Acceptance and commitment therapy (ACT) for people with dementia experiencing psychological distress: A hermeneutic single-case efficacy design (HSCED) series

Introduction People with dementia have a high prevalence of psychological distress but are underserved with evidence-based psychological interventions. To promote choice and improve clinical outcomes, there is a necessity to test different psychological intervention options for this population. Purpose This study aimed to investigate the effectiveness and acceptability of acceptance and commitment therapy (ACT) for people with dementia, considering carer-supported, remote delivery and necessary therapy adaptations. Methods A hermeneutic single-case efficacy design series was used to analyse the therapy process and change for three clients with dementia and psychological distress. A matrix of quantitative and qualitative data was collated (“rich case records”) and subject to critical analyses by three independent psychotherapy experts (“judges”) who identified change processes and determined the outcome for each client. Results Adjudication concluded that one client made positive changes, specifically reliable reductions in psychological distress, which were largely attributable to ACT. Two clients remained unchanged. Discussion/Conclusion Where change was achieved, the ACT-specific processes of values, committed action and acceptance, in combination with non-specific therapy factors, including a strong client–carer relationship, existing client interests and individualised therapy adaptations, were facilitative. Hence, ACT may be a feasible and effective vehicle for therapeutic change by helping carers to better meet the needs of their loved ones. Future research to optimise ACT delivery in this population may be beneficial. Furthermore, the assessment of carer factors (e.g., their psychological flexibility and the client–carer relationship) may strengthen the evidence base for systemic ACT use

A service evaluation of the assessment process in a Step4 Psychological Therapies Service

Purpose This study aims to improve the efficiency of the assessment process within a Step4 Psychological Therapies Service by identifying factors related to assessment non-attendance and service suitability for referred clients. Design/methodology/approach Referral and assessment information was accessed between October 2019 and March 2020 from Step4 routine service data, electronic client records where necessary and Step4 staff self-report questionnaires. Findings All clients offered an assessment during this time attended. Findings indicated several factors could influence service suitability in meeting client need. These included individual differences such as readiness to change, which was not necessarily identified at referral or prior to assessment, and potential systemic factors, such as the opt-in procedure, which possibly impeded access. Though the necessity for assessment in clarifying client needs and treatment was indicated, an assessment (from referral to assessment appointment) that led to discharge could take an excess of one working day of service time, associated with considerable opportunity cost to other clients awaiting assessment. Recommendations are made for improving assessment efficiency. Originality/value With a high prevalence of poor mental health in the UK, efforts must be made to identify and reduce additional demand upon service time and resources within mental health services to effectively meet people�s needs. Recommendations to improve assessment process efficiency include the use of a standardised referral form, offer of follow-up support procedures, increased client involvement, a streamlined opt-in battery and ongoing monitoring to ensure shared practice between clinicians. These are transferable to other mental health services, with implications for subsequent quality and timeliness of care

Attitudes towards CBT in Trainee Clinical Psychologists

PurposeThis paper aims to address how one Doctorate in Clinical Psychology (DClinPsy) programme contributes to the shaping of attitudes of its trainee clinical psychologists (TCPs) towards cognitive behavioural therapy (CBT).Design/methodology/approachA total of 28 TCPs completed an online, mixed-methods questionnaire relating to their attitudes towards CBT, what factors had influenced their attitude and how competent they felt in applying CBT to clinical practice.FindingsThe majority of respondents reported a positive attitude towards CBT. There was a statistically significant positive change at an individual level in TCPs’ views of CBT between the point at which they applied for the DClinPsy and the present day. Thematic analysis of qualitative data identified influential factors on the development of TCP attitudes towards CBT. The vast majority of TCPs reported that they felt competent applying CBT in their clinical practice.Research limitations/implicationsOverall, the DClinPsy has a positive effect on TCPs’ attitudes towards CBT. However, the influence of placements has a more mixed effect on attitudes. A small sample size reduced the reliability of these conclusions. Recommendations for further evaluation have been made.Originality/valueThis paper evaluates the effect of a DClinPsy programme on TCPs’ attitudes towards CBT. The value is that it establishes which components of the course have different effects on trainee attitudes

