Rory Allott - Academia.edu (original) (raw)

Papers by Rory Allott

Research paper thumbnail of Spot the Difference: Comparing Three Approaches to CBT

Research paper thumbnail of Perceived empowerment in people with a dual diagnosis of schizophrenia spectrum disorder and substance misuse

Social Psychiatry and Psychiatric Epidemiology, Oct 19, 2013

Purpose The aims of the present study were to validate a measure of empowerment in a British popu... more Purpose The aims of the present study were to validate a measure of empowerment in a British population of people with a dual diagnosis of schizophrenia and substance misuse and assess relationships between empowerment and other key outcomes. Method Patients participating in a large randomised control trial for Motivational Interviewing for Drug and Alcohol misuse in Schizophrenia or psychosis (MIDAS trial) completed measures of empowerment, symptoms, global functioning and substance use at baseline, 12-and 24-month follow-ups. Results A three factor model of empowerment: self-efficacy and control; power and anger; and activism provided the best fit of the data across all three time points. There was some evidence of associations between empowerment and both symptoms and global functioning, although these associations were not consistent across subscales. Changes in empowerment predicted changes in symptoms and functioning at follow-up. Conclusions Empowerment is a broadly defined construct and its meaning may differ across different populations of people with severe and enduring mental health problems. Empowerment is a key component of recovery and should be assessed in treatments in addition to more traditional outcome measures of symptoms and functioning.

Research paper thumbnail of Psychiatric nursing staff construing people who experience psychosis and substance misuse

Research paper thumbnail of The use of the repertory grid technique to examine staff beliefs about clients with dual diagnosis

Clinical Psychology & Psychotherapy, Mar 1, 2009

Aim: This paper reports a study exploring how individual psychiatric staff construes clients with... more Aim: This paper reports a study exploring how individual psychiatric staff construes clients with psychosis who misuse substances. Background: A dual diagnosis of substance misuse is common in clients with psychosis. Previous studies have suggested that psychiatric staff feel ill-equipped to work with these clients, and hold negative views of them, affecting client care and recovery. Understanding staff attitudes can inform training and practice. Method: Twelve psychiatric nursing staff working in an inpatient service for adults with enduring mental health diffi culties in England were interviewed. Using a repertory grid technique, staff were asked to describe clients and acquaintances who did and did not misuse substances, themselves and colleagues. Findings: All staff made critical judgements of some clients, particularly clients with dual diagnosis, but were less judgemental towards acquaintances who misused substances. Staff who used fewer dimensions to construe people appeared to make a clear distinction between clients and non-clients. This distinction was not apparent for staff with more cognitively complex construct systems. Specifi c factors that could be implicated in the organization of individuals' construct systems included personal experience of services as a carer; these staff made less distinction between clients and non-clients. Conclusion: Further training is needed for staff working with clients with a dual diagnosis. Training packages need to consider the personal experiences and views of staff. Reducing the boundaries between staff and clients might enable staff to better understand the actions of clients and improve client care.

Research paper thumbnail of Integrated Motivational Interviewing and Cognitive-Behavioural Therapy for Bipolar Disorder with Comorbid Substance Use

Clinical Psychology & Psychotherapy, Sep 1, 2011

Although comorbid substance use is a common problem in bipolar disorder, there has been little re... more Although comorbid substance use is a common problem in bipolar disorder, there has been little research into options for psychological therapy. Studies to date have concentrated on purely cognitive-behavioural approaches, which are not equipped to deal with the ambivalence to change exhibited by many towards therapy designed to change substance use. This paper provides the first report of an integrated psychological treatment approach for bipolar disorder with comorbid substance use. The intervention reported combines motivational interviewing and cognitive-behavioural therapy to address ambivalence and equips individuals with strategies to address substance use. Across five individual case studies, preliminary evidence is reported to support the acceptability and the feasibility of this approach. Despite most participants not highlighting their substance use as a primary therapy target, all but one exhibited reduced use of drugs or alcohol at the end of therapy, sustained at 6 months' follow-up. There was some evidence for improvements in mood symptoms and impulsiveness, but this was less clear-cut. The impact of social and relationship issues on therapy process and outcome is discussed. The implications of the current findings for future intervention research in this area are considered.

