Chloe Randal - Academia.edu (original) (raw)

Papers by Chloe Randal

Psychotherapy Research, 2015

Despite prevailing beliefs about the potential benefits and harmfulness of mindfulness for people... more Despite prevailing beliefs about the potential benefits and harmfulness of mindfulness for people who hear voices, there is a paucity of research into staff and service user views. Q-methodology was used to explore views about mindfulness groups for voice-hearers. Opportunistic sampling of mental healthcare staff (N = 14) and service users with psychosis (N = 17). Both samples were analysed using principle components factor analysis to identify the range of attitudes held by staff and service users. Staff participants were particularly knowledgeable and interested in mindfulness. A single staff consensus factor was found suggesting mindfulness is helpful, and not harmful for mental health, but uncertainty surrounded its usefulness for voice-hearers. Service users held four distinct attitudes: (i) mindfulness helps to calm a racing mind; (ii) mindfulness helps to manage stress; (iii) mindfulness improves well-being, and does not alter the brain, reality beliefs, or cause madness; and (iv) mindfulness helps with managing thoughts, fostering acceptance, and is acceptable when delivered in a group format. Staff viewed mindfulness groups for psychosis as helpful, not harmful, but were uncertain about their utility. Consistent with previous research, service users viewed mindfulness groups as useful to promote well-being and reduce distress for individuals experiencing psychosis.

Clinical Psychology Forum

An audit conducted within the psychology department of a medium secure unit identified how psycho... more An audit conducted within the psychology department of a medium secure unit identified how psychologists spent their time at work. Indirect clinical work took up much of the psychologists’ time. Direct client contact accompanied a significant amount of preparatory/report-writing work.

In the UK, routine monitoring and feedback to therapists regarding client progress represents a p... more In the UK, routine monitoring and feedback to therapists regarding client progress represents a promising but neglected opportunity to improve therapeutic outcome…until now. This paper describes the first UK implementation of a Monitoring and Feedback System (MFS) in routine clinical practice, gives direct insight into encountered barriers and recommends solutions, to inspire and inform future adoption of similar systems. A methodology for the development and application of an MFS in an Adult Psychological Therapies service is presented. The service offers various therapies for clients defined as severe and complex. The backbone of the present MFS was two brief distress measures, which consenting clients completed before each therapy session, and one post session measure assessing helpfulness, alliance and stage of therapy. Therapists received feedback after each client’s fourth session. A three month pilot phase preceded official implementation, representing an opportunity to hone ...

Aim: This study aims to assess the feasibility and effectiveness of collecting sessional outcome ... more Aim: This study aims to assess the feasibility and effectiveness of collecting sessional outcome data from clients and providing feedback to therapists about symptoms and alliance. We aim to assess whether the benefits of monitoring and feedback on client outcome observed in the US, translate to routine UK secondary care psychological therapies. Therapists’ use of feedback and issues of acceptability and compliance will be explored. Method: Outcome data was collected from consenting clients across two South West Yorkshire sites. Our feedback system used two brief distress measures, which clients completed before each therapy session, and one post session measure assessing helpfulness, alliance and stage of therapy. This data combined with benchmark data determines clients ‘not on track’. Therapists received feedback after each client’s fourth session. Reflexive dialogue between therapists, service users and researchers was implemented. Results: To date, we have found that it is feas...

Research demonstrating the positive effects of Mindfulness-Based Interventions (MBIs) has led to ... more Research demonstrating the positive effects of Mindfulness-Based Interventions (MBIs) has led to a growing interest in the use of mindfulness across a range of populations and psychological difficulties. This thesis explores the feasibility and benefits of mindfulness in relation to self-esteem and psychosis.Paper one is a systematic review exploring the relationship between mindfulness and self-esteem. The review had two main aims: to synthesise and critically appraise studies exploring the association between mindfulness and self-esteem, and studies investigating the impact of MBIs on self-esteem. Thirty-two studies were identified and quality assessed to guide interpretation of results. All cross-sectional studies found significant positive correlations between dispositional mindfulness and self-esteem, whilst improvements in self-esteem were found in the majority of MBI studies. Despite largely positive findings, the review highlighted the need to interpret these with caution du...

