Self-disclosure by adolescents in therapy for eating difficulties: A Q-Methodology study.

Facilitating client self-disclosure is essential to therapeutic effectiveness. Given the long-term consequences of eating difficulties for adolescents, there is a need for more research on self-disclosure in this group. This study investigated factors likely to influence adolescents' decisions to self-disclose during psychological therapy for eating difficulties using Q-methodology. Participants (n = 28), recruited through child and adolescent mental health services in the UK, completed a task that involved sorting 47 statements to represent their viewpoint on self-disclosure. The 28 completed sorts were subjected to a by-participant factor analysis in order to identify distinct viewpoints in the sample. Three distinct factors were extracted. One factor emphasised the importance of therapist self-disclosure on decisions to disclose. In contrast, another factor placed more emphasis on the influence of eating disorder identity and readiness to change on disclosure decisions. The third factor placed emphasis on the quality of the therapeutic relationship and readiness to change as having most influence. Given the absence of a unifying factor representing what influences the decision to disclose, clinicians should ensure they explore with young people what might influence their decision to disclose.

Exploring the experiences and responses of siblings living with a brother or sister with obsessive compulsive disorder.

OBJECTIVES: The impact of having a child with diagnosed obsessive-compulsive disorder (OCD) can reportedly cause significant disruption to caregiver routines and negatively affect their mental health. Less is known about the impact to other first-degree relatives such as siblings due to limited research. It should not be assumed that findings in the caregiver literature can simply be applied to siblings. This study, therefore, aimed to explore the experiences and responses of cohabiting siblings of a brother or sister with an OCD diagnosis. METHOD: Eight participant siblings were recruited from a UK specialist OCD NHS clinic and interviewed via telephone about their experiences co-habiting with a brother or sister with OCD. Interviews were transcribed and subjected to interpretative phenomenological analysis (IPA). RESULTS: Two superordinate themes of 'OCD as a dangerous dictator' and the 'unifying/polarising influence of OCD on relationships' were interpreted from the eight participant experiences. Siblings spoke to OCD creating a dictatorial environment characterised by sibling loss, helplessness and adjustment. This fragile domestic environment seemingly pushed non-anxious siblings to the periphery of the family or conversely centralised their position through parentification. CONCLUSIONS: Many of the sibling experiences of frustration, distress avoidance, helplessness and symptom accommodation are mirrored in the burgeoning caregiver literature. Longitudinal studies are required to track sibling experiences over the course of their siblings OCD journey and expand our knowledge in this area. Counselling services, sibling support groups and inclusion in family assessment, formulation and treatment are possible avenues of exploration for siblings of those with an OCD diagnosis.

Feasibility and efficacy of an online compassion-focused imagery intervention for veterinarian self-reassurance, self-criticism and perfectionism.

BACKGROUND: Veterinarians report high levels of psychological distress and self-criticism. However, there is minimal research investigating psychological interventions for veterinarians. Evidence suggests that compassion-focused therapy is effective at reducing distress in those with high self-criticism. This study aimed to investigate the feasibility and preliminary effectiveness of a 2-week online compassionate imagery intervention for veterinarians. METHODS: A one-group repeated measures design was used with 128 veterinarians. Participants completed measures of perfectionism, self-criticism, self-reassurance and fears of compassion four times, at 2-week intervals (at baseline, pre-intervention, post-intervention and 2-week follow-up). Participants answered written questions about their intervention experience post-intervention. RESULTS: Content analysis of the qualitative data found the intervention to be acceptable and beneficial to participants. Overall, study attrition was 50.8%, which is reasonable for a low-cost intervention. Minimal differences were found between participants who dropped out compared to those who completed the intervention. Perfectionism, work-related rumination and self-criticism were significantly reduced post-intervention, and these effects were maintained at follow-up. Resilience and self-reassurance remained unchanged. Fears of compassion reduced over the baseline period and pre-post intervention, questioning the validity of the measure. CONCLUSION: Overall, in the context COVID-19, the intervention showed impressive feasibility and preliminary effectiveness. Randomised control trials are recommended as the next step for research to establish the intervention's effectiveness.

Effectiveness of self-compassion-related interventions for reducing self-criticism: A systematic review and meta-analysis.

