Guided versus self-guided internet delivered cognitive behavioural therapy for diagnosed anxiety and related disorders: a preliminary meta-analysis.

Guided and self-guided internet-delivered cognitive-behavioural therapy (ICBT) has been demonstrated to be efficacious in the treatment of anxiety and related disorders (ARDs). The aim of the current study was to examine the efficacy of guided and self-guided ICBT for adults diagnosed with ARDs using a meta-analytic synthesis of randomised controlled trials directly comparing the two treatment approaches. Eleven studies (n = 1414) were included. There was a small, but significantly pooled between-group effect size at post-treatment (g = 0.16; 95% CI: 0.03-0.28) favouring guided ICBT. At follow-up, the between-group effect size was small and non-significant (g = 0.13; 95% CI: -0.04-0.30). Gender distribution moderated outcome at post-treatment (higher proportions of females resulted in a smaller between-group effect size). Type of support provided in the guided-treatment arm moderated treatment outcome at follow-up (those receiving synchronous support had a larger between-group effect size). Amount of guidance in the guided-treatment arm moderated effect sizes at post-treatment and follow-up (more guidance leading to larger between-group effect sizes). Automated reminders, disorder type, and treatment length did not moderate outcomes. The results suggest that guided and self-guided ICBT interventions result in similar outcomes, however guided interventions may be marginally more effective in the short term.

Prevalence of body dysmorphic disorder: A systematic review and meta-analysis.

Body dysmorphic disorder (BDD) is characterised by a preoccupation with a perceived defect in appearance. This preoccupation results in the completion of repetitive/time consuming behaviours to reduce distress. While the disorder results in considerable distress and impairment, the prevalence of the disorder is largely unknown, as BDD has not been examined in large epidemiological studies. The aim of the current study was to provide an estimate of BDD prevalence in a variety of settings using a meta-analytic approach using only studies that have made a diagnosis using a structured diagnostic interview. Twenty-two studies met criteria (n = 7159) and the pooled point-prevalence estimate for BDD was 11.3% across all studies with high levels of heterogeneity (I2 = 95.81). The pooled point-prevalence estimate was 20.0% in cosmetic/dermatology settings, 7.4% in mental health settings, and 6.7% in 'other' settings (including students and professional ballet dancers). The risk of bias assessment indicated questionable methodological quality in some of the included studies. While this study provides an important improvement on the existing literature there is a need to include BDD in epidemiological studies in order to have a more accurate understanding of the prevalence rate of this mental health condition in the community.

The impact of the built environment on loneliness: A systematic review and narrative synthesis.

Loneliness is a pressing public health issue. Although quintessentially individual, it is shaped by wider environmental, cultural, socio-economic, and political circumstances. Using a systematic review methodology, this paper draws on interdisciplinary research to conceptualise the relationship between the built environment and loneliness. We present a narrative synthesis of 57 relevant studies to characterise the body of evidence and highlight specific built-environment elements. Our findings demonstrate the need for further conceptual and empirical explorations of the multifaceted ways in which built environments can prevent loneliness, supporting calls for investment into this public-health approach.

New School Technology Meets Old School Technique: Intensity Modulated Proton Therapy and Laparoscopic Pelvic Sling Facilitate Safe and Efficacious Treatment of Pelvic Sarcoma.

Purpose: Small bowel tolerance may be dose-limiting in the management of some pelvic and abdominal malignancies with curative-intent radiation therapy. Multiple techniques previously have been attempted to exclude the small bowel from the radiation field, including the surgical insertion of an absorbable mesh to serve as a temporary pelvic sling. This case highlights a clinically meaningful application of this technique with modern radiation therapy. Methods and Materials: A patient with locally invasive, unresectable high-grade sarcoma of the right pelvic vasculature was evaluated for definitive radiation therapy. The tumor immediately abutted the small bowel. The patient underwent laparoscopic placement of a mesh sling to retract the abutting small bowel and subsequently completed intensity modulated proton therapy. Results: The patient tolerated the mesh insertion procedure and radiation therapy well with no significant toxic effects. The combination approach achieved excellent dose metrics, and the patient has no evidence of progression 14 months out from treatment. Conclusions: The combination of mesh as a pelvic sling and proton radiation therapy enabled the application of a curative dose of radiation therapy and should be considered for patients in need of curative-intent radiation when the bowel is in close proximity to the target.

Vaginal Sparing Radiotherapy Using IMPT and Daily Dilator Placement for Women with Anal Cancer.

