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Gunby C, Isham L, Smailes H, Bradbury-Jones C, Damery S, Harlock J, Maxted F, Smith D, Taylor J. Working the Edge: The Emotional Experiences of Commissioning and Funding Arrangements for Service Leaders in the Sexual Violence Voluntary Sector. Violence Against Women 2024; 30:1783-1803. [PMID: 38509824 PMCID: PMC11041076 DOI: 10.1177/10778012241239945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
The specialist voluntary sector plays a crucial role in supporting survivors of sexual violence. However, in England, short-term funding underpins the sector's financial stability. This article examines sector leaders' ways of coping, resisting and being affected by funding practices. Using the concept of edgework, we show how funding and commissioning dynamics push individuals to the edge of service sustainability, job satisfaction, and emotional well-being. We examine how these edges are "worked," for example, by circumventing and remolding the edge. We offer an original way to theorize participants, make visible the emotional toll of service precarity and offer suggestions for support.
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Affiliation(s)
- Clare Gunby
- School of Nursing and Public Health, Manchester Metropolitan University, Manchester, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louise Isham
- Department of Social Work and Social Care, University of Birmingham, Birmingham, UK
| | - Harriet Smailes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- School of Criminology, University of Leicester, Leicester, UK
| | | | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jenny Harlock
- Warwick Medical School, University of Warwick, Warwick, UK
| | | | - Deb Smith
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Julie Taylor
- School of Nursing, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
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Isham L, Loe BS, Hicks A, Wilson N, Bentall RP, Freeman D. Daydreaming and grandiose delusions: development of the Qualities of Daydreaming Scale. Behav Cogn Psychother 2024; 52:262-276. [PMID: 38372129 DOI: 10.1017/s1352465824000018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Daydreaming may contribute to the maintenance of grandiose delusions. Repeated, pleasant and vivid daydreams about the content of grandiose delusions may keep the ideas in mind, elaborate the details, and increase the degree of conviction in the delusion. Pleasant daydreams more generally could contribute to elevated mood, which may influence the delusion content. AIMS We sought to develop a brief questionnaire, suitable for research and clinical practice, to assess daydreaming and test potential associations with grandiosity. METHOD 798 patients with psychosis (375 with grandiose delusions) and 4518 non-clinical adults (1788 with high grandiosity) were recruited. Participants completed a daydreaming item pool and measures of grandiosity, time spent thinking about the grandiose belief, and grandiose belief conviction. Factor analysis was used to derive the Qualities of Daydreaming Scale (QuOD) and associations were tested using pairwise correlations and structural equation modelling. RESULTS The questionnaire had three factors: realism, pleasantness, and frequency of daydreams. The measure was invariant across clinical and non-clinical groups. Internal consistency was good (alpha-ordinals: realism=0.86, pleasantness=0.93, frequency=0.82) as was test-retest reliability (intra-class coefficient=0.75). Daydreaming scores were higher in patients with grandiose delusions than in patients without grandiose delusions or in the non-clinical group. Daydreaming was significantly associated with grandiosity, time spent thinking about the grandiose delusion, and grandiose delusion conviction, explaining 19.1, 7.7 and 5.2% of the variance in the clinical group data, respectively. Similar associations were found in the non-clinical group. CONCLUSIONS The process of daydreaming may be one target in psychological interventions for grandiose delusions.
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Affiliation(s)
- Louise Isham
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Bao Sheng Loe
- The Psychometrics Centre, Cambridge Judge Business School, University of Cambridge, Cambridge, UK
| | - Alice Hicks
- Patient Advisory Group, Oxford Cognitive Approaches to Psychosis (O-CAP), Department of Experimental Psychology, University of Oxford, UK
- The McPin Foundation, London, UK
| | - Natalie Wilson
- Patient Advisory Group, Oxford Cognitive Approaches to Psychosis (O-CAP), Department of Experimental Psychology, University of Oxford, UK
- The McPin Foundation, London, UK
| | | | - Daniel Freeman
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Tolmeijer E, Waite F, Isham L, Bringmann L, Timmers R, van den Berg A, Schuurmans H, Staring ABP, de Bont P, van Grunsven R, Stulp G, Wijnen B, van der Gaag M, Freeman D, van den Berg D. Correction: Testing the combination of Feeling Safe and peer counselling against formulation-based cognitive behaviour therapy to promote psychological wellbeing in people with persecutory delusions: study protocol for a randomized controlled trial (the Feeling Safe-NL Trial). Trials 2023; 24:813. [PMID: 38110947 PMCID: PMC10726522 DOI: 10.1186/s13063-023-07750-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Affiliation(s)
- Eva Tolmeijer
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands.
- Department of Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands.
| | - Felicity Waite
- Department of Experimental Psychology, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Isham
- Department of Experimental Psychology, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Laura Bringmann
- Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Robin Timmers
- Voice-Hearing Support and Recovery-Team, RIBW Nijmegen and Rivierenland, Nijmegen, The Netherlands
- University of Applied Sciences Nijmegen, Nijmegen, The Netherlands
| | - Arjan van den Berg
- Department of Health, Wellbeing and Sport, Zadkine College Rotterdam, Rotterdam, The Netherlands
| | | | - Anton B P Staring
- ABC Department for First Episode Psychosis, Altrecht Psychiatric Institute, Utrecht, The Netherlands
| | - Paul de Bont
- Mental Health Organizations Oost Brabant, Boekel, The Netherlands
| | - Rob van Grunsven
- Department of Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Gert Stulp
- Department of Sociology, University of Groningen, Groningen, The Netherlands
| | - Ben Wijnen
- Centre of Economic Evaluation and Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
| | - Daniel Freeman
- Department of Experimental Psychology, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
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Tolmeijer E, Waite F, Isham L, Bringmann L, Timmers R, van den Berg A, Schuurmans H, Staring ABP, de Bont P, van Grunsven R, Stulp G, Wijnen B, van der Gaag M, Freeman D, van den Berg D. Testing the combination of Feeling Safe and peer counselling against formulation-based cognitive behaviour therapy to promote psychological wellbeing in people with persecutory delusions: study protocol for a randomized controlled trial (the Feeling Safe-NL Trial). Trials 2023; 24:644. [PMID: 37798792 PMCID: PMC10557156 DOI: 10.1186/s13063-023-07661-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Persecutory delusions are strong threat beliefs about others' negative intentions. They can have a major impact on patients' day-to-day life. The Feeling Safe Programme is a new translational cognitive-behaviour therapy that helps patients modify threat beliefs and relearn safety by targeting key psychological causal factors. A different intervention approach, with growing international interest, is peer counselling to facilitate personal recovery. Combining these two approaches is a potential avenue to maximize patient outcomes. This combination of two different treatments will be tested as the Feeling Safe-NL Programme, which aims to promote psychological wellbeing. We will test whether Feeling Safe-NL is more effective and more cost-effective in improving mental wellbeing and reducing persecutory delusions than the current guideline intervention of formulation-based CBT for psychosis (CBTp). METHODS A single-blind parallel-group randomized controlled trial for 190 out-patients who experience persecutory delusions and low mental wellbeing. Patients will be randomized (1:1) to Feeling Safe-NL (Feeling Safe and peer counselling) or to formulation-based CBTp, both provided over a period of 6 months. Participants in both conditions are offered the possibility to self-monitor their recovery process. Blinded assessments will be conducted at 0, 6 (post-treatment), 12, and 18 months. The primary outcome is mental wellbeing. The overall effect over time (baseline to 18-month follow-up) and the effects at each timepoint will be determined. Secondary outcomes include the severity of the persecutory delusion, general paranoid ideation, patient-chosen therapy outcomes, and activity. Service use data and quality of life data will be collected for the health-economic evaluation. DISCUSSION The Feeling Safe-NL Trial is the first to evaluate a treatment for people with persecutory delusions, while using mental wellbeing as the primary outcome. It will also provide the first evaluation of the combination of a peer counselling intervention and a CBT-based program for recovery from persecutory delusions. TRIAL REGISTRATION Current Controlled Trials ISRCTN25766661 (retrospectively registered 7 July 2022).
