On the interpretation of lateral manganin gauge stress measurements in polymers

Encapsulated wire-element stress gauges enable changes in lateral stress during shock loading to be directly monitored. However, there is substantial debate with regards to interpretation of observed changes in stress behind the shock front; a phenomenon attributed both to changes in material strength and shock- dispersion within the gauge-encapsulation. Here, a pair of novel techniques which both modify or remove the embedding medium where such stress gauges are placed within target materials have been used to try and inform this debate. The behavior of three polymeric materials of differing complexity was considered, namely polystyrene, the commercially important resin transfer moulding RTM 6 resin and a commercially available fat lard. Comparison to the response of embedded gauges has suggested a possible slight decrease in the absolute magnitude of stress. However, changing the encapsulation has no detectable effect on the gradient behind the shock in such polymeric systems

Is the content of patient’s written emotional disclosure associated with improved health outcomes for asthma patients?

Written emotional disclosure (WED) is a self-directed, writing intervention. Treatment effects post-WED vary between studies, prompting research into which variables promote the largest improvements. Thus far, research has focused on the frequency of certain linguistic properties of the writing, and subjective stress-related ratings. This study tests the feasibility of using an objective coding framework for stress typology to categorise WED extracts and explores whether any characteristics of the stress described were associated with intervention outcomes. WED extracts from a randomised controlled trial of patients with asthma were coded using an objective stress typology framework. The contents of the WED extracts were reviewed to ascertain whether the experience met the DSM-5 definition for trauma, involved abuse, and was experienced directly or vicariously. Also analysed were the degree of upheaval and upset associated with the event described, together with the time of the event, and number of events written about. Correlational analyses indicated that improvements in asthma-related outcomes were associated with writing about experiences that occurred in childhood, constituted abuse, or caused greater upheaval (all ps <. 05). We found some evidence that the treatment effects of WED may be dependent on what types of stressful experiences participants write about. The use of our objective stress coding scheme was only partially successful as it could not be applied consistently to all WED extracts. Findings require replication using a prospective experimental design

Systemic Risk-Shifting in Financial Networks

Banks face different but potentially correlated risks from outside the financial system. Financial connections can share these risks, but also create the means by which shocks can propagate. We examine this tradeoff in the context of a new stylised fact

Guided self-help cognitive behavioral intervention for VoicEs (GiVE): study protocol for a pilot randomized controlled trial

Background: Cognitive behavior therapy for psychosis (CBTp) is an effective intervention for people who hear distressing voices (auditory hallucinations). However, there continues to be a problem of poor access to CBTp. Constraints on health care funding require this problem to be addressed without a substantial increase in funding. One solution is to develop guided self-help forms of CBTp to improve access, and a symptom-specific focus on, for example, distressing voices (auditory verbal hallucinations) has the potential to enhance effectiveness. We term this cognitive behavior therapy for distressing voices (CBTv). Methods/design: This trial is an external pilot randomized controlled trial comparing the effects of 12 week guided self-help CBTv (with eight therapist support sessions) with a wait list control condition. Informed consent will be obtained from each participant. Half of the 30 participants will be randomized to receive guided self-help CBTv immediately; the remaining half will receive the intervention after a 12-week delay. All participants will continue with their usual treatment throughout the study. Outcomes will be assessed using questionnaires completed at baseline and 12 weeks postrandomization. Interviews will be offered to all those who receive therapy immediately to explore their experiences with the intervention. Discussion: The outcomes of this trial, both quantitative and qualitative, will inform the design of a definitive randomized controlled trial of guided self-help CBTv. If this intervention is effective, it could help to increase access to CBT for those who hear distressing voices

A Systematic Review of the Effects of Urban Living on Suicidality and Self-Harm in the UK and Ireland

