Doctorate in Clinical Psychology: Main Research Portfolio

: 1) The Psychological Treatment of Post-Traumatic Stress Disorder in People with Psychosis; 2) Supporting the supporters: Evaluation of a consultation service for children in care; 3) The psychological impact of social support following a traumatic event.

Abstract

Main Research Project Children may use social support to manage symptoms of post-traumatic stress disorder (PTSD). Good perceived social support is associated with fewer PTSD symptoms. Limited research exists about actual support children receive post-trauma and whether this is associated with PTSD. This study explored actual and perceived support, factors that influence actual and perceived support and the relationship between social support and PTSD 4-weeks and 3-months post-trauma. Eighty-nine children and their parents completed measures of PTSD and social support 4-weeks after attending the emergency department following a single-incident trauma. Seventy children completed PTSD measures 3-months post-trauma. Children had good levels of perceived social support which was associated with lower perceived barriers to support, after controlling for gender. Perceived social support at 4-weeks predicted PTSD cross-sectionally, after controlling for age, but did not predict change in PTSD at 3-months. Eighty-percent of children felt they needed support post-trauma, seeking it from parents or friends. Actual support did not predict PTSD cross-sectionally or longitudinally. These findings support previous research that perceived social support is protective post-trauma. More information is needed about what support children want post-trauma and whether they receive this. These findings will help inform interventions to promote perceived social support post-trauma. Service Improvement Project Children in care are at increased risk of developing mental health problems potentially due to the increased experience and impact of social and environmental risk factors in their early life. However, there are difficulties accessing mental health services that understand their specific needs. Mental health consultations have been recommended to increase access to mental health services for those working with children in care. A child and adolescent mental health service has been providing a consultation service to social workers for over 4 years. Clare Dixon reports the results of an audit of 83 consultations and a survey completed by 34 social workers, to gather their views about the consultations. The results showed that consultations were utilised by several social work teams, were requested for a variety of reasons and resulted in a range of outcomes. The social workers were positive about their experiences of the consultations and reported that it gave them a better understanding of the difficulties they were experiencing and how to manage them. The results highlighted difficulties with the internal administration processes, practicalities 6 and social workers’ understanding of what the consultations provide. Recommendations were provided highlighting areas of good practice and ways to improve the consultations that are provided to the social workers for children in care. Critical Review of the Literature The prevalence of post-traumatic stress disorder (PTSD) in people with psychosis is high. Intervention guidelines for psychosis recommended that if PTSD is diagnosed then intervention guidelines for PTSD should be followed. However, studies evaluating PTSD interventions often exclude people with psychosis. Eighteen studies were included in this review which aimed to evaluate the evidence for the effectiveness of PTSD interventions for people with psychosis and see if there was any additional impact on symptoms of psychosis. Interventions included trauma-focused cognitive therapies, EMDR, prolonged exposure, video testimony and written emotional disclosure to treat single and multiple traumas. The findings suggest PTSD interventions have some positive effects for people with psychosis but there are considerable methodological limitations which bias the results and limit the conclusions that can be drawn. The findings also provide some tentative evidence that the interventions have a positive impact on comorbid symptoms of psychosis but there are several limitations to consider. More work is needed adopting stronger methodologies with better controls and looking at symptoms of psychosis as a specific outcome of the intervention. This review concludes that evidence in this area is still in its infancy thus limited conclusions can be drawn about the effectiveness of PTSD interventions for people with psychosis. Executive SummaryConnecting NarrativeAcknowledgements

Date of Award	30 Aug 2016
Original language	English
Awarding Institution	University of Bath
Supervisor	Sarah Halligan (Supervisor), Rachel Hiller (Supervisor), Lorna Hogg (Supervisor), Cathy Randle-Phillips (Supervisor), Paul Salkovskis (Supervisor) & Liz Stott (Supervisor)