Peer-supported Open Dialogue: a thematic analysis of trainee perspectives on the approach and training.

BACKGROUND: Open Dialogue (OD) is a Finnish social network based model of care, with practice and organisational aspects. Peer-supported Open Dialogue (POD) is a UK version involving peer workers, whose contributions include building on fragmented social networks. Fifty-four NHS staff undertook the first training in POD between 2014 and 2015. The training course was organised as four separate residential weeks, together with reflective sharing on an online platform. AIMS: This study aimed to explore the perspectives of the POD trainees on the training and the POD approach. METHODS: At the end of the training year, four focus groups were conducted using a semi-structured interview measure examining trainees' perspectives on the training and POD approach. A thematic analysis was performed on the transcripts to analyse data. RESULTS: Four superordinate themes emerged: personal experience, practice development, principles of POD, and pedagogical issues, each with a variety of subordinate themes. CONCLUSIONS: The course was widely reported as a positive experience, with substantial changes in attitudes and approaches to clinical work arising thus. Across the four superordinate themes, participant responses described a highly experiential course, experienced as an emotional journey which enabled them to embody the principles of POD, as well as use them at work.

Examining cognitive functioning of adult acute psychiatric inpatients through a brief screening assessment.

OBJECTIVE: Psychiatric inpatients present with multiple difficulties, including comorbid diagnoses, social problems, trauma, and high levels of psychiatric medication use. All of these factors have been associated with poorer cognitive functioning, which is rarely assessed. The aim of this study was to examine the acceptability of a brief cognitive screening assessment, and identify the cognitive and psychological profile of current psychiatric inpatients. METHOD: A cross-sectional design was adopted. Participants (N = 75) were administered brief measures of cognitive functioning, the Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005), and psychological global distress, Clinical Outcomes of Routine Evaluation-Outcome Measure, (CORE-OM; Evans et al., 2002) within the first 4 weeks of their hospital admissions. RESULTS: The MoCA was identified as acceptable for the inpatient environment. Most of the participants (79%) met the cut-off for mild cognitive impairment. No significant differences were found across diagnoses in regard to cognitive functioning, but participants with diagnoses of personality disorder experienced the most psychological global distress. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Acute psychiatric inpatient wards should consider mild cognitive impairments when assessing and treating people with serious mental illness and make appropriate adaptations to their care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A brief cognitive therapy intervention for internalised stigma in acute inpatients who experience psychosis: A feasibility randomised controlled trial.

Internalised stigma is problematic for people who experience psychosis therefore psychological interventions are required. This study examine the feasibility and acceptability of a brief Cognitive Behavioural Therapy (CBT) intervention for internalised stigma with psychiatric inpatients experiencing psychosis. A feasibility randomised controlled trial was conducted, comparing CBT with a psychoeducational (PE) control arm. Thirty participants (aged 18-65, with psychosis, and currently admitted to a psychiatric hospital) were randomised to one of two conditions. Participants were assessed at baseline, post-intervention (two weeks) and at follow-up (one month). Both interventions incorporated two hours of sessions over a two week period. The outcomes examined were internalised stigma (primary outcome), stigma, attitudes toward mental health problems, personal recovery, depression and self-esteem. Recruitment was conducted over a seven month period from five psychiatric wards. Forty five potential participants were approached and 30 (66%) consented to take part. Fifteen participants were randomised to CBT and 15 to PE. Feasibility data demonstrated that both the research process and interventions were feasible and acceptable. Examination of outcomes demonstrated that there was no identified benefit of one intervention type over another. There were no adverse events related to study participation. A future definitive trial is required with improved methodological rigor.

The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalised shame and self-esteem.

Internalised shame and self-esteem have both been proposed to play an integral role in the relationship between stigma and its negative psychological sequelae in people who experience psychosis, but there has been little quantitative exploration to examine their roles further. The aim of this study was to examine the relationship of stigma (experienced and perceived) with emotional distress and recovery in psychosis, and to examine internalised shame and self-esteem as potential mediators. A total of 79 participants were included for the purposes of this study. Participants were administered a battery of assessment measures examining experienced and perceived stigma, internalised shame, self-esteem, depression, hopelessness, and personal recovery. Results illustrated that stigma (experienced and perceived) was significantly associated with internalised shame, low self-esteem, depression, hopelessness and poor personal recovery. Stigma (experienced and perceived) and its relationship with depression, hopelessness and personal recovery was mediated by both internalised shame and low self-esteem. In conclusion, stigma can have significant negative emotional consequences and impede recovery in people with psychosis. This may indicate that stigma needs to be addressed therapeutically for people with psychosis with a particular emphasis on addressing internalised shame and low self-esteem.

Semi-structured Interview Measure of Stigma (SIMS) in psychosis: Assessment of psychometric properties.

Stigma is a significant difficulty for people who experience psychosis. To date, there have been no outcome measures developed to examine stigma exclusively in people with psychosis. The aim of this study was develop and validate a semi-structured interview measure of stigma (SIMS) in psychosis. The SIMS is an eleven item measure of stigma developed in consultation with service users who have experienced psychosis. 79 participants with experience of psychosis were recruited for the purposes of this study. They were administered the SIMS alongside a battery of other relevant outcome measures to examine reliability and validity. A one-factor solution was identified for the SIMS which encompassed all ten rateable items. The measure met all reliability and validity criteria and illustrated good internal consistency, inter-rater reliability, test retest reliability, criterion validity, construct validity, sensitivity to change and had no floor or ceiling effects. The SIMS is a reliable and valid measure of stigma in psychosis. It may be more engaging and acceptable than other stigma measures due to its semi-structured interview format.