Main Research ProjectAn investigation of perceptions of OCD, caregiver burden, distress and accommodationCaring for someone with Obsessive Compulsive Disorder has a demonstrated impact on psychological distress and quality of life. Relatives often struggle to know how best to help and it has been suggested that most engage in some form of accommodation of symptoms. Given the impact of OCD on carers, and the potentially detrimental effects of symptom accommodation and interpersonal difficulties on treatment outcome, it seems appropriate to include family members in treatments, but it is not yet fully understood which factors contribute to these interpersonal difficulties. The self-regulation model suggests that carers’ perceptions of an individual’s difficulties will have implications for both emotional and behavioural responses. For this purpose, individuals with OCD and their caregivers completed questionnaires to assess their appraisals of OCD, psychological distress, perceived criticism, caregiver burden and family accommodation. Caregiver perceptions of severe consequences of OCD were associated with increased perceived burden, whereas perceptions of chronicity and consequences were both independently associated with higher levels of caregiver psychological distress. Caregiver appraisals of OCD were not associated with levels of accommodation, but the appraisals of personal control held by the individual with OCD were, with lower perceived control associated with more accommodation. These findings suggest that aspects of the self-regulation model can be used to understand that appraisals of the chronicity, consequences and control one has over OCD can influence the distress of caregivers and also the extent to which they engage in potentially unhelpful accommodating behaviours. It is hoped that this model can help therapists to fine-tune the already efficacious treatments available.Service Improvement ProjectImproving Multidisciplinary Clinical Discussion on an Inpatient Mental Health WardPurpose – Multidisciplinary team (MDT) clinical supervision is being used in many mental health services but at present has not received adequate attention by researchers in order to generate evidence based approaches. This paper aims to explore the utility and staff perspectives of an MDT model of clinical supervision in the form of a “Clinical Discussion Group” (CDG) on an acute inpatient mental health ward within the context of the current literature on the components of effective supervision in order to make recommendations for practice.Design/Methodology/Approach – Twelve members of staff working on the ward were interviewed to gather their perspective on attendance, helpful aspects, outcomes, unhelpful aspects, and changes. Interview transcripts were analysed using thematic analysis.Findings - eleven themes were identified, three within “The Group and how it operates” (Attendance, Discussion Topics and Facilitation), five within “Impact and Usefulness” (Valued by Staff, Understanding a Case, Emotional Benefit, Learning and Working together as a Team) and three within “Changes to the Group” (Organisation, Discussion Topic and Group Outcomes).Originality/Value – This paper explores the benefits and challenges of a CDG from the perspective of the staff who attend. It presents some recommendations for good practice which should be of use to managers and supervisors who wish to use team supervision to improve patient outcomes and also makes suggestions for future research in this field.Critical Review of the LiteratureInvolving the wider system in skills-based treatments for Borderline Personality Disorder: A systematic reviewThe transactional model of Borderline Personality Disorder (BPD) describes how both individual factors and systemic factors influence each other reciprocally to contribute towards the development and maintenance BPD. As such, treatments involving family members or carers have the potential to result in better outcomes. This paper reviews evidence for the effectiveness of involving family systems in skills based treatment approaches for BPD. A systematic search yielded 17 studies of 3 different skills based interventions that included members of the patients’ system: Dialectical Behaviour Therapy- Adolescents (DBT-A); Systems Training for Emotional Predictability and Problem Solving (STEPPS); and Family Connections. Each of the 3 types of intervention were effective in significantly reducing symptoms of BPD. However the heterogeneity of the research available limits the conclusions that can be drawn regarding the additive benefit of involving the wider system. More rigourous research designs focusing on the comparison of skills based interventions with and without systemic components will enable the identification of the mechanisms through which systemic involvement can improve outcomes for people with BPD.
|Date of Award||17 Aug 2015|
|Supervisor||Paul Salkovskis (Supervisor), Claire Lomax (Supervisor), Brynjar Halldorsson (Supervisor), Maria Loades (Supervisor), Emma Griffith (Supervisor) & Katharine Christie (Supervisor)|