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 Design/methodology/approach Five electronic reference databases and the EThOS database for unpublished research were systematically searched, as well as two pertinent journals.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

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

The transition into adulthood for children with a severe intellectual disability: parents’ views

Objectives: This study used the grounded theory to explore parents’ views of the transition into adulthood of their child with a severe intellectual disability. The study also sought to explore the processes that parents engage in for making psychological adjustments, to appreciate their role during this transition. This study is imperative for developing a psychologically informed theory that can be understood by both parents and clinicians. Methods: Twelve parents of 11 children with a severe intellectual disability were recruited for interview from charitable organizations accessed by parents (e.g. Mencap). Data collection used a combination of open-ended structured questions and non-directed probing. NVivo 10 software was used to assist the grounded theory coding and analysis process. Results: The analysis developed five processes that parents engaged in during their child’s transition into adulthood: ‘defining adulthood’, ‘noticing adult development’, ‘perceiving barriers to adulthood’, ‘worrying,’ and ‘making psychological adjustments’. Common to these was seen to be a core process of ‘making comparisons with perceived “norms”’. Contrasting findings are critically discussed alongside extant literature. Additionally, a transition model of parents’ views and adjustments is proposed, grounded in the study findings. Conclusions: Parents engage in a series of interactional processes throughout the transition trajectory, which are likely to influence how they make adjustments. Clinical interventions could challenge parent perceptions; encourage peer support; embrace systemic ways of working with parents through their child’s transition into adulthood; and use the presented model to help parents understand their experiences and any adjustment-related problems

Examining anxiety and depression in haematology cancer patients in ongoing treatment and under watchful waiting: A systematic review and meta-analysis

Introduction The present review aimed to establish prevalence rates of anxiety and depression in adults with haematology cancer, with a focus on the differences between patients under treatment and patients under watchful waiting. Method Five databases (Scopus, Medline, PsycINFO, EThOS, CINAHL) were searched throughout June 2021. Key search terms included haematology cancer, anxiety, depression, in treatment and watchful waiting. Study and sample characteristics, prevalence rates and mean self-reported scores of anxiety and depression data were extracted. Results A total of 18 eligible papers were included in the review. Quality appraisal indicated papers were of adequate standard. Depression data from 2720 participants (14.5% under watchful waiting) and anxiety data from 2520 participants (15.9% under watchful waiting) were analysed through subgroup meta-analyses. The prevalence of anxiety was 34% amongst adults receiving treatment and 24.5% amongst those under watchful waiting. The prevalence of depression amongst adults receiving treatment was 31.3%, significantly higher than 16.1% of adults under watchful waiting. Conclusion Overall, adults with haematology cancer were at greater risk of experiencing anxiety and depression than the general population, with greatest risk in those under treatment. The findings indicate the need for future research to examine availability and effectiveness of targeted psychological interventions

Evaluating Trauma Informed Care training for services supporting individuals experiencing homelessness and multiple disadvantage

Purpose – Implementing trauma informed care (TIC) for individuals facing homelessness and multiple disadvantage is proposed to help both service users and staff work effectively and therapeutically together. However, the effectiveness of implementing TIC via training is debatable. This study explores the effects of a fourday trauma informed care and psychologically informed environments training package in such services. Design and methodology – The analysis explores the effect of this training on the degree of trauma informed care as measured by the TICOMETER, a psychometrically robust organisational measure of TIC. The study examines group and individual level changes from before training and again at six-month and oneyear follow-up time-points. Findings – At the group level analysis, three of the five TICOMETER domains (Knowledge & Skills, Relationships, and Policies & Procedures) were higher when compared to pre-training scores. The remaining two domains (Service Delivery and Respect) did not improve. Individual level analysis showed some participants’ scores decreased following training. Overall, the training appeared to modestly improve the degree of trauma informed care as measured by the TICOMETER, and these effects were sustained at one-year follow-up. Research limitations – Findings are limited by the design and low response rates at follow-up. Originality – This paper is the first UK study to use the TICOMETER. Practical implications – Training is necessary but not sufficient for the implementation of TIC and needs to be complemented with wider organisational and system level changes

Service user and carer representatives’ experiences of the personal effects of involvement in clinical psychology training

PurposeExtant literature exploring service user (SU) involvement in clinical psychology training has been limited by its sampling from singular training programmes and its restricted application of psychological theory. This research seeks to counter limitations by exploring SUs’ experiences across multiple clinical psychology training programmes in the UK and by deductively applying psychological theory relating to power, recovery, identity and group development.Design/methodology/approachSemi-structured interviews were conducted with 14 participants. A deductive thematic analysis was used to analyse qualitative data.FindingsFive main themes were identified: environment determines sense of safety; meeting challenges; sense of purpose, worth and value; the person you see now is not the person I was; and wanting to break the glass ceiling.Research limitations/implicationsCarers are underrepresented and the sample does not contain SUs who were no longer involved in training.Practical implicationsIt is important that the environment fosters psychological safety for SUs, via positive and supportive relationships with trainees and staff, with SUs being treated as equals and financially reimbursed as such. SUs and professionals need to explore managing and sharing power to enable SUs to feel valued and to reap benefits from involvement, including developing a positive sense of identity.Originality/valueThe research is part of the early literature exploring SUs’ experiences of involvement in clinical psychology training and is, to the best of the authors’ knowledge, the first to explore the personal effects of involvement across multiple programmes

