219 research outputs found
âEveryone should do itâ: Client experience of a 12-week dialectical behaviour therapy group programme â An interpretative phenomenological analysis
Objective: There is a dearth of practice-based evidence of adapted or âDBTinformedâ
transdiagnostic models, which could provide services and
clinicians with information of what works and for whom, in which
settings. This paper aims to bridge this gap by exploring the client
experience of a 12-week transdiagnostic dialectical behaviour therapy
(DBT) group programme in a private psychiatric hospital. Method: Five
participants with varied clinical diagnoses and previous therapeutic
experiences were interviewed following completion of one or more of the
same adapted DBT programme, comprising of the standard four modules
over 12 weeks, including a weekly skills group and 1:1 therapy.
Interpretative phenomenological analysis (IPA) was applied to give voice
to the clientsâ lived experience of the group. Results: Three master themes
were identified: âPre DBT: Crisis & Desperationâ; âIn-session: Belongingâ;
and âThe Real World: Livingâ, each characterised by four sub-themes,
highlighting helpful and hindering factors of clientsâ current and previous
therapeutic experiences. Conclusion: Overall this version of DBT in a
transdiagnostic setting was experienced as helpful and positive by
participants; main outcomes included being able to build a life worth
living, feel hope and joy, build DBT skills into a lifestyle, and develop
reflective practice. Implications for clinical practice, service delivery and
policy are also discussed. The article aims to provide clinicians with
practice-based evidence to inform the delivery of DBT as well as
supporting the case for the use of DBT with various disorders, thus paving
the way for future research in this area
Outcomes for 18 to 25-year-olds with borderline personality disorder in a dedicated young adult only DBT programme compared to a general adult DBT programme for all ages 18
Aim
Targeting young adults with borderline personality disorder (BPD) for treatment may carry significant social and clinical benefits. We aimed to evaluate a communityâbased Dialectical Behaviour Therapy (DBT) programme delivered exclusively to young adults with BPD.
Methods
We describe a naturally occurring nonâequivalent, quasiâexperimental comparison of outcomes for young adults (18â25âyears) with BPD following 1 year of treatment in either a young adult only DBT programme or a general adult DBT programme (18+ years). Twentyâfour young adults enrolled in a communityâbased young adult DBT programme open only to 18â to 25âyearâolds with BPD. Another 13 young adults, also 18â25âyears, enrolled in a general adult DBT programme open to all ages above 18âyears. Both treatment conditions offered all modes of standard DBT for 1 year. Participants completed a battery of selfâreport measures on mental health symptoms at baseline and again at treatment completion after 1 year. Discharge rates at 2 years postâtreatment completion were also recorded.
Results
Better outcomes were found on borderline symptom severity and general psychopathology among completers of young adult DBT, with a large effect size for treatment condition as well as greater clinically significant change. Discharge rates from mental health services 24âmonths later were also higher for completers of young adult DBT.
Conclusions
There may be advantages in delivering DBT to young adults in an ageâspecific programme, possibly due to group cohesion. Methodological limitations apply, such as small sample size and nonârandomization. Further controlled research is needed
Talking about sex after traumatic brain injury: perceptions and experiences of multidisciplinary rehabilitation professionals
Purpose: Research indicates that although 50â60% of people who have had a traumatic brain injury (TBI) experience changes in sexual functioning, sexuality issues remain largely unaddressed in rehabilitation. This study aimed to explore rehabilitation professionalsâ perceptions and experiences of discussing sexuality with service-users who have had a TBI.
Method: Purposeful sampling was used to recruit 24 participants from two local National Health Service trusts and from a national charity. Four focus groups were conducted with pre-existing groups of professionals, using a semi-structured interview schedule. Focus group data were transcribed verbatim and analysed using thematic analysis.
Results: Six main themes were derived from the analysis: (1) sexuality after TBI is a specialist issue; (2) sexuality is a sensitive subject; (3) practicalities of discussing sexuality; (4) roles and responsibilities; (5) dilemmas about risk and vulnerabilities; and (6) organisational and structural issues.
