74 research outputs found
Long‐term patterns in interpersonal behaviour amongst psychopathic patients in secure inpatient treatment: A follow‐up study
No full textPsychopathy is a disorder that is partly defined by with maladaptive interpersonal behaviour and has significant effects on treatment outcomes. A previous study (Draycott et al., 2011) found that higher levels of psychopathy led to a specific interpersonal ‘trajectory’ amongst patients in a secure psychiatric treatment programme during the first 9 months of their admission. In that programme, more psychopathic patients became increasingly dominant over time, and less psychopathic patients became increasingly hostile. This study is a longer-term follow-up and extension of that study, extending the window of observation to 33 months of treatment. It was found that the more psychopathic patients\u27 increased dominance returned to baseline levels by 33 months, as did the less psychopathic patients\u27 increased hostility. This suggests that treatment for this group is not idiopathic but leaves unanswered the question as to what these divergent trajectories represent. Copyright © 2015 John Wiley & Sons, Ltd
The Effects of Varying Maternal Dietary Fat Quantity and Composition on Disease Programming in the Offspring: a Focus on Essential Fatty Acids
No full textIt is only through hearing stories from others that I realise just how lucky I have been. Bev, Simon and Matt, firstly I can’t thank you enough for taking a chance and giving this PhD opportunity to someone fresh out of their undergraduate degree. Your support over the years has been overwhelming. The support with animal work, meticulous checking, constructive comments and advice on paper drafts, travel grants, conference abstracts, data analysis and presentations have shaped me into a better scientist and writer. The opportunities you have openly and generously supported to travel the world and to see so much more of what is in it have shaped me as person. Working under your supervision has only enhanced my desire to pursue a career in scientific research and I can honestly say I have enjoyed every moment of this PhD. I know how fortunate I have been to complete this PhD with that feeling. A huge thanks is also owed to all of the staff and colleagues at both the University of Nottingham and the University of Adelaide for creating such a supportive and welcoming environment to work in, there are simply too many of you to name. I have worked in two departments, both of which I have felt very lucky to have been a part of and I can only hope that this continues to be the case wherever I may end up in the future. I would like to take this opportunity to particularly thank Grace George, Zoe Daniel and Simon Welham. Grace, a rat wasn’t something I knew how to handle until you showed me. Zoe, a PCR plate wasn’t something I knew how to load until you taught me how. Simon, a PhD wasn’t something I ever thought I could achieve and I wouldn’t have attempted it if it wasn’t for the encouragement and confidence you instilled in me throughout a short summer placement. Special gratitude will always go to my family. No matter what I do in my professional career you will always provide me with laughter, perspective and purpose. Finally, I would like to respectfully acknowledge the contribution made by the laboratory rats for the completion of this research.Thesis (Ph.D.) -- University of Adelaide, School of Agriculture, Food & Wine, 202
Perspectives on positive risk taking from people diagnosed with a borderline personality disorder : an interpretative phenomenological analysis.
No full textBackground: People with a borderline personality disorder diagnosis can require support from mental health services for managing risk behaviour. Evidence suggests current inpatient and community treatment can be unhelpful for this group, who usually require specialist approaches. Positive risk taking has been developed to help community teams manage risk with people with a borderline personality disorder.
Aim: To understand how positive risk taking is experience by people with a borderline personality disorder diagnosis.
Method: A qualitative study using Interpretative Phenomenological Analysis (IPA) to analyse transcripts from semi-structured interviews. Nine adults with a diagnosis of borderline personality disorder and experiences of positive risk taking approaches were sampled from one NHS Trust. Participants were either currently or had previously been under the care of a community mental health recovery service.
Results: Participants’ engagement in positive risk taking was coloured by earlier negative experiences of the healthcare system (including previous risk management), interpersonal complexity in professional relationships and experiences of isolation. When participants were engaged in positive risk taking or with approaches using positive risk taking principles, these were experienced as a helpful alternative to traditional risk management. This seemed contingent upon collaborative and trusting relationships with professionals who created an emotional ‘safety net’, which appeared to empower participants to connect with outside agencies and challenge recovery-relapse patterns of service use.
Conclusions: Positive risk taking seems to have the potential to benefit others with a borderline personality disorder based upon participants’ experiences. Participants’ experiences compliment those of service users in other studies emphasising the importance of interpersonal factors, such as compassion and empathy, when working with personality disorder. Positive risk taking itself was relatively unfamiliar to participants though findings are clinically relevant. Participants’ experiences suggest more training and increased resources are required to implement positive risk taking successfully with borderline personality disorder
How, if at all, is therapeutic alliance experienced by individuals attending the STEPPS group programme?
No full textAbstract
Objectives. The aim of this study was to gain service users’ perspectives on whether therapeutic alliance, if at all, featured as part of their experience of the Systems Training for Emotional Predictability and Problem Solving (STEPPS) group programme.
Design. A qualitative, semi-structured interview-based study to explore service users experiences of therapeutic alliance within their treatment.