Research paper thumbnail of The development and evaluation of a brief risk screening instrument for the psychiatric inpatient setting

Journal of Psychiatric and Mental Health Nursing, 1999

The development and evaluation of a brief risk screening instrument for the psychiatric inpatient... more The development and evaluation of a brief risk screening instrument for the psychiatric inpatient setting This paper reports on the development and evaluation of a risk screening instrument (RSI) intended for use by nursing sta on general acute psychiatric admission wards. The RSI comprised six questions concerning patient status on admission (e.g. sex, legal status, employment) and 11 items of judgement concerning the presentation of the patient (e.g. threatening behaviour, suicidality, family and social support). The interrater reliability of the RSI was calculated to be 85% overall. The predictive value of the RSI was not con®rmed when tested against harmful incidents subsequent to admission. However, the mean RSI score of that group of patients involved in harmful incidents tended to be higher than that group of patients not involved in such incidents, and all such incidents were found to occur within eight days of admission. Analysis of other data collected in the course of the study revealed discrete patient groups and provided systematic insights into their characteristics, which are potentially valuable when considering the nursing skills required on acute psychiatric inpatient units. It is concluded that the RSI tested has the potential to contribute to the assessment and management of risk within the acute psychiatric inpatient setting, by augmenting and guiding clinical judgement.

Research paper thumbnail of Parents who experience psychosis: A qualitative exploration

British Journal of Medical Psychology, Mar 13, 2023

Research paper thumbnail of Cognitive Behavioural Therapy in Management of Hyperacusis: A Narrative Review and Clinical Implementation (Review Article)

Background and Aim: The aim of this article was to critically discuss the clinical application of... more Background and Aim: The aim of this article was to critically discuss the clinical application of a cognitive behaviour therapy (CBT) protocol for the treatment of hyperacusis and its associated distress. Methods: Narrative review Recent Findings: Reviewing the research literature suggests that hyperacusis, anxiety and safety seeking behaviours may be linked. Therefore, it seems reasonable to suggest that clinical management of hyperacusis should also include addressing co-existing anxiety and avoidance behaviour. Although, there is strong evidence supporting the effectiveness of CBT in treating anxiety, the studies directly assessing the effect of CBT on hyperacusis are limited. In this paper, the clinical implementation of a CBT protocol for hyperacusis rehabilitation is discussed. Conclusion: Although a causal relationship between anxiety and hyperacusis is not clear, there is a growing body of evidence suggesting a possible link between them. In the absence of a cure for hyperacusis, treatment of the anxiety component of the condition could be beneficial.

Research paper thumbnail of Cognitive behavioural therapy in management of hyperacusis: a narrative review and clinical implementation

DOAJ (DOAJ: Directory of Open Access Journals), Jun 1, 2016

Background and Aim: The aim of this article was to critically discuss the clinical application of... more Background and Aim: The aim of this article was to critically discuss the clinical application of a cognitive behaviour therapy (CBT) protocol for the treatment of hyperacusis and its associated distress. Methods: Narrative review Recent Findings: Reviewing the research literature suggests that hyperacusis, anxiety and safety seeking behaviours may be linked. Therefore, it seems reasonable to suggest that clinical management of hyperacusis should also include addressing co-existing anxiety and avoidance behaviour. Although, there is strong evidence supporting the effectiveness of CBT in treating anxiety, the studies directly assessing the effect of CBT on hyperacusis are limited. In this paper, the clinical implementation of a CBT protocol for hyperacusis rehabilitation is discussed. Conclusion: Although a causal relationship between anxiety and hyperacusis is not clear, there is a growing body of evidence suggesting a possible link between them. In the absence of a cure for hyperacusis, treatment of the anxiety component of the condition could be beneficial.

Research paper thumbnail of What about the children? Adult mental health practitioners' experiences and views of family‐focused practice in Early Intervention Services

Psychology and Psychotherapy: Theory, Research and Practice

BackgroundThere is a significant risk of negative outcomes for families when a parent experiences... more BackgroundThere is a significant risk of negative outcomes for families when a parent experiences serious mental illness. Family‐focused practice (FFP) emphasises the “whole family” as the unit of care and has been found to improve outcomes for service users and their families. Despite its benefits, FFP is not routinely implemented in UK adult mental health services. This study explores adult mental health practitioners' experiences and views of FFP within Early Intervention Psychosis Services in the UK.MethodsSixteen adult mental health practitioners employed in three Early Intervention Psychosis teams in the Northwest of England were interviewed. Interview data were analysed using thematic analysis.ResultsFive core themes were generated: (1) A limited understanding of FFP, (2) Our practitioners, (3) Our approach, (4) Our families and (5) Our services. Practitioners' understanding of FFP was limited and typically excluded dependent children. Practitioners' age, professi...

