Effectiveness of a volunteer befriending programme for patients with schizophrenia: randomised controlled trial.

BACKGROUND: Befriending by volunteers has the potential to reduce the frequent social isolation of patients with schizophrenia and thus improve health outcomes. However, trial-based evidence for its effectiveness is limited. AIMS: To conduct a randomised controlled trial of befriending for patients with schizophrenia or related disorders. METHOD: Patients were randomised to a befriending programme for 1 year or to receive information about social activities only (trial registration: ISRCTN14021839). Outcomes were assessed masked to allocation at the end of the programme; at 12 months and at a 6-month follow-up. The primary outcome was daily time spent in activities (using the Time Use Survey (TUS)) with intention-to-treat analysis. RESULTS: A total of 124 patients were randomised (63 intervention, 61 active control) and 92 (74%) were followed up at 1 year. In the intervention group, 49 (78%) met a volunteer at least once and 31 (49%) had more than 12 meetings. At 1 year, mean TUS scores were more than three times higher in both groups with no significant difference between them (adjusted difference 8.9, 95% CI -40.7 to 58.5, P = 0.72). There were no significant differences in quality of life, symptoms or self-esteem. However, patients in the intervention group had significantly more social contacts than those in the control group at the end of the 12-month period. This difference held true at the follow-up 6 months later. CONCLUSIONS: Although no difference was found on the primary outcome, the findings suggest that befriending may have a lasting effect on increasing social contacts. It may be used more widely to reduce the social isolation of patients with schizophrenia.

Effectiveness of a Cancer Bereavement Therapeutic Group.

This study examined the effectiveness of a novel cancer bereavement group. Twenty-seven participants attended a sixsession cancer bereavement therapeutic group. Data were collected at baseline, intervention completion, and three-month follow-up. Grief intensity and symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety were reduced postintervention, and self-compassion increased. At follow-up, improvement remained for grief, PTSD, and depression. A small quasi-experimental waiting-list comparison group showed no change on any measure between baseline and waiting-list end. This study provides preliminary evidence that a brief therapeutic group is an effective intervention for cancer bereavement.

A randomised controlled trial of guided internet-based cognitive behavioural therapy for perfectionism: Effects on psychopathology and transdiagnostic processes.

BACKGROUND AND OBJECTIVES: Perfectionism is a transdiagnostic process that has been associated with a range of psychopathology and also with other transdiagnostic processes. We have previously shown that guided internet-based cognitive behavioural therapy (ICBT) can reduce symptoms of dysfunctional perfectionism, however, no impact was observed on symptoms of depression and anxiety. Here we explore the impact of guided ICBT for perfectionism on symptoms of other associated psychopathology, specifically obsessive-compulsive disorder (OCD) and eating disorders, and also on other associated transdiagnostic processes (self-esteem, intolerance of uncertainty, and self-compassion). METHODS: Participants who presented with clinical levels of perfectionism were randomised to an experimental group that received the intervention (n = 62), or a wait list control group (n = 58). Questionnaires assessing symptoms of OCD, eating disorders, self-esteem, intolerance of uncertainty, and fear of self-compassion were completed pre-intervention, post-intervention (12 weeks), and at follow-up (24 weeks). Between group effect sizes are reported. RESULTS: The intervention led to significant decreases in symptoms of OCD (d = -0.9; CI: -1.4, -0.4) and eating disorders (d = -0.6; CI: -1.0, -0.1), and had an impact on other transdiagnostic processes resulting in increased self-esteem (d = 0.7; CI: 0.2, 1.2), decreases in intolerance of uncertainty (d = -0.9; CI: -1.4, -0.4), and fear of self-compassion (d = -0.8; CI: -1.3, -0.3). At follow-up changes were maintained in symptoms of OCD (d = -1.3; CI: -1.8, -0.8), disordered eating (d = -0.7; CI: -1.2, -0.2), intolerance of uncertainty (d = -0.8; CI: -1.2, -0.3), and fear of self-compassion (d = -1.0; CI: -1.5, -0.5). CONCLUSIONS: Guided ICBT for perfectionism improves associated psychopathology and transdiagnostic processes. ClinicalTrials.gov registration no. NCT02756871.

Processes of recovery through routine or specialist treatment for borderline personality disorder (BPD): a qualitative study.