Psychotherapy Research, 2015

To investigate the barriers and facilitators of an effective implementation of an outcome monitor... more To investigate the barriers and facilitators of an effective implementation of an outcome monitoring and feedback system in a UK National Health Service psychological therapy service. An outcome monitoring system was introduced in two services. Enhanced feedback was given to therapists after session 4. Qualitative and quantitative methods were used, including questionnaires for therapists and patients. Thematic analysis was carried out on written and verbal feedback from therapists. Analysis of patient outcomes for 202 episodes of therapy was compared with benchmark data of 136 episodes of therapy for which feedback was not given to therapists. Themes influencing the feasibility and acceptability of the feedback system were the extent to which therapists integrated the measures and feedback into the therapy, availability of administrative support, information technology, and complexity of the service. There were low levels of therapist actions resulting from the feedback, including discussing the feedback in supervision and with patients. The findings support the feasibility and acceptability of setting up a routine system in a complex service, but a number of challenges and barriers have to be overcome and therapist differences are apparent. More research on implementation and effectiveness is needed in diverse clinical settings.

Clinical Psychology & Psychotherapy, 2015

There are an increasing, but limited, number of studies investigating the benefits of mindfulness... more There are an increasing, but limited, number of studies investigating the benefits of mindfulness interventions for people experiencing psychosis. To our knowledge, changes following mindfulness for psychosis have not yet been explored from a personal construct perspective. This study had two main aims: (i) to explore changes in the way a person construes their self, others and their experience of psychosis following a Mindfulness-Based Cognitive Therapy (MBCT) group; and (ii) to replicate the findings of other studies exploring the feasibility and potential benefits of MBCT for psychosis. Sixteen participants, with experience of psychosis, completed an 8-week MBCT group. Participants completed pre-group and post-group assessments including a repertory grid, in addition to a range of outcome measures. There was some evidence of changes in construing following MBCT, with changes in the way participants viewed their ideal self and recovered self, and an indication of increased self-understanding. Improvements were found in participants' self-reported ability to act with awareness and in recovery. This study demonstrates the feasibility and potential benefits of MBCT groups for people experiencing psychosis. Furthermore, it provides some evidence of changes in construal following MBCT that warrant further exploration. Large-scale controlled trials of MBCT for psychosis are needed, as well as studies investigating the mechanisms of change. Copyright © 2015 John Wiley & Sons, Ltd. MBCT may contribute to change in individuals' perceptions and increase self-understanding. The study highlights the importance of measuring change in recovery following MBCT. Findings support the need for person-centred approaches to assessment and monitoring of personal change following therapy. Similar studies using a control group are needed in order to identify whether the changes found are attributable to participation in an MBCT group. Copyright © 2015 John Wiley & Sons, Ltd.

Mindfulness, 2015

ABSTRACT This main aim of this review was to synthesise and critically appraise studies investiga... more ABSTRACT This main aim of this review was to synthesise and critically appraise studies investigating (i) the association between mindfulness and self-esteem, and (ii) the impact of mindfulness-based interventions (MBIs) on self-esteem. A further aim was to identify priorities for future research. A systematic review was conducted using electronic databases, resulting in 32 studies meeting the inclusion criteria. Fifteen studies explored the association between dispositional mindfulness and self-esteem, and 17 studies investigated change in self-esteem following a MBI. Cross-sectional studies found significant positive correlations between dispositional mindfulness and self-esteem, whilst the majority of MBI studies resulted in significant increases in self-esteem. Studies were quality-assessed which highlighted that these findings should be interpreted with caution due to methodological weaknesses. More robust research is needed to corroborate these findings and to investigate the impact of mindfulness as an intervention for low self-esteem.

Psychotherapy Research, 2015

Despite prevailing beliefs about the potential benefits and harmfulness of mindfulness for people... more Despite prevailing beliefs about the potential benefits and harmfulness of mindfulness for people who hear voices, there is a paucity of research into staff and service user views. Q-methodology was used to explore views about mindfulness groups for voice-hearers. Opportunistic sampling of mental healthcare staff (N = 14) and service users with psychosis (N = 17). Both samples were analysed using principle components factor analysis to identify the range of attitudes held by staff and service users. Staff participants were particularly knowledgeable and interested in mindfulness. A single staff consensus factor was found suggesting mindfulness is helpful, and not harmful for mental health, but uncertainty surrounded its usefulness for voice-hearers. Service users held four distinct attitudes: (i) mindfulness helps to calm a racing mind; (ii) mindfulness helps to manage stress; (iii) mindfulness improves well-being, and does not alter the brain, reality beliefs, or cause madness; and (iv) mindfulness helps with managing thoughts, fostering acceptance, and is acceptable when delivered in a group format. Staff viewed mindfulness groups for psychosis as helpful, not harmful, but were uncertain about their utility. Consistent with previous research, service users viewed mindfulness groups as useful to promote well-being and reduce distress for individuals experiencing psychosis.