Team formulation in practice: Forms, functions, and facilitators

Purpose: Despite the popularity of team formulation, there is a lack of knowledge about workable implementation in practice. The purpose of this paper is to: (1) characterise team formulation, based upon examples from practice; and (2) identify factors perceived to support or obstruct workable implementation in practice. Design/Methodology: An online survey recruited UK Clinical Psychologists (N=49) with experience in team formulation from a range of work contexts. Examples of team formulation in practice were analysed using Framework Analysis. Findings: Four novel types of team-formulation with different functions and forms are described: case review, formulating behaviour experienced as challenging, formulating the staff-service user relationship, and formulating with the service-user perspective. A number of factors perceived to support and obstruct team formulation were identified including team distress, facilitating change, managing difference and informing practice. These were common across team-formulation types. Practical Implications: The team-formulation types identified could be used to standardise team-formulation practice. Several common factors, including managing team distress, were identified as aiding workable implementation across team-formulation types. Future research should investigate the key processes and links to outcomes of team-formulation in practice. Originality/value: This paper presents two original, practice-based and practice-informing frameworks: describing (1) novel forms and functions of team-formulation and (2) the factors supporting and obstructing facilitation in practice. This paper is the first to highlight the common factors that seem to facilitate workable implementation of team-formulation in practice

Service user and carer representatives’ experiences of the personal effects of involvement in clinical psychology training

PurposeExtant literature exploring service user (SU) involvement in clinical psychology training has been limited by its sampling from singular training programmes and its restricted application of psychological theory. This research seeks to counter limitations by exploring SUs’ experiences across multiple clinical psychology training programmes in the UK and by deductively applying psychological theory relating to power, recovery, identity and group development.Design/methodology/approachSemi-structured interviews were conducted with 14 participants. A deductive thematic analysis was used to analyse qualitative data.FindingsFive main themes were identified: environment determines sense of safety; meeting challenges; sense of purpose, worth and value; the person you see now is not the person I was; and wanting to break the glass ceiling.Research limitations/implicationsCarers are underrepresented and the sample does not contain SUs who were no longer involved in training.Practical implicationsIt is important that the environment fosters psychological safety for SUs, via positive and supportive relationships with trainees and staff, with SUs being treated as equals and financially reimbursed as such. SUs and professionals need to explore managing and sharing power to enable SUs to feel valued and to reap benefits from involvement, including developing a positive sense of identity.Originality/valueThe research is part of the early literature exploring SUs’ experiences of involvement in clinical psychology training and is, to the best of the authors’ knowledge, the first to explore the personal effects of involvement across multiple programmes

The impacts of the visible differences in appearance caused by burn injuries, and medical tattooing as an appearance-based intervention

Portfolio Abstract Burns injuries can affect both adults and children. They can cause severe and enduring physical and psychological consequences, for both the individual and their family. Changes to appearance are a fundamental part of a burn injury. Medical tattooing (MT) is an intervention designed to address appearance/body dissatisfaction. Systematic Review: a systematic search was completed of five electronic databases (CINAHL, Cochrane Library, MEDLINE, EMBOSE and PsycINFO), reference lists and ‘cited by’ referencing sources to identify and evaluate all published qualitative research literature on the psychological experiences of parents of children who have experienced burn injuries. Seven studies met the selection criteria and four themes were identified: ‘the trauma of witnessing a family member’s burn injury’, ‘the ‘mixed blessing’ of hospitalisation’, ‘attempting to return to ‘normal’ life -adapting to new roles’, and ‘guilt and blame: core issues’. The results suggest parents experience three phases of recovery following a child’s burn, all impacted on by feelings of guilt and blame. Journal Article: Interpretative Phenomenological Analysis (IPA) was applied to eight in-depth interviews with burn survivors with medical tattoos. Three themes were extracted: Management of Hope, The Process and Impacts of MT: ‘Normal-ish is Fantastic’ which were set within a context of ‘Conflict about Legitimacy’. The findings suggest MT may facilitate a regained sense of normality and an improved sense of being acceptable in society. However, a potential paradox was identified between a pressure to conform to certain expectations of appearance and a sense that a desire to meet these expectations is also not viewed as important or acceptable. By understanding these experiences, healthcare professionals can increase awareness of the lived experienced of individuals with burn injuries and of those around them. It also demonstrates that MT is a potentially valuable intervention. Further research needs are highlighted

Developing a tool to support diagnostic delivery of dementia

It is increasingly recognised that there are challenges affecting the current delivery of dementia diagnoses. Steps are required to address this. Current good practice guidelines provide insufficient direction and interventions from other healthcare settings do not appear to fully translate to dementia care settings. This project has taken a sequential two-phase design to developing a tool specific to dementia diagnostic delivery. Interviews with 14 participants explored good diagnostic delivery. Thematic analysis produced key themes (overcoming barriers, navigation of multiple journeys and completing overt and covert tasks) that were used to inform the design of a tool for use by clinicians, patients and companions. The tool was evaluated for acceptability in focused group discussions with 13 participants, which indicated a desire to use the tool and that it could encourage good practice. Adaptations were highlighted and incorporated to improve acceptability. Future research is now required to further evaluate the tool