Background: Recovery processes in borderline personality disorder (BPD) are poorly understood.Aims: This study explored how recovery in BPD occurs through routine or specialist treatment, as perceived by service users (SUs) and therapists.Methods: SUs were recruited from two specialist BPD services, three community mental health teams, and one psychological therapies service. Semi-structured interviews were conducted with 48 SUs and 15 therapists. The "framework" approach was used to analyse the data.Results: The findings were organized into two domains of themes. The first domain described three parallel processes that constituted SUs' recovery journey: fighting ambivalence and committing to taking action; moving from shame to self-acceptance and compassion; and moving from distrust and defensiveness to opening up to others. The second domain described four therapeutic challenges that needed to be addressed to support this journey: balancing self-exploration and finding solutions; balancing structure and flexibility; confronting interpersonal difficulties and practicing new ways of relating; and balancing support and independence.Conclusions: Therapies facilitating the identified processes may promote recovery. The recovery processes and therapeutic challenges identified in this study could provide a framework to guide future research.

"We're stronger if we work together": experiences of naturally occurring peer support in an inpatient setting.

Background: Research on peer support in mental health inpatient settings has focussed on formalised programmes. Naturally occurring peer support - spontaneous interactions without structure or roles - has received little attention. Aims: This study aimed to provide a detailed picture of service-users' experiences of giving and receiving support in an acute inpatient setting, and possible challenges encountered in such interactions. Staff perceptions were obtained in order to provide another perspective. Method: Twelve service-users and seven staff took part in semi-structured interviews. Braun and Clarke's method of thematic analysis was used to analyse the transcripts. Results: Service-users described a range of supportive interactions that were highly valued; themes included "Responding to distress", "Talking about personal stuff" and "We're stronger if we work together". They also described challenges and barriers, such as having to "tread carefully" and "personal difficulties", which made it difficult to engage in giving and receiving peer support. Staff accounts were broadly consistent with those of service-users, but showed less understanding of the nature of peer support and emphasised its risks. Conclusions: Naturally occurring peer support should be a recognised aspect of an inpatient stay. Staff education and policy should focus on creating environments for it to flourish.

'Between a rock and a hard place': family members' experiences of supporting a relative with bipolar disorder.

PURPOSE: Clinical guidelines emphasise the central role of family members in supporting people with bipolar disorder. However, there has been little focus on the challenges family members face in supporting their relative. This qualitative study explored the challenges of providing support to a relative with bipolar disorder, and how family members attempted to meet these challenges. Factors that helped or hindered their efforts were also explored, including experiences of professional support. METHODS: Semi-structured interviews were conducted with 18 family members (partners, parents, adult children, and siblings). Transcripts were analysed using the Framework approach. RESULTS: Participants faced numerous challenges pertaining to the nature of the disorder and specific illness phases, their relative's responses to their attempts to help, and the limitations of support from healthcare professionals. Although participants were resourceful in managing these challenges, they strongly valued professional input. Six themes were identified: 'Not knowing: like being in a minefield', 'It's out of my control: sitting waiting for the next thing to happen', 'Treading on eggshells', 'Picking up on signs', 'Times of crisis: between a rock and a hard place', and 'I have to make my voice heard'. CONCLUSIONS: Family members supporting a relative with bipolar disorder face significant challenges but show considerable resourcefulness in managing them. The findings underline the importance of input from healthcare professionals to help family members effectively support their relative and manage the challenges they face. Professional support should be strengths-based, and tailored to family members' needs.

Psychological interventions for caregivers of people with bipolar disorder: A systematic review and meta-analysis.

AIMS: Clinical guidelines recommend that psychological interventions be offered to caregivers of people with bipolar disorder. However, there is little clarity about the efficacy of such interventions. This review examined the efficacy of psychological interventions in improving caregiver-focused outcomes, including burden, psychological symptoms and knowledge. METHOD: A systematic search for controlled trials was conducted using a combination of electronic database searches (PsycINFO, MEDLINE, and CENTRAL), and hand searches. Risk of bias was assessed using the Cochrane Collaboration tool. Outcomes were meta-analysed using Review Manager (RevMan). RESULTS: Nine studies met inclusion criteria. All meta-analyses compared psychoeducation to a control. At post-treatment there was a large effect of psychoeducation on burden (g = -0.8, 95% CI: -1.32, -0.27). However, there was high heterogeneity, confidence intervals were wide, and the effect was not maintained at follow-up. The apparent effect of psychoeducation on psychological symptoms was driven by a single outlying study. There was a very large effect on knowledge at post-treatment (g = 2.60, 95% CI: 1.39, 3.82) and follow-up (g = 2.41, 95% CI: 0.85, 3.98). LIMITATIONS: There was considerable diversity in study methodology and quality. The number of included studies and sample sizes were small. CONCLUSIONS: This review provides tentative meta-analytic evidence for the efficacy of psychoeducation in improving caregiver burden at post-treatment, and knowledge at post-treatment and follow-up. Services could consider offering psychoeducation as part of a multi-disciplinary package of care. However, more methodologically rigorous research is needed before clinical recommendations can be made with confidence.

