The experience of hearing distressing voices has recently been conceptualised within relational terms, whereby the voice is perceived as a person-like stimulus with whom the hearer has a difficult ...relationship. Therapeutic approaches are being developed that seek to modify the relating of the hearer towards the voice, and a conversation has begun about what or who may be changing within these therapies. We sought to empirically inform this discussion by exploring the experience of patients who had received Relating Therapy. Methods: A semi-structured change interview was used to explore the experience of nine participants. Interviews were transcribed verbatim and were analysed using thematic analysis. Results: The analysis of data generated three themes - two of which related to aspects of change (in me and in voices), and one which related to a therapy process (role plays). Conclusions: The findings suggested that changes can be evident in both the hearer and the voice, as a consequence of the hearer adopting a different (more assertive) approach to communicating with the voice. Such communication can enable the hearer to perceive themselves as less vulnerable to the communicative intentions of others.
Background
Calls have been made to rethink the mental health support currently available for young people. This study aims to help re-focus and reduce the inaccessibility of mental health services by ...offering an adapted version of a theoretically-driven, evidence-based, guided psychosocial intervention known as ‘Groups 4 Health’ (G4H). To date, the G4H intervention has mainly been trialled in Australia, with promising positive effects on social connection, mental health and well-being. The present study examines the feasibility of running a randomised controlled trial when delivering the G4H intervention for young people in the UK.
Methods
The TOGETHER study is a feasibility randomised controlled trial of an adapted version of the G4H intervention. Participants are aged 16–25, currently experiencing mental health difficulties and recruited from mental health services. The target sample size is 30, with 15 in each trial arm. Participants are randomly allocated to either G4H plus treatment as usual, or treatment as usual alone. The primary outcomes of interest are the feasibility of recruitment, randomisation, data collection and retention to the study at 10 and 14 week follow up, as well as the acceptability, and accessibility of the study protocol and G4H intervention.
Discussion
The results of this study will indicate if further optimisation is required to improve the feasibility, acceptability and accessibility of the intervention and study protocol procedures as perceived by end users and practitioners. This offers a significant opportunity to support the local and national demand for accessible, innovative, and effective psychosocial youth mental health support.
Trial registration
ISRCTN registry (
ISRCTN12505807
). Registration date: 11/04/2022.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Hearing distressing voices is a key feature of psychosis. The time between voice onset and disclosure may be crucial as voices can grow in complexity. This study aimed to investigate barriers and ...enablers to early voice disclosure. In total, 20 voice hearers were interviewed, and Thematic Analysis was used to identify themes. Beliefs about the effect of disclosure on self and others acted as a barrier and enabler to voices being discussed. Voice hearing awareness should be increased among young people, the public, and care services. To support earlier disclosure, measures should be taken to increase skill among those likely to be the recipients of disclosure.
The national response to COVID-19 has had a severe impact on adult social care settings, with high mortality amongst people receiving and providing care in England. Care workers had to rapidly adapt ...to new infection control measures to protect themselves, their colleagues, and the people receiving care. Infection control in residential and domiciliary care is always complex, but COVID-19 infection control measures impacted exceptionally on care workers’ working and everyday lives. We undertook qualitative interviews with care workers and managers (n = 10) in residential and domiciliary care for older people in the Southeast England during the first wave of the pandemic to understand their experiences, solutions, and concerns to implement guidance in practice. Data were analysed using framework analysis, and the following eight themes were identified: (1) Increasing visibility and support for the sector; (2) the impact of negative messaging about the sector; (3) feelings of isolation; (4) accessibility and usability of guidance; (5) social care staff as agents in producing and sharing good practice; (6) managing expectations and the impact of conflicting messages in the media; (7) improving communication with hospitals; and (8) problems in the early pandemic. The findings reveal widespread concerns for the marginalisation of the sector in the policy response and the inadequacy of infection control guidance. Guidance would benefit from a better understanding of domiciliary and residential care settings. This might involve the following steps: (a) coproduction of guidance with adult social care stakeholders, including those in direct-care roles and (b) a shift away from a clinical model of infection control towards a more flexible approach that attends to the inherent variability of care settings.
Background: Existing models of the phases of hearing distressing voices have relied upon data from cross-sectional designs and the retrospective accounts of hearers. There is a need for a ...longitudinal study to examine the phases of voice hearing over time.
Methods: A longitudinal, mixed-methods design was used. Stage 1 - semi-structured interviews were conducted at nine monthly intervals at four time-points with voice hearers (n = 12) from Early Intervention in Psychosis Services. Data were Thematically Analysed. Stage 2 - findings were mapped onto an integrated model of voice hearing.
Results: Stage 1 analysis generated higher-order themes: "Common Pathway", "Voices Stop", "Voices Continue but Beliefs Change", and "Voices Continue but Beliefs do not Change". Stage 2 analysis generated a potential framework for a revised model of voice hearing over time with three novel sub-group pathways.
Conclusions: Findings suggested three novel sub-group pathways. Beliefs about voices influenced the course of voice hearing. Changes in beliefs were associated with acceptance, meaning-making and recovery: whereas beliefs that did not change were associated with ongoing voice-related distress. Findings highlight the importance of therapeutic conversations in supporting hearers to explore their experiences with voices.
Evidence exists for the effectiveness of cognitive behaviour therapy for psychosis with moderate effect sizes, but the evidence for cognitive behaviour therapy specifically for distressing voices is ...less convincing. An alternative symptom-based approach may be warranted and a body of literature has explored distressing voices from an interpersonal perspective. This literature has informed the development of relating therapy and findings from a case series suggested that this intervention was acceptable to hearers and therapists.
