilitating family‐focused practice (FFP). The current review systematically synthesized quantitative and qualitative literature of practitioner perspectives and experiences of FFP in adult mental health settings to identify modifiable factors associated with its successful implementation. Five databases were searched systematically leading to the inclusion and quality assessment of 19 papers, ten of which were quantitative and nine qualitative. Analysis was guided by a narrative synthesis approach. Factors shown to influence FFP functioned at both practitioner and workplace levels and included personal attitudes, beliefs about job role, and perceptions of workplace support. Practitioners who felt that a family‐focussed approach was inappropriate or detrimental to service users or outside of their remit as mental health professionals were less likely to adopt this approach. For those who saw the potential benefits of FFP, lack of confidence in their ability to deliver such an approach and lack of training can be barriers, as can lack of support and resources within services. This review highlights the need for actions to boost the awareness of adult mental health practitioners working with parents and to increase their confidence. It also makes the case for broader organizational support if family‐focussed practice is to be implemented successfully

The development of intrusive thoughts to obsessions

The aim of this thesis was to consider the role of appraisals of intrusive thoughts in the development of Obsessive-Compulsive Disorder. A narrative literature review explored the hypothesis that 'normal' intrusive thoughts lie on a continuum with clinical obsessions. The review discussed previous research on intrusive thoughts in nonclinical samples and drew comparisons with characteristics of clinical obsessions. An internet-based empirical investigation employed a randomised controlled trial design in order to test the effectiveness of an intervention based on normalising information in reducing problematic meta-cognitive beliefs. A large sample (N = 148) of young adults (aged 18-20 years) was screened in to the study based on high levels of problematic meta-cognitive beliefs. Participants completed questionnaire measures of meta-cognitive beliefs, obsessive-compulsive symptoms, reactions to intrusive thoughts and experiential avoidance. Participants completed an interactive quiz based on normalising information (experimental condition) or pet information (control condition). Significant reductions in problematic meta-cognitive beliefs and experiential avoidance were observed in both conditions, thus no additional benefit of normalising information was indicated. The implications of these findings are discussed in the context of the potential normalising effects of symptom monitoring. Overall this thesis supports the comparison of 'normal' intrusive thoughts and obsessions and suggests that negative appraisals, such as problematic metacognitive beliefs, may not be the only defining factor in the development of Obsessive-Compulsive Disorder.EThOS - Electronic Theses Online ServiceGBUnited Kingdo