Psychotherapy Research, 2015

Despite prevailing beliefs about the potential benefits and harmfulness of mindfulness for people... more Despite prevailing beliefs about the potential benefits and harmfulness of mindfulness for people who hear voices, there is a paucity of research into staff and service user views. Q-methodology was used to explore views about mindfulness groups for voice-hearers. Opportunistic sampling of mental healthcare staff (N = 14) and service users with psychosis (N = 17). Both samples were analysed using principle components factor analysis to identify the range of attitudes held by staff and service users. Staff participants were particularly knowledgeable and interested in mindfulness. A single staff consensus factor was found suggesting mindfulness is helpful, and not harmful for mental health, but uncertainty surrounded its usefulness for voice-hearers. Service users held four distinct attitudes: (i) mindfulness helps to calm a racing mind; (ii) mindfulness helps to manage stress; (iii) mindfulness improves well-being, and does not alter the brain, reality beliefs, or cause madness; and (iv) mindfulness helps with managing thoughts, fostering acceptance, and is acceptable when delivered in a group format. Staff viewed mindfulness groups for psychosis as helpful, not harmful, but were uncertain about their utility. Consistent with previous research, service users viewed mindfulness groups as useful to promote well-being and reduce distress for individuals experiencing psychosis.

Clinical Psychology Forum

An audit conducted within the psychology department of a medium secure unit identified how psycho... more An audit conducted within the psychology department of a medium secure unit identified how psychologists spent their time at work. Indirect clinical work took up much of the psychologists’ time. Direct client contact accompanied a significant amount of preparatory/report-writing work.

In the UK, routine monitoring and feedback to therapists regarding client progress represents a p... more In the UK, routine monitoring and feedback to therapists regarding client progress represents a promising but neglected opportunity to improve therapeutic outcome…until now. This paper describes the first UK implementation of a Monitoring and Feedback System (MFS) in routine clinical practice, gives direct insight into encountered barriers and recommends solutions, to inspire and inform future adoption of similar systems. A methodology for the development and application of an MFS in an Adult Psychological Therapies service is presented. The service offers various therapies for clients defined as severe and complex. The backbone of the present MFS was two brief distress measures, which consenting clients completed before each therapy session, and one post session measure assessing helpfulness, alliance and stage of therapy. Therapists received feedback after each client’s fourth session. A three month pilot phase preceded official implementation, representing an opportunity to hone ...

Aim: This study aims to assess the feasibility and effectiveness of collecting sessional outcome ... more Aim: This study aims to assess the feasibility and effectiveness of collecting sessional outcome data from clients and providing feedback to therapists about symptoms and alliance. We aim to assess whether the benefits of monitoring and feedback on client outcome observed in the US, translate to routine UK secondary care psychological therapies. Therapists’ use of feedback and issues of acceptability and compliance will be explored. Method: Outcome data was collected from consenting clients across two South West Yorkshire sites. Our feedback system used two brief distress measures, which clients completed before each therapy session, and one post session measure assessing helpfulness, alliance and stage of therapy. This data combined with benchmark data determines clients ‘not on track’. Therapists received feedback after each client’s fourth session. Reflexive dialogue between therapists, service users and researchers was implemented. Results: To date, we have found that it is feas...

Research demonstrating the positive effects of Mindfulness-Based Interventions (MBIs) has led to ... more Research demonstrating the positive effects of Mindfulness-Based Interventions (MBIs) has led to a growing interest in the use of mindfulness across a range of populations and psychological difficulties. This thesis explores the feasibility and benefits of mindfulness in relation to self-esteem and psychosis.Paper one is a systematic review exploring the relationship between mindfulness and self-esteem. The review had two main aims: to synthesise and critically appraise studies exploring the association between mindfulness and self-esteem, and studies investigating the impact of MBIs on self-esteem. Thirty-two studies were identified and quality assessed to guide interpretation of results. All cross-sectional studies found significant positive correlations between dispositional mindfulness and self-esteem, whilst improvements in self-esteem were found in the majority of MBI studies. Despite largely positive findings, the review highlighted the need to interpret these with caution du...

