Cognitive-Behavioural Therapy

Cognitive-behavioural therapy (CBT) is a generic term, encompassing both: (1) approaches underpinned by an assumption that presenting emotional and behavioural difficulties are cognitively mediated or moderated; and (2) atheoretical bricolages of cognitive and behavioural techniques. This latter category may include effective therapeutic packages (perhaps acting through mechanisms articulated in the first category) but, when theory is tacit, it becomes harder to make analytical generalisations or to extrapolate principles that could guide idiographic formulation and intervention. In contrast, the first category of approaches posits that presenting difficulties may be formulated from an assessment of individual cognitive content (thought processes and underlying beliefs) and implies that we can bring about change in presenting difficulties through change in associated cognitions. Within this chapter, we formulate the case of ‘Molly’, using the theoretical model of CBT articulated by A. T. Beck, to understand the client’s presentation, current difficulties, and potential areas for intervention

How do differential explanations of voice-hearing influence attributions and behavioural intentions towards voice-hearers?

Explanations regarding the etiology of mental health difficulties have been found to affect public attitudes towards those who experience such difficulties. Utilizing a large, randomized parallel-groups design (N=1,004), we examined how standardized differential explanations of voice-hearing influence public attitudes, attributions, and behavioral intentions towards voice-hearers. Additionally, we incorporated a behavioral outcome measure to examine whether reported behavioral intentions towards voice-hearers were related to responses towards an individual with a history of voice-hearing. Consistent with attribution theory, mediated pathways between attributions and intentions were identified: broadly, viewing the voice-hearer's behavior as dangerous, within their personal responsibility, and global was associated with more coercive intentions – and these were mediated by feelings of fear, anger, and pity. Reported behavioral intentions demonstrated small-to-moderate associations with our behavioral outcome measure. The findings suggest that explanations regarding the etiology of mental health difficulties that seek to reduce public attributions of dangerousness, personal responsibility, and globality may facilitate more helpful responses towards voice-hearers

Applying family life cycle concepts in psychological practice with children and young people

Family life cycle models offer a framework for understanding family development and defining ‘normative’ transitions within this developmental progression. As such, family life cycle models have the potential to inform clinical practice: by allowing case presentations to be contextualised in terms of broader systemic and temporal processes, and possible disruptions to expected transitions. This article critically considers how family life cycle models, and the notion of normative transition, might be used to support psychological understanding and intervention when working clinically with children and young people. Models of normative development and transition may be helpfully integrated with broader psychological models to inform idiographic case formulation, and thereby influence practice. Although normative models can be used indicatively, care should be taken not to use these models prescriptively

Perceptions of wellness recovery action plan (WRAP) training: a systematic review and metasynthesis

Purpose The purpose of this systematic review was to address two questions: what is the qualitative evidence for the effects of the Wellness Recovery Action Plan (WRAP) training, as perceived by adults with mental health difficulties using it? What is the quality of qualitative literature evaluating WRAP? Design/methodology/approach Five electronic reference databases and the EThOS database for unpublished research were systematically searched, as well as two pertinent journals. Study quality was assessed using Critical Appraisal Skills Programme criteria and results analysed using thematic synthesis. Findings Of 73 studies, 12 qualitative papers met inclusion criteria and were generally good quality. Analyses demonstrated expected findings, such as increased understanding and active management of mental health in the context of group processes. Results also highlighted that WRAP training promoted acceptance and improved communication with professionals. Peer delivery of WRAP was highly valued, with contrasting perceptions of peers and professionals evident. Some cultural considerations were raised by participants from ethnic minorities. Research limitations/implications WRAP training participation has positive self-perceived effects beyond those captured by measures of recovery. Broader implications are suggested regarding earlier access to WRAP, professional support and communication between professionals and service users. Recommendations for further research include the relationship between social support and illness self-management and peer-delivered acceptance-based approaches. Multiple time-point qualitative studies could offer insights into WRAP training processes and whether changes are sustained

Do they practice what we teach? Follow-up evaluation of a Schema Therapy training programme

This study evaluated a three-day Schema Therapy training programme for trainee clinical psychologists. The training used an experiential model of learning, which was intended to encourage the transfer of knowledge and techniques from the learning environment into clinical practice. Using a mixed-methods approach, the training programme was evaluated in terms of: (1) self-reported changes in knowledge, confidence and willingness to use Schema Therapy-informed techniques; (2) whether the training was integrated into clinical practice; and (3) the perceived barriers/facilitators to achieving practice integration. Participants – 17 of the 19 trainee clinical psychologists enrolled on the Schema Therapy training programme – completed assessments immediately pre- and post-training. Participants were subsequently followed-up for reassessment three months after the training. Group- and individual-level analyses showed that most participants reported training-related gains in knowledge and confidence; these were largely sustained at follow-up, and were associated with post-training practice integration of Schema Therapy concepts and techniques. Analysis of qualitative data identified factors moderating use of training in practice. Findings of the study have implications for future delivery and evaluation of training in cognitive-behavioural therapies

Do they practice what we teach? Follow-up evaluation of a Schema Therapy training programme

