Authors:Jennifer Cuppage; Katie Baird, Jennifer Gibson, Richard Booth, David Hevey Abstract: ObjectivesThis study aimed to examine the effectiveness of a compassion focused therapy (CFT) group with a transdiagnostic population, as compared to treatment as usual (TAU). A secondary aim was to explore the potential processes of change within the treatment.DesignA non-randomized control trial was used.MethodFifty-eight participants who engaged in group CFT were compared to 29 participants receiving TAU. Group CFT consisted of 14 sessions twice weekly for 5 weeks and once weekly for 4 weeks. Participants completed measures of psychopathology, shame, self-criticism, fears of self-compassion, and social safeness, at pre-treatment, post-treatment, and 2-month follow-up. Potential processes of change were examined using correlations and regression analysis.ResultsSignificantly greater improvements were found for levels of psychopathology, fears of self-compassion and social safeness for CFT, compared to TAU. Additionally, analyses showed improvements in shame and self-criticism within the CFT group but not the TAU group. All improvements were maintained at 2-month follow-up. Improvements in psychopathology were predicted by changes in self-criticism and fears of self-compassion.ConclusionCompassion focused therapy appears to be an effective group intervention for a range of mental health difficulties. The positive impact of the CFT model with a transdiagnostic group emphasizes the value of addressing underlying psychological process, rather than symptoms alone.Practitioner pointsCompassion focused therapy is a multimodal therapy designed to target high levels of shame and self-criticism.Compassion focused therapy has been shown previously to have positive results within a range of diagnostic-specific populations. While there is an emerging research base, limited studies assessing effectiveness with transdiagnostic populations have been published.CFT was shown to have a significant effect in reducing levels of psychopathology, compared to TAU.A number of potential processes of change were identified: Changes in psychopathology were significantly correlated with changes in self-criticism and fears of self-compassion. PubDate: 2017-10-17T07:05:37.171625-05: DOI: 10.1111/bjc.12162
Authors:Anne Gordon; Penelope J. Davis, Susan Patterson, Christopher A. Pepping, James G. Scott, Kerri Salter, Melissa Connell Abstract: ObjectiveSocial Cognition and Interaction Training (SCIT) has demonstrated effectiveness in improving social cognition and functioning of people with schizophrenia. This pilot study examines the acceptability, feasibility, and effectiveness of SCIT with individuals who have schizophrenia-spectrum disorders and are receiving care through a public mental health service.MethodIn a pragmatic randomized waitlist controlled trial, 36 participants (aged 19–55 years) with a schizophrenia spectrum disorder were randomly allocated to SCIT or treatment as usual (TAU). Measures of theory of mind, emotion perception, attributional bias, social skills, quality of life, life skills, depression, anxiety, and stress were administered pre- and post-intervention with follow-up conducted 4 months later. All wait-list controls subsequently received the intervention and a secondary within-group analysis was conducted including these participants.ResultsWhile no significant differences were found between groups on any outcomes, there was strong engagement with the SCIT intervention. Of the 21 participants in the intervention group, the completion rate was 85.71% with a median attendance rate of 17 sessions. Within subject analyses of SCIT participants over time showed significant improvements in quality of life, emotion recognition, social skills, and a trend towards better life skills from pre- to post-intervention. These gains were sustained at the 4-month follow-up time.Conclusions and implications for practiceAlthough this study showed limited benefits in outcomes associated with SCIT compared with TAU, it demonstrated the acceptability of SCIT to participants in a real world public health setting shown by high retention, attendance, and positive feedback.This pilot shows SCIT can be implemented in routine clinical practice and lays the foundation for a larger pragmatic study.Practitioner pointsSCIT can be implemented successfully in a real-world community mental health setting.SCIT had high levels of acceptability to these participants.LimitationsThe small sample size meant there was insufficient power to detect differences between groups on outcome measures.The study did not include measures of psychiatric symptoms or neuropsychological functioning which may have influenced participants’ capacity to benefit from SCIT. PubDate: 2017-10-09T02:40:19.580004-05: DOI: 10.1111/bjc.12161