Methods. Seven individuals diagnosed with Borderline Personality Disorder (BPD), who were attending STEPPS groups, were interviewed as part of the study.
Results. Three themes were identified from the data using thematic analysis: ‘A process of identification and feeling understood, ‘Building camaraderie’ and ‘Recognising positive change’, processes that map directly onto the concept of therapeutic alliance. Group members sought out opportunities to relate to one another, a process which was facilitated by the content and structure of the treatment. Therapeutic bonds were built within the group, and these positive relationships appeared to increase mutual engagement and commitment to see the treatment through. As part of this experience, participants noticed positive changes within themselves, which they attributed to attending the STEPPS programme.
Conclusion. Service users experiences outlined within this study suggest that therapeutic alliance featured in the STEPPS treatment. Whilst STEPPS focuses on being a skills based programme, the relationships formed between all group members emerged as an important mechanism from which change was made possible. Further research is required to build on these findings and investigate the extent to which therapeutic alliance affects treatment outcome and drop out within this treatment package for individuals with BPD
Effective therapeutic components in systems training for emotional predictability and problem solving (STEPPS) for borderline personality disorder.
No full textPsychotherapies for borderline personality disorder (BPD) utilise a variety of theoretical models and practical approaches to effect changes that ultimately lead to a reduction in BPD symptomatology or related improvements (e.g. quality of life). Different psychotherapies vary in the underlying mechanisms that are theoretically proposed to effect this change. Accordingly, they are composed of differing proposed therapeutic components. This thesis aimed to identify effective therapeutic components in psychotherapies for BPD broadly, and Systems Training for Emotional Predictability and Problem Solving (STEPPS) specifically. Part one of this portfolio presents a review of the empirical literature that specifically examines effective therapeutic components in psychotherapies for BPD. Semantic complexities inherent in conducting this type of process research are considered, and the specific scope of this portfolio within the wider ‘mechanisms of change’ literature is defined. Results synthesise identified effective therapeutic components into four themes that illustrate the broader landscape within which the empirical paper is set. Part two of this portfolio presents an empirical paper that investigated effective therapeutic components in STEPPS, a psychoeducational group treatment for BPD. Results support an association between acquisition of behaviour and emotion regulation skills (the primary treatment component proposed in the STEPPS manual) and improvement in BPD symptoms. Results also support an association between group process (a potential effective therapeutic component related to group alliance) and improvement in BPD symptoms, reflecting results from wider literature. Parts three and four of this portfolio summarise the clinical experience gained on placements throughout the PsychD course, and all other written assignments completed
Predictors of response to systems training for emotional predictability and problem solving (STEPPS) for the treatment of borderline personality disorder.
No full textBorderline Personality Disorder (BPD) is a heterogeneous diagnosis which encapsulates a wide range of symptom presentations. There are now a number of effective treatments for BPD but individuals vary in their response to these different treatments. Understanding people’s suitability to treatment would be beneficial in targeting and individualising BPD treatment efforts. This thesis aimed to explore the BPD related predictors of treatment response. Part one of this portfolio presents a narrative review of predictors of BPD treatment outcomes. BPD severity, symptoms and subgroups predictors were included in this review. Findings support previous reports that people with more severe BPD show larger improvements following treatment, although there was a tendency for this to occur in more skills-based treatments compared with reflective treatments. The findings on symptom level predictors were varied and would benefit from replication. Subgroup research is still in its early stages but findings suggest an important role of internal and external coping styles. Part two presents an empirical paper investigating predictors of response to Systems Training for Emotional Predictability and Problem Solving (STEPPS). Severity of BPD was examined as a predictor of outcomes alongside each of the 9 DSM symptom criteria for BPD. Findings are discussed in relation to the different methods of managing missing data. Severity was found to be predictive of response. When severity was broken down into its symptom level sub-parts, identity disturbance and dissociation were the most reliable predictors of response to STEPPS
Mentalizing in first-episode psychosis : correlates with symptomatology and traits of borderline personality disorder.
No full textBackground: Comorbid borderline personality disorder (BPD) in psychosis is poorly understood, despite research suggesting that it contributes to poorer outcomes at 5 and 10-year follow-up. Mentalizing (the ability to attribute thoughts and feelings to self and others) is thought to be a transdiagnostic factor that contributes to core impairments in BPD and symptoms of psychosis. This study aimed to explore the relationship between mentalizing, positive and negative symptoms of psychosis, and traits of borderline personality disorder, in a sample of patients with first-episode psychosis, and in a non-clinical sample.
Method: 32 adults with first-episode psychosis (FEP) and 149 non-clinical participants were assessed using the reflective functioning questionnaire (RFQ). The RFQ measures two dimensions of mentalizing, certainty (RFQc) and uncertainty (RFQu) about mental states. Traits of BPD and symptoms of psychosis were measured using the self-report version of the Zanarini rating scale for BPD, the Community Assessment of Psychic Experiences (CAPE), and the Green et al, paranoid thought scale.