Conclusions: Our findings suggest that a more proactive approach to addressing sexuality issues be taken by incorporating sexuality into assessments and by having sexuality information available for service-users. Support for professionals is also needed in the form of the development of policy, on-going training and supervision
Is Japan Really Back? The "Abe Doctrine" and Global Governance
Japanese Prime Minister Abe Shinzo has emerged as the âcomeback kidâ of Japanese politics and in his second term of office is now widely regarded as a rare example of strong leadership as he seeks to arrest and reverse his countryâs perceived decline. The strategy to achieve these objectives has come to be known as the âAbe Doctrine,â which represents a radical but risky shift in foreign policy. This article outlines the tenets of the evolving Abe Doctrine and then applies them to the Abe administrationâs behaviour in the mechanisms of global governance, a highly pertinent but overlooked example. It argues that although a more strategic and coherent approach to global governance has emerged under Abe than had been previously evident, this has been at the expense of the norm of internationalism that has traditionally shaped Japanâs role
Multimodal therapy in an inpatient setting
Inpatient Multimodal Therapy (imt) is a residential treatment program, lasting a maximum of 36 weeks, for patients with severe neurotic symptoms. A group of 44 chronic obsessive-compulsive patients and a group of 40 chronic phobic patients were treated in order to assess the outcome and the process of treatment and to identify prognostic factors associated with the effect. At follow-up-on average, eight months after discharge-it was found that 60% had improved, 32% had remained the same, and 8% had deteriorated, indicating that, in general, the treatment was beneficial. That these effects were long-lasting is supported by the fact that, at follow-up, 78% of all patients were no longer receiving treatment, 18% were receiving outpatient or day treatment, and 4% were receiving inpatient treatment. Phobic patients appear to have gained more from the multimodal approach than did obsessive-compulsive patients, as indicated by the fact that the severity of symptoms decreased as they improved in rational thinking, assertiveness, and arousal. By contrast, obsessive-compulsive patients relapsed more than phobic patients did. This was attributed to the fact that the former gained less from the rational-emotive training, denied problems with assertiveness, and did not practice the acquired relaxation skills. It further appeared that a favorable outcome could be induced in patients who (1) expressed relatively mild symptoms in this otherwise severe group, (2) reported relatively few additional complaints, (3) could clearly indicate interpersonal problems, and (4) did not use psychotropic drugs. These prognostic factors are so widespread that not much weight can be ascribed to them. Yet they are useful for indication of imt until better predictors are found
Access to primary care for socio-economically disadvantaged older people in rural areas: exploring realist theory using structural equation modelling in a linked dataset
Background: Realist approaches seek to answer questions such as âhow?â, âwhy?â, âfor whom?â, âin what circumstances?â and âto what extent?â interventions âworkâ using context-mechanism-outcome (CMO) configurations. Quantitative methods are not well-established in realist approaches, but structural equation modelling (SEM) may be useful to explore CMO configurations. Our aim was to assess the feasibility and appropriateness of SEM to explore CMO configurations and, if appropriate, make recommendations based on our access to primary care research. Our specific objectives were to map variables from two large population datasets to CMO configurations from our realist review looking at access to primary care, generate latent variables where needed, and use SEM to quantitatively test the CMO configurations. Methods: A linked dataset was created by merging individual patient data from the English Longitudinal Study of Ageing and practice data from the GP Patient Survey. Patients registered in rural practices and who were in the highest deprivation tertile were included. Three latent variables were defined using confirmatory factor analysis. SEM was used to explore the nine full CMOs. All models were estimated using robust maximum likelihoods and accounted for clustering at practice level. Ordinal variables were treated as continuous to ensure convergence. Results: We successfully explored our CMO configurations, but analysis was limited because of data availability. Two hundred seventy-six participants were included. We found a statistically significant direct (context to outcome) or indirect effect (context to outcome via mechanism) for two of nine CMOs. The strongest association was between âease of getting through to the surgeryâ and âbeing able to get an appointmentâ with an indirect mediated effect through convenience (proportion of the indirect effect of the total was 21%). Healthcare experience was not directly associated with getting an appointment, but there was a statistically significant indirect effect through convenience (53% mediated effect). Model fit indices showed adequate fit. Conclusions: SEM allowed quantification of CMO configurations and could complement other qualitative and quantitative techniques in realist evaluations to support inferences about strengths of relationships. Future research exploring CMO configurations with SEM should aim to collect, preferably continuous, primary data
A multiple timepoint pre-post evaluation of a âsexual respectâ dvd to improve competence in discussing sex with patients with disability
Sexual problems are common after chronic illnesses and disability, yet research indicates that this is a neglected area in healthcare services. Evaluation studies provide evidence of the effectiveness of education in enhancing professionalsâ knowledge, skills, and comfort in addressing patientsâ sexual concerns. However, there are limited evaluations aimed at improving ability to discuss sexuality when working with people with disabilities. The overall aim of this study was to evaluate a âSexual Respectâ DVD as an intervention to improve competence in addressing âsexuality and disabilityâ. A mixed methods design was used with both quantitative and qualitative components. Nursing studentsâ self-report ratings of knowledge, confidence, comfort and willingness (to discuss sexuality) levels were collected across four time points: baseline, pre-intervention, post-intervention, and follow-up. Data were analysed using one-way repeated measures ANOVAs with post hoc comparisons. Open-ended qualitative comments relating to the barriers and facilitators to discussing sexuality were analysed using content analysis and subsequent frequency analysis. Reported barriers included lack of knowledge about sexÂŹuality and disability issues, the patientâs level of disability, and waiting for the patient to raise sexuality issues first. Facilitators included education/training, written information, and if the patient raised it first. Overall, the DVD intervention had a significant and positive impact on nursing studentsâ self-reported knowledge, confidence, comfort and willingness levels. The findings are discussed in relation to the PLISSIT model, which emphasises the importance of a proactive approach to addressing sexuality issues
Mentalization-based treatment in groups for adolescents with borderline personality disorder (BPD) or subthreshold BPD versus treatment as usual (M-GAB): study protocol for a randomized controlled trial
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