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Affiliation(s)
- Eva Tolmeijer
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands.
- Department of Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands.
| | - Felicity Waite
- Department of Experimental Psychology, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Isham
- Department of Experimental Psychology, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Laura Bringmann
- Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Robin Timmers
- Voice-Hearing Support and Recovery-Team, RIBW Nijmegen and Rivierenland, Nijmegen, The Netherlands
- University of Applied Sciences Nijmegen, Nijmegen, The Netherlands
| | - Arjan van den Berg
- Department of Health, Wellbeing and Sport, Zadkine College Rotterdam, Rotterdam, The Netherlands
| | | | - Anton B P Staring
- ABC Department for First Episode Psychosis, Altrecht Psychiatric Institute, Utrecht, The Netherlands
| | - Paul de Bont
- Mental Health Organizations Oost Brabant, Boekel, The Netherlands
| | - Rob van Grunsven
- Department of Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Gert Stulp
- Department of Sociology, University of Groningen, Groningen, The Netherlands
| | - Ben Wijnen
- Centre of Economic Evaluation and Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
| | - Daniel Freeman
- Department of Experimental Psychology, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
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Isham L, Loe BS, Hicks A, Wilson N, Bentall RP, Freeman D. The Difficulties of Grandiose Delusions: Harms, Challenges, and Implications for Treatment Engagement. Schizophr Bull 2023; 49:1194-1204. [PMID: 36916279 PMCID: PMC10483449 DOI: 10.1093/schbul/sbad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND AND HYPOTHESIS Grandiose delusions may entail difficult responsibilities and detrimental actions for patients. Recognition of these consequences by patients may provide an avenue for engagement in treatment. Furthermore, when patients carry out actions within the delusional system ("immersion behaviors") or spend considerable time thinking about their grandiose beliefs this may contribute to the persistence of the grandiosity and further harmful consequences. We, therefore, investigated grandiose-related subjective harm, immersion behaviors, and perseverative thinking. STUDY DESIGN A cross-sectional study with 798 patients with psychosis (375 of whom had grandiose delusions) and 4518 nonclinical adults. Factor analyses using data from participants scoring highly on grandiosity were used to form 3 scales: subjective harm from exceptional experiences questionnaire; immersion behaviors questionnaire; and thinking about exceptional experiences questionnaire. Associations with grandiosity were tested using structural equation modeling. STUDY RESULTS A total of 268 (77.9%) patients with grandiose delusions identified grandiose-related harms in the past 6 months and 199 (55.1%) wanted help. Immersion behaviors and perseverative thinking were highly prevalent, and explained 39.5% and 20.4% of the variance in grandiosity, respectively. Immersion behaviors and perseverative thinking were significantly associated with subjective harm, even when severity of grandiosity was controlled. Requests for help were associated with higher levels of subjective harm, use of immersion behaviors, and perseverative thinking but not severity of grandiosity. CONCLUSIONS Acting on grandiose delusions, including harmful behaviors and excessive thinking about grandiose delusions, may be routes for clinicians to engage patients in treatment. This could be a starting point for targeted psychological interventions for grandiose delusions.
