Hearing voices: How do substances affect the relationship with voices, coping and compliance?

Objectives: The cognitive model offers a useful framework to understand the emotional and behavioural consequences of voice-hearing experience. Substance use can be viewed as a way of coping with these emotional and behavioural consequences. This research explores how substance use as a coping strategy may affect voice-hearers‟ beliefs about their relationships with the voices, how they cope with the voices and compliance with command hallucinations. Design: This research used a qualitative design to analyse the experiences of participants that have used substances as a way of coping with hearing voices giving commands. Participants were recruited from early intervention services and community mental health services within a local NHS Trust. Methods: Semi-structured interviews were held with nine participants and analysed using a thematic analysis to identify themes amongst the accounts of their experiences. Participants also completed a Beliefs About Voices Questionnaire (BAVQ-R) as a triangulation measure of the appraisals of the voices. Results: Six themes in total were identified during the analysis and a theme of control was interpreted as central to the research question. These themes were: Control; emotional moderation; relationships; self-concept; understanding of psychosis and function of the substance use. Many participants viewed themselves as passively using substances which took control of themselves and their voices. Participants also used substances to disengage from the emotional effect of hearing voices Conclusions: The research suggests that people who hear voices may use substances to lessen the control of the voice. For some this may mean remaining passive and attributing substances (including anti-psychotic medication) as having control over the voice. This has implications for how services can successfully engage individuals in treatment. The effect of substance use on compliance with commands remains unclear

Transition to adult mental health services for young people with Attention Deficit/Hyperactivity Disorder (ADHD): A qualitative analysis of their experiences

BackgroundThere is little research on the process of transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). More recently, there is growing recognition that Attention Deficit/Hyperactivity Disorder (ADHD) may persist into adulthood requiring services beyond age 18. However, despite National Institute for Health and Clinical Excellence (NICE) Guidance which recommends specialist services for adults with ADHD, there is currently a lack of such services in the UK. The aim of the current study is to explore the experiences of young people with ADHD during transition from CAMHS to AMHS.MethodSemi-structured qualitative interviews with ADHD patients accessing CAMHS clinics in Nottinghamshire were analysed using thematic analysis.ResultsTen semi-structured interviews were transcribed and analysed. We found that patients’ relationships with their clinician were a key factor in both their reported experience of CAMHS and the transition process. Perceived responsibility of care was also pivotal in how the transition process was viewed. Nature and severity of problems and patients expectations of adult services were also contributing factors in the transition process. The need for continued parental support was openly accepted and thought to be required by the majority of young people with ADHD during transition.ConclusionsTimely preparation, joint working, good clinician relationships and parental support serve to facilitate the process of transition for young people with ADHD. Nature and severity of problems are perceived to impede or facilitate transition, with predominantly more ‘complex presentations’ with associated mental health problems more familiar to AMHS (e.g. self-harm, depression) making for smoother transitions to adult services. Transitions to AMHS were more difficult when ADHD was viewed as the main or sole clinical problem. Further exploration of young people’s experiences of transition and their engagement with and experience of adult services is required to provide an overall picture of facilitators to successful transition and integration into adult services

Anxiety Gremlins: mixed methods sequential explanatory evaluation of a CBT group intervention for children

Although research evidence supports the efficacy of cognitive behavioural therapy (CBT) for anxiety in children, it is important to examine practice-based evidence of effectiveness in typical clinical contexts. This study evaluated a CBT group intervention – ‘Anxiety Gremlins’ – for childhood anxiety. Participants were 36 children (19 boys, 17 girls) aged 8–13, referred for anxiety symptoms at a UK NHS service. The 8-session intervention included six child sessions (2 h) and two parent sessions (1 h). Self-report outcome measures of anxiety symptoms, life functioning and therapeutic relationships were used to measure change pre- and post-intervention. Semi-structured interviews were conducted with group facilitators and analysed through deductive content analysis to identify barriers and facilitators to change. No substantive differences were found between aggregated scores on pre- versus post-intervention outcome measures. Reliable change in anxiety symptoms was identified in 10 children (31%), with five improvers and five deteriorators. Interviews with facilitators identified disruption in group flow, lack of facilitator time to prepare and reflect, and the complexity of clients as hindering factors. Children meeting like-minded peers to share their stories and high engagement in the therapeutic process were helpful factors. Anxiety Gremlins did not demonstrate effectiveness on outcome measures, and this contrasted with clinical opinion. Recommendations were made for the service to revisit the intervention content and the method for recruiting children to the group – as complexity/co-morbidity was linked to poorer outcomes. Future research could explore fidelity to an adapted intervention and include interviews with children and their parents