Research paper thumbnail of Parents who experience psychosis: A qualitative exploration

British Journal of Medical Psychology, Mar 13, 2023

Research paper thumbnail of Spot the Difference: Comparing Three Approaches to CBT

Research paper thumbnail of Cognitive behavioural therapy in management of hyperacusis: a narrative review and clinical implementation

Auditory and Vestibular Research, 2016

Background and Aim: The aim of this article was to critically discuss the clinical application of... more Background and Aim: The aim of this article was to critically discuss the clinical application of a cognitive behaviour therapy (CBT) protocol for the treatment of hyperacusis and its asso­ciated distress. Methods: Narrative review Recent Findings: Reviewing the research lit­erature suggests that hyperacusis, anxiety and safety seeking behaviours may be linked. Therefore, it seems reasonable to suggest that clinical management of hyperacusis should also include addressing co-existing anxiety and avoidance behaviour. Although, there is strong evidence supporting the effectiveness of CBT in treating anxiety, the studies directly assessing the effect of CBT on hyperacusis are limited. In this paper, the clinical implementation of a CBT protocol for hyperacusis rehabilitation is discussed. Conclusion: Although a causal relationship bet­ween anxiety and hyperacusis is not clear, there is a growing body of evidence suggesting a pos­sible link between them. In the absence of a cure for hyp...

Research paper thumbnail of Psychiatric nursing staff construing people who experience psychosis and substance misuse

In Dcp Annual Conference 13 Dec 2007 14 Dec 2007 London 2007, 2007

Research paper thumbnail of Perceived empowerment in people with a dual diagnosis of schizophrenia spectrum disorder and substance misuse

Social Psychiatry and Psychiatric Epidemiology, 2013

Purpose The aims of the present study were to validate a measure of empowerment in a British popu... more Purpose The aims of the present study were to validate a measure of empowerment in a British population of people with a dual diagnosis of schizophrenia and substance misuse and assess relationships between empowerment and other key outcomes. Method Patients participating in a large randomised control trial for Motivational Interviewing for Drug and Alcohol misuse in Schizophrenia or psychosis (MIDAS trial) completed measures of empowerment, symptoms, global functioning and substance use at baseline, 12-and 24-month follow-ups. Results A three factor model of empowerment: self-efficacy and control; power and anger; and activism provided the best fit of the data across all three time points. There was some evidence of associations between empowerment and both symptoms and global functioning, although these associations were not consistent across subscales. Changes in empowerment predicted changes in symptoms and functioning at follow-up. Conclusions Empowerment is a broadly defined construct and its meaning may differ across different populations of people with severe and enduring mental health problems. Empowerment is a key component of recovery and should be assessed in treatments in addition to more traditional outcome measures of symptoms and functioning.

Research paper thumbnail of Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial

BMJ, 2010

To evaluate the effectiveness of integrated motivational interviewing and cognitive behavioural t... more To evaluate the effectiveness of integrated motivational interviewing and cognitive behavioural therapy in addition to standard care for patients with psychosis and a comorbid substance use problem. Two centre, open, rater blind randomised controlled trial. Secondary care in the United Kingdom. 327 patients with a clinical diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder and a diagnosis of dependence on or misuse of drugs, alcohol, or both according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. The intervention was integrated motivational interviewing and cognitive behavioural therapy plus standard care, which was compared with standard care alone. Phase one of therapy-"motivation building"-concerns engaging the patient, then exploring and resolving ambivalence for change in substance use. Phase two-"action"-supports and facilitates change using cognitive behavioural approaches. Up to 26 therapy sessions were delivered over one year. The primary outcome was death from any cause or admission to hospital in the 12 months after completion of therapy. Secondary outcomes were frequency and amount of substance use (assessed using the timeline followback method), readiness to change, perceived negative consequences of use, psychotic symptom ratings, number and duration of relapses, and global assessment of functioning and deliberate self harm at 12 and 24 months, with additional timeline followback assessments at 6 and 18 months. Analysis was by intention to treat and robust treatment effect estimates were produced. 327 participants were randomly allocated to either the intervention (n=164) or treatment as usual (n=163). At 24 months, 326 (99.7%) were assessed on the primary outcome and 246 (75.2%) on the main secondary outcomes. Treatment had no beneficial effect on hospital admissions or death during follow-up, with 23.3% (38/163) of the therapy group and 20.2% (33/163) of controls deceased or admitted (adjusted odds ratio 1.16, 95% confidence interval 0.68 to 1.99; P=0.579). Therapy had no effect on the frequency of substance use or the perceived negative consequences of misuse, but did have a statistically significant effect on amount used per substance using day (adjusted ORs for main substance 1.50, 95% CI 1.08 to 2.09; P=0.016; and all substances 1.48, 95% CI 1.07 to 2.05; P=0.017). Treatment had a statistically significant effect on readiness to change use at 12 months (adjusted OR 2.05, 95% CI 1.26 to 3.31; P=0.004) that was not maintained at 24 months (0.78, 95% CI 0.48 to 1.28; P=0.320). There were no effects of treatment on clinical outcomes such as relapses, psychotic symptoms, functioning, and self harm. Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and substance misuse do not improve outcome…