Sexual dysfunction is a common toxicity and detrimental for the quality of life of women treated with chemoradiotherapy for anal cancer. Sexual dysfunction occurs because the vagina is closely approximated to the anal canal and typically receives substantial doses of radiation. Strategies for mitigation have largely been focused on posttreatment therapy and symptom management. The use of daily vaginal dilator placement during radiotherapy to mitigate dose to the vagina has been previously explored with modest gains, while proton therapy is under active investigation for the treatment of anal cancer. Use of proton therapy for anal cancer reduces dose to some organs at risk but may inadvertently increase vaginal toxicity if the proton beam terminates in the vaginal tissue. Herein, we present the case histories of 2 women treated for squamous cell carcinoma of the anal canal with the novel combination of intensity-modulated proton therapy and daily vaginal dilator placement to maximally reduce dose to the vagina and protect it from areas of increased energy deposition at the end of the proton range.

Stuck in separation: Liminality, graffiti arts and the forensic institution as a failed rite of passage.

Forensic psychiatric institutions are tasked with both containment and transformation, with securely policing the border between institution and society and readying patients for return to the community. Forensic institutions can thus be theorised as a form of 'rite of passage', engaged in a process of transformation which both navigates and demarcates social limits. This article contributes to literature on risk and control in clinical institutions by offering a novel theoretical synthesis of features of rites of passage and liminality, as facilitated by an art project in a forensic setting. Through the prism of the Graffiti and Wellbeing Project (GWP), an arts initiative, we explore the ways in which forensic institutions thus offer or impede opportunities for transformation. The project engendered a space for the transformation of difficult emotions and histories through the medium of art creating a liminal space of transformation within the confines of a secure institution. Drawing on Douglas, Kristeva and Bahktin, we argue that forensic institutions largely attempt to manage their own transgressive, marginal status, and the abject experiences of patients, through a recourse to order, suppression and sublimation. We argue for a wider range of responses to the transgressive and marginal experiences and behaviours prevalent in forensic settings, drawing on examples from the GWP.

Contending with the minimum data set: Subjectivity, linearity and dividualising experiences in Improving Access to Psychological Therapies.

Improving Access to Psychological Therapies has lead to a huge increase in the delivery of psychological therapy within the United Kingdom over the past 10 years. Central to the culture of Improving Access to Psychological Therapies is outcome monitoring, brought into every therapeutic encounter through the compulsory collection of the minimum data set in each session. This article explores the role of compulsory outcome monitoring in service users' experiences of using Improving Access to Psychological Therapies, with a focus on how these forms are folded into distress, therapy and recovery. Data from a small-scale qualitative study are drawn upon. Thematic analysis was conducted on multimodal interviews with current service users. The article explores the ways in which the minimum data set acted as a 'quasi object', exploring three main roles of the minimum data set: as an authorising mediator, an alienating adversary and a deferring gatekeeper. Pictures of therapeutic progress, as presented via outcome measures, often ran counter to users' reported experience of distress. We conclude that far from being a neutral and objective assessment tool, the minimum data set functions as a living actant in the therapeutic encounter.

Living 'in between' outside and inside: The forensic psychiatric unit as an impermanent assemblage.

This paper presents analysis from 'a study of staff and patient experiences of the restrictive environments of a forensic psychiatric unit. The paper conceptualises the forensic unit as an impermanent assemblage, enacted in and through practices that hold a future life outside the unit simultaneously near, yet far. We show how the near-far relations between life inside and outside the unit operate in three ways; 1) in relation to the 'care pathway', 2) practices of dwelling, and 3) creating and maintaining connections to life 'beyond' the unit. The paper concludes with a discussion about possible ways to overcome the limitations to recovery that can arise through practices of impermanence.

Life lines: Loss, loneliness and expanding meshworks with an urban Walk and Talk group.

There is ample evidence that loneliness and social isolation are important in the development of distress, and harmful to recovery. UK mental health services, however, have been moving away from interventions which prioritise relationality, and towards professionally-led, individualised treatments. In addition, those experiencing distress experience multiple spatial exclusions which can compound isolation and loneliness. This paper examines the role of an urban Walk and Talk group in the lives of long term mental health service users. Using an ecological frame, Ingold's concept of 'meshwork' is used to explore the complex of social, personal and spatial relationships which contribute to participants' experiences of everyday living. Four themes are explored: Fading lines: Fossilised meshworks of loneliness and loss; Therapeutic nodes: Atomised sanctuary and respite in everyday space; Reciprocity and authenticity: Strengthening relational meshworks; and Remaking everyday spaces: Revitalising meshworks through collectivity. The findings are discussed in light of the literature on loneliness, relationships and mental health interventions.