Self-criticism is the process of negative self-evaluation. High levels are associated with psychopathology and poorer therapeutic outcomes. Self-compassion interventions were developed to explicitly target self-criticism. The aim of this review was to estimate the overall effect of self-compassion-related interventions on self-criticism outcomes and investigate potential moderating variables. A systematic search of the literature identified 20 randomized controlled trials (RCTs) that met the inclusion criteria. Nineteen papers, involving 1350 participants, had sufficient data to be included in the meta-analysis. Pre- and post-data points were extracted for the compassion and control groups. Study quality was assessed using an adapted version of the Cochrane Collaboration's risk of bias tool, which concluded that studies were of moderate quality. Meta-analysis findings indicated that self-compassion-related interventions produce a significant, medium reduction in self-criticism in comparison with control groups (Hedges' g = 0.51, 95% CI [0.33-0.69]). Moderator analysis found greater reductions in self-criticism when self-compassion-related interventions were longer and compared with passive controls rather than active. The remaining moderators of forms of self-criticism, sample type, intervention delivery, intervention setting and risk of bias ratings were insignificant. Overall, the review provides promising evidence of the effectiveness of self-compassion-related interventions for reducing self-criticism. However, results are limited by moderate quality studies with high heterogeneity. Directions for future research indicate that more RCTs with active controls, follow-ups, consistent use and reporting of measures and diverse samples are needed.

The effects of group singing on the wellbeing and psychosocial outcomes of children and young people: a systematic integrative review.

Supporting the wellbeing of young people is a growing issue internationally. Reviews of adult studies suggest the potential of group singing to meet this agenda. This review aimed to examine current evidence regarding the effects of group singing on the wellbeing and psychosocial outcomes of children and young people. A systematic integrative review of electronic databases, including primary research studies which examined wellbeing or psychosocial outcomes for children and young people involved in group singing, yielded thirteen studies. Conclusions about the effectiveness of group singing could not be drawn from quantitative studies, which were of low quality. Qualitative synthesis indicates group singing may support young people's wellbeing through mechanisms of 'social connectedness' and confidence. Current conclusions are limited and additional, high quality qualitative and quantitative research is required to build on these findings. Further careful study may support the development and funding of group singing projects.

What is the relationship between fear of self, self-ambivalence, and obsessive-compulsive symptomatology? A systematic literature review.

Obsessive-compulsive disorder (OCD) is one of the most debilitating health conditions in the world. There has been a vast amount of research into factors that increase the likelihood of developing OCD, and there are several explanatory models. Current cognitive models of OCD can be split into appraisal-based and self-doubt models. To date, cognitive-behavioural therapy for OCD (grounded in appraisal-based models) is the recommended treatment approach, and research into the importance of self-doubt beliefs has been somewhat neglected. This paper therefore aims to consolidate current research, utilizing a systematic review approach, to establish the relationship between fear of self, self-ambivalence, and obsessive-compulsive symptomatology. A systematic search was conducted based on inclusion criteria identified for this review. Papers were then individually appraised for quality and key data extracted from each paper. A total of 11 studies were included in the final sample. Fear of self and self-ambivalence were both consistently found to be significant predictors of obsessive-compulsive symptomatology. In particular, research suggests that there is a strong link between self-doubt beliefs and obsessions and obsessional beliefs related to OCD. Limitations of the review and suggestions for future research are made and applications to clinical practice discussed.

Disclosure in therapy by clients with eating difficulties: a Q-Methodology study.

Disclosure by those with eating difficulties is of considerable importance to clinicians and researchers. The aim of the present study was to explore variability in factors considered likely to influence the decision to disclose during psychological therapy by people who experience such difficulties. Thirty-seven participants recruited through a UK-based eating disorder charity completed a Q-sort task. This invited them to sort 47 statements onto a grid reflecting what would make them more or less likely to disclose in therapy. The thirty-seven Q-sorts were analysed using PQ method software. This resulted in the extraction of three factors explaining 41 percent of the variance. Participants loading on the first factor considered maintaining an eating disorder identity as most influential whilst participants loading on the second factor considered the therapeutic relationship as most influential. Those loading on the third factor considered personal readiness and feelings of security as most influential. This study suggests that clinicians need to assess influences on the decision to disclose for individual clients and to modify the early stages of intervention accordingly. Future research could assess the utility of using the Q-sort process and materials in this study as a way to elicit influences on disclosure decisions.