Research paper thumbnail of The use of the repertory grid technique to examine staff beliefs about clients with dual diagnosis

Clinical Psychology & …, 2009

Aim: This paper reports a study exploring how individual psychiatric staff construes clients with... more Aim: This paper reports a study exploring how individual psychiatric staff construes clients with psychosis who misuse substances.Background: A dual diagnosis of substance misuse is common in clients with psychosis. Previous studies have suggested that psychiatric staff feel ill-equipped to work with these clients, and hold negative views of them, affecting client care and recovery. Understanding staff attitudes can inform training and practice.Method: Twelve psychiatric nursing staff working in an inpatient service for adults with enduring mental health difficulties in England were interviewed. Using a repertory grid technique, staff were asked to describe clients and acquaintances who did and did not misuse substances, themselves and colleagues.Findings: All staff made critical judgements of some clients, particularly clients with dual diagnosis, but were less judgemental towards acquaintances who misused substances. Staff who used fewer dimensions to construe people appeared to make a clear distinction between clients and non-clients. This distinction was not apparent for staff with more cognitively complex construct systems. Specific factors that could be implicated in the organization of individuals' construct systems included personal experience of services as a carer; these staff made less distinction between clients and non-clients.Conclusion: Further training is needed for staff working with clients with a dual diagnosis. Training packages need to consider the personal experiences and views of staff. Reducing the boundaries between staff and clients might enable staff to better understand the actions of clients and improve client care. Copyright © 2009 John Wiley & Sons, Ltd.

Research paper thumbnail of Distress in Parkinson's disease: contributions of disease factors and metacognitive style

The British Journal of Psychiatry, 2005

Research paper thumbnail of Improving general practitioners’ assessment and management of suicide risk

… Journal of Health …, 2001

Standards for assessing and managing suicide risk were developed and incorporated into a guidance... more Standards for assessing and managing suicide risk were developed and incorporated into a guidance manual for general practitioners. The effects of the manual on opinions and practice were evaluated using a quasi-experimental controlled before/after design, comparing participating general practitioners with others who did not use the manual. Thirty four general practitioners participated over a six-month period. The intervention group showed changes in perceptions, with increased satisfaction with their own methods and in their recognition and assessment of suicide risk. Their practice changed, with increased recording of relevant factors in notes. The comparison group did not change in these ways. It is concluded that general practitioners' practice and opinions in assessing and managing suicide risk were significantly improved using a minimal intervention. Given the importance of the topic and the small size of this study, further research is needed, examining changes in professional practice, knowledge and attitudes.

Research paper thumbnail of Drug education in primary schools: putting policy and research into practice

Health Education, 2000

Reports on evaluation of a school-based drug education programme delivered throughout a mixed rur... more Reports on evaluation of a school-based drug education programme delivered throughout a mixed rural and urban county in the North of England. Measurement approaches and methods to encourage parents to participate are described. Building on recent research, and in keeping with current UK drug prevention policy, the programme aimed to provide pupils with information about drugs and training in life and resistance skills. The needs of teachers, pupils and parents were assessed, and training and support provided based on those needs. This phase of the project was conducted in ten schools and involved 633 children aged nine to ten years, 33 teachers and 320 parents. Needs assessment showed that parents and teachers lacked confidence, knowledge and skills in talking about drugs with young people. Following the intervention, teachers reported improvement in all these areas. Pupils showed more realism in their statements about coping with drug issues, and parents expressed more confidence in talking to their children about drugs after the intervention. New methods to improve attendance at parent evenings were well received. Evaluation and needs assessment methods need to be improved still further, and there is a need for more dismantling and process evaluations of multi-component programmes to determine what works and why.