This study evaluated a three-day Schema Therapy training programme for trainee clinical psychologists. The training used an experiential model of learning, which was intended to encourage the transfer of knowledge and techniques from the learning environment into clinical practice. Using a mixed-methods approach, the training programme was evaluated in terms of: (1) self-reported changes in knowledge, confidence and willingness to use Schema Therapy-informed techniques; (2) whether the training was integrated into clinical practice; and (3) the perceived barriers/facilitators to achieving practice integration. Participants – 17 of the 19 trainee clinical psychologists enrolled on the Schema Therapy training programme – completed assessments immediately pre- and post-training. Participants were subsequently followed-up for reassessment three months after the training. Group- and individual-level analyses showed that most participants reported training-related gains in knowledge and confidence; these were largely sustained at follow-up, and were associated with post-training practice integration of Schema Therapy concepts and techniques. Analysis of qualitative data identified factors moderating use of training in practice. Findings of the study have implications for future delivery and evaluation of training in cognitive-behavioural therapies

Modelling smoking motivation: mood, personality and appetitive behaviour

The overarching aim of this research was to investigate the role of affectivity in real-world smoking behaviour. The motivational relationship between affect and smoking was conceptualised within an interactive hierarchical framework: assessing associations with natural situational variability over time, and moderation by relevant individual differences (chiefly, BIS-BAS scores - as reflecting affective disposition/motivational sensitivity). An initial questionnaire study was undertaken towards the development of a diary design that would be useful in capturing experiences around everyday smoking behaviour (Chapter 4). This design was then applied in a series of diary studies that were set up to address questions pertaining to the central aim of the research. The main body of the thesis is structured around these areas of enquiry. Chapter 5 tested competing theoretical models of mood-smoking motivation in everyday contexts and Chapter 6 extended this Investigation hierarchically: to ascertain whether there are individual differences in identified motivational experiences. Chapter 7 compared smoking with natural appetitive behaviour (food consumption) to better demarcate parts of the motivational process that might be set awry in reinforcement of non-natural consumption. The influence of more general periodic shifts in motivational experiences and behaviour on consumption/desire to consume was examined in Chapter 8. The final investigative chapter (Chapter 9) compared processes identified for normal smoking behaviour with processes during deprivation/abstinence. Each chapter draws on data from the diary studies as appropriate. Findings were generally congruent with other naturalistic research in supporting positive mood enhancement (principally, anticipatory elevation of hedonic tone) as a motivation for normal smoking. BAS reward-sensitivity moderated hedonic incentive effects, but not in the expected direction. Comparisons with natural consumption behaviour suggested that motivations for natural appetitive rewards may differ from those for acquired substance use. Notably, smoking motivations changed somewhat during deprivation, when tense arousal and frustration emerged as operative factors. Chapter 10 considers the implications of the research for models of mood and personality. These include implications for conceptualising reinforcement sensitivity

The efficacy of Cognitive Behavioral Therapy for adults with ADHD: a systematic review and meta-analysis of Randomized Controlled Trials

Objective: To systematically review the literature on published randomized controlled trials (RCTs) of cognitive behavioral therapy (CBT) for adult ADHD and to establish the effectiveness of CBT in reducing ADHD symptoms. Method: A systematic review of nine RCTs and two subsequent meta-analyses of eight of the studies were conducted. Results: Just nine studies were identified, of generally good quality but with some limitations. Four trials (total N = 160) compared CBT with waiting list controls, and three trials (total N = 191) compared CBT with appropriate active control groups. Meta-analyses showed that CBT was superior to waiting list with a moderate to large effect size (standardized mean difference [SMD] = 0.76, 95% confidence interval [CI] [0.21, 1.31], p = .006) and superior to active control groups with a small to moderate effect size (SMD = 0.43, 95% CI [0.14, 0.71], p = .004). Conclusion: These results give support to the efficacy of CBT in reducing symptoms of ADHD post-intervention

Perceptions of therapeutic principles in a therapeutic community

Purpose: This study aimed to explore staff and service users’ perceptions of therapeutic principles within a unique male high secure learning disability therapeutic community (LDTC). Design/methodology/approach: A qualitative approach was adopted using deductive content analysis and inductive thematic analysis. Twelve participants took part in a semi-structured interview to explore their perceptions of Haigh’s (2013) quintessence principles and any further additional therapeutic features in the environment not captured by the theory. Findings: All five quintessence principles were identified in the LDTC environment. Some limits to the principle of ‘agency’ were highlighted, with specific reference to difficulties implementing a flattened hierarchy in a forensic setting. Additional therapeutic features were identified including; security and risk, responsivity, and more physical freedom which appear to aid implementation of the quintessence principles. Research limitations/implications: The study was performed within a single case study design. Therefore results remain specific to this LDTC. However, the finding of these principles in such a unique setting may indicate Haigh’s (2013) quintessence principles are evident in other TC environments. Originality/value: This is the first research paper that has attempted to test whether Haigh’s (2013) quintessence principles are evident within a given therapeutic community. The research provides empirical evidence for the quintessence principles in a novel TC setting and suggests recommendations for future research