Are acceptance and commitment therapy-based interventions effective for reducing burnout in direct-care staff? A systematic review and meta-analysis

Purpose: Work-related stress amongst staff working in direct care roles in mental health and intellectual disability settings is associated with a range of problematic outcomes. There has been a proliferation of research into the use of acceptance and commitment therapy (ACT)-based interventions in this staff population. The purpose of this paper is to review the extant literature. Design/methodology/approach: A systematic search of the literature was conducted, and seven studies identified which met the criteria for inclusion in the review, of which four were eligible for meta-analysis. Findings: Results of the meta-analysis were most convincing for the effectiveness of ACT-interventions to reduce psychological distress within a subgroup of those with higher distress at baseline. There was no statistically significant effect for the amelioration of burnout, nor for an increase in psychological flexibility (a key ACT construct). Research limitations/implications: Conceptual issues are considered including the purpose and treatment targets of ACT interventions, such as supporting valued living rather than diminishing stress per se. Methodological issues are discussed around the measurement of psychological flexibility. Originality/value: This review makes recommendations for future research and for the implementation of ACT-interventions for work-related stress in these settings

“I don’t want to take buprenorphine for the rest of my life”: Acceptance and Commitment Therapy for a Client Struggling to Reduce Low-Dose Buprenorphine (a Hermeneutic Single-Case Efficacy Design)

The misuse of substances is often maintained by both physical and psychological factors. Opioid-substitution medications manage physical aspects of addiction; however, difficulties with emotional regulation and avoidance perpetuate continued substance misuse. In the UK, individuals who misuse substances are often excluded from mental health services, meaning these underlying difficulties are not addressed. Acceptance and Commitment Therapy (ACT) seeks to reduce emotional avoidance. A hermeneutic single-case efficacy design was used to evaluate the effects of ACT within drugs and alcohol service. Quantitative and qualitative data was critically analysed to understand factors involved in identified changes. Analysis recognised the client progressed towards two of three of their goals, related to motivation and anxiety. Their psychological flexibility also increased. ACT processes played a key role in this; however, the therapeutic relationship and psychopharmacological factors were also noted. Study limitations and clinical and research implications are discussed

A brief acceptance and commitment intervention for work‐related stress and burnout amongst frontline homelessness staff: A single case experimental design series

Purpose Recent intervention research for burnout amongst those working in health and social care contexts has found acceptance and commitment therapy (ACT) interventions to be of use but has provided less clarity on the role of psychological flexibility (a key ACT construct). This study further evaluated the usefulness of ACT for burnout and work-engagement and assessed the role of psychological flexibility in contributing to therapeutic change. Procedure A nonconcurrent multiple-baseline across-participants single-case experimental design was used. Four participants were recruited from a homelessness organization in the East Midlands, England. The ACT-intervention was split into three modules to reflect the three aspects of the ACT triflex, and the sequence of delivery was randomized for each participant in order to test the relationship between these aspects. Findings Support was found for the ACT intervention reducing exhaustion and increasing work-engagement. Psychological Flexibility increased in all participants and was temporally related to increases in other outcome variables in some instances. Delivery of the intervention focussed on any given aspect of the ACT triflex could increase different domains of psychological flexibility. Implications This study adds to the growing body of research in favour of ACT interventions for burnout and adds to the understanding of psychological flexibility as a mediating variable

Factors associated with psychological distress for couples facing head and neck cancer: A systematic literature review

Objectives Cancer patients in supportive relationships display improved health and survival outcomes. Identifying factors that might respond to intervention for Head and Neck Cancer (HNC) dyads is important as HNC patients and their partners experience heightened distress. This article systematically reviewed and evaluated the research findings and methodological quality of studies which identified factors influencing psychological distress for couples facing HNC. Methods PsycINFO, Medline, and CINAHL were searched. Studies were included if they used validated psychological distress measures and quantitative data collection methods. Eleven studies satisfied inclusion criteria. Results Studies identified factors associated with the psychological distress experienced by couples facing HNC, with substantial effect size variation. These factors included clinical, sociodemographic, relational, and psychological variables. Factors associated with increased psychological distress included disease burden, reduced social contact, perception of reduced relationship quality, and less adaptive/assimilative coping although the effect sizes displayed considerable heterogeneity. Overall, studies possessed good methodological quality but generally could have been improved by minimising the risk of non-response bias and fully reporting relational characteristics. Conclusions The implications of these results for clinical practice and future research are discussed. Further research is recommended to report effect sizes more consistently for both dyad members to gain greater insight into couple-level distress and to perform moderator analyses to identify which variables influence the magnitude of psychological distress