Research paper thumbnail of Spot the Difference: Comparing Three Approaches to CBT

Research paper thumbnail of Perceived empowerment in people with a dual diagnosis of schizophrenia spectrum disorder and substance misuse

Social Psychiatry and Psychiatric Epidemiology, Oct 19, 2013

Purpose The aims of the present study were to validate a measure of empowerment in a British popu... more Purpose The aims of the present study were to validate a measure of empowerment in a British population of people with a dual diagnosis of schizophrenia and substance misuse and assess relationships between empowerment and other key outcomes. Method Patients participating in a large randomised control trial for Motivational Interviewing for Drug and Alcohol misuse in Schizophrenia or psychosis (MIDAS trial) completed measures of empowerment, symptoms, global functioning and substance use at baseline, 12-and 24-month follow-ups. Results A three factor model of empowerment: self-efficacy and control; power and anger; and activism provided the best fit of the data across all three time points. There was some evidence of associations between empowerment and both symptoms and global functioning, although these associations were not consistent across subscales. Changes in empowerment predicted changes in symptoms and functioning at follow-up. Conclusions Empowerment is a broadly defined construct and its meaning may differ across different populations of people with severe and enduring mental health problems. Empowerment is a key component of recovery and should be assessed in treatments in addition to more traditional outcome measures of symptoms and functioning.

Research paper thumbnail of Psychiatric nursing staff construing people who experience psychosis and substance misuse

Research paper thumbnail of The use of the repertory grid technique to examine staff beliefs about clients with dual diagnosis

Clinical Psychology & Psychotherapy, Mar 1, 2009

Aim: This paper reports a study exploring how individual psychiatric staff construes clients with... more Aim: This paper reports a study exploring how individual psychiatric staff construes clients with psychosis who misuse substances. Background: A dual diagnosis of substance misuse is common in clients with psychosis. Previous studies have suggested that psychiatric staff feel ill-equipped to work with these clients, and hold negative views of them, affecting client care and recovery. Understanding staff attitudes can inform training and practice. Method: Twelve psychiatric nursing staff working in an inpatient service for adults with enduring mental health diffi culties in England were interviewed. Using a repertory grid technique, staff were asked to describe clients and acquaintances who did and did not misuse substances, themselves and colleagues. Findings: All staff made critical judgements of some clients, particularly clients with dual diagnosis, but were less judgemental towards acquaintances who misused substances. Staff who used fewer dimensions to construe people appeared to make a clear distinction between clients and non-clients. This distinction was not apparent for staff with more cognitively complex construct systems. Specifi c factors that could be implicated in the organization of individuals' construct systems included personal experience of services as a carer; these staff made less distinction between clients and non-clients. Conclusion: Further training is needed for staff working with clients with a dual diagnosis. Training packages need to consider the personal experiences and views of staff. Reducing the boundaries between staff and clients might enable staff to better understand the actions of clients and improve client care.

Research paper thumbnail of Integrated Motivational Interviewing and Cognitive-Behavioural Therapy for Bipolar Disorder with Comorbid Substance Use

Clinical Psychology & Psychotherapy, Sep 1, 2011

Although comorbid substance use is a common problem in bipolar disorder, there has been little re... more Although comorbid substance use is a common problem in bipolar disorder, there has been little research into options for psychological therapy. Studies to date have concentrated on purely cognitive-behavioural approaches, which are not equipped to deal with the ambivalence to change exhibited by many towards therapy designed to change substance use. This paper provides the first report of an integrated psychological treatment approach for bipolar disorder with comorbid substance use. The intervention reported combines motivational interviewing and cognitive-behavioural therapy to address ambivalence and equips individuals with strategies to address substance use. Across five individual case studies, preliminary evidence is reported to support the acceptability and the feasibility of this approach. Despite most participants not highlighting their substance use as a primary therapy target, all but one exhibited reduced use of drugs or alcohol at the end of therapy, sustained at 6 months' follow-up. There was some evidence for improvements in mood symptoms and impulsiveness, but this was less clear-cut. The impact of social and relationship issues on therapy process and outcome is discussed. The implications of the current findings for future intervention research in this area are considered.