Results: Patients with FEP were significantly more impaired on the RFQ compared to the non-clinical sample, showing significantly lower certainty, and higher uncertainty about mental states. Regression analysis showed significant associations between higher scores on the RFQu and negative symptoms of psychosis in both groups. Significant associations were also found between higher RFQu and increasing BPD traits in the non-clinical sample.
Conclusions: The present research provides evidence that impairments in mentalizing may be a core component of the process underlying negative symptoms of psychosis across both clinical and non-clinical samples. Mentalizing impairments may also be associated with BPD traits, but this finding was only confirmed in the non-clinical sample. Mentalizing should therefore be considered in the early assessment and treatment of patients experiencing these difficulties
Trauma, attachment and inpatient perceptions of restrictive practice in forensic mental health services
No full textIntroduction: The use of restrictive practices is necessary in forensic services to manage risk and maintain safety, however, restrictive practices can contradict recovery principles. There is no known research to date that has explored forensic inpatient perceptions of restrictive practice. Furthermore, there is a high prevalence of childhood trauma in forensic populations and insecure attachments, both of which may impact patient perceptions of restrictive practice, yet no previous research has explored this relationship. Method: The study used a mixed methods design with a self-report attachment style measure and a semi-structured interview to gather qualitative data about perceptions of restrictive practice. Childhood trauma data was collected from patient clinical records. 30 male participants were inpatients recruited from three NHS forensic hospitals. Data were analysed using thematic analysis and correlational statistics. Results: High levels of trauma, attachment anxiety and avoidance were prevalent in the sample and perceptions of restrictive practice varied. Quantitative analyses lacked power, but themes emerged from the qualitative data which described: being controlled by the system is hard; progression through services; the hospital environment impacts care and the need for connection, and these were discussed in relation to restrictive practice, trauma and attachment literature. Conclusion: Whilst restrictive practices help to maintain physical safety and security, they can both help and hinder psychological security of forensic services users at the same time, which is further complicated by trauma and attachment difficulties in the forensic population. Clinical implications are discussed, and the study reinforces the need for forensic services to be trauma-informed, using a whole-systems approach
Sounds of nature : what influences judgments of nature-based and non-nature-sounds?
No full textObjectives: This study aims to replicate previous findings that nature-sounds are preferred over non-nature-sounds. It also aims to explore possible links between any feelings or thoughts that sounds evoke in individuals and how they then rate those sounds, and how these might link to current theories of stress reduction and attention restoration.
Method: Using a questionnaire design, 104 participants listened to three nature-based and three non-nature-sounds. They were then asked to rate the sounds and invited to describe thoughts and feelings that came to mind whilst listening to the sounds. These written responses were then examined and coded resulting in nine variables being created, such as mentioning a memory, writing in the first person, mentioning nature and positivity of written comment. Mean sound ratings were then compared between responses that did and did not match the variables.
Results: Nature-sounds received higher sound ratings than non-nature-sounds and they generated more positive comments. The presence of the above variables also resulted in higher sound ratings overall for the nature-sounds than the non-nature sounds, with the use of positive emotive words, mentioning a memory and mentioning nature having the biggest effects.
Conclusion: The results suggest some support for both stress reduction and attention restoration, as well as highlighting a possible role for positive affect and memories that seems to be linked more with nature than non-nature-sounds. This may support the use of nature and nature-sounds in individualised therapeutic interventions that may generate positive emotions, process negative ones, broaden mindsets and, facilitate stress reduction and attention restoration.</p
Psychopathy and Empathy: The Role of Attention
No full textBackground: Psychopathy has been shown in the literature to have significant consequences for both the individuals themselves and the people and societies around them. The Response Modulation Hypothesis (RMH) posits that the processes underlying psychopaths’ difficulties are related to narrow, goal-directed attentional focus. The RMH has had good support in the literature, yet, it has not (with one exception) been applied to psychopaths’ difficulties with empathy. Aims: This study examined the RMH’s effects on psychopaths’ use of empathy, extending prior research by using ecologically valid, emotionally laden stimuli to induce empathic responding. It was hypothesised that individuals higher in psychopathy would shower greater empathy when asked to focus their attention on empathy-related information. Method: This study utilised a between-subjects, experimental design. 129 participants took part in an online survey where they were asked to watch an empathy-inducing vignette. Participants were randomised into either ‘control’, ‘empathy’ or ‘non-empathy’ groups, which asked participants to focus their attention on different aspects of the vignette. Participants’ written description of the vignette was also coded for the number of emotion words used to determine whether this differed across conditions. Results: Contrary to the hypothesis, no significant effect of task instruction, nor its interaction with psychopathy was found for participants’ empathic responding to the vignette. Furthermore, although the number of emotion words used somewhat differed across conditions (with more words being used in the empathy condition), these differences were not significant. Emotion words were also not significantly associated with psychopathy or empathy. Conclusion: Overall, this study did not find empirical support for the RMH in relation to psychopaths’ use of empathy. However, results are discussed in the context of the present study’s sample and methodology. Suggestions for future research to address the limitations of this study are made
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