First-person narratives around sexuality in residential healthcare settings: a meta-ethnographic synthesis

The aim of this review is to identify, critically appraise, and synthesise the existing literature exploring adults’ narratives around sexuality within residential healthcare settings from a first-person perspective. A systematic literature review was undertaken. Six databases were searched. A meta-ethnographic approach was used to synthesise studies’ findings. Thirteen studies using qualitative methodology that met the inclusion criteria were identified. The synthesis revealed six key themes: how service users define sexuality, sexuality as something not to be discussed (“privates are private”), sexuality as a separate aspect of the self (“sectionality”), hopes and fears for the future, the impact of the environment (“physicality of being physical”), and adapted sexuality. The studies included were of varying quality. Sexuality remains an important aspect for many residents, yet is rarely noted or discussed with them by healthcare staff. The residential healthcare environment presents implicit and explicit barriers to sexuality expression, causing residents to adapt how they experience their sexuality. Findings from this review highlight the importance of considering service users’ perspectives, and the need for open communication between residents and practitioners to facilitate care provision that acknowledges the barriers of the environment on sexuality and considers the person beyond the presenting illness

Factors influencing the transition experience of carers for persons with dementia, when the person with dementia moves into a care home: Systematic review and meta-synthesis

Aims: To understand factors influencing the experience of carers for people with dementia, when that person moves from living in the community to living in residential care. Specifically, we aimed to identify facilitators and inhibitors of carer adjustment during this transition. Method: A systematic search of CINAHL, EMBASE, PubMed, and PsycINFO databases was conducted. Nine qualitative articles published between 2001–2017, based on the experiences of 141 carers, were included. Thematic analysis was applied to the data, with the concepts of transition inhibitors and facilitators being used to structure the analytic process. Results: Analysis produced five themes, representing factors that could affect carer experiences of the focal transition-process: modifying the difficulty of this process according to their presence or absence. The themes were (1) Connection, pertaining to the carer feeling connected to the person with dementia and professionals during this transition; (2) Informed & Informing, relating to exchange of information between the carer and facility staff or health professionals; (3) The facility: welcoming & skilful, dealing with carer perceptions of the facility and their confidence in the staff; (4) It’s What You Make of It, discussing the meaning the carer made of the admission and the impact this had; and (5) Sharing Responsibility, addressing how carers were affected by the perceived sharing of responsibility for care-provision. Conclusions: A supportive network has a significant role to play in facilitating this transition for carers. However, further research into what carers would find useful during this time is needed

A Systematic Review of the Barriers and Facilitators to Adherence to Mindfulness-Based Cognitive Therapy for Those with Chronic Conditions

Purpose: Mindfulness-Based Cognitive Therapy (MBCT) can improve the lives of those with a chronic condition and psychological distress, however high drop-out rates limit benefits. MBCT might be a candidate treatment for this population if non-adherence can be overcome. This review explores the existing literature on the barriers and facilitators to adherence to MBCT for those with chronic conditions. Method: Databases MEDLINE, PsycINFO, CINAHL and Scopus were searched between 28th May and 11th June 2021. We included empirical papers that identified barriers and/or facilitators to MBCT adherence in patients with chronic conditions – excluding non-English and grey literature. Papers were screened and duplicates removed. Extracted data included: setting, design, aim, sample-size, population, and identified barriers/facilitators to MBCT adherence. The Mixed Methods Appraisal Tool (MMAT) was adapted and used to appraise the quality of studies. Results: 20 papers were eligible for review. Synthesis identified six themes (in prevalence order): (1) Practical Factors (e.g., time and other commitments), (2) Motivation (e.g., change-readiness), (3) Patient clinical and demographic characteristics (e.g., current physical health), (4) Connection with others (facilitators and group members), (5) Credibility (perception of the intervention) and (6) Content Difficulty (intervention accessibility). Findings highlight potential adaptations to implementation (e.g., clear treatment rationale, preference matching, and eliciting and responding to individual concerns or obstructive assumptions) that could address barriers and harness facilitators. Conclusion: This review contributes a higher-order understanding of factors that may support/obstruct client adherence to MBCT with implications for future implementation in research and practice. Future research should prioritise open exploration of barriers/facilitators