We conducted a systematic review to answer the following: (a) Is there any evidence to support increased prevalence of suicidality and self-harm (i.e. self-harm or suicidality) in urban versus rural environments? (b) What aspects of the urban environment pose risk for suicidality and self-harm? Thirty-five studies met our criteria. Our findings reflect a mixed picture, but with a tendency for urban living to be associated with an increased risk of suicidality and self-harm over rural living, particularly for those living in deprived areas. Further research should focus on the clustering and additive effects of risk and protective factors for suicidality and self-harm in urban environments

Patient experience of Guided self-help CBT intervention for VoicEs (GiVE) delivered within a pilot randomized controlled trial

Background: Access to cognitive behaviour therapy for those with psychosis (CBTp) remains poor. The most frequently endorsed barrier to implementation is a lack of resources. To improve access to CBTp, we developed a brief form of CBTp that specifically targets voice-related distress. The results of our pilot trial of guided self-help CBT for voices (GiVE) suggest the therapy is both acceptable and beneficial. Aims: The present study aims to explore the subjective patient experience of accessing GiVE in the context of a trial. Method: We interviewed 9 trial participants using the Change Interview and a mixed methods approach. Results: Most participants reported at least one positive change that they attributed to GiVE. We extracted five themes: (1) changes that I have noticed; (2) I am not alone; (3) positive therapy experiences; (4) I want more therapy; and (5) helping myself. The themes indicate that participating in the GiVE trial was generally a positive experience. The main areas in which participants experienced changes were improved self-esteem, and the ability to cope with voices. Positive changes were facilitated by embracing and enacting ‘self-help’ and having support both in and out of the therapy sessions. Conclusions: The findings support the use of self-help materials with those distressed by hearing voices, but that support both within and outside the clinical setting can aid engagement and outcomes. Overall, the findings support the continued investigation of GiVE

The psychological therapy preferences of patients who hear voices

Background Voice-hearing is a common, phenomenologically diverse, experience across different mental health diagnoses. Patient preferences for psychological therapies are helpful in informing treatment commissioning and provision, especially in the context of complex and variable experiences like voice-hearing. There is, however, very limited evidence as to the psychological therapy preferences of transdiagnostic voice-hearers. Methods Three-hundred and thirty-five voice hearers were recruited from secondary care NHS mental health services across England, between 2020 and 2022. Participants completed a questionnaire battery, involving a psychological therapy preference survey. Participants ranked their preferences across categories of practical, technical and relational therapy elements. Therapy preferences were examined using non-parametric ANOVAs and the significance of pairwise comparisons between different therapy elements. Results There were significant differences in all categories of preference elements. Clear hierarchies of preference were observed in therapy location, timing, delivery, and therapy approach. Preferences were evident, albeit with less clear vertical hierarchies, for number of sessions, mode, therapist qualities, and therapy focus, tasks and outcomes. Discussion Overall, participants expressed a preference for individual, face-to-face intervention of at least nine sessions, with a highly experienced therapist and a core focus on enhancing coping strategies for voice-hearing experiences

Understanding the barriers to accessing symptom-specific cognitive behavior therapy (CBT) for distressing voices: reflecting on and extending the lessons learnt from the CBT for psychosis literature

The experience of hearing voices ('auditory hallucinations') can cause significant distress and disruption to quality of life for people with a psychosis diagnosis. Psychological therapy in the form of Cognitive Behavior Therapy for psychosis is recommended for the treatment of positive symptoms, including distressing voices, but is rarely available to patients in the UK. Cognitive Behavior Therapy for psychosis has recently evolved with the development of symptom-specific therapies that focus upon only one symptom of psychosis at a time. Preliminary findings from randomized controlled trials suggest that these symptom-specific therapies can be more effective for distressing voices than the use of broad CBT protocols, and have the potential to target voices trans-diagnostically. Whilst this literature is evolving, consideration must be given to the potential for a symptom-specific approach to overcome some of the barriers to delivery of evidence-based psychological therapies within clinical services. These barriers are discussed in relation to the UK mental health services, and we offer suggestions for future research to enhance our understanding of these barriers