Preliminary Development of the Food Allergy Coping and Emotions Questionnaires for Children, Adolescents, and Young People: Qualitative Analysis of Data on IgE-Mediated Food Allergy from Five Countries.

BACKGROUND: We have previously developed a food allergy-specific developmental model, that explained emotions and coping styles, among children aged 6 to 15years in Ireland. OBJECTIVE: The objective of this study was to investigate the usefulness of the developmental model in a large multicountry data set, including any mediators of coping style, and to use the findings to generate an item pool that will form the basis for 3 age-appropriate self-report questionnaires to measure coping and emotions. METHODS: We conducted deductive thematic analysis on secondary data from interviews with 274 participants aged 6 to 23 years, and 119 parents from Australia, Ireland, Italy, the UK, and the USA. Analysis was undertaken across the entire data set. RESULTS: The Food Allergy Coping and Emotions (FACE) model has 5 major themes: (1) experiences and emotions, (2) search for normality, (3) management and coping, (4) "external mediators," and (5) "internal mediators" (between emotions and coping). These themes were present across countries, but differed according to age. CONCLUSIONS: Early-life experiences provide the foundation for later cognitions and behaviors. The expanded FACE developmental model is useful in explaining emotions and coping styles across different age groups and countries. These data will also be used to generate an age-specific bank of items for the development of 3 (age-specific self-report, and parent proxy) questionnaires to assess emotions and coping in food allergy. Findings provide insight into how particular styles of coping develop and vary from patient to patient and may also guide clinician-patient communication and the development of individualized management strategies.

Transportations of space, time and self: the role of reading groups in managing mental distress in the community.

BACKGROUND: The practice of reading and discussing literature in groups is long established, stretching back into classical antiquity. Although benefits of therapeutic reading groups have been highlighted, research into participants' perceptions of these groups has been limited. AIMS: To explore the experiences of those attending therapeutic reading groups, considering the role of both the group, and the literature itself, in participants' ongoing experiences of distress. METHOD: Eleven participants were recruited from two reading groups in the South-East of England. One focus group was run, and eight individuals self-selected for individual interviews. The data were analysed together using a thematic analysis drawing on dialogical theories. RESULTS: Participants described the group as an anchor, which enabled them to use fiction to facilitate the discussion of difficult emotional topics, without referring directly to personal experience. Two aspects of this process are explored in detail: the use of narratives as transportation, helping to mitigate the intensity of distress; and using fiction to explore possibilities, alternative selves and lives. CONCLUSIONS: For those who are interested and able, reading groups offer a relatively de-stigmatised route to exploring and mediating experiences of distress. Implications in the present UK funding environment are discussed.

"Zip me up, and cool me down": Molar narratives and molecular intensities in 'helicopter' mental health services.

Experiences of the space-time dimensions of contemporary mental health services are shaped according to what we describe here as a 'helicopter service', where professionals drop down into service users' lives for short, often pre-determined bursts of time. This can create a system where users' experiences are observed and assessed from a more distanced and circumscribed perspective. This paper considers the implications of these systemic changes, using interviews with current UK service users. To help in the exploration of the complexities faced by service users', we use Deleuze and Guatarri's (1987) distinction between molar and molecular forms of organisation. A process oriented thematic analysis discusses: a) Affording narratives of distress: Molarity, monitoring and space in service interactions and b) Narratives in therapy: Compartmentalising the distressed self. Multiple aspects of the relationship between space and distress are explored. An understanding of experiences of distress beyond the boundaries of the molar, which considers its intensive, molecular and transformative nature, may help to open up engagement with the affective and emotional dimensions of mental health.

Seeking fluid possibility and solid ground: space and movement in mental health service users' experiences of 'crisis'.

Since the closure of the UK asylums, 'the community' has become short hand for describing a variety of disparate and complex spaces, in which service users manage their experiences of distress. An examination of such spaces here forms the basis of an analysis of the way in which service users move through and within space, to establish agency and dis/order while distressed. Seventeen participants, with various experiences of mental distress took part in a qualitative study, and a further textual analysis was conducted on eight published autobiographies. In the context of the interviews, participants presented drawings of the spaces they occupy during times of crisis, wellbeing and recovery. All texts were analysed using a thematic approach, informed by theories of embodiment and relational space. In this paper, the focus is directed towards two key patterns of movement, in order to explore ways in which participants experiencing various forms of mental health crisis used space in order to maintain and manage feelings of agency. Firstly, incidents where participants described moving towards fluid, outside spaces are explored, with agency being established through seeking, and utilising, greater possibilities for action and engaging others. In addition, the opposite pattern of movement is also explored, using incidents where participants described moving indoors, using the private space of the home to establish order and restore feelings of agency and strength, in contrast to overwhelming experiences in public space. Connections between these patterns of movement and particular forms of distress are discussed. It is argued that community and private spaces are integral to the ways in which selfhood, agency and action is experienced in mental distress, which in turn has implications for policy, treatment and community action.

