Mindfulness and emotional regulation as sequential mediators in the relationship between attachment security and depression

Depression is a significant global health issue that has previously been associated with negative early care experiences and insecure attachment styles. This has led to much interest in identifying variables that may interrupt this relationship and prevent detrimental personal, social and economic outcomes. Recent research has indicated associations between the two seemingly distinct constructs of secure attachment and mindfulness, with similar positive outcomes. One hundred and forty eight participants completed an online survey exploring a possible sequential cognitive processing model, which predicted that higher levels of mindfulness and then emotional regulation would mediate the relationship between attachment and depression. Full mediation was found in regards to secure, preoccupied and dismissive attachment, whereas partial mediation was identified in the case of fearful attachment. The results support the possibility of an alternative cognitive processing pathway that may interrupt the association between negative early care experiences and concomitant negative mental health outcomes. Further exploration of this relationship is indicated

Personality disorder: A mental health priority area

Personality disorders have received limited recognition as a public health priority, despite the publication of treatment guidelines and reviews showing effective treatments are available. Inclusive approaches to understanding and servicing personality disorder are required that integrate different service providers. This viewpoint paper identifies pertinent issues surrounding early intervention, treatment needs, consumer and carer experiences, and the need for accurate and representative data collection in personality disorder as starting points in mental health care reform

Incidence, Severity and Responses to Reportable Student Self-Harm and Suicidal Behaviours in Schools: A One-Year Population-Based Study

2020, The Author(s). School staff have a unique opportunity to detect and respond to mental health issues including self-harm and suicidal behaviour in adolescents. There is limited knowledge about how these incidents are managed in schools. This study aims to understand the incidence rates, perceived severity and management of self-harm and suicidal behaviour incidents by schools. A total of 1525 school incidents were analysed for rate, severity and response. Pearson\u27s χ2 test was used to understand incident rates of self-harm and suicidal behaviours compared to all other incidents, and if incident category was related to emergency service involvement. A Kruskal-Wallis ANOVA analysed differences in severity ratings for incidents, and relative risk ratios determined the probability that first responder services will be engaged in self-harm and suicidal behaviour incidents. Self-harm and suicidal behaviour incidents (n = 77) accounted for 5.05% of all incidents and were more likely to be rated highly severe compared to other incidents. Incidents of self-harm and suicidal behaviours were 1.43 times more likely to have police involvement and 8.37 times more likely to have ambulance involvement compared to other incidents that caused harm to students, staff or property including welfare and violence incidents. The findings highlight the severity of reportable self-harm and suicidal behaviour incidents as they required an emergency response. We discuss the potential missed opportunity for early intervention by school staff and services, which may hinder future disclosure or help-seeking by at-risk young people. Training of school staff may provide knowledge and confidence to respond appropriately to self-harm and suicidal behaviour incidents and prevent escalation requiring emergency intervention

The lived experience of recovery in borderline personality disorder: a qualitative study

BackgroundThe concept of recovery in borderline personality disorder (BPD) is not well defined. Whilst clinical approaches emphasise symptom reduction and functioning, consumers advocate for a holistic approach. The consumer perspective on recovery and comparisons of individuals at varying stages have been minimally explored.MethodFourteen narratives of a community sample of adult women with a self-reported diagnosis of BPD, were analysed using qualitative interpretative phenomenological analysis to understand recovery experiences. Individuals were at opposite ends of the recovery continuum (seven recovered and seven not recovered).ResultsRecovery in BPD occurred across three stages and involved four processes. Stages included; 1) being stuck, 2) diagnosis, and 3) improving experience. Processes included; 1) hope, 2) active engagement in the recovery journey, 3) engagement with treatment services, and 4) engaging in meaningful activities and relationships. Differences between individuals in the recovered and not recovered group were prevalent in the improving experience stage.ConclusionRecovery in BPD is a non-linear, ongoing process, facilitated by the interaction between stages and processes. Whilst clinical aspects are targets of specialist interventions, greater emphasis on fostering individual motivation, hope, engagement in relationships, activities, and treatment, may be required within clinical practice for a holistic recovery approach