Authors:Katie Grogan; Claire I. Gormley, Brendan Rooney, Robert Whelan, Hanni Kiiski, Marie Naughton, Jessica Bramham Abstract: ObjectivesThe aim of this study was to examine symptom profiles of people diagnosed with attention-deficit/hyperactivity disorder (ADHD) and/or anxiety (ANX) in order to determine the validity of widely used ADHD and ANX rating scales for differential diagnostic use and to develop modified measures that take symptom overlap into account.DesignA cross-sectional design was used to assess differences in rating scale scores between clinical (n = 52) and control (n = 74) samples as well as differences among subgroups of the clinical sample (22 ADHD; 16 ADHD + ANX; 14 ANX).MethodParticipants completed an online questionnaire where they responded to the Conners Adult ADHD Rating Scale (CAARS; Conners, Erhardt, & Sparrow, ) and State Trait Anxiety Inventory scales (STAI; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, ).ResultsResults showed that the CAARS and STAI had limited sensitivity and specificity and may lack in ability to differentially diagnose ADHD and/or ANX. Cluster analysis was used to guide the proposal of modifications for the two scales, which were to use inattentive items only for the CAARS and to exclude state ANX-present items on the STAI for use in differential diagnosis. Further parametric analysis supported these proposed modifications.ConclusionsClinicians should be made aware of the limitations of the CAARS and STAI scales in terms of specificity, when used to inform differential diagnosis of ADHD and ANX. Further analysis on the psychometric properties of these modified scales is needed in order to confirm that they are valid and reliable scales.Practitioner pointsClinical implicationsIt is possible that widely used self-report rating scales are not valid for use in the context of assessing adult ADHD when ANX is present.Clinicians should take alternative approaches to measuring ADHD symptoms in the context of ANX.Findings of the present study suggest the use of inattentive items only for the CAARS and to exclude state ANX-present items on the STAI for differential diagnostic use.Limitations of the studyThe sample sizes of the clinical subgroups were relatively small.Diagnoses were not confirmed using a semi-structured clinical interview.Alternative cluster approaches (e.g., two-step clustering using larger samples) would provide further insight. PubDate: 2017-09-12T01:32:00.587267-05: DOI: 10.1111/bjc.12156
Authors:Cerith S. Waters; Neil Frude, Paul E. Flaxman, Jane Boyd Abstract: ObjectivesTo examine the effects of a 1-day acceptance and commitment therapy (ACT) workshop on the mental health of clinically distressed health care employees, and to explore ACT's processes of change in a routine practice setting.DesignA quasi-controlled design, with participants block allocated to an ACT intervention or waiting list control group based on self-referral date.MethodsParticipants were 35 health care workers who had self-referred for the ACT workshop via a clinical support service for staff. Measures were completed by ACT and control group participants at pre-intervention and 3 months post-intervention. Participants allocated to the waitlist condition went on to receive the ACT intervention and were also assessed 3 months later.ResultsAt 3 months post-intervention, participants in the ACT group reported a significantly lower level of psychological distress compared to the control group (d = 1.41). Across the 3-month evaluation period, clinically significant change was exhibited by 50% of ACT participants, compared to 0% in the control group. When the control group received the same ACT intervention, 69% went on to exhibit clinically significant change. The ACT intervention also resulted in significant improvements in psychological flexibility, defusion, and mindfulness skills, but did not significantly reduce the frequency of negative cognitions. Bootstrapped mediation analyses indicated that the reduction in distress in the ACT condition was primarily associated with an increase in mindfulness skills, especially observing and non-reactivity.ConclusionsThese findings provide preliminary support for providing brief ACT interventions as part of routine clinical support services for distressed workers.Practitioner pointsA 1-day ACT workshop delivered in the context of a routine staff support service was effective for reducing psychological distress among health care workers.The brief nature of this group intervention means it may be particularly suitable for staff support and primary care mental health service settings.The findings indicate that the beneficial effects of an ACT workshop on distressed employees' mental health were linked to improvements in specific mindfulness skills.Study limitations include non-random allocation of participants to the ACT and control groups, and measurement of mediators and outcome at the same time point (3 months post-intervention). PubDate: 2017-08-30T05:55:23.030959-05: DOI: 10.1111/bjc.12155