Exploring psychosis and bipolar disorder in women: a critical review of the qualitative literature.

BACKGROUND: The experiences of women with severe mental illness warrant particular consideration to identify the strategies they use to facilitate recovery. This review systematically examined women's experiences of psychosis and bipolar disorder. METHODS: Following an extensive database search, 13 studies met inclusion criteria. Noblit and Hare's metasynthesis approach was used to synthesise these qualitative studies exploring the experiences of 250 women, of which 78 (31.2%) were also mothers. RESULTS: Twelve sub-ordinate themes were identified and categorised into three overarching themes: 1) women's beliefs about illness, 2) perceived consequences of illness, and 3) strategies used to cope with illness. Contextual factors and spiritual beliefs were found to be important in these women's illness appraisals. Women incorporated diagnosis-related information into illness models if it was concordant with their existing beliefs. CONCLUSIONS: Women reported negative illness consequences relating to stigma, loss of self-determination and changes to relationships. They employed various strategies in order to cope with illness. Barriers to strategy use and clinical recommendations are presented.

Effect of age and storage conditions on the volatile organic compound profile of blood.

Cadaver-detection dogs are used by the police to locate missing persons, victims of homicide, and human remains following mass disasters. Training is conducted using a variety of training aids including blood which can be hours, weeks or months old and stored under variable conditions. The aim of this study was to chemically profile human blood using solid-phase microextraction coupled with gas chromatography-mass spectrometry to determine how the volatile organic compound (VOC) profile changed over time and under variable storage conditions. The VOC profiles of fresh and degraded blood were analyzed as well as blood stored at room temperature, refrigerated, and frozen. Fresh and degraded blood samples produced distinctive VOC patterns with VOC profiles becoming more complex over time. Freezing the blood produced a complex VOC profile that was clearly discriminated from the VOC profile for blood stored at room temperature or in a refrigerator. This study highlights the importance of standardizing the age and storage conditions when using blood as a training aid to ensure cadaver-detection dogs are exposed to an accurate representation of the blood VOCs they may encounter at a scene.

The process of recovery in women who experienced psychosis following childbirth.

BACKGROUND: Psychosis following childbirth affects 1-2 mothers per 1000 deliveries. Onset is rapid and functioning is severely affected. Although prognosis in terms of symptom remission is generally good, long-term disability can persist. The study's aim was to develop a theoretical understanding of recovery from psychosis following childbirth. METHODS: Semi-structured interviews were conducted with 12 women with experience of psychosis following childbirth. Interview transcripts were analysed using grounded theory methodology. RESULTS: A theory of four superordinate themes was developed from the data, including: (i) the process of recovery; (ii) evolving an understanding; (iii) strategies for recovery; and (iv) sociocultural context. The process of recovery and women's understanding of their experience were conceptualised as parallel processes, which informed one another. Women found that a diagnosis facilitated their use of particular strategies. CONCLUSIONS: This study highlighted a complex and ongoing process of recovery from psychosis following childbirth. Sensitivity to a woman's position in the process of recovery has the potential to facilitate professionals in assessing readiness for different interventions which will be likely to result in women feeling more understood, accepted and supported.

Heterotopias of control: placing the material in experiences of mental health service use and community living.

Concrete sites of mental health care have been argued to be relatively 'forgotten' under a community care model emphasising social inclusion and personalisation (Spandler, 2007; Bowers et al., 2005, 2006, 2009; Quirk et al., 2006). Drawing on two sets of data, visual interviews conducted with service users and already published narratives of distress; this paper examines the role of the material layout of these spaces in the production and negotiation of service users' subjectivity. Service use sites are here argued to partially act as 'heterotopias' (Foucault, 1986) of 'control' (Deleuze, 1992), with the detail of the material environments, dominated by observation, locks and barriers, acting to 'make visible' to service users a devalued and stigmatised service user position. Strategies to moderate this 'modulated' (Deleuze, 1992) subjectivity are described in community spaces, including using home, work or exercise spaces to moderate such a subject position.