Individual psychological therapy in an acute inpatient setting: Service user and psychologist perspectives.

OBJECTIVES: The acute inpatient setting poses potential challenges to delivering one-to-one psychological therapy; however, there is little research on the experiences of both receiving and delivering therapies in this environment. This qualitative study aimed to explore service users' and psychologists' experiences of undertaking individual therapy in acute inpatient units. It focused on the relationship between service users and psychologists, what service users found helpful or unhelpful, and how psychologists attempted to overcome any challenges in delivering therapy. DESIGN: The study used a qualitative, interview-based design. METHODS: Eight service users and the six psychologists they worked with were recruited from four acute inpatient wards. They participated in individual semi-structured interviews eliciting their perspectives on the therapy. Service users' and psychologists' transcripts were analysed together using Braun and Clarke's (2006, Qualitative Research in Psychology, 3, 77) method of thematic analysis. RESULTS: The accounts highlighted the importance of forming a 'human' relationship - particularly within the context of the inpatient environment - as a basis for therapeutic work. Psychological therapy provided valued opportunities for meaning-making. To overcome the challenges of acute mental health crisis and environmental constraints, psychologists needed to work flexibly and creatively; the therapeutic work also extended to the wider context of the inpatient unit, in efforts to promote a shared understanding of service users' difficulties. CONCLUSIONS: Therapeutic relationships between service users and clinicians need to be promoted more broadly within acute inpatient care. Psychological formulation can help both service users and ward staff in understanding crisis and working collaboratively. Practice-based evidence is needed to demonstrate the effectiveness of adapted psychological therapy models. PRACTITIONER POINTS: Developing 'human' relationships at all levels of acute inpatient care continues to be an important challenge for clinical practice. Due to the distress of individuals and the constraints of the acute inpatient environment, psychologists need to be flexible and adaptable in delivering individual therapy. Making meaning and psychological formulation can give service users a sense of hope and empowerment, and can contribute to a shared understanding within the ward team of service users' difficulties.

The effectiveness of telephone-delivered psychological therapies for depression and anxiety: A systematic review.

Objectives The telephone is increasingly used to deliver psychological therapies for common mental health problems. This review addressed the following question: are evidence-based psychological therapies for adults with depression and/or anxiety effective in reducing psychological symptoms when delivered over the telephone? Method A systematic search for articles published over a 25-year period (January 1991-May 2016) was performed using the databases PsycINFO, PubMed and Web of Science. Citation searches, manual searches of bibliographies of relevant papers, and hand searches of key journals were also conducted. The quality of the studies included for review was assessed using the Effective Public Health Practice Project Quality Assessment Tool. Results Fourteen studies met inclusion criteria for the review. Ten reported findings from telephone treatment for depression and four for anxiety. Nine studies used randomised controlled designs, two used quasi-experimental designs and three used uncontrolled designs. Thirteen studies reported reductions in symptoms of depression or anxiety. Cohen's d ranged from 0.25-1.98 (median = 0.61) for controlled studies and from 1.13-1.90 (median = 1.26) for uncontrolled studies. Only four studies reported clinically significant change. Conclusions The findings indicate that telephone-delivered interventions show promise in reducing symptoms of depression and anxiety. Further research is required to establish the types of interventions that are most effective and the characteristics of clients who find them beneficial.

Clients' experiences of treatment and recovery in borderline personality disorder: A meta-synthesis of qualitative studies.

OBJECTIVE: This review synthesized findings from qualitative studies exploring clients' experiences of their treatment for borderline personality disorder (BPD) and their perceptions of recovery. METHOD: Fourteen studies were identified through searches in three electronic databases. The Critical Appraisal Skills Programme was used to appraise the methodological quality of the studies. Thematic analysis was used to synthesize the findings. RESULTS