Depictions of acne and psoriasis influence interpersonal aversion.

The presence of a dermatological condition may deter contact with the affected person because it falsely signals the threat of infection. The current study investigated interpersonal aversion towards individuals with the appearance of acne and psoriasis. Participants (N = 196) either viewed a female face with the appearance of acne, psoriasis, or no visible dermatological condition. Participants rated the attractiveness of the person, and indicated their willingness for social and indirect contact with them. The person depicted with acne was rated significantly less attractive than the person with psoriasis or no dermatological condition. Participants reported significantly less willingness for indirect contact with the person depicted with acne or psoriasis compared to the person with no visible dermatological condition. In contrast, participants expressed more willingness for social contact with a person with acne than with the person with psoriasis or no dermatological condition. Group differences were significant when controlling for attractiveness ratings. Unwarranted fear of infection might underpin avoidance and discriminatory behaviour towards those with skin conditions. Further research is required to understand factors that influence avoidance of contact.

Does modifying personal responsibility moderate the mental contamination effect?

BACKGROUND AND OBJECTIVES: Mental contamination is the psychological sense of internal dirtiness that arises in the absence of physical contact with a perceived contaminant. Mental contamination can be evoked through imagining perpetrating a moral transgression. This study experimentally evoked mental contamination by asking men to imagine perpetrating a non-consensual kiss. It explored whether reducing sense of personal responsibility for the kiss moderated the mental contamination effect. METHODS: Male students (N = 60) imagined giving either a consensual or non-consensual kiss. Personal responsibility for the kiss was manipulated in one of two non-consensual kiss conditions by way of the inclusion of social influence information. Feelings of mental contamination were assessed by self-report and through a behavioural index. RESULTS: Mental contamination was successfully induced in the two non-consensual kiss conditions. There was evidence to support the hypothesis that reducing personal responsibility might moderate specific components of mental contamination (shame, dirtiness and urge to cleanse). The effect of responsibility modification was evident in the self-report measures, but not in the behavioural index. LIMITATIONS: The sample comprised male university students which limits generalizability of the findings. The behavioural assessment of mental contamination was limited to a proxy measure. CONCLUSIONS: Imagined moral violations are associated with increases in indices of mental contamination. Further research should investigate whether feelings of shame, dirtiness and urge to cleanse are particularly responsive to responsibility modifications.

Therapist self-disclosure and the therapeutic alliance in the treatment of eating problems.

Evidence is mixed regarding the potential utility of therapist self-disclosure. The current study modelled relationships between perceived helpfulness of therapist self-disclosures, therapeutic alliance, patient non-disclosure, and shame in participants (n = 120; 95% women) with a history of eating problems. Serial multiple mediator analyses provided support for a putative model connecting the perceived helpfulness of therapist self-disclosures with current eating disorder symptom severity through therapeutic alliance, patient self-disclosure, and shame. The analyses presented provide support for the contention that therapist self-disclosure, if perceived as helpful, might strengthen the therapeutic alliance. A strong therapeutic alliance, in turn, has the potential to promote patient disclosure and reduce shame and eating problems.

The Relationship between Co-rumination and Internalizing Problems: A Systematic Review and Meta-analysis.

Co-rumination refers to the process of engaging in repeated discussion of personal problems in dyadic relationships. The current systematic review and meta-analysis provided an evaluation of the relationship between co-rumination and internalizing problems in children, adolescents and young adults, along with an investigation of potential moderator variables. Studies were eligible for inclusion if they quantitatively assessed the relationship between co-rumination and depression, anxiety and/or internalizing problems using validated measures. An electronic search was conducted in PsycINFO, PsycARTICLES, Medline, Scopus and the Cochrane Library database of systematic reviews for studies published since 2002. In addition, unpublished studies were located by contacting authors in the field and by online searches of dissertation databases. Thirty-eight studies were deemed eligible for inclusion comprising a total of 12 829 community-based participants. A random-effects model was employed in the analysis, and effect sizes were obtained exclusively from cross-sectional data. Small to moderate effect sizes were found across four outcomes representing internalizing problems (mean corrected correlation range 0.14 to 0.26), with no significant variability across these variables. Female participants were found to score significantly higher on measures of co-rumination compared with males (d = -0.55). Moderator analyses revealed mixed findings. No significant effects were found for age, gender or publication status. A significant effect was found for co-rumination questionnaire version used (p = 0.05), and a marginal effect found for co-rumination partner (same-sex best friend versus other confidants; p = 0.08). These findings indicate that co-rumination may have a modest but significant association with internalizing problems. The implications of these findings and directions for further research are discussed. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Co-rumination has maladaptive (repetitive, unproductive discussion of problems) components, but also shows an association with friendship satisfaction. The current review found that co-rumination has small-moderate association with depression and anxiety. Practitioners should be aware of the way in which people discuss affective distress with others.