Authors:Marie-Lotte Van Beveren; Kaitlin Harding, Wim Beyers, Caroline Braet Abstract: ObjectivesLow positive emotionality (PE) represents a temperamental vulnerability to depression in youth. Until now, little research has examined the mechanisms linking PE to depressive symptoms. Starting from integrated cognitive-affective models of depression, we aimed to study adaptive emotion regulation (ER) as a key underlying mechanism in the temperament–depression relationship.MethodsThis study investigated whether adaptive ER strategies mediate the association between PE and depressive symptoms in a large community-based sample of youth, using a cross-sectional design. Participants were 1,655 youth (54% girls; 7–16 years, M = 11.41, SD = 1.88) who filled out a set of questionnaires assessing temperament, adaptive ER strategies, and depressive symptoms.ResultsResults revealed that low PE was significantly related to higher depressive symptoms among youth and that a lack of total adaptive ER abilities mediated this relationship. More specifically, the infrequent use of problem-solving appeared to be of significant importance. Problems in positive refocusing and a deficient use of forgetting mediated the relationships between low PE and high negative emotionality (NE) in predicting depressive symptoms. Reappraisal and distraction were not significant mediators.ConclusionResults highlight the need to account for temperamental PE and adaptive ER strategies when studying youth depression. The findings contribute to a more nuanced understanding on the differential role of temperamental risk factors for developing depressive symptoms at an early stage and advocate for greater attention to adaptive ER strategies.Practitioner pointsClinical interventions for youth depression may be improved by incorporating adaptive emotion regulation (ER) strategies and enhancing positive emotions.Youth low in positive emotionality (PE) may especially benefit from learning adaptive ER skills.Clinical practitioners should focus on alleviating negative emotions and enhancing positive emotions, especially among youth low in PE. PubDate: 2017-08-21T02:25:22.644963-05: DOI: 10.1111/bjc.12151
Authors:Chen Zhu; Xiaoqi Sun, Suzanne Ho-wai So Abstract: ObjectivesBelief inflexibility has been suggested to maintain delusions. Different measures of assessing belief inflexibility have been developed, and it remains unclear whether patients with delusions display belief inflexibility similarly across measures. As delusions consist of multiple dimensions, the aim of this meta-analytic review was to examine how belief inflexibility is related to different aspects of delusions (conviction, distress, and preoccupation) and to compare these associations between interview-based and task-based measures of belief inflexibility.MethodsWe conducted a systematic database search (PsycINFO, PsycARTICLES, PubMed, and MEDLINE) and identified relevant articles using the following search items: belief*, delusion*, or overvalued idea*; psychosis or schizo*; flexib*, inflexib*, change, revision, or update. Meta-analyses were conducted for each dimension of delusions and were reported according to the PRISMA guidelines.ResultsA total of 16 studies, with a total sample of 1,065, were included in the analysis. Belief inflexibility was associated with global severity of delusions (Hedges' g = 0.452, p PubDate: 2017-08-14T06:40:57.99436-05:0 DOI: 10.1111/bjc.12154
Authors:Lamprini Psychogiou; Nicholas J. Moberly, Elizabeth Parry, Abigail Emma Russell, Selina Nath, Angeliki Kallitsoglou Abstract: ObjectivesAlthough rumination can have a negative influence on the family environment and the quality of parent–child interactions, there is little research on the role of parental rumination in predicting adverse child outcomes over time. This longitudinal study examined whether mothers’ and fathers’ brooding rumination would each uniquely predict emotional symptoms in preschool children.MethodsThe initial sample consisted of 160 families (including 50 mothers with past depression, 33 fathers with past depression, and 7 fathers with current depression according to the Structural Clinical Interview for DSM-IV). Families were seen at two times separated by 16 months. Children's mean age at the entry into the study was 3.9 years (SD = 0.8). Each parent independently completed the Ruminative Response Scale, the Child Behavior Checklist, the Patient Health Questionnaire, and the Dyadic Adjustment Scale.ResultsFathers’ brooding rumination significantly predicted children's emotional symptoms over 16 months when controlling for child emotional