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Affiliation(s)
- Louise Isham
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Bao Sheng Loe
- The Psychometrics Centre, Cambridge Judge Business School, University of Cambridge, Cambridge, UK
| | - Alice Hicks
- Patient Advisory Group, Oxford Cognitive Approaches to Psychosis (O-CAP), Department of Psychiatry, University of Oxford, UK
- The McPin Foundation, London, UK
| | - Natalie Wilson
- Patient Advisory Group, Oxford Cognitive Approaches to Psychosis (O-CAP), Department of Psychiatry, University of Oxford, UK
- The McPin Foundation, London, UK
| | | | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Isham L, Sheng Loe B, Hicks A, Wilson N, Bird JC, Bentall RP, Freeman D. The meaning in grandiose delusions: measure development and cohort studies in clinical psychosis and non-clinical general population groups in the UK and Ireland. Lancet Psychiatry 2022; 9:792-803. [PMID: 36049491 DOI: 10.1016/s2215-0366(22)00236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The content of grandiose delusions-inaccurate beliefs that one has special powers, wealth, mission, or identity-is likely to be highly meaningful. The meaning, for example providing a sense of purpose, could prove to be a key factor in the delusion taking hold. We aimed to empirically define and develop measures of the experience of meaning in grandiose delusions and the sources of this meaning, and to test whether severity of grandiosity in clinical and non-clinical populations is associated with level of meaning. METHODS We did a cross-sectional self-report questionnaire study in two cohorts: non-clinical participants aged 18 years and older, with UK or Irish nationality or residence; and patients with affective or non-affective psychosis diagnoses, aged 16 years and older, and accessing secondary care mental health services in 39 National Health Service providers in England and Wales. Participants with high grandiosity completed two large item pools: one assessing the experience of meaning in grandiose delusions (Grandiosity Meaning Measure [termed gram]) and one assessing the sources of meaning (Grandiosity Meaning Measure-Sources [termed grams]). The Grandiosity Meaning Measure and Grandiosity Meaning Measure-Sources were developed using exploratory factor analysis and confirmatory factor analysis. Structural equation modelling was used to test the associations of meaning with the severity of grandiosity. The primary outcome measure for grandiosity was the Specific Psychotic Experiences Questionnaire (grandiosity subscale) and associations were tested with the Grandiosity Meaning Measure and the Grandiosity Meaning Measure-Sources. FINDINGS From Aug 30, 2019, to Nov 21, 2020, 13 323 non-clinical participants were enrolled. 2821 (21%) were men and 10 134 (76%) were women, 11 974 (90%) were White, and the mean age was 39·5 years (SD 18·6 [range 18-93]). From March 22, 2021, to March 3, 2022, 798 patients with psychosis were enrolled. 475 (60%) were men and 313 (39%) were women, 614 (77%) were White, and the mean age was 43·4 years (SD 13·8 [range 16-81]). The experience of meaning in relation to grandiose delusions had three components: coherence, purpose, and significance. The sources of meaning had seven components: positive social perceptions, spirituality, overcoming adversity, confidence in self among others, greater good, supporting loved ones, and happiness. The measurement of meaning was invariant across clinical and non-clinical populations. In the clinical population, each person typically endorsed multiple meanings and sources of meaning for the grandiose delusion. Meaning in grandiose delusions was strongly associated with severity of grandiosity, explaining 53·5% of variance, and with grandiose delusion conviction explaining 27·4% of variance. Grandiosity was especially associated with sense of purpose, and grandiose delusion conviction with coherence. Similar findings were found for the non-clinical population. INTERPRETATION Meaning is inherently tied to grandiose delusions. This study provides a framework for research and clinical practice to understand the different types of meaning of grandiosity. The framework is likely to have clinical use in psychological therapy to help guide patients to find sources of equivalent meaning from other areas of their lives and thereby reduce the extent to which the grandiose delusion is needed. FUNDING Health Education England and National Institute for Health and Care Research.
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Affiliation(s)
- Louise Isham
- Oxford Cognitive Approaches to Psychosis, Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Bao Sheng Loe
- The Psychometrics Centre, Cambridge Judge Business School, University of Cambridge, Cambridge, UK
| | - Alice Hicks
- Patient Advisory Group, University of Oxford, Oxford, UK; The McPin Foundation, London, UK
| | - Natalie Wilson
- Patient Advisory Group, University of Oxford, Oxford, UK; The McPin Foundation, London, UK
| | - Jessica C Bird
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Daniel Freeman
- Oxford Cognitive Approaches to Psychosis, Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
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Freeman D, Emsley R, Diamond R, Collett N, Bold E, Chadwick E, Isham L, Bird JC, Edwards D, Kingdon D, Fitzpatrick R, Kabir T, Waite F. Comparison of a theoretically driven cognitive therapy (the Feeling Safe Programme) with befriending for the treatment of persistent persecutory delusions: a parallel, single-blind, randomised controlled trial. Lancet Psychiatry 2021; 8:696-707. [PMID: 34246324 PMCID: PMC8311296 DOI: 10.1016/s2215-0366(21)00158-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is a large clinical need for improved treatments for patients with persecutory delusions. We aimed to test whether a new theoretically driven cognitive therapy (the Feeling Safe Programme) would lead to large reductions in persecutory delusions, above non-specific effects of therapy. We also aimed to test treatment effect mechanisms. METHODS We did a parallel, single-blind, randomised controlled trial to test the Feeling Safe Programme against befriending with the same therapists for patients with persistent persecutory delusions in the context of non-affective psychosis diagnoses. Usual care continued throughout the duration of the trial. The trial took place in community mental health services in three UK National Health Service trusts. Participants were included if they were 16 years or older, had persecutory delusions (as defined by Freeman and Garety) for at least 3 months and held with at least 60% conviction, and had a primary diagnosis of non-affective psychosis from the referring clinical team. Patients were randomly assigned to either the Feeling Safe Programme or the befriending programme, using a permuted blocks algorithm with randomly varying block size, stratified by therapist. Trial assessors were masked to group allocation. If an allocation was unmasked then the unmasked assessor was replaced with a new masked assessor. Outcomes were assessed at 0 months, 6 months (primary endpoint), and 12 months. The primary outcome was persecutory delusion conviction, assessed within the Psychotic Symptoms Rating Scale (PSYRATS; rated 0-100%). Outcome analyses were done in the intention-to-treat population. Each intervention was provided individually over 6 months. This trial is registered with the ISRCTN registry, ISRCTN18705064. FINDINGS From Feb 8, 2016, to July 26, 2019, 130 patients with persecutory delusions (78 [60%] men; 52 [40%] women, mean age 42 years [SD 12·1, range 17-71]; 86% White, 9% Black, 2% Indian; 2·3% Pakistani; 2% other) were recruited. 64 patients were randomly allocated to the Feeling Safe Programme and 66 patients to befriending. Compared with befriending, the Feeling Safe Programme led to significant end of treatment reductions in delusional conviction (-10·69 [95% CI -19·75 to -1·63], p=0·021, Cohen's d=-0·86) and delusion severity (PSYRATS, -2·94 [-4·58 to -1·31], p<0·0001, Cohen's d=-1·20). More adverse events occurred in the befriending group (68 unrelated adverse events reported in 20 [30%] participants) compared with the Feeling Safe group (53 unrelated adverse events reported in 16 [25%] participants). INTERPRETATION The Feeling Safe Programme led to a significant reduction in persistent persecutory delusions compared with befriending. To our knowledge, these are the largest treatment effects seen for patients with persistent delusions. The principal limitation of our trial was the relatively small sample size when comparing two active treatments, meaning less precision in effect size estimates and lower power to detect moderate treatment differences in secondary outcomes. Further research could be done to determine whether greater effects could be possible by reducing the hypothesised delusion maintenance mechanisms further. The Feeling Safe Programme could become the recommended psychological treatment in clinical services for persecutory delusions. FUNDING NIHR Research Professorship and NIHR Oxford Health Biomedical Research Centre.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Rowan Diamond
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Nicola Collett
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Emily Bold
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Eleanor Chadwick
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Isham
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jessica C Bird
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Danielle Edwards
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - David Kingdon
- Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
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Bradbury-Jones C, Isham L, Morris AJ, Taylor J. The "Neglected" Relationship Between Child Maltreatment and Oral Health? An International Scoping Review of Research. Trauma Violence Abuse 2021; 22:265-276. [PMID: 31043121 DOI: 10.1177/1524838019841598] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Globally, the oral health needs of children who have, or are suspected of having, experienced abuse or neglect has become a focus of concern. It is thus valuable and timely to map the contemporary nature of the research landscape in this expanding field. This review reports the findings of a scoping review of the international empirical literature. The aim was to explore the relationship between child maltreatment and oral health and how this complex issue is addressed in contemporary dental, health, and social work practice. The review identified 68 papers, analysis of which identified three themes: (1) There is a relationship between poor oral health and child maltreatment that is well evidenced but conceptually underdeveloped. (2) There are discrepancies between the knowledge of members of the dental team about child maltreatment and their confidence and aptitude to identify and report child protection concerns. (3) There are areas of local-level policy and practice development that seek to improve working relationships between dentists and health and social work practitioners; however, there is widespread evidence that the oral health needs of this group of vulnerable children are not consistently met. To orientate critical discussion and planning for future research and practice, we present the Patterns, Advances, Gaps, Evidence for practice and Research recommendations (PAGER) framework. The review's findings are likely to be of interest to researchers, practitioners, and policy makers working across dentistry, health and social work.
