The relationship between the therapeutic alliance and suicidal experiences in people with psychosis receiving therapy

Few studies have examined the relationship between the therapeutic alliance in therapy and suicidal experiences. No studies have examined this relationship with people with non-affective psychosis. The present study sought to redress this gap in the literature. Sixty-four participants with non-affective psychosis and suicidal experiences who were receiving a suicide-focused cognitive therapy were recruited. Self-reported suicidal ideation, suicide plans, suicide attempts, depression, and hopelessness were collected from participants prior to starting therapy. Suicidal experience measures were collected again post-therapy at 6 months. Therapeutic alliance ratings were completed by clients and therapists at session 4 of therapy. Dose of therapy was documented in number of minutes of therapy. Data were analyzed using correlation coefficients, independent samples t-tests, a multiple hierarchical regression, and a moderated linear regression. There was no significant relationship found between suicidal ideation prior to therapy and the therapeutic alliance at session 4, rated by both client and therapist. However, there was a significant negative relationship between the client-rated therapeutic alliance at session 4 and suicidal ideation at 6 months, after controlling for pre-therapy suicidal ideation, depression, and hopelessness. Furthermore, the negative relationship between the client-rated alliance and suicidal ideation was the strongest when number of minutes of therapy was 15 h or below. A stronger therapeutic alliance developed in the first few sessions of therapy is important in ameliorating suicidal thoughts in people with psychosis. Nevertheless, it is not necessarily the case that more hours in therapy equates to a cumulative decrease in suicidal ideation of which therapists could be mindful. A limitation of the current study was that the alliance was analyzed only at session 4 of therapy, which future studies could seek to redress

Experiential avoidance in non‐suicidal self‐injury and suicide experiences: A systematic review and meta‐analysis

From Wiley via Jisc Publications RouterHistory: received 2020-09-07, rev-recd 2021-03-15, accepted 2021-04-26, pub-electronic 2021-06-29Article version: VoRPublication status: PublishedAbstract: Introduction: This systematic review and meta‐analysis aimed to (i) examine the associations between experiential avoidance (EA), non‐suicidal self‐injury (NSSI), and suicide experiences, and (ii) identify sample‐ and methodological‐related variables affecting the strength of these associations. Method: Medline, Embase, PsychINFO, Web of Science, and CINAHL were searched until April 2020. Random‐effect meta‐analyses were applied. The I2 statistic and the Egger's test assessed heterogeneity and publication bias. Meta‐regression analyses were used to evaluate the impact of moderator variables on the strength of these associations. Results: Data from 19 independent studies based on n = 9900 participants were pooled. The analyses demonstrated a weak but significant association between EA and NSSI. None of the examined moderator variables influenced the strength of this relationship. There was an indication of publication bias, suggesting that this association may have been inflated. The associations between EA, and suicide ideation and behaviors were moderate to strong. Discussion: The current study concluded that (i) the EA model for NSSI should be revised by incorporating new evidence implicating feelings of relief in NSSI, and (ii) future studies should examine interactive factors between EA and key psychological components in the pathways to suicide experiences because these findings have direct clinical implications

Autobiographical memory specificity and cognitive style across the bipolar disorder spectrum

Bipolar disorder is characterised by intense fluctuations in mood, including the experience of severe episodes of depression, mania and hypomania. The experience of bipolar disorder can also be associated with biases in various cognitive processes, including rumination in response to positive and negative mood states and tendencies to make dysfunctional self-appraisals. Preliminary research has also suggested that bipolar disorder may be associated with deficits in the recall of specifically detailed autobiographical memories. The lack of specificity in the recall of autobiographical memories, known as the 'overgeneral' recall bias, refers to tendencies to generate generalised memory representations as the memory recall process is terminated prior to the activation of specifically detailed memories. This overgeneral recall of autobiographical memories can also contribute to ruminative thought patterns, impair the generation of effective solutions to problems, and is associated with poor illness outcomes. The overgeneral bias has been extensively researched within major depressive disorder and suicidality, but has been comparatively under-researched in bipolar disorder and in vulnerable individuals. A series of eight studies were designed to: (i) investigate the cross-sectional associations across measures of positive and negative rumination and self-appraisal with the vulnerability to hypomania, and investigate the associations of these cognitive styles with prospective mood symptoms in an at-risk sample; (ii) investigate the cognitive vulnerability to hypomania in relation to rumination, problem-solving and autobiographical memory specificity; (iii) conduct a preliminary investigation into the associations between goal-related memory processes and extreme goal-pursuit in relation to hypomania vulnerability; (iv) investigate whether the vulnerability to hypomania and future bipolar disorders is associated with similar patterns of overgeneral memory recall on a standardised cue memory task; and (v) investigate the patterns of autobiographical memory specificity within a remitted bipolar sample. The heightened vulnerability to future bipolar disorders was associated with tendencies to engage in both positive and negative forms of ruminative thought processes, and with poorer psychosocial problem-solving, however, this relationship with problem-solving was not independent of current mood symptoms. The results of two studies indicated that the heightened vulnerability to hypomania was associated with an overgeneral memory bias across two different assessments of memory specificity, in direct contrast to previous research. Individuals diagnosed with bipolar disorder also reported more extreme overgenerality during memory recall than a sample of age and gender-matched healthy controls, but were able to recall some specifically detailed negative memories in short response latencies compared to non-bipolar control participants. The research presented within this thesis supports the notion of a continuum of increasing overgenerality in the bipolar disorder spectrum, inclusive of at-risk individuals to people formally diagnosed with bipolar disorder. Although bipolar disorder appears to be associated with a trait-based overgeneral memory bias, bipolar individuals appear to have ready access to some specific negative memories even during remission from symptoms. The clinical implications of this research, methodological considerations in the assessment of memory specificity, and directions for further investigations into the nature of autobiographical memory recall in bipolar spectrum disorders are discussed.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