symptoms, couple adjustment, parents’ depressive symptoms, mothers’ brooding and reflective rumination, and fathers’ reflective rumination at baseline. Unexpectedly, mothers’ brooding rumination did not significantly predict child emotional symptoms over time. Correlational analyses showed significant associations between parents’ rumination and lower levels of couple adjustment.ConclusionsFindings suggest that fathers’ brooding rumination may play a unique role in their children's emotional outcomes. If these findings are replicated, studies should examine the processes by which these links occur and their implications for clinical interventions.Practitioner pointsRumination is prevalent among individuals with depression, but to date no studies have examined the possible role of mothers’ and fathers’ brooding rumination in predicting children's emotional symptoms.Fathers’ brooding rumination was positively associated with children's emotional symptoms over time when controlling for mothers’ rumination and other important characteristics.Parental rumination might be a promising target for both prevention and intervention strategies for parents with depression and their children.The findings of this study could inform parenting interventions (e.g., educate parents about the possible effects of rumination on family interactions and children's outcomes, help parents notice when they ruminate, teach them to replace rumination with more adaptive strategies).The findings should be interpreted with caution. The study relied on self-reports, and therefore, the data are subject to shared method variance which may have artificially inflated associations between parent and child outcomes.The sample consisted of well-educated parents, and therefore, the findings should be generalized to other populations with caution. PubDate: 2017-08-14T06:35:22.228824-05: DOI: 10.1111/bjc.12148
Authors:James Dudley; Catrin Eames, John Mulligan, Naomi Fisher Abstract: ObjectivesDeveloping compassion towards oneself has been linked to improvement in many areas of psychological well-being, including psychosis. Furthermore, developing a non-judgemental, accepting way of relating to voices is associated with lower levels of distress for people who hear voices. These factors have also been associated with secure attachment. This study explores associations between the constructs of mindfulness of voices, self-compassion, and distress from hearing voices and how secure attachment style related to each of these variables.DesignCross-sectional online.MethodOne hundred and twenty-eight people (73% female; Mage = 37.5; 87.5% Caucasian) who currently hear voices completed the Self-Compassion Scale, Southampton Mindfulness of Voices Questionnaire, Relationships Questionnaire, and Hamilton Programme for Schizophrenia Voices Questionnaire.ResultsResults showed that mindfulness of voices mediated the relationship between self-compassion and severity of voices, and self-compassion mediated the relationship between mindfulness of voices and severity of voices. Self-compassion and mindfulness of voices were significantly positively correlated with each other and negatively correlated with distress and severity of voices.ConclusionMindful relation to voices and self-compassion are associated with reduced distress and severity of voices, which supports the proposed potential benefits of mindful relating to voices and self-compassion as therapeutic skills for people experiencing distress by voice hearing.Practitioner pointsGreater self-compassion and mindfulness of voices were significantly associated with less distress from voices. These findings support theory underlining compassionate mind training.Mindfulness of voices mediated the relationship between self-compassion and distress from voices, indicating a synergistic relationship between the constructs.Although the current findings do not give a direction of causation, consideration is given to the potential impact of mindful and compassionate approaches to voices. PubDate: 2017-08-12T01:15:28.224592-05: DOI: 10.1111/bjc.12153
Authors:Jane Waite; John Rose, Lucy Wilde, Kate Eden, Chris Stinton, Jo Moss, Chris Oliver Abstract: ObjectivesThis study examined parental perceptions of behaviours that challenge (CB) in their adult children with intellectual disability (ID), and explored whether perceptions mediated associations between CB and parental psychological distress.DesignA within-group correlational design was employed.MethodsSixty-five parents reported on individuals with genetic syndromes and ID who had chronic CB. Parents completed the Illness Perception Questionnaire-Revised (IPQ-R) adapted to measure perceptions of self-injury, aggression or property destruction, alongside assessments of parental locus of control, attributions about behaviour, parental psychological distress, and CB.ResultsA high proportion of parents evidenced anxiety and depression at clinically significant levels (56.9% and 30.8%, respectively). Contrary to predictions, psychological distress was not significantly associated with CB. The perception that the adult with ID exerted control over the parent's life mediated the association between CB and parental psychological distress. Few parents endorsed operant reinforcement as a cause of CB ( PubDate: 2017-08-12T00:51:02.052229-05: DOI: 10.1111/bjc.12146