Understanding the concept of resilience in relation to looked after children: A Delphi survey of perceptions from education, social care and foster care.

There has been a surge of interest regarding the application of resilience theory in childcare practice and how resilience can be promoted among vulnerable children, in particular, looked after children. However, little is known about how people working with looked after children understand the concept of resilience. This study aimed to explore how social workers, teachers and foster carers, working with looked after children, understand resilience and whether there is consensus as to what constitutes resilience. The study also sought to explore whether there are differences in how resilience is constructed across these groups. In total, 106 participants took part in a Delphi survey (34 teachers, 36 foster carers, 36 social workers). There was moderate consensus that resilience related to survival, coping and a sense of self-worth. Resilience was not considered a panacea but a concept that also had limitations. Participants understood resilience in ways that were both similar and different to existing conceptualisations within the literature. However, there were many aspects of resilience for which there was no consensus or significant difference of opinion between the participant groups. The need for further training and research is discussed, in order to support attempts to promote resilience among looked after children.

Development and validation of the Adolescent Shame-Proneness Scale.

Like other self-conscious emotions, shame takes on particular significance during late childhood and adolescence because of a developing capacity for self-reflection, self-other comparisons, and sensitivity to the views of others. Shame is a potentially important variable in adolescent well-being given its established associations with depression, reduced feelings of self-worth, and problematic anger. Three studies are reported that describe the development and validation of the Adolescent Shame-Proneness Scale (ASPS), a novel semi-idiographic measure of shame-proneness. The ASPS is a 19-item measure assessing 3 components of shame-proneness-negative self-evaluation, externalization, and emotional discomfort. Taken together, the studies support the reliability and validity of the ASPS as a semi-idiographic measure of shame-proneness in adolescents aged 11 to 18 years. ASPS scores correlate as expected with scores on existing measure of shame-proneness and with measures of anger, negative affect, and self-esteem. More important, the data suggest that ASPS scores are related to, but distinct from, guilt. Confirmatory factor analysis supported the validity of the ASPS factor structure (RMSEA = .08, SRMR = .05, CFI = .97, NNFI = .97). The ASPS represents a unique contribution to existing options for measuring shame-proneness in research and clinical contexts. Further work is required to assess the ASPS' temporal stability and its viability and psychometric properties in more culturally diverse samples. (PsycINFO Database Record

Pancreas and islet transplantation: psychological themes pre- and posttransplant.

PURPOSE OF REVIEW: To date, islet and whole pancreas transplantation have been largely researched and reported separately. Therefore, for the first time, this review seeks to examine together the recently reported psychological issues as they relate to the two different types of transplantation. RECENT FINDINGS: In relation to pancreas transplantation, recent findings indicate potential issues relating to energy levels, including sleep problems; mood problems (anxiety, depression, traumatic stress); social interactions; and identity issues. Similarly, the research on islet allotransplantation (ITA) indicates mood disruptions associated with Type I diabetes mellitus (T1DM), which seem to improve as a result of treatment with ITA. SUMMARY: The review indicates a need for more research to guide effective intervention to optimize psychological recovery post islet and/or pancreas transplantation for patients with T1DM. Effective psychological intervention for this group relies on researchers eliciting more detailed knowledge of pretransplant psychosocial issues, not only in relation to how these might vary by transplant group, but also in relation to patient health status vis-à-vis microvascular complications and glycaemic control, and how these issues change across the whole transplant journey.

Development of Measures to Assess Personal Recovery in Young People Treated in Specialist Mental Health Services.