Family, Partner and Carer Intervention Manual for Personality Disorders

Families, partners and carers of persons with personality disorder experience significant distress and burden within this role (Bailey & Grenyer, 2013, 2014; Day, Bourke, Townsend, & Grenyer, 2018). Treatment guidelines now recommend supporting families and carers, including involving them in the treatment process to improve wellbeing and thereby assist them in effectively caregiving for the person with personality disorder. This manual has been designed to help services engage and work with families and carers of persons with personality disorder in a brief four session intervention that aims to provide information, support and strategies. This manual has been developed in accordance with the relational model advocated by the Project Air Strategy for Personality Disorders (see The Relational Model of Treatment in the Project Air Strategy Treatment Guidelines). The relational model involves an integrative and collaborative approach to personality disorders treatment, focussing not only on the person with personality disorder but also carers, health services and clinicians. In the relational treatment model, the person’s problems are seen as stemming from problematic and dysfunctional relationship patterns that have developed over time (Grenyer, 2012). These relationship patterns are considered both intrapersonal (how the person relates to themselves, including their feelings and thoughts) and interpersonal (how they relate to others). The relational model recognises that responsibility for effective relationships also rests with others involved in the person’s life. It is now recognised that a service system that works together in an integrated manner better supports people with personality disorders, rather than any sector working in isolation (Grenyer, 2014; Grenyer, Lewis, Fanaian, & Kotze, 2018). Therefore, clinicians, case managers, carers, youth workers, teachers, school counsellors and the broader community share a joint responsibility to respond effectively to the person in a way that is helpful and encouraging (Townsend, Gray, Lancaster, & Grenyer, 2018). Indeed, longitudinal research indicates that clinicians attitudes towards working with individuals with a personality disorder has improved, reflecting the hope and optimism of treatment providers and the wider community informed by over 27 years of evidence and treatment (Day, Hunt, Cortis-Jones, & Grenyer, 2018). Caring for and helping people with personality disorders is everyone\u27s business (Grenyer, Ng, Townsend, & Rao, 2017) and everyone can choose to adopt the key principles from the Project Air Strategy model. This manual was utilized in a randomized controlled trial that sought to provide education and support to carers of individuals with a personality disorder (Grenyer et al., 2018). Compared to waitlist control groups, participants reported improvements in their relationship with their relative with a personality disorder and improvements in family empowerment (reflecting carers ability to take an active role in supporting their relatives treatment). At a 12 month follow-up these improvements were maintained and carers also reported an improvement in their mental health and decreased levels of burden.https://ro.uow.edu.au/uowbooks/1025/thumbnail.jp

A Randomized Controlled Trial of Group Psychoeducation for Carers of Persons With Borderline Personality Disorder

Carers of persons with borderline personality disorder (BPD) experience high burden. Treatment guidelines advocate involving carers in comprehensive therapy approaches. This study is a randomized controlled trial of group psychoeducation, compared to waitlist. Group psychoeducation involved 6-8 carers per group and focused on improving relationship patterns between carers and relatives with BPD, psychoeducation about the disorder, peer support and self-care, and skills to reduce burden. Carers were randomized into intervention (N = 33) or waitlist (N = 35). After 10 weeks, those in the intervention reported improvements in dyadic adjustment with their relative, greater family empowerment, and reduced expressed emotion, sustained after 12 months. There were also improvements in carers\u27 perceptions of being able to play a more active role, such as interacting with service providers. This study demonstrates that providing structured group programs for carers can be an effective way of extending interventions to a group experiencing high burden

Brief intervention manual for personality disorders

This manual is designed to help services intervene early and better support young people and adults with personality disorders. It is particularly focused on clients in crisis, who have complex needs, by providing practical therapeutic techniques in the prevention and treatment of high-risk challenging behaviours. It describes a four session brief intervention that can act as the first step in a treatment journey for people with this disorder

Complaint risk among mental health practitioners compared with physical health practitioners::A retrospective cohort study of complaints to health regulators in Australia

Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. To understand complaint risk among mental health practitioners compared with physical health practitioners. Design Retrospective cohort study, using incidence rate ratios (IRRs) to analyse complaint risk and a multivariate regression model to identify predictors of complaints. Setting National study using complaints data from health regulators in Australia. Participants All psychiatrists and psychologists (a € mental health practitioners\u27) and all physicians, optometrists, physiotherapists, osteopaths and chiropractors (a € physical health practitioners\u27) registered to practice in Australia between 2011 and 2016. Outcome measures Incidence rates, source and nature of complaints to regulators. Results In total, 7903 complaints were lodged with regulators over the 6-year period. Most complaints were lodged by patients and their families. Mental health practitioners had a complaint rate that was more than twice that of physical health practitioners (complaints per 1000 practice years: psychiatrists 119.1 vs physicians 48.0, p\u3c0.001; psychologists 21.9 vs other allied health 7.5, p\u3c0.001). Their risk of complaints was especially high in relation to reports, records, confidentiality, interpersonal behaviour, sexual boundary breaches and the mental health of the practitioner. Among mental health practitioners, male practitioners (psychiatrists IRR: 1.61, 95% CI 1.39 to 1.85; psychologists IRR: 1.85, 95% CI 1.65 to 2.07) and older practitioners (≥65 years compared with 36-45 years: psychiatrists IRR 2.37, 95% CI 1.95 to 2.89; psychologists IRR 1.78, 95% CI 1.47 to 2.14) were at increased risk of complaints. Conclusions Mental health practitioners were more likely to be the subject of complaints than physical health practitioners. Areas of increased risk are related to professional ethics, communication skills and the health of mental health practitioners themselves. Further research could usefully explore whether addressing these risk factors through training, professional development and practitioner health initiatives may reduce the risk of complaints about mental health practitioners