Authors:Eva J. Vekas; Tracey D. Wade Abstract: ObjectivesPerfectionism is considered to be an underlying mechanism of relevance to a broad array of indicators of psychological distress. The current research examined the impact of a three-session intervention targeting perfectionism in children on perfectionism, self-criticism, and well-being.DesignThe design of the current study can be considered quasi-experimental as the intervention and control classes were not randomly allocated but decided by convenience factors at the school level.MethodsStudents (aged 10.08–12.79 years) were allocated to the intervention (N = 107, 41 boys) or control condition (N = 105, 33 boys), completing self-report assessments on perfectionism, self-criticism, and well-being at baseline, post-intervention, and 3-month follow-up.ResultsAt post-intervention, children in the intervention group had significantly lower perfectionism than the control group (d = 0.35, 95% confidence intervals [CI]: 0.07–0.62) and at 3-month follow-up had significantly higher levels of well-being (d = 0.33, 95% CI: 0.06–0.60). As predicted by theory, decreases in perfectionism mediated the relationship between condition and improved well-being.ConclusionsThis exploratory study provides evidence for the usefulness of a brief universal prevention programme targeting perfectionism. Future research should use more robust designs, explore longer-term effects, and the impact on a wider range of variables, including scholastic achievement.Practitioner pointsClinical implicationsPerfectionism linked with negative outcomes in children can be decreased in a classroom setting.Decreasing perfectionism leads to improved well-being in children.LimitationsMore rigorous designs along with better assessment of perfectionism are required in further evaluations.The impact of perfectionism on scholastic achievement in children requires further investigation. PubDate: 2017-07-31T06:55:27.963501-05: DOI: 10.1111/bjc.12152
Authors:Hannah Murray; Sharif El-Leithy, Jo Billings Abstract: ObjectivesIntensive cognitive therapy for post-traumatic stress disorder (PTSD) has been shown to be as effective as weekly treatment in controlled trials. In this study, outcome data comparing standard and intensive treatments delivered in routine clinical practice were analysed.MethodsA consecutive case series of intensive treatment cases were compared to matched control cases who had completed weekly treatment.ResultsBoth groups showed significant improvements on PTSD and depression measures. The intensive group showed larger PTSD symptomatic improvement. There were differences between the groups in age and time since trauma, suggesting selection biases in who is offered, and/or who chooses intensive treatment.ConclusionsFor some individuals, an intensive format may be more effective than weekly treatment. PubDate: 2017-07-25T05:51:04.90736-05:0 DOI: 10.1111/bjc.12150
Authors:Genevieve A. Dingle; Elyse Williams, Jolanda Jetten, Jonathon Welch Abstract: ObjectivesAdults with mental health conditions commonly experience difficulties with emotion regulation which affect their social functioning. Arts-based groups provide opportunities for shared emotional experiences and emotion regulation. This study explores emotion regulation strategies and the emotional effects of arts-based group participation in adults with mental health problems and in controls.Design and methodThe 62 participants included 39 adults with chronic mental health problems who were members of arts-based groups (ABG) and 23 comparison choir (CC) members who were not specifically experiencing mental health problems. The repeated measures design included self-reports of emotion upon waking (T1), the hour before group (T2), end of the group (T3), and evening (T4), as well as participant notes to explain their emotion ratings at each time. They also completed measures of individual and interpersonal emotion regulation.ResultsThe ABG participants engaged marginally more in affect worsening strategies than CC (p = .057 and .08), but there were no other group differences. All participants reported a significant increase in positive emotions, F (3, 180) = 28.044, p PubDate: 2017-07-18T23:06:30.499438-05: DOI: 10.1111/bjc.12149