BACKGROUND: Recovery has become a central concept in mental health service delivery, and several recovery-focused measures exist for adults. The concept's applicability to young people's mental health experience has been neglected, and no measures yet exist. Aim The aim of this work is to develop measures of recovery for use in specialist child and adolescent mental health services. METHOD: On the basis of 21 semi-structured interviews, three recovery measures were devised, one for completion by the young person and two for completion by the parent/carer. Two parent/carer measures were devised in order to assess both their perspective on their child's recovery and their own recovery process. The questionnaires were administered to a UK sample of 47 young people (10-18 years old) with anxiety and depression and their parents, along with a measure used to routinely assess treatment progress and outcome and a measure of self-esteem. RESULTS: All three measures had high internal consistency (alpha ≥ 0.89). Young people's recovery scores were correlated negatively with scores on a measure used to routinely assess treatment progress and outcome (r = -0.75) and positively with self-esteem (r = 0.84). Parent and young persons' reports of the young person's recovery were positively correlated (r = 0.61). Parent report of the young person's recovery and of their own recovery process were positively correlated (r = 0.75). CONCLUSION: The three measures have the potential to be used in mental health services to assess recovery processes in young people with mental health difficulties and correspondence with symptomatic improvement. The measures provide a novel way of capturing the parental/caregiver perspective on recovery and caregivers' own wellbeing. KEY PRACTITIONER MESSAGE: No tools exist to evaluate recovery-relevant processes in young people treated in specialist mental health services. This study reports on the development and psychometric evaluation of three self-report recovery-relevant assessments for young people and their caregivers. Findings indicate a high degree of correspondence between young person and caregiver reports of recovery in the former. The recovery assessments correlate inversely with a standardized symptom-focused measure and positively with self-esteem.

Adolescents with anxiety and depression: is social recovery relevant?

UNLABELLED: Social recovery has become a prominent aspect of mental health service design and delivery in the past decade. Much of the literature on social recovery is derived from first-person accounts or primary research with adult service users experiencing severe mental illness. There is a lack of both theoretical and empirical work that could inform consideration of how the concept of social recovery might apply to adolescents experiencing common (non-psychotic) mental health problems such as anxiety and depression. The current study was conducted to understand the process of experiencing anxiety and depression in young people. Semi-structured interviews were conducted with nine adolescents with anxiety and depression (seven girls and two boys aged 14-16 years) and 12 mothers who were recruited from a specialist Child and Adolescent Mental Health Service in the South of England. Thematic analysis indicated that young people do experience a process of 'recovery'; the processes participants described have some congruence with the earlier stages of adult recovery models involving biographical disruption and the development of new meanings, in this case of anxiety or depression, and changes in sense of identity. The accounts diverge with regard to later stages of adult models involving the development of hope and responsibility. The findings suggest that services should attend to social isolation and emphasise support for positive aspirations for future selves whilst also attending to young people's and parents' expectations about change. Methodological challenges face enquiry about 'recovery' given its connotations with cure in everyday language. KEY PRACTITIONER MESSAGE: Theoretical and empirical work on social recovery in young people and families is lacking. Using interviews, this study sought to understand the relevance of social recovery for adolescents with anxiety and depression and their mothers. Findings suggest some congruence with the earlier stages of adult recovery models involving meaning and identity. Findings diverge with regard to later stages of adult recovery models involving hope and responsibility. Social recovery in mental health services for young people needs significant empirical attention and critical debate.

Obsessive-compulsive disorder in children and adolescents: parental understanding, accommodation, coping and distress.

Parental accommodation of pediatric OCD is common and is associated with negative affect in parents. Qualitative accounts of caring for a child with OCD are limited and no studies have assessed differences between mothers and fathers in accommodation, coping and distress. The current study used a mixed methods approach to understand parental accommodation, negative affect and coping. Forty-one mothers and 29 fathers of 43 children with OCD were asked to write narratives about their understanding and management of OCD and to complete measures of accommodation, coping, and distress. Symptom accommodation was high with almost half of the parents watching the child complete rituals or waiting for the child on a daily basis. Analysis of parental narratives indicated a distressing struggle between engaging in and resisting accommodation in order to manage their own and their child's anger and distress. T-tests and correlation analysis indicated that accommodation did not differ significantly between mothers and fathers but was more strongly associated with negative affect in mothers. Analyses indicated that mothers reported using all types of coping strategy more often than fathers, particularly escape-avoidance, taking responsibility and using social support. Escape-avoidance coping was positively correlated with accommodation and negative affect in both mothers and fathers. Interventions that target parental constructions of OCD and their behavioural and emotional responses to it may assist in reducing the occurrence of accommodation, avoidant coping and parental distress.

