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Fibromyalgia remains a difficult condition to diagnose and treat. Research suggests that this leads to frustrating experiences for service users and healthcare professionals. This has led to negative healthcare professional attitudes towards working with those with fibromyalgia. The research to date reports negative attitudes and predominantly investigates attitudes of primary care physicians. This study explores the attitudes of a range of healthcare professionals towards those diagnosed with fibromyalgia. Using Q-methodology, 27 healthcare professionals completed a sorting task and questionnaire to prioritise statements relating to a range of different attitudes towards service users. All participants significantly loaded onto three factors that explained a total of 64% of the data variance. Factor 1 reflected the attitude 'Service users with fibromyalgia are no different to other service users and I enjoy working with them'. Factor 2 reflected the attitude 'Service users with fibromyalgia are inaccurate informants of their own condition due to lack of understanding of their condition and are not likely to engage in treatments'. Factor 3 reflected the attitude 'Service users with fibromyalgia are trustworthy with a lot of clinical problems [but I lack confidence in specialist skills to support them]'. Contrary to the current literature, there appears to be supportive attitudes from healthcare professionals towards service users diagnosed with fibromyalgia. Increased specialised training, clinical exposure to working with fibromyalgia and reflective practice spaces were identified as elements that could improve healthcare professional attitudes.

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Women with Tourette's syndrome (TS) continue to be under-researched, despite female sex being associated with increased tic-related impairment in adulthood. Existing literature indicates that individuals with TS are more likely than the general population to report self-stigma, but little is known about the subjective identities of women with TS and how this relates to psychological wellbeing. Semi-structured interviews were conducted via Zoom with a purposive sample of 11 females. All were diagnosed with TS and aged 18-28. Data was transcribed verbatim and thematic analysis applied. Five themes were established: "I'm not normal", "I just want to be me", I'm a "people pleaser", seeing oneself as an "outsider", and "it's just part of me…it's not going anywhere". Difficulties with self-acceptance and the autonomy to be one's true self were noted and appeared to be intensified by stereotypical gender roles and attempts to conceal tics. Findings also suggested that personal growth and feelings of mastery can be achieved through embracing TS as part of one's identity, or recognising it as just one aspect of the self. Psychological support focused on accepting and living with tics rather than reducing them may benefit this population and is currently difficult to access. Consideration should also be given to improving the availability of support groups where women with TS can meet others like themselves. Supplementary Information: The online version contains supplementary material available at 10.1007/s10882-023-09911-x.

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Background: Self-harm usually begins during adolescence and adolescents that self-harm most commonly confide in friends, yet to date, there is little research from the friend's perspective. Objective: This qualitative study explores adolescents' experiences of what it is like to have a friend who self-harms by cutting and what this experience means for friendship, the wider peer group and psychological well-being. Methods: Semi-structured interviews were conducted face-to-face with a community sample of eight females aged between 13 and 18 years, living in England. Interpretative Phenomenological Analysis was used to analyse the data. Results: Four superordinate themes emerged: desperately searching for meaning, I will be there at all costs, too hot to handle and identification. Adolescents were concerned about escalations in their friends' behaviours and felt a sense of duty to help, but the majority experienced a dilemma as to whether to disclose to others and all reported some form of distress. Conclusions: The results highlight the important, yet complex nature of friendship in this context. Friends play a key role in supporting adolescents who self-harm but need greater support managing this role and the effects. Schools/colleges should educate young people about self-harm to increase their knowledge and skills in relation to supporting a friend with this issue. Furthermore, they should promote environments for talking about mental health openly to give young people increased opportunities for help-seeking.

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BACKGROUND: Sexual offending has been attributed to empathy deficits, implicating interventions targeting empathy as a potential mechanism for reducing sexually harmful behaviour. However, there is less known about how appropriate and effective interventions are for individuals with intellectual disabilities. This review aims to provide a comprehensive synthesis of research findings in this area. METHOD: Four databases were searched, yielding 13 studies meeting the inclusion criteria which were appraised using the CCAT. RESULTS: CBT group treatments adapted from mainstream treatment programmes for people with intellectual disabilities were widely used, demonstrating improvements in empathy and reductions in sexually abusive behaviour overall. CONCLUSIONS: Studies are limited by sample sizes, lack of control groups and inconsistent definitions of intellectual disabilities and sexually abusive behaviour. Future research should include evaluation of models other than CBT, further assessment of empathy-specific interventions and understanding of the mechanism underpinning empathy change.

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OBJECTIVES: Service users with complex mental health difficulties are more difficult to engage in treatment and drop-out rates are higher, resulting in poorer clinical outcomes. Cognitive analytic therapy (CAT) is widely applied to service users with complex needs and shows promise in terms of engagement and outcomes. The aim of the present study was to examine the 'lived experience' of service users who have been retained in a full course of CAT treatment to provide important insights to why CAT seems to be an engaging psychotherapy, to inform future CAT delivery and practice with clients with complex needs. METHOD: Semi-structured interviews were undertaken with six service users aged between 25 and 47 years who had accessed secondary mental health care services and had received an average of 24 sessions of CAT. Transcripts were analysed using interpretative phenomenological analysis (IPA). RESULTS: The analysis yielded three superordinate themes with subthemes within these. The first superordinate theme referred to changes due to CAT (e.g., insight, tools to cope). The second theme referred to strong emotions evoked by CAT (e.g., feeling frustrated, scared, and upset). The final theme concerned the process of CAT (e.g., endings and therapeutic relationship). CONCLUSIONS: Whilst service users appeared to develop increased insight and acquire skills, there was variance in experiences of sustained and meaningful change post-therapy. The findings suggest adaptations may be required with these service users such as delivering the sequential diagrammatic reformulation (SDR) in a hopeful way and addressing systemic barriers to 'exits' being made. PRACTITIONER POINTS: Overall, service users with complex mental health difficulties describe benefitting from CAT, identifying improved insight and the acquisition of tools to cope. However, therapists need to be attuned to the potential fragility of service users and risk of negative affect, particularly during the reformulation phase. Consideration of delivering the SDR in a hopeful way may be therapeutic. Systemic factors such as service users being pulled to maintain the status quo in their relationships, and lack of support for or resistance to change by important others limit service users from availing of 'exits' from problem procedures. This implicates the need for more attention to systemic and possibly multi-agency working with this group of service users.