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Affiliation(s)
| | - Louise Isham
- 1724University of Birmingham, Birmingham, United Kingdom
| | | | - Julie Taylor
- 1724University of Birmingham, Birmingham, United Kingdom
- Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom
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Isham L, Scott J, Taylor J. Feasibility and acceptability of the "Never Events" method in the context of multi-agency child protection: findings from an exploratory study. J Interprof Care 2021:1-5. [PMID: 33784923 DOI: 10.1080/13561820.2021.1884053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/27/2020] [Accepted: 01/27/2021] [Indexed: 10/21/2022]
Abstract
This report outlines an exploratory study that investigated whether the "Never Events" system - first used in healthcare contexts to identify and investigate preventable incidents that cause serious harm or death as a result of human error - could be adapted in the context of UK multi-agency child protection. Using a sequential design, two online surveys were carried out that explored practitioners' (n = 46) views about the feasibility of adopting the Never Events model and what, if any, incidents or events could be investigated plausibly using such a model. Practitioners were drawn from a purposive sample. An inter-disciplinary panel of senior practitioners - drawn from nursing, public health, social work and child mental health services- discussed the surveys' findings and the list of proposed child protection Never Events. The findings indicate that the complex, judgment-based nature of child protection contributes to difficulties creating shared understandings about what constitutes harm and the extent to which multi-agency systems can share decision-making and responsibility for the way they identify and support families. Thinking through and discussing the relative strengths and limitations of the Never Events model may nevertheless be a valuable exercise in interprofessional training and the design of highly localized review and reporting systems.
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Affiliation(s)
- Louise Isham
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jane Scott
- Centre of Child Well-being and Protection, University of Stirling, Stirling, UK
| | - Julie Taylor
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Isham L, Griffith L, Boylan A, Hicks A, Wilson N, Byrne R, Sheaves B, Bentall RP, Freeman D. Understanding, treating, and renaming grandiose delusions: A qualitative study. Psychol Psychother 2021; 94:119-140. [PMID: 31785077 PMCID: PMC7984144 DOI: 10.1111/papt.12260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/23/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Grandiose delusions are arguably the most neglected psychotic experience in research. OBJECTIVES We aimed to discover from patients: whether grandiose delusions have harmful consequences; the psychological mechanisms that maintain them; and what help patients may want from clinical services. DESIGN A qualitative interview design was used to explore patients' experiences of grandiose delusions. METHOD Fifteen patients with past or present experiences of grandiose delusions who were attending psychiatric services were interviewed. Thematic analysis and grounded theory were used to analyse the data. RESULTS Participants reported physical, sexual, social, occupational, and emotional harms from grandiose delusions. All patients described the grandiose belief as highly meaningful: it provided a sense of purpose, belonging, or self-identity, or it made sense of unusual or difficult events. The meaning from the belief was not synonymous with extreme superiority or arrogance. The meaning obtained appeared to be a key driver of the persistence of the beliefs. Other maintenance factors were subjectively anomalous experiences (e.g., voices), symptoms of mania, fantasy elaboration, reasoning biases, and immersive behaviours. Participants described insufficient opportunities to talk about their grandiose beliefs and related experiences and were generally positive about the possibility of a psychological therapy. CONCLUSIONS We conclude that grandiosity is a psychologically rich experience, with a number of maintenance factors that may be amenable to a targeted psychological intervention. Importantly, the term 'grandiose delusion' is an imprecise description of the experience; we suggest 'delusions of exceptionality' may be a credible alternative. PRACTITIONER POINTS Harm from grandiose delusions can occur across multiple domains (including physical, sexual, social, occupational, and emotional) and practitioners should assess accordingly. However, grandiose delusions are experienced by patients as highly meaningful: they provide a sense of purpose, belonging, or self-identity, or make sense of unusual or difficult events. Possible psychological maintenance mechanisms that could be a target for intervention include the meaning of the belief, anomalous experiences, mania, fantasy elaboration, reasoning biases, and immersive behaviours. Patients are keen to have the opportunity to access talking therapies for this experience. Taking extra time to talk at times of distress, 'going the extra mile', and listening carefully can help to facilitate trust.