Relationships between magical thinking, obsessive-compulsiveness and other forms of anxiety in a sample of non-clinical children.

Despite the obvious phenomenological similarities between magical thinking and obsessive-compulsiveness, the relationship between them has been the subject of few empirical investigations in samples of children. The present study aimed to examine the relationship between a general epistemic stance towards magical causation and tendencies towards obsessive-compulsiveness in a non-clinical sample of schoolchildren. One-hundred and two children, aged between 5 and 10 years (48 boys and 54 girls), completed questionnaire measures designed to assess magical thinking, obsessive-compulsiveness, and other forms of anxiety. School teachers completed a measure of strengths and difficulties for each child. General belief in magical causation was correlated with all types of anxiety, not just obsessive-compulsiveness, with significant correlations shown for boys in the sample, but not girls. General belief in magical causation contributed little to the prediction of obsessive-compulsiveness beyond general anxiety. In this study, a general epistemic stance towards magical causation did not differentiate obsessive-compulsiveness from other anxiety dimensions. The findings are considered in the context of developmental theories of magical and scientific causal reasoning.

The Hot Flush Beliefs Scale: a tool for assessing thoughts and beliefs associated with the experience of menopausal hot flushes and night sweats.

OBJECTIVES: Approximately 15-20% of women experience their hot flushes and night sweats as problematic. There is some evidence that cognitive appraisals may help explain individual variation, and that cognitive behaviour therapy can alleviate related distress. This paper describes the development of the Hot Flush Beliefs Scale (HFBS), a questionnaire to assess women's appraisals, and reports on the reliability, validity and factor structure of the scale. METHODS: An initial pool of 63 items was generated from several sources: empirical literature, clinicians' views, and in-depth interviews, with the aim of reflecting common thoughts and beliefs about flushes and sweats. A total of 103 women, aged 41-64 years completed the initial measure. Principal components analysis and principal axis factoring were applied to the data, with both orthogonal and oblique rotation to determine the most coherent and interpretable solution. RESULTS: Exploratory factor analysis culminated in a 27-item measure comprising three dimensions: beliefs about self in social context; beliefs about coping with hot flushes; beliefs about coping with night sweats/sleep. The HFBS was internally consistent, with subscale alphas ranging from 0.78 to 0.93, and test-retest reliability 0.74-0.78. Validity was supported through correlations with other measures of mood and menopause beliefs. CONCLUSIONS: Preliminary analysis of the HFBS reveals it to be a psychometrically sound instrument. The HFBS has the benefit of being grounded in women's experiences and shows initial promise as a tool to aid further clinical and theoretical understanding of the impact of hot flushes and night sweats.

Attitudes toward obsessive-compulsive disorders--an experimental investigation.

BACKGROUND: Fear, embarrassment and stigma are salient factors contributing to reluctance to seek help for psychological distress. Although vignette studies have often been employed to assess attitudes towards psychological disorders, no study has specifically assessed attitudes towards Obsessive-Compulsive Disorder (OCD). METHODS: An experimental study assessing attitudes toward obsessive-compulsive problems is presented. One hundred and thirteen undergraduate students were given vignettes describing three subtypes of obsessive-compulsive problem (harming, washing and checking). They were asked to make judgements about fear, shame and social acceptance, and to evaluate how they themselves might feel if they experienced the problems described in the vignettes. RESULTS: The obsessive-compulsive problems described in the vignettes were evaluated differently in terms of shame, fear and social acceptance. The harming problems were rated as being the most unacceptable, followed by the washing behaviour, and then the checking behaviour. CONCLUSION: The findings suggest that attitudes to obsessive-compulsive problems are likely to be complex and that help-seeking influences may vary across the different subtypes of this disorder. The implications for people seeking help for obsessive-compulsive problems are pointed out.