La interacción en el juego de roles en la clase de inglés con estudiantes de segundo grado del Colegio Distrital Marco Tulio Fernández

El objetivo de esta investigación se centró en identificar cómo interactuaban los estudiantes de segundo grado de primaria de un colegio oficial de Bogotá, durante la realización de unos juegos de roles en la clase de inglés. Los juegos fueron diseñados por las docentes en formación de acuerdo a la cotidianidad que viven los niños de esta edad, como ir al médico, de compras, actuar su superhéroe, etc. De manera simultánea al desarrollo de la práctica se hicieron una serie de observaciones que se registraron en algunos instrumentos de investigación concluyéndose que los niños desarrollaron mejor su interacción dentro del aula de clases con una actividad en la cual ellos pudieran divertirse demostrando sus habilidades interpretativas, familiarizándose al mismo tiempo con la lengua extranjer

The role of pride in women with anorexia nervosa : a grounded theory study

Objective: Theory and clinical literature suggest that pride may play an important role in the maintenance of restrictive eating disorders. A grounded theory study explored experiences of, and reflections on, pride among women with a current or past diagnosis of anorexia nervosa. Design: This is a qualitative study using grounded theory. Method: Semi-structured interviews were conducted with 21 women recruited from an eating disorders unit in England, and from a UK self-help organization. Grounded theory from a constructivist lens was used. Analysis involved coding, constant comparison and memo-writing. Results: Pride evolves over the course of anorexia. Two overarching conceptual categories were identified: ‘Pride becoming intertwined with anorexia’ and ‘Pride during the journey towards recovery’. These categories encompassed different forms of pride: ‘alluring pride’, ‘toxic pride’, ‘pathological pride’, ‘anorexia pride’, ‘shameful pride’, ‘recovery pride’ and ‘resilient pride’. Initially, pride contributed to self-enhancement and buffered negative emotions. As the condition progressed, pride became a challenge to health and interfered with motivation to change. During recovery, perceptions of pride altered as a healthy approach to living ensued. Conclusions: The evolving nature of pride plays a central role in development, maintenance, and treatment of anorexia. Understanding of pride and its role in psychotherapeutic work with this client group may increase motivation to change and promote recovery. Future work should investigate if tackling pride in eating disorders increases treatment efficacy and reduces the risk of relapsing

The Relationship between the Therapeutic Alliance and Suicidal Experiences in People with Psychosis Receiving Therapy

From MDPI via Jisc Publications RouterHistory: accepted 2021-10-07, pub-electronic 2021-10-12Publication status: PublishedFunder: Efficacy and Mechanism Evaluation Programme; Grant(s): 13/161/25Few studies have examined the relationship between the therapeutic alliance in therapy and suicidal experiences. No studies have examined this relationship with people with non-affective psychosis. The present study sought to redress this gap in the literature. Sixty-four participants with non-affective psychosis and suicidal experiences who were receiving a suicide-focused cognitive therapy were recruited. Self-reported suicidal ideation, suicide plans, suicide attempts, depression, and hopelessness were collected from participants prior to starting therapy. Suicidal experience measures were collected again post-therapy at 6 months. Therapeutic alliance ratings were completed by clients and therapists at session 4 of therapy. Dose of therapy was documented in number of minutes of therapy. Data were analyzed using correlation coefficients, independent samples t-tests, a multiple hierarchical regression, and a moderated linear regression. There was no significant relationship found between suicidal ideation prior to therapy and the therapeutic alliance at session 4, rated by both client and therapist. However, there was a significant negative relationship between the client-rated therapeutic alliance at session 4 and suicidal ideation at 6 months, after controlling for pre-therapy suicidal ideation, depression, and hopelessness. Furthermore, the negative relationship between the client-rated alliance and suicidal ideation was the strongest when number of minutes of therapy was 15 h or below. A stronger therapeutic alliance developed in the first few sessions of therapy is important in ameliorating suicidal thoughts in people with psychosis. Nevertheless, it is not necessarily the case that more hours in therapy equates to a cumulative decrease in suicidal ideation of which therapists could be mindful. A limitation of the current study was that the alliance was analyzed only at session 4 of therapy, which future studies could seek to redress