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Affiliation(s)
- Louise Isham
- Oxford Cognitive Approaches to Psychosis (O‐CAP)Department of PsychiatryUniversity of OxfordUK,Oxford Health NHS Foundation TrustUK
| | - Laura Griffith
- Health Services Management CentreUniversity of BirminghamUK
| | - Anne‐Marie Boylan
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordUK
| | - Alice Hicks
- Patient Advisory GroupOxford Cognitive Approaches to Psychosis (O‐CAP)Department of PsychiatryUniversity of OxfordUK,The McPin FoundationLondonUK
| | - Natalie Wilson
- Patient Advisory GroupOxford Cognitive Approaches to Psychosis (O‐CAP)Department of PsychiatryUniversity of OxfordUK,The McPin FoundationLondonUK
| | - Rory Byrne
- Psychosis Research UnitGreater Manchester Mental Health NHS Foundation TrustUK
| | - Bryony Sheaves
- Oxford Cognitive Approaches to Psychosis (O‐CAP)Department of PsychiatryUniversity of OxfordUK,Oxford Health NHS Foundation TrustUK
| | | | - Daniel Freeman
- Oxford Cognitive Approaches to Psychosis (O‐CAP)Department of PsychiatryUniversity of OxfordUK,Oxford Health NHS Foundation TrustUK
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Bloomfield MA, Chang T, Woodl MJ, Lyons LM, Cheng Z, Bauer‐Staeb C, Hobbs C, Bracke S, Kennerley H, Isham L, Brewin C, Billings J, Greene T, Lewis G. Psychological processes mediating the association between developmental trauma and specific psychotic symptoms in adults: a systematic review and meta-analysis. World Psychiatry 2021; 20:107-123. [PMID: 33432756 PMCID: PMC7801841 DOI: 10.1002/wps.20841] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Experiencing psychological trauma during childhood and/or adolescence is associated with an increased risk of psychosis in adulthood. However, we lack a clear knowledge of how developmental trauma induces vulnerability to psychotic symptoms. Understanding the psychological processes involved in this association is crucial to the development of preventive interventions and improved treatments. We sought to systematically review the literature and combine findings using meta-analytic techniques to establish the potential roles of psychological processes in the associations between developmental trauma and specific psychotic experiences (i.e., hallucinations, delusions and paranoia). Twenty-two studies met our inclusion criteria. We found mediating roles of dissociation, emotional dysregulation and post-traumatic stress disorder (PTSD) symptoms (avoidance, numbing and hyperarousal) between developmental trauma and hallucinations. There was also evidence of a mediating role of negative schemata, i.e. mental constructs of meanings, between developmental trauma and delusions as well as paranoia. Many studies to date have been of poor quality, and the field is limited by mostly cross-sectional research. Our findings suggest that there may be distinct psy-chological pathways from developmental trauma to psychotic phenomena in adulthood. Clinicians should carefully ask people with psychosis about their history of developmental trauma, and screen patients with such a history for dissociation, emotional dysregulation and PTSD symptoms. Well conducted research with prospective designs, including neurocognitive assessment, is required in order to fully understand the biopsychosocial mechanisms underlying the association between developmental trauma and psychosis.
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Affiliation(s)
- Michael A.P. Bloomfield
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of PsychiatryUniversity College LondonLondonUK,Traumatic Stress Clinic, St. Pancras Hospital, Camden and Islington NHS Foundation TrustLondonUK,NIHR University College London Hospitals Biomedical Research CentreUniversity College HospitalLondonUK,National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Tinya Chang
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of PsychiatryUniversity College LondonLondonUK
| | - Maximillian J. Woodl
- Traumatic Stress Clinic, St. Pancras Hospital, Camden and Islington NHS Foundation TrustLondonUK
| | - Laura M. Lyons
- Traumatic Stress Clinic, St. Pancras Hospital, Camden and Islington NHS Foundation TrustLondonUK
| | - Zhen Cheng
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of PsychiatryUniversity College LondonLondonUK
| | - Clarissa Bauer‐Staeb
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of PsychiatryUniversity College LondonLondonUK,Department of PsychologyUniversity of BathBathUK
| | - Catherine Hobbs
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of PsychiatryUniversity College LondonLondonUK,Department of PsychologyUniversity of BathBathUK
| | - Sophie Bracke
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of PsychiatryUniversity College LondonLondonUK
| | - Helen Kennerley
- University of OxfordOxfordUK,Oxford Centre for Cognitive TherapyWarneford Hospital, Oxford Health NHS Foundation TrustOxfordUK
| | - Louise Isham
- Oxford Centre for Cognitive TherapyWarneford Hospital, Oxford Health NHS Foundation TrustOxfordUK,Department of PsychiatryUniversity of OxfordOxfordUK
| | - Chris Brewin
- Research Department of Clinical, Health and Educational PsychologyUniversity College LondonLondonUK
| | - Jo Billings
- Division of PsychiatryUniversity College LondonLondonUK
| | - Talya Greene
- Division of PsychiatryUniversity College LondonLondonUK,Community Mental Health DepartmentUniversity of HaifaHaifaIsrael
| | - Glyn Lewis
- Division of PsychiatryUniversity College LondonLondonUK
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12
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Waite F, Sheaves B, Isham L, Reeve S, Freeman D. Sleep and schizophrenia: From epiphenomenon to treatable causal target. Schizophr Res 2020; 221:44-56. [PMID: 31831262 PMCID: PMC7327507 DOI: 10.1016/j.schres.2019.11.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Sleep disturbance is a common clinical issue for patients with psychosis. It has been identified as a putative causal factor in the onset and persistence of psychotic experiences (paranoia and hallucinations). Hence sleep disruption may be a potential treatment target to prevent the onset of psychosis and reduce persistent psychotic experiences. The aim of this review is to describe developments in understanding the nature, causal role, and treatment of sleep disruption in psychosis. METHOD A systematic literature search was conducted to identify studies, published in the last five years, investigating subjective sleep disruption and psychotic experiences. RESULTS Fifty-eight papers were identified: 37 clinical and 21 non-clinical studies. The studies were correlational (n = 38; 20 clinical, 18 non-clinical), treatment (n = 7; 1 non-clinical), qualitative accounts (n = 6 clinical), prevalence estimates (n = 5 clinical), and experimental tests (n = 2 non-clinical). Insomnia (50%) and nightmare disorder (48%) are the most prevalent sleep problems found in patients. Sleep disruption predicts the onset and persistence of psychotic experiences such as paranoia and hallucinations, with negative affect identified as a partial mediator of this relationship. Patients recognise the detrimental effects of disrupted sleep and are keen for treatment. All psychological intervention studies reported large effect size improvements in sleep and there may be modest resultant improvements in psychotic experiences. CONCLUSIONS Sleep disruption is a treatable clinical problem in patients with psychosis. It is important to treat in its own right but may also lessen psychotic experiences. Research is required on how this knowledge can be implemented in clinical services.
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Affiliation(s)
- Felicity Waite
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK; Sleep and Circadian Neuroscience Institute, University of Oxford, UK.