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PURPOSE: It is increasingly acknowledged that understanding of the process and impact of psychotherapy is enhanced by awareness of the experience of service users. Cognitive analytic therapy (CAT) was developed as a time-limited and integrative psychotherapeutic approach. Although reviews have been published on CAT outcome studies, no reviews are currently available on service users' experience of CAT. This paper aims to systematically review and synthesize what is known about service users' experience of CAT. METHODS: A systematic search of HDAS, Cochrane, and Ethos databases was conducted. Following this, fourteen papers were selected for review, appraised using CASP tools, and then thematically synthesized. RESULTS: CAT therapy enabled service users to acquire useful knowledge and skills. Most service users found CAT tools helpful in gaining insight into their reciprocal roles and patterns. However, CAT was experienced by some service users as a painful, frightening, and upsetting process, particularly in relation to the sequential diagrammatical reformulation (SDR) and reformulation letter. The importance of the therapeutic relationship was highlighted, as well as difficulties some service users had with trusting their therapist. CONCLUSIONS: CAT is helpful in supporting service users to understand their patterns and to identify useful coping skills. However, some service users can experience strong emotions in therapy and struggle to trust their therapist. Greater attention to working within the service users' zone of proximal development (ZPD) and engendering hope during the reformulation stage may attenuate some of these risks. Recommendations are made for future research directions. PRACTITIONER POINTS: CAT therapy enables users to develop insight to their reciprocal roles and patterns and helpful coping skills. The service user's ZPD should be worked with when delivering CAT to manage risk of distress and reciprocal role enactments and enhance the working alliance. CAT therapists should explore ways to engender hope by attending to any helpful reciprocal roles, patterns, and exits.

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PRIMARY OBJECTIVE: To carry out a clinical and cost-outcome evaluation of a neurobehavioural post-acute rehabilitation programme in the UK. RESEARCH DESIGN: The study was a multi-centre prospective cohort study of adults with acquired brain injury admitted for residential rehabilitation. Comprehensive data were collected on type of residence, amount and type of care, functional independence, engagement in constructive occupation and participation in social roles. PROCEDURES: Data were gathered on admission relating to individuals' levels of care and functioning, both pre-morbidly and at the time of admission (pre-rehabilitation). Additional information about functioning was collected upon discharge (post-rehabilitation). Follow-up data was collated in person, by telephone or by post after an average of 18 months by a researcher who was blind to the rehabilitation outcomes. The data were analysed in terms of clinical outcomes and support costs. Savings in costs of care or support were calculated on the basis of difference between pre-rehabilitation and follow-up support costs minus the costs of rehabilitation. RESULTS: Significant gains were evident at discharge and follow-up in virtually all indices of social outcome. Improvements were recorded in type of accommodation, levels of care, functional ability, productive occupation and performance of social roles. Patients admitted within 1 year of injury made the most progress, but improvements were made regardless of time since injury. Patients continued to benefit from rehabilitation well beyond the period when most natural recovery would take place. Economic calculations suggested that the initial costs of rehabilitation are generally offset by savings in care costs within 2 years. Sensitivity analysis on estimated savings in care costs yielded projected lifetime savings of between Pounds 1.1-0.8 M for persons admitted for rehabilitation within 12 months of injury, Pounds 0.7- Pounds 0.5 M within 2 years of injury and Pounds 0.5-0.36 M for admissions after 2 years. CONCLUSIONS: Specialist rehabilitation for neurobehavioural disability produces comprehensive and sustainable improvements in the life of individuals with brain injury. The initial costs associated with neurobehavioural rehabilitation are offset by savings in costs of support in the medium and longer term.

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PRIMARY OBJECTIVE: To investigate the impact of disorders of arousal and sleep disturbance on everyday living and participation in rehabilitation. RESEARCH DESIGN: Survey of rehabilitation centres based on naturalistic observation. METHOD: One hundred and thirty-five adults with acquired brain injury were reported by rehabilitation staff in seven centres across the UK for presence of arousal and/or sleep disturbance, the impact on rehabilitation and daily living and treatment strategies in use. OUTCOMES: Disturbance of arousal or sleep patterns was reported in 47% of the sample, with significant adverse effect on activity evident in two-thirds of such cases. Prevalence of disordered arousal was consistent over time for up to 10 years post-injury. Concurrent psychiatric illness, but not epilepsy, was associated with arousal and sleep disorder. Non-pharmacological interventions and benzodiazepine/hypnotic drugs were in use in 34% and 20% of cases respectively. In all cases of prescribed hypnotic drugs, period of use exceeded recommended UK guidelines. CONCLUSIONS: Long-term outcome from severe brain injury can be compromised by enduring disturbance of arousal, most commonly evidenced as sleep disorder. Treatment should be based on judicious use of medication (beyond hypnotic drugs) and greater emphasis on non-pharmacological management.

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