Psychotherapy Research, 2015

To investigate the barriers and facilitators of an effective implementation of an outcome monitor... more To investigate the barriers and facilitators of an effective implementation of an outcome monitoring and feedback system in a UK National Health Service psychological therapy service. An outcome monitoring system was introduced in two services. Enhanced feedback was given to therapists after session 4. Qualitative and quantitative methods were used, including questionnaires for therapists and patients. Thematic analysis was carried out on written and verbal feedback from therapists. Analysis of patient outcomes for 202 episodes of therapy was compared with benchmark data of 136 episodes of therapy for which feedback was not given to therapists. Themes influencing the feasibility and acceptability of the feedback system were the extent to which therapists integrated the measures and feedback into the therapy, availability of administrative support, information technology, and complexity of the service. There were low levels of therapist actions resulting from the feedback, including discussing the feedback in supervision and with patients. The findings support the feasibility and acceptability of setting up a routine system in a complex service, but a number of challenges and barriers have to be overcome and therapist differences are apparent. More research on implementation and effectiveness is needed in diverse clinical settings.

Clinical Psychology & Psychotherapy, 2015

There are an increasing, but limited, number of studies investigating the benefits of mindfulness... more There are an increasing, but limited, number of studies investigating the benefits of mindfulness interventions for people experiencing psychosis. To our knowledge, changes following mindfulness for psychosis have not yet been explored from a personal construct perspective. This study had two main aims: (i) to explore changes in the way a person construes their self, others and their experience of psychosis following a Mindfulness-Based Cognitive Therapy (MBCT) group; and (ii) to replicate the findings of other studies exploring the feasibility and potential benefits of MBCT for psychosis. Sixteen participants, with experience of psychosis, completed an 8-week MBCT group. Participants completed pre-group and post-group assessments including a repertory grid, in addition to a range of outcome measures. There was some evidence of changes in construing following MBCT, with changes in the way participants viewed their ideal self and recovered self, and an indication of increased self-understanding. Improvements were found in participants' self-reported ability to act with awareness and in recovery. This study demonstrates the feasibility and potential benefits of MBCT groups for people experiencing psychosis. Furthermore, it provides some evidence of changes in construal following MBCT that warrant further exploration. Large-scale controlled trials of MBCT for psychosis are needed, as well as studies investigating the mechanisms of change. Copyright © 2015 John Wiley & Sons, Ltd. MBCT may contribute to change in individuals' perceptions and increase self-understanding. The study highlights the importance of measuring change in recovery following MBCT. Findings support the need for person-centred approaches to assessment and monitoring of personal change following therapy. Similar studies using a control group are needed in order to identify whether the changes found are attributable to participation in an MBCT group. Copyright © 2015 John Wiley & Sons, Ltd.

Mindfulness, 2015

ABSTRACT This main aim of this review was to synthesise and critically appraise studies investiga... more ABSTRACT This main aim of this review was to synthesise and critically appraise studies investigating (i) the association between mindfulness and self-esteem, and (ii) the impact of mindfulness-based interventions (MBIs) on self-esteem. A further aim was to identify priorities for future research. A systematic review was conducted using electronic databases, resulting in 32 studies meeting the inclusion criteria. Fifteen studies explored the association between dispositional mindfulness and self-esteem, and 17 studies investigated change in self-esteem following a MBI. Cross-sectional studies found significant positive correlations between dispositional mindfulness and self-esteem, whilst the majority of MBI studies resulted in significant increases in self-esteem. Studies were quality-assessed which highlighted that these findings should be interpreted with caution due to methodological weaknesses. More robust research is needed to corroborate these findings and to investigate the impact of mindfulness as an intervention for low self-esteem.

Psychotherapy Research, 2015

Despite prevailing beliefs about the potential benefits and harmfulness of mindfulness for people... more Despite prevailing beliefs about the potential benefits and harmfulness of mindfulness for people who hear voices, there is a paucity of research into staff and service user views. Q-methodology was used to explore views about mindfulness groups for voice-hearers. Opportunistic sampling of mental healthcare staff (N = 14) and service users with psychosis (N = 17). Both samples were analysed using principle components factor analysis to identify the range of attitudes held by staff and service users. Staff participants were particularly knowledgeable and interested in mindfulness. A single staff consensus factor was found suggesting mindfulness is helpful, and not harmful for mental health, but uncertainty surrounded its usefulness for voice-hearers. Service users held four distinct attitudes: (i) mindfulness helps to calm a racing mind; (ii) mindfulness helps to manage stress; (iii) mindfulness improves well-being, and does not alter the brain, reality beliefs, or cause madness; and (iv) mindfulness helps with managing thoughts, fostering acceptance, and is acceptable when delivered in a group format. Staff viewed mindfulness groups for psychosis as helpful, not harmful, but were uncertain about their utility. Consistent with previous research, service users viewed mindfulness groups as useful to promote well-being and reduce distress for individuals experiencing psychosis.