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford, UK,Oxford Health NHS Foundation Trust, UK,Sleep and Circadian Neuroscience Institute, University of Oxford, UK
| | - Louise Isham
- Department of Psychiatry, University of Oxford, UK,Oxford Health NHS Foundation Trust, UK
| | | | - Daniel Freeman
- Department of Psychiatry, University of Oxford, UK,Oxford Health NHS Foundation Trust, UK,Sleep and Circadian Neuroscience Institute, University of Oxford, UK
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13
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14
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Isham L, Bradbury-Jones C, Hewison A. Female family carers' experiences of violent, abusive or harmful behaviour by the older person for whom they care: a case of epistemic injustice? Sociol Health Illn 2020; 42:80-94. [PMID: 31515820 DOI: 10.1111/1467-9566.12986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Family carers affected by violent, abusive or harmful behaviour by the older person for whom they care face social and epistemic challenges in developing and sharing knowledge about their experiences. These difficulties have contributed to a situation in which there is a paucity of evidence and public discourse about how we understand violence and harm instigated by people who have care needs or are 'vulnerable'. This paper reports the findings of a qualitative study that involved 12 in-depth interviews with female carers affected by violence, abuse or harm. The study was informed theoretically by Miranda Fricker's concept of epistemic injustice which was used as a framework for analysis. There were two principal findings: (1) Carers were sensitive to anticipatory stigma and loss of moral autonomy. As a result, they self-censured what they shared and, at times, were met with subtle but powerful processes of silencing. (2) Carers had limited linguistic and conceptual resources to explain the emotional and social aspects of the harm they experienced, exacerbated by implicit social norms about the 'private' and gendered nature of familial care. To conclude, we discuss the implications of these findings for sociological research and health and social care practice.
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Affiliation(s)
- Louise Isham
- School of Nursing, University of Birmingham, Birmingham, UK
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15
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Combes G, Damery S, Gunby C, Harlock J, Isham L, Jones A, Maxted F, Parmar P, Schaub J, Smith D, Taylor J, Bradbury-Jones C. Supporting survivors of sexual violence: protocol for a mixed-methods, co-research study of the role, funding and commissioning of specialist services provided by the voluntary sector in England. BMJ Open 2019; 9:e035739. [PMID: 31852714 PMCID: PMC6937104 DOI: 10.1136/bmjopen-2019-035739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The voluntary sector provides a range of specialist services to survivors of sexual violence, many of which have evolved from grass roots organisations responding to unmet local needs. However, the evidence base is poor in terms of what services are provided to which groups of survivors, how voluntary sector specialist (VSS) services are organised and delivered and how they are commissioned. This will be the first national study on the role of the voluntary sector in supporting survivors in England. METHODS AND ANALYSIS This study uses an explanatory sequential naturalistic mixed-methods design with two stages. For stage 1, two national surveys of providers' and commissioners' views on designing and delivering VSS services will facilitate detailed mapping of service provision and commissioning in order to create a taxonomy of VSS services. Variations in the national picture will then be explored in stage 2 through four in-depth, qualitative case studies using the critical incident technique to explain the observed variations and understand the key contextual factors which influence service provision. Drawing on theory about the distinctive service contribution of the voluntary sector, survivors will be involved as co-researchers and will play a central role in data collection and interpretation. ETHICS AND DISSEMINATION Ethical approval has been granted by the University of Birmingham research ethics committee for stage 1 of the project. In line with the sequential and co-produced study design, further applications for ethical review will be made in due course. Dissemination activities will include case study and end-of-project workshops; good practice guides; a policy briefing; project report; bitesize findings; webinars; academic articles and conference presentations. The project will generate evidence about what survivors want from and value about services and new understanding about how VSS services should be commissioned and provided to support survivors to thrive in the long term.
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Affiliation(s)
- Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Clare Gunby
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jenny Harlock
- Social Science ans Systems in Health, University of Warwick, Coventry, UK
| | - Louise Isham
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alice Jones
- Avon and Somerset Constabulary, Portishead, UK
| | | | - Priti Parmar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jason Schaub
- School of Social Work and Social Care, University of Birmingham, Birmingham, UK
| | - Deb Smith
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Julie Taylor
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Caroline Bradbury-Jones
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Isham L, Hewison A, Bradbury-Jones C. When Older People Are Violent or Abusive Toward Their Family Caregiver: A Review of Mixed-Methods Research. Trauma Violence Abuse 2019; 20:626-637. [PMID: 29333998 DOI: 10.1177/1524838017726425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
What happens when family caregivers experience violence and abuse from the older person for whom they care? Although this issue has received little global attention, it is relevant to researchers, practitioners, and policy makers working across the intersecting fields of older age care and medicine, adult protection and safeguarding, and domestic and intimate partner violence. To date, these fields have generated diverse explanations of violence and abuse in older age illness and how best to respond to it. This article reports the findings of a systematic literature review of 18 quantitative, qualitative, and mixed-methods studies that investigated violent and abusive behavior by older people toward their family caregivers. The review identified three central themes in the literature: (1) There are inconsistent definitions and measurements used in research about harmful, violent, and abusive behavior toward family caregivers. (2) Violent and abusive behavior toward caregivers is a sensitive and hidden topic that poses practical and methodological challenges for researchers. (3) There is some evidence to suggest that people who were violent and abusive in their earlier life-or who had a poor relationship with their family member in the past-are more likely to continue to experience violence and abusive behavior in later life. There were two central ways in which violence and abuse were conceptualized and investigated: as a "symptom of illness" or as an "act of abuse" and we present a visual map of the relationship between these two conceptualizations drawn from our analysis of the literature. We conclude by discussing the implications of the findings and recommend future directions for practice, research, and policy to support affected families.
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Affiliation(s)
- Louise Isham
- University of Birmingham, Birmingham, United Kingdom
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Waite F, Diamond R, Collett N, Chadwick E, Bold E, Teale AL, Taylor KM, Kirkham M, Twivy E, Causier C, Carr L, Bird JC, Černis E, Isham L, Freeman D. The comments of voices on the appearance of patients with psychosis: 'the voices tell me that I am ugly'. BJPsych Open 2019; 5:e86. [PMID: 31537204 PMCID: PMC6788219 DOI: 10.1192/bjo.2019.66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There are high rates of obesity and low self-esteem in patients with psychosis. The occurrence of negative voice content directly about appearance is therefore plausible. Derogatory comments about appearance are likely to be distressing, increase depression and contribute to social withdrawal. AIMS To systematically assess the occurrence of voice content regarding appearance and identify correlates. METHOD Sixty patients experiencing verbal auditory hallucinations at least once a week in the context of non-affective psychosis completed a measure assessing positive and negative voice content about appearance. They also completed assessments about body image, self-esteem, psychiatric symptoms and well-being. RESULTS Fifty-five (91.7%) participants reported hearing voices comment on their appearance. A total of 54 (90%) patients reported negative voice content about their appearance with 30 (50%) patients experienced negative appearance comments on a daily basis. The most common negative comment was 'the voices tell me that I am ugly' (n = 48, 80%). There were 39 (65%) patients who reported positive voice content on appearance. The most frequent positive comment was 'I look as nice as other people' (n = 26, 43.3%). Negative voice content about appearance was associated with body image concerns, paranoia, voice hearing severity, depression, worry, negative self-beliefs and safety-seeking behaviours. Positive appearance voice content was associated with greater body esteem and well-being and lower levels of depression and insomnia. CONCLUSIONS Voice content about appearance is very common for patients seen in clinical services. Negative voice content may reflect - and subsequently reinforce - negative beliefs about one's appearance, low self-esteem, worry and paranoia. DECLARATION OF INTEREST None.