An external pilot randomized controlled trial (RCT) comparing outcomes for 15 patients receiving 16 hours (weekly sessions of one hour) of relating therapy and their usual treatment with 15 patients receiving only their usual treatment. Participants will be assessed using questionnaires at baseline, 16 weeks (post-intervention), and 36 weeks (follow-up).
Expected outcomes will include a refined study protocol and an estimate of the effect size to inform the sample size of a definitive RCT. If evidence from a fully powered RCT suggests that relating therapy is effective, the therapy will extend the range of evidence-based psychological therapies available to people who hear distressing voices.
Current Controlled Trials ISRCTN registration number 44114663. Registered on 13 June 2013.
This paper proposes and analyses a stochastic model for the spread of an infectious disease transmitted between clients and care workers in the UK domiciliary (home) care setting. Interactions ...between clients and care workers are modelled using specially generated networks, with network parameters reflecting realistic patterns of care needs and visit allocation. These networks are then used to simulate a susceptible-exposed-infected-recovered/dead (SEIR/D)-type epidemic dynamics with different numbers of infectious and recovery stages. The results indicate that with the same overall capacity provided by care workers, the minimum peak proportion of infection and the smallest overall size of infection are achieved for the highest proportion of overlap between visit allocation, i.e. when care workers have the highest chances of being allocated a visit to the same client they have visited before. An intuitive explanation of this is that while providing the required care coverage, maximising overlap in visit allocation reduces the possibility of an infectious care worker inadvertently spreading the infection to other clients. The model is generic and can be adapted to any directly transmitted infectious disease, such as, more recently, corona virus disease 2019, provided accurate estimates of disease parameters can be obtained from real data.
Evidence suggests substance-misusing women (SMW) experience disproportionate sexual health morbidity and poor uptake of interventions including contraception and cervical screening, yet there has ...been little investigation of sexual health service access issues for this population.
Twenty women with problem drug use in Hastings in South East England, UK participated in a one-to-one interview with a researcher to explore experiences and beliefs surrounding access to a range of sexual health service interventions. Transcripts were open-coded and themes were elicited and organised concerning barriers to access.
Drug-use lifestyles, trauma and low self-worth framed the lives of SMW and hindered sexual health service access through: depleted practical and emotional resources to enable attendance; high perceived emotional cost of discussing sexual histories, and coping with tests and unfavourable results; and low anticipated value of sexual health interventions due to low perception and minimisation of risk and perceived incompatibility between drug use and sexual well-being.
A range of practical, social and emotional barriers to sexual health service access exist for this population, presenting a context from within which use of services may come at considerable personal cost to SMW. Interventions addressing anticipated stigma and emotional, hygiene and fiscal concerns are warranted for this population.
Hearing voices (also known as auditory verbal hallucinations) can be a distressing experience. Negative beliefs about voices are associated with negative emotional and behavioural consequences. It is ...important to understand peoples' experiences with voices and the different stages of managing them. However, there is no conclusive empirically supported theoretical model illustrating the phases that individuals may encounter when coping with their experiences over time. Typically, research has focused upon retrospective accounts of voice hearing. The aim of this dissertation was to develop an empirically supported model of the stages of voice hearing. This was achieved by examining service users' experiences with voices over time, identifying different phases of managing voices, and exploring how these phases affected therapeutic intervention. Chapter one is an introduction to the research in this area. Chapter two outlines the methodological processes and issues within this programme of research. Chapter three provides a systematic literature review of longitudinal studies examining distressing voices in clinical populations. Chapter four examines time one interviews and discusses the barriers and enablers to the disclosure of voices. Chapter five reports the findings from interviews with clinicians and explores the barriers and enablers to starting and continuing a conversation about voices with service users. Chapter six presents a model developed from an integration and evaluation of existing models in relation to data generated from interviews conducted longitudinally. Chapter seven summarises findings, discusses the theoretical and clinical implications, outlines the limitations of the programme of research and proposes future directions to continue the research.
Objective:
‘Gay’ businesses providing physical and virtual sex spaces for men who have sex with men (MSM) have been shown empirically to be useful sites for public health and health promotion ...interventions. While HIV incidence in Europe has been more or less stable in recent years, the number of infections attributed to MSM has continued to increase with new cases almost doubling in Western and Central Europe between 2000 and 2006. Set within the context of the Everywhere Project, the objective of this study was to explore the feasibility and acceptability to ‘gay’ businesses of developing and implementing a European model of HIV prevention focusing on MSM that provides common prevention standards across eight European countries.
Design:
A qualitative study
Setting:
‘Gay’ businesses that bring men together and facilitate sex between them in ‘gay’ tourist destinations and other European capital cities.
Method:
Semi-structured qualitative interviews were conducted with 54 ‘gay’ business representatives from different European cities. Interviews were recorded, transcribed, translated, and analyzed using a ‘framework’ approach.
Results:
Many representatives of ‘gay’ businesses reported being willing to provide HIV prevention activities that target MSM in their venues and perceive this as part of improving their corporate image of being a socially responsible enterprise. However, concerns were voiced around issues such as fear of alienating customers, and inciting stigma and discrimination, safe-sex fatigue and lack of knowledge of prevention messages, as well as the need for appropriate condom and lubricant distribution networks. Businesses also reflected on the potential benefits and disadvantages of being involved in a scheme that provides a common and recognizable framework for HIV prevention across multiple European countries.
Conclusions:
Early conclusions from this exploratory research suggest that a European-wide model of HIV prevention is acceptable and feasible to those working in ‘gay’ businesses. Further investigations, however, are required to develop solutions in order to overcome identified social, cultural and practical barriers.
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