Research paper thumbnail of The development and evaluation of a brief risk screening instrument for the psychiatric inpatient setting

Journal of Psychiatric and Mental Health Nursing, 1999

The development and evaluation of a brief risk screening instrument for the psychiatric inpatient... more The development and evaluation of a brief risk screening instrument for the psychiatric inpatient setting This paper reports on the development and evaluation of a risk screening instrument (RSI) intended for use by nursing sta on general acute psychiatric admission wards. The RSI comprised six questions concerning patient status on admission (e.g. sex, legal status, employment) and 11 items of judgement concerning the presentation of the patient (e.g. threatening behaviour, suicidality, family and social support). The interrater reliability of the RSI was calculated to be 85% overall. The predictive value of the RSI was not con®rmed when tested against harmful incidents subsequent to admission. However, the mean RSI score of that group of patients involved in harmful incidents tended to be higher than that group of patients not involved in such incidents, and all such incidents were found to occur within eight days of admission. Analysis of other data collected in the course of the study revealed discrete patient groups and provided systematic insights into their characteristics, which are potentially valuable when considering the nursing skills required on acute psychiatric inpatient units. It is concluded that the RSI tested has the potential to contribute to the assessment and management of risk within the acute psychiatric inpatient setting, by augmenting and guiding clinical judgement.

Research paper thumbnail of Parents who experience psychosis: A qualitative exploration

British Journal of Medical Psychology, Mar 13, 2023

Research paper thumbnail of Cognitive Behavioural Therapy in Management of Hyperacusis: A Narrative Review and Clinical Implementation (Review Article)

Background and Aim: The aim of this article was to critically discuss the clinical application of... more Background and Aim: The aim of this article was to critically discuss the clinical application of a cognitive behaviour therapy (CBT) protocol for the treatment of hyperacusis and its associated distress. Methods: Narrative review Recent Findings: Reviewing the research literature suggests that hyperacusis, anxiety and safety seeking behaviours may be linked. Therefore, it seems reasonable to suggest that clinical management of hyperacusis should also include addressing co-existing anxiety and avoidance behaviour. Although, there is strong evidence supporting the effectiveness of CBT in treating anxiety, the studies directly assessing the effect of CBT on hyperacusis are limited. In this paper, the clinical implementation of a CBT protocol for hyperacusis rehabilitation is discussed. Conclusion: Although a causal relationship between anxiety and hyperacusis is not clear, there is a growing body of evidence suggesting a possible link between them. In the absence of a cure for hyperacusis, treatment of the anxiety component of the condition could be beneficial.

Research paper thumbnail of Cognitive behavioural therapy in management of hyperacusis: a narrative review and clinical implementation

DOAJ (DOAJ: Directory of Open Access Journals), Jun 1, 2016

Background and Aim: The aim of this article was to critically discuss the clinical application of... more Background and Aim: The aim of this article was to critically discuss the clinical application of a cognitive behaviour therapy (CBT) protocol for the treatment of hyperacusis and its associated distress. Methods: Narrative review Recent Findings: Reviewing the research literature suggests that hyperacusis, anxiety and safety seeking behaviours may be linked. Therefore, it seems reasonable to suggest that clinical management of hyperacusis should also include addressing co-existing anxiety and avoidance behaviour. Although, there is strong evidence supporting the effectiveness of CBT in treating anxiety, the studies directly assessing the effect of CBT on hyperacusis are limited. In this paper, the clinical implementation of a CBT protocol for hyperacusis rehabilitation is discussed. Conclusion: Although a causal relationship between anxiety and hyperacusis is not clear, there is a growing body of evidence suggesting a possible link between them. In the absence of a cure for hyperacusis, treatment of the anxiety component of the condition could be beneficial.

Research paper thumbnail of What about the children? Adult mental health practitioners' experiences and views of family‐focused practice in Early Intervention Services

Psychology and Psychotherapy: Theory, Research and Practice

BackgroundThere is a significant risk of negative outcomes for families when a parent experiences... more BackgroundThere is a significant risk of negative outcomes for families when a parent experiences serious mental illness. Family‐focused practice (FFP) emphasises the “whole family” as the unit of care and has been found to improve outcomes for service users and their families. Despite its benefits, FFP is not routinely implemented in UK adult mental health services. This study explores adult mental health practitioners' experiences and views of FFP within Early Intervention Psychosis Services in the UK.MethodsSixteen adult mental health practitioners employed in three Early Intervention Psychosis teams in the Northwest of England were interviewed. Interview data were analysed using thematic analysis.ResultsFive core themes were generated: (1) A limited understanding of FFP, (2) Our practitioners, (3) Our approach, (4) Our families and (5) Our services. Practitioners' understanding of FFP was limited and typically excluded dependent children. Practitioners' age, professi...