Authors:Louise Liddon; Roger Kingerlee, John A. Barry Abstract: ObjectiveThere is some evidence that men and women deal with stress in different ways; for example, a meta-analysis found that women prefer to focus on emotions as a coping strategy more than men do. However, sex differences in preferences for therapy is a subject little explored.DesignA cross-sectional online survey.MethodParticipants (115 men and 232 women) were recruited via relevant websites and social media. The survey described therapies and asked participants how much they liked each. Their coping strategies and help-seeking behaviour were assessed too.ResultsSurvey data were analysed using multiple linear regression. After familywise adjustment of the alpha for multiple testing to p PubDate: 2017-07-09T23:05:22.609573-05: DOI: 10.1111/bjc.12147
Authors:Robyn Langdon; Michaela Flynn, Emily Connaughton, Martin Brüne Abstract: ObjectivesEvidence of impairment in explicit mentalizing in people with schizophrenia has inspired interventions to improve awareness of others’ mental states in these individuals. Less is known of implicit mentalizing in schizophrenia, with current findings mixed. We sought to resolve previous inconsistencies using Heider & Simmel's (H&S) classic animation to elicit spontaneous mentalizing and examined relations between spontaneous and deliberative mentalizing.MethodsForty-five schizophrenia outpatients and 27 general-community controls completed two explicit theory-of-mind (TOM) tasks and then described the H&S animation (to elicit spontaneous social attributions about emotionally driven, as well as goal-driven, behaviours), before and after an instruction to think of the shapes as people. Accuracy of basic and social facts and frequencies of personification and different mental-state terms were recorded.ResultsExplicit TOM performance was impaired in patients. Patients also generated fewer social (but not basic) facts than controls to describe the H&S animation, and used less mental-state language, before, and even more so, after the ‘people’ instruction, despite that both groups had used more personification terms after the ‘people’ instruction. Measures of explicit and spontaneous mentalizing contributed independently to discriminating between groups.ConclusionsPatients respond less to the bottom-up signals of agency that ought normally to elicit spontaneous social attributions, even when cued to think of the stimuli as people, and the stimuli depict emotionally driven, as well as goal-driven, behaviour. That impairments of spontaneous and deliberative mentalizing dissociate in schizophrenia suggests that training deliberative mentalizing may not be enough; interventions to improve spontaneous mentalizing are also needed.Practitioner pointsFindingsPeople with schizophrenia were less likely than controls to spontaneously attribute causal mental states when viewing dynamic signals of emotionally driven and goal-driven behaviours.These impairments were even more pronounced when participants were instructed to think of the stimuli as people, suggesting that perceiving others in social roles does not prompt people with schizophrenia to anthropomorphize about others as agents motivated by their own inner worlds.Impairments of spontaneous mentalizing were found to co-occur independently with explicit mentalizing deficits in schizophrenia, consistent with the claim that humans can access two distinct systems for understanding others’ minds.Findings suggest that interventions to improve conscious deliberative mentalizing in schizophrenia may not be enough; we also need to target implicit mentalizing processes.LimitationsThe patient sample was chronic and only mildly symptomatic. As such, findings cannot be generalized to other stages and phases of the illness.All patients were also medicated, allowing for the possibility that automatic responses to socially salient stimuli may have been pharmacologically attenuated. Future research may examine whether unmedicated young people at ultra-high risk of psychosis show a similar profile of mentalizing impairment.Future work may also examine whether impairments of deliberative and spontaneous mentalizing associate differentially with social functioning and different cognitive domains in schizophrenia. PubDate: 2017-06-12T00:45:53.978635-05: DOI: 10.1111/bjc.12144