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Affiliation(s)
- Felicity Waite
- Research Clinical Psychologist, Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
| | - Rowan Diamond
- Research Clinical Psychologist, Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
| | - Nicola Collett
- Research Clinical Psychologist, Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
| | - Eleanor Chadwick
- Research Assistant, Department of Psychiatry, University of Oxford, UK
| | - Emily Bold
- Research Assistant, Department of Psychiatry, University of Oxford, UK
| | - Ashley-Louise Teale
- Research Assistant, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, UK
| | - Kathryn M Taylor
- Research Assistant, Department of Psychiatry, University of Oxford, UK
| | - Miriam Kirkham
- Research Assistant, Department of Psychiatry, University of Oxford, UK
| | - Eve Twivy
- Research Assistant, Department of Psychiatry, University of Oxford, UK
| | - Chiara Causier
- Research Assistant, Department of Psychiatry, University of Oxford, UK
| | - Lydia Carr
- Research Assistant, Department of Psychiatry, University of Oxford, UK
| | - Jessica C Bird
- Research Clinical Psychologist, Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
| | - Emma Černis
- Research Clinical Psychologist, Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
| | - Louise Isham
- Research Clinical Psychologist, Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
| | - Daniel Freeman
- Professor of Clinical Psychology, Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
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18
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Freeman D, Morrison A, Bird JC, Chadwick E, Bold E, Taylor KM, Diamond R, Collett N, Černis E, Isham L, Lister R, Kirkham M, Teale AL, Twivy E, Waite F. The weeks before 100 persecutory delusions: the presence of many potential contributory causal factors. BJPsych Open 2019; 5:e83. [PMID: 31526411 PMCID: PMC6749142 DOI: 10.1192/bjo.2019.67] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The period before the formation of a persecutory delusion may provide causal insights. Patient accounts are invaluable in informing this understanding. AIMS To inform the understanding of delusion formation, we asked patients about the occurrence of potential causal factors - identified from a cognitive model - before delusion onset. METHOD A total of 100 patients with persecutory delusions completed a checklist about their subjective experiences in the weeks before belief onset. The checklist included items concerning worry, images, low self-esteem, poor sleep, mood dysregulation, dissociation, manic-type symptoms, aberrant salience, hallucinations, substance use and stressors. Time to reach certainty in the delusion was also assessed. RESULTS Most commonly it took patients several months to reach delusion certainty (n = 30), although other patients took a few weeks (n = 24), years (n = 21), knew instantly (n = 17) or took a few days (n = 6). The most frequent experiences occurring before delusion onset were: low self-confidence (n = 84); excessive worry (n = 80); not feeling like normal self (n = 77); difficulties concentrating (n = 77); going over problems again and again (n = 75); being very negative about the self (n = 75); images of bad things happening (n = 75); and sleep problems (n = 75). The average number of experiences occurring was high (mean 23.5, s.d. = 8.7). The experiences clustered into six main types, with patients reporting an average of 5.4 (s.d. = 1.0) different types. CONCLUSIONS Patients report numerous different experiences in the period before full persecutory delusion onset that could be contributory causal factors, consistent with a complex multifactorial view of delusion occurrence. This study, however, relied on retrospective self-report and could not determine causality. DECLARATION OF INTEREST None.
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Affiliation(s)
- Daniel Freeman
- Professor of Clinical Psychology, Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
| | - Anthony Morrison
- Professor of Clinical Psychology, Greater Manchester Mental Health NHS Foundation Trust; and Division of Psychology and Mental Health, University of Manchester, UK
| | - Jessica C Bird
- Research Clinical Psychologist, Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
| | - Eleanor Chadwick
- Research Assistant, Department of Psychiatry, University of Oxford, UK
| | - Emily Bold
- Research Assistant, Department of Psychiatry, University of Oxford, UK
| | - Kathryn M Taylor
- Research Assistant, Department of Psychiatry, University of Oxford, UK
| | - Rowan Diamond
- Research Clinical Psychologist, Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
| | - Nicola Collett
- Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
| | - Emma Černis
- Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
| | - Louise Isham
- Research Clinical Psychologist, Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
| | - Rachel Lister
- Research Clinical Psychologist, Department of Psychiatry, University of Oxford; and Oxford Health NHS Foundation Trust, UK
| | - Miriam Kirkham
- Research Assistant, Department of Psychiatry, University of Oxford, UK
| | | | - Eve Twivy
- Research Assistant, Department of Psychiatry, University of Oxford, UK
| | - Felicity Waite
- Research Clinical Psychologist, University of Oxford; and Oxford Health NHS Foundation Trust, UK
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Freeman D, Bold E, Chadwick E, Taylor KM, Collett N, Diamond R, Černis E, Bird JC, Isham L, Forkert A, Carr L, Causier C, Waite F. Suicidal ideation and behaviour in patients with persecutory delusions: Prevalence, symptom associations, and psychological correlates. Compr Psychiatry 2019; 93:41-47. [PMID: 31319194 DOI: 10.1016/j.comppsych.2019.07.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/08/2019] [Accepted: 07/05/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To determine the prevalence of suicidal ideation and behaviour - and their correlates - in patients with persecutory delusions. METHODS 110 patients with persecutory delusions in the context of non-affective psychosis were assessed for suicidal thoughts and behaviours over the past month. Symptom and psychological assessments were also completed. RESULTS The severity of suicidal ideation was: no suicidal ideation (n = 26, 23.6%); wish to be dead (n = 21, 19.1%); nonspecific active suicidal thoughts (n = 14, 12.7%); suicidal thoughts with methods but no intent (n = 29, 26.4%); suicidal thoughts with intent but no specific plan (n = 13, 11.8%); and suicidal intent with plan (n = 7, 6.4%). In the past month, five patients (4.5%) had made an actual, interrupted, or aborted suicide attempt. The severity of suicidal ideation was associated with higher levels of depression, paranoia, hallucinations, anger, insomnia, negative beliefs about the self and others, pessimism, worry, and delusion safety-seeking behaviours and lower levels of psychological well-being and reward responsiveness. Severity of ideation was not associated with cannabis or alcohol use, working memory, pain, or meaningful activity levels. CONCLUSIONS Patients with persecutory delusions are typically in a severe state of psychological stress, and at risk of suicide, as indicated by very high levels of suicidal ideation. This exploratory study also identifies correlates of suicidal ideation that could be investigated in causal research designs.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK.
| | - Emily Bold
- Department of Psychiatry, University of Oxford, UK
| | | | | | - Nicola Collett
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Rowan Diamond
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Emma Černis
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Jessica C Bird
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Louise Isham
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Ava Forkert
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Lydia Carr
- Department of Psychiatry, University of Oxford, UK
| | | | - Felicity Waite
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
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20
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Bradbury-Jones C, Isham L, Taylor J. The complexities and contradictions in participatory research with vulnerable children and young people: A qualitative systematic review. Soc Sci Med 2018; 215:80-91. [PMID: 30218806 DOI: 10.1016/j.socscimed.2018.08.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 08/26/2018] [Accepted: 08/30/2018] [Indexed: 12/18/2022]
Abstract
Participatory research carried out by or with children, has become a well-established and valuable part of the research landscape investigating children's lives, views and needs. So too has a critical agenda about its ethical implications and methodological complexities. One criticism is that the involvement of children who may be considered 'vulnerable' or 'marginalised' has been slower to take root within mainstream participatory practice. This means that there has been less focus on how groups such as disabled children or children affected by abuse or neglect can shape and challenge adult-dominated types of knowledge and decision-making that are likely to affect them. This article reports on the findings of a qualitative systematic literature review of thirteen contemporary papers. The review was undertaken by a UK team in 2017. The included articles explored some core ethical and methodological issues involved in carrying out participatory research with vulnerable children and young people. It reports on three themes: 1) The extent to which participatory spaces could recalibrate opportunities and attention given to marginalised and silenced groups; 2) The ways in which these children and young people could develop skills and exercise political and moral agency through participatory activity, and, 3) How to facilitate meaningful engagement with individuals and groups and reconcile this with a critical appreciation of the important but limited nature of research as means of political and social change. The review provides a unique, contemporary analysis of participatory research with vulnerable children, illuminating in particular its conceptual complexities and contradictions, particularly regarding power, empowerment and voice. Its overall utility and interest is augmented by the disciplinary and geographical breadth of the included articles, rendering it relevant to many contexts and countries.
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Affiliation(s)
| | | | - Julie Taylor
- University of Birmingham, England, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Sheaves B, Freeman D, Isham L, McInerney J, Nickless A, Yu LM, Rek S, Bradley J, Reeve S, Attard C, Espie CA, Foster R, Wirz-Justice A, Chadwick E, Barrera A. Stabilising sleep for patients admitted at acute crisis to a psychiatric hospital (OWLS): an assessor-blind pilot randomised controlled trial. Psychol Med 2018; 48:1694-1704. [PMID: 29108526 PMCID: PMC6088775 DOI: 10.1017/s0033291717003191] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND When patients are admitted onto psychiatric wards, sleep problems are highly prevalent. We carried out the first trial testing a psychological sleep treatment at acute admission (Oxford Ward sLeep Solution, OWLS). METHODS This assessor-blind parallel-group pilot trial randomised patients to receive sleep treatment at acute crisis [STAC, plus standard care (SC)], or SC alone (1 : 1). STAC included cognitive-behavioural therapy (CBT) for insomnia, sleep monitoring and light/dark exposure for circadian entrainment, delivered over 2 weeks. Assessments took place at 0, 2, 4 and 12 weeks. Feasibility outcomes assessed recruitment, retention of participants and uptake of the therapy. Primary efficacy outcomes were the Insomnia Severity Index and Warwick-Edinburgh Mental Wellbeing Scale at week 2. Analyses were intention-to-treat, estimating treatment effect with 95% confidence intervals. RESULTS Between October 2015 and July 2016, 40 participants were recruited (from 43 assessed eligible). All participants offered STAC completed treatment (mean sessions received = 8.6, s.d. = 1.5). All participants completed the primary end point. Compared with SC, STAC led to large effect size (ES) reductions in insomnia at week 2 (adjusted mean difference -4.6, 95% CI -7.7 to -1.4, ES -0.9), a small improvement in psychological wellbeing (adjusted mean difference 3.7, 95% CI -2.8 to 10.1, ES 0.3) and patients were discharged 8.5 days earlier. One patient in the STAC group had an adverse event, unrelated to participation. CONCLUSIONS In this challenging environment for research, the trial was feasible. Therapy uptake was high. STAC may be a highly effective treatment for sleep disturbance on wards with potential wider benefits on wellbeing and admission length.
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Affiliation(s)
- Bryony Sheaves
- Sleep & Circadian Neuroscience Institute (SCNi), Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Daniel Freeman
- Sleep & Circadian Neuroscience Institute (SCNi), Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Louise Isham
- Sleep & Circadian Neuroscience Institute (SCNi), Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Josephine McInerney
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Alecia Nickless
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Ly-Mee Yu
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Stephanie Rek
- Sleep & Circadian Neuroscience Institute (SCNi), Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Jonathan Bradley
- Sleep & Circadian Neuroscience Institute (SCNi), Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Sarah Reeve
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Caroline Attard
- Berkshire Healthcare NHS Foundation Trust, Prospect Park Hospital, Honey End Lane, Tilehurst, Reading, Berkshire, RG30 4EJ, UK
| | - Colin A. Espie
- Sleep & Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, OMPI, Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Russell Foster
- Sleep & Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, OMPI, Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Anna Wirz-Justice
- Centre for Chronobiology, Psychiatric Hospital, University of Basel, Wilhelm Klein Strasse 27, CH-4012 Basel, Switzerland
| | - Eleanor Chadwick
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Alvaro Barrera
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
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Abstract
OBJECTIVES This study aimed to investigate post-traumatic stress symptoms (PTSS) in childhood brain tumour survivors and their parents. A further aim was to explore the relationship between objective illness parameters, parent-child interactions, coping styles and PTSS. METHODS A cross-sectional correlational design was employed. Fifty-two childhood brain tumour survivors, aged 8-16, and 52 parents completed a battery of questionnaires designed to assess quality of parent-child interactions, monitoring and blunting attentional coping styles and PTSS. RESULTS Over one-third (35%) of survivors and 29% of their parents reported severe levels of PTSS (suggestive of post-traumatic stress disorder 'caseness'). Increased parent-child conflict resolution for survivors and number of tumour recurrences for parents independently predicted the variance in PTSS. CONCLUSIONS For a substantial proportion of brain tumour survivors and their parents the process of survivorship is a considerably distressing experience.
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Affiliation(s)
- M Bruce
- Institute of Psychiatry, King's College London, London, UK.
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