Research paper thumbnail of Parents who experience psychosis: A qualitative exploration

British Journal of Medical Psychology, Mar 13, 2023

Research paper thumbnail of Spot the Difference: Comparing Three Approaches to CBT

Research paper thumbnail of Cognitive behavioural therapy in management of hyperacusis: a narrative review and clinical implementation

Auditory and Vestibular Research, 2016

Background and Aim: The aim of this article was to critically discuss the clinical application of... more Background and Aim: The aim of this article was to critically discuss the clinical application of a cognitive behaviour therapy (CBT) protocol for the treatment of hyperacusis and its asso­ciated distress. Methods: Narrative review Recent Findings: Reviewing the research lit­erature suggests that hyperacusis, anxiety and safety seeking behaviours may be linked. Therefore, it seems reasonable to suggest that clinical management of hyperacusis should also include addressing co-existing anxiety and avoidance behaviour. Although, there is strong evidence supporting the effectiveness of CBT in treating anxiety, the studies directly assessing the effect of CBT on hyperacusis are limited. In this paper, the clinical implementation of a CBT protocol for hyperacusis rehabilitation is discussed. Conclusion: Although a causal relationship bet­ween anxiety and hyperacusis is not clear, there is a growing body of evidence suggesting a pos­sible link between them. In the absence of a cure for hyp...

Research paper thumbnail of Psychiatric nursing staff construing people who experience psychosis and substance misuse

In Dcp Annual Conference 13 Dec 2007 14 Dec 2007 London 2007, 2007

Research paper thumbnail of Perceived empowerment in people with a dual diagnosis of schizophrenia spectrum disorder and substance misuse

Social Psychiatry and Psychiatric Epidemiology, 2013

Purpose The aims of the present study were to validate a measure of empowerment in a British popu... more Purpose The aims of the present study were to validate a measure of empowerment in a British population of people with a dual diagnosis of schizophrenia and substance misuse and assess relationships between empowerment and other key outcomes. Method Patients participating in a large randomised control trial for Motivational Interviewing for Drug and Alcohol misuse in Schizophrenia or psychosis (MIDAS trial) completed measures of empowerment, symptoms, global functioning and substance use at baseline, 12-and 24-month follow-ups. Results A three factor model of empowerment: self-efficacy and control; power and anger; and activism provided the best fit of the data across all three time points. There was some evidence of associations between empowerment and both symptoms and global functioning, although these associations were not consistent across subscales. Changes in empowerment predicted changes in symptoms and functioning at follow-up. Conclusions Empowerment is a broadly defined construct and its meaning may differ across different populations of people with severe and enduring mental health problems. Empowerment is a key component of recovery and should be assessed in treatments in addition to more traditional outcome measures of symptoms and functioning.

Research paper thumbnail of Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial

BMJ, 2010

To evaluate the effectiveness of integrated motivational interviewing and cognitive behavioural t... more To evaluate the effectiveness of integrated motivational interviewing and cognitive behavioural therapy in addition to standard care for patients with psychosis and a comorbid substance use problem. Two centre, open, rater blind randomised controlled trial. Secondary care in the United Kingdom. 327 patients with a clinical diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder and a diagnosis of dependence on or misuse of drugs, alcohol, or both according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. The intervention was integrated motivational interviewing and cognitive behavioural therapy plus standard care, which was compared with standard care alone. Phase one of therapy-"motivation building"-concerns engaging the patient, then exploring and resolving ambivalence for change in substance use. Phase two-"action"-supports and facilitates change using cognitive behavioural approaches. Up to 26 therapy sessions were delivered over one year. The primary outcome was death from any cause or admission to hospital in the 12 months after completion of therapy. Secondary outcomes were frequency and amount of substance use (assessed using the timeline followback method), readiness to change, perceived negative consequences of use, psychotic symptom ratings, number and duration of relapses, and global assessment of functioning and deliberate self harm at 12 and 24 months, with additional timeline followback assessments at 6 and 18 months. Analysis was by intention to treat and robust treatment effect estimates were produced. 327 participants were randomly allocated to either the intervention (n=164) or treatment as usual (n=163). At 24 months, 326 (99.7%) were assessed on the primary outcome and 246 (75.2%) on the main secondary outcomes. Treatment had no beneficial effect on hospital admissions or death during follow-up, with 23.3% (38/163) of the therapy group and 20.2% (33/163) of controls deceased or admitted (adjusted odds ratio 1.16, 95% confidence interval 0.68 to 1.99; P=0.579). Therapy had no effect on the frequency of substance use or the perceived negative consequences of misuse, but did have a statistically significant effect on amount used per substance using day (adjusted ORs for main substance 1.50, 95% CI 1.08 to 2.09; P=0.016; and all substances 1.48, 95% CI 1.07 to 2.05; P=0.017). Treatment had a statistically significant effect on readiness to change use at 12 months (adjusted OR 2.05, 95% CI 1.26 to 3.31; P=0.004) that was not maintained at 24 months (0.78, 95% CI 0.48 to 1.28; P=0.320). There were no effects of treatment on clinical outcomes such as relapses, psychotic symptoms, functioning, and self harm. Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and substance misuse do not improve outcome…