Authors:Kirsty Miller; Juliet R. H. Wakefield, Fabio Sani Abstract: ObjectivesThe aim of the study was to investigate the link between social group identification and mental health outcomes in a sample of secondary school pupils. Based on previous work, it was predicted that multiple high group identifications would protect against psychological ill health. Furthermore, it was predicted that better mental health would also predict greater number of group identifications, thus creating a ‘virtuous circle’.DesignA longitudinal questionnaire design was used.MethodsA total of 409 Scottish secondary school pupils aged 13–17 completed a questionnaire twice over a year. Pupils’ responses regarding their mental health and the extent of their identification with three groups (the family, school, and friends) were measured.ResultsA path analysis of the data showed that greater number of high group identifications predicted better mental health outcomes amongst participants. However, better mental health also predicted greater number of high group identifications, suggesting that there is a cyclical relationship between both variables.ConclusionsThe findings have both theoretical and practical implications. They highlight the importance of conceptualizing the link between group identification and mental health as cyclical, rather than unidirectional. This reconceptualization has implications for mental health promotion strategies, as it highlights the importance of attempting to turn a potentially ‘vicious cycle’ of social disidentification and mental ill health into a ‘virtuous cycle’ of social identification and mental health.Practitioner pointsResults showed that in a population of 409 high school pupils, the more high group identifications pupils had, the better their mental health outcomes.Better mental health also predicted a greater number of high group identifications over time.The findings suggest that we would benefit from conceptualizing the relationship between group identification and mental outcomes as being cyclical rather than unidirectional.Viewing the relationship between group identification and mental health in this way enables us to consider interventions which help turn a ‘vicious cycle’ into a ‘virtuous cycle’.LimitationsA potential limitation of the work relates to the use of self-report questionnaires which may elicit socially desirable responses.The sample only consists of high school pupils from mainstream public schools within Scotland. PubDate: 2017-06-08T05:10:19.533954-05: DOI: 10.1111/bjc.12143
Authors:Ruth Wadman; David Clarke, Kapil Sayal, Marie Armstrong, Caroline Harroe, Pallab Majumder, Panos Vostanis, Ellen Townsend Abstract: ObjectivesYoung people in the public care system (‘looked-after’ young people) have high levels of self-harm.DesignThis paper reports the first detailed study of factors leading to self-harm over time in looked-after young people in England, using sequence analyses of the Card Sort Task for Self-harm (CaTS).MethodsYoung people in care (looked-after group: n = 24; 14–21 years) and young people who had never been in care (contrast group: n = 21; 13–21 years) completed the CaTS, describing sequences of factors leading to their first and most recent episodes of self-harm. Lag sequential analysis determined patterns of significant transitions between factors (thoughts, feelings, behaviours, events) leading to self-harm across 6 months.ResultsYoung people in care reported feeling better immediately following their first episode of self-harm. However, fearlessness of death, impulsivity, and access to means were reported most proximal to recent self-harm. Although difficult negative emotions were salient to self-harm sequences in both groups, young people with no experience of being in care reported a greater range of negative emotions and transitions between them. For the contrast group, feelings of depression and sadness were a significant starting point of the self-harm sequence 6 months prior to most recent self-harm.ConclusionsSequences of factors leading to self-harm can change and evolve over time, so regular monitoring and assessment of each self-harm episode are needed. Support around easing and dealing with emotional distress is required. Restricting access to means to carry out potentially fatal self-harm attempts, particularly for the young persons with experience of being in care, is recommended.Practitioner pointsSelf-harm (and factors associated with self-harm) can change and evolve over time; assessments need to reflect this.Looked-after young people reported feeling better after first self-harm; fearlessness of death, access to means, and impulsivity were reported as key in recent self-harm.Underlying emotional distress, particularly depression and self-hatred were important in both first and most recent self-harm.Looked-after young people should undergo regular monitoring and assessment of each self-harm episode and access to potentially fatal means should be restricted.The CaTS would have clinical utility as an assessment toolRecruiting participants can be a significant challenge in studies with looked-after children and young people.Future research with larger clinical samples would be valuable. PubDate: 2017-06-08T02:40:25.986411-05: DOI: 10.1111/bjc.12145
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