Listening to other people's traumatic experiences: What makes it hard and what could protect professionals from developing related distress? A qualitative investigation

Listening to people talk about their trauma experiences involves indirect exposure to trauma (IET) and can trigger emotional distress. Existing studies about the risk factors for post-IET distress have methodological limitations and reported inconsistent results, making their findings difficult to meaningfully synthesise. Also, most of them did not focus explicitly on trauma narratives and did not explore qualitatively the opinions and experiences of professionals who work closely with trauma survivors. The present study involved 36 professionals who worked with trauma survivors and used a qualitative design to investigate: (a) the perceived impact of the survivors' accounts, (b) the factors they deemed as important to be psychologically prepared for trauma accounts, and (c) their strategies for coping with IET. The semi-structured interviews conducted yielded rich data that was analysed thematically and organised in 13 subordinate themes, and 4 master themes. Listening to trauma narratives was thought to lead to emotional distress when it challenges the listener's 'basic assumptions' of safety and justice, when the listener has reduced sense of control and operates outside their 'window of tolerance', when empathic responses are too strong, and psychological preparedness for trauma-narratives is perceived as insufficient. Recommendations for future research and implications for practice are discussed.

Exploring barriers and facilitators for mental health professionals delivering behavioural activation to young people with depression: qualitative study using the Theoretical Domains Framework

BACKGROUND

Depression prevalence among young people is increasing, with growing pressures on specialist mental health services. Manualised behavioural activation therapy may be effective for young people, and can be delivered by a range of mental health professionals (MHPs). This study explored clinician perspectives of barriers and facilitators to implementing behavioural activation with young people in routine practice.

AIMS

We conducted a qualitative study with individual semi-structured interviews with MHPs, as part of a wider feasibility study.

METHOD

Participants were mental health professionals (therapists and supervisors) from two UK NHS sites delivering manualised behavioural activation for young people. Data were analysed with an inductive followed by deductive approach, applying the Theoretical Domains Framework (TDF) to understand key influences on practice change. Identified domains were mapped onto possible behaviour change techniques (BCTs) to support implementation, using the Theory and Techniques Tool (TTT).

RESULTS

Nine MHPs were interviewed. Thirteen of fourteen TDF domains were relevant, including perceived professional identity, beliefs about own capabilities and perceived positive or negative consequences of using manualised behavioural activation, social influences, memory and attention, and environmental resources. Fourteen theory-linked BCTs were identified as possible strategies to help clinicians overcome barriers (e.g. integrating behavioural practice/rehearsal, prompts and persuasive communications within training, and supervision).

CONCLUSIONS

Behavioural science approaches (TDF, TTT) helped conceptualise key barriers and facilitators for MHPs delivering manualised behavioural activation with young people. Interventions using BCTs to address identified barriers could help the implementation of new therapies into routine practice, working to bridge the research-practice gap in clinical psychology.