Research paper thumbnail of The use of the repertory grid technique to examine staff beliefs about clients with dual diagnosis

Clinical Psychology & …, 2009

Aim: This paper reports a study exploring how individual psychiatric staff construes clients with... more Aim: This paper reports a study exploring how individual psychiatric staff construes clients with psychosis who misuse substances.Background: A dual diagnosis of substance misuse is common in clients with psychosis. Previous studies have suggested that psychiatric staff feel ill-equipped to work with these clients, and hold negative views of them, affecting client care and recovery. Understanding staff attitudes can inform training and practice.Method: Twelve psychiatric nursing staff working in an inpatient service for adults with enduring mental health difficulties in England were interviewed. Using a repertory grid technique, staff were asked to describe clients and acquaintances who did and did not misuse substances, themselves and colleagues.Findings: All staff made critical judgements of some clients, particularly clients with dual diagnosis, but were less judgemental towards acquaintances who misused substances. Staff who used fewer dimensions to construe people appeared to make a clear distinction between clients and non-clients. This distinction was not apparent for staff with more cognitively complex construct systems. Specific factors that could be implicated in the organization of individuals' construct systems included personal experience of services as a carer; these staff made less distinction between clients and non-clients.Conclusion: Further training is needed for staff working with clients with a dual diagnosis. Training packages need to consider the personal experiences and views of staff. Reducing the boundaries between staff and clients might enable staff to better understand the actions of clients and improve client care. Copyright © 2009 John Wiley & Sons, Ltd.

Research paper thumbnail of Distress in Parkinson's disease: contributions of disease factors and metacognitive style

The British Journal of Psychiatry, 2005

Research paper thumbnail of Improving general practitioners’ assessment and management of suicide risk

… Journal of Health …, 2001

Standards for assessing and managing suicide risk were developed and incorporated into a guidance... more Standards for assessing and managing suicide risk were developed and incorporated into a guidance manual for general practitioners. The effects of the manual on opinions and practice were evaluated using a quasi-experimental controlled before/after design, comparing participating general practitioners with others who did not use the manual. Thirty four general practitioners participated over a six-month period. The intervention group showed changes in perceptions, with increased satisfaction with their own methods and in their recognition and assessment of suicide risk. Their practice changed, with increased recording of relevant factors in notes. The comparison group did not change in these ways. It is concluded that general practitioners' practice and opinions in assessing and managing suicide risk were significantly improved using a minimal intervention. Given the importance of the topic and the small size of this study, further research is needed, examining changes in professional practice, knowledge and attitudes.

Research paper thumbnail of Drug education in primary schools: putting policy and research into practice

Health Education, 2000

Reports on evaluation of a school-based drug education programme delivered throughout a mixed rur... more Reports on evaluation of a school-based drug education programme delivered throughout a mixed rural and urban county in the North of England. Measurement approaches and methods to encourage parents to participate are described. Building on recent research, and in keeping with current UK drug prevention policy, the programme aimed to provide pupils with information about drugs and training in life and resistance skills. The needs of teachers, pupils and parents were assessed, and training and support provided based on those needs. This phase of the project was conducted in ten schools and involved 633 children aged nine to ten years, 33 teachers and 320 parents. Needs assessment showed that parents and teachers lacked confidence, knowledge and skills in talking about drugs with young people. Following the intervention, teachers reported improvement in all these areas. Pupils showed more realism in their statements about coping with drug issues, and parents expressed more confidence in talking to their children about drugs after the intervention. New methods to improve attendance at parent evenings were well received. Evaluation and needs assessment methods need to be improved still further, and there is a need for more dismantling and process evaluations of multi-component programmes to determine what works and why.