Research portfolio submitted in part fulfilment of the requirements for the degree of Doctorate in Clinical Psychology

  • Jara Falkenburg

Student thesis: Doctoral ThesisDoctor of Clinical Psychology (DClinPsy)


Critical Literature Review: Clinician and patient experience of psychological formulation: A qualitative synthesis using meta-ethnographyBackground: Formulation is generally deemed an essential part of mental health treatment and psychological practice. Considering this and the abundance of existing formulation frameworks, there is surprising paucity of research. Several reviews of the little quantitative evidence have already been conducted, but there has been no review of the existing qualitative literature. Inclusion of qualitative findings in reviews and evidence-based practice is important as they can provide a deeper understanding of patient and clinician experience. Aims: The current review thus aimed to: (1) systematically find, synthesise, and critique qualitative research on the experience of psychological formulation according to patients and clinicians; (2) use meta-ethnography to develop an interpretative conceptual model of existing literature to provide a better overview for patients, healthcare professionals, and policy makers within mental healthcare; and (3) make recommendations to improve practice and guide further research. Methods: Meta-ethnography was used to interpret and synthesise findings. A systematic search found 17 papers meeting inclusion criteria: ten regarding patient views, six regarding clinician views of formulation with patients, and four regarding clinician views of formulation with other staff. Quality was assessed using the Critical Appraisal Skills Programme’s (CASP, 2017) qualitative appraisal tool. Results: Four core themes with 12 subthemes were identified: (1) “Function of formulation”; (2) “Intra-connection: Connecting with the self”; (3) “Inter-connection: Connecting with others”; and (4) “Wider context”. Sensitivity analysis demonstrated overall theme pattern did not differ according to quality. Conclusions: Themes were synthesised using a “line of argument approach”, producing a new conceptual model regarding patient and clinician experience of formulation. Clinical implications for patients and their carers, clinicians, and service managers, policy makers, and funders are discussed and directions for further qualitative and quantitative research are given. Keywords: case conceptualisation, clinician experience, formulation, meta-ethnography, meta-synthesis, patient perspective, qualitative research, reformulation, review, service user experience, staff experience, therapist experienceService Improvement Project: Patient and staff views of psychiatric ward activities and efforts to increase choice: A qualitative studyBackground: Assessing staff and patient views of psychiatric inpatient activities is both clinically and economically important. However, no study has yet answered the National Institute of Clinical Excellence’s (NICE, 2011a) call for qualitative research into the “activities and occupations service users want on inpatient wards”. Aims: This paper aimed to respond to this call and fill gaps in the literature by exploring staff and patient views of activities in one acute psychiatric inpatient unit, including: which activities are viewed as most beneficial and best-liked, and why; which other activities participants wish to see offered; whether staff and patient views differ; and how efforts to increase choice are experienced. Method: Seven staff and three inpatients participated in two focus groups using open-ended interview schedules. Findings: Thematic analysis resulted in five core themes: 1) Preferred Activities, 2) Benefits, 3) Challenges, 4) Choice, and 5) Improvement. Each had two to six subthemes. Conclusions: Themes echoed the limited existing research and guidelines on psychiatric inpatient activity provision. Both groups identified their best-liked activities. Several activity suggestions and possible benefits of activities were described, alongside best-liked activities, experience of choice, and challenges to these. Both similarities and differences were found between staff and inpatients. Implications: Further research to explore activities in mental health units with inpatients and staff from different professional backgrounds is needed to continue developing evidence-based guidelines.Keywords: acute mental health, acute psychiatry, crisis, inpatient ward, mental healthcare, patient satisfaction, patient participation, qualitative research, service users’ views, treatment, United KingdomMain Research Project: Unpacking the relationship between social anxiety and state paranoia through experimental manipulation of state anxietyBackground: Research demonstrates significant overlap between social anxiety (SA) and paranoia, relating to comorbidity, shared psychological processes, and developmental pathways. Taylor and Stopa (2013) suggest heightened anxiety can temporarily shift individuals with trait-SA towards experiencing increased paranoia, but this has not been experimentally investigated. Aims: The present study aimed to test this theory by evaluating the effects of an anxiety-task on state-paranoia and state-SA in three groups: those with clinical trait-SA (SA-group), those with both clinical trait-SA and trait-paranoia (SAP-group), and healthy controls. Method: 47 participants (twelve SAP-participants, ten SA-participants, and 25 controls) were asked to complete one sociodemographic and four baseline questionnaires (Social Anxiety Interaction and Social Phobia Scales, Green et al. Paranoid Thoughts Scale, and Depression Anxiety Stress Scale-Short Form) to evaluate trait-levels of SA, paranoia, and affect, respectively. Participants then completed three Visual Analogue Scales (VAS) before and after an anxiety-task (Bentall Anagrams Task) to assess differences in state-SA, state-paranoia, and state-affect. Results: Contrary to previous research, results did not find an effect of anxiety-task on state-symptomatology. Although findings supported hypotheses regarding differences between state-SA and state-paranoia scores before the anxiety-task, they therefore did not substantiate the hypothesis that the anxiety-task would lead to increased state-paranoia for individuals with SA. Discussion: This is the first study that aimed to experimentally evaluate Taylor and Stopa’s (2013) hypothesis and one of few to include both clinical groups and controls. Due to failed manipulation of the anxiety-task, the experiment was not a true test of their hypothesis. Several possible reasons are discussed with important implications for research. Keywords: paranoia, social anxiety, social anxiety disorder, social phobia, psychosis
Date of Award29 Sep 2017
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorLorna Hogg (Supervisor), Emma Griffith (Supervisor), Cathy Randle-Phillips (Supervisor) & Megan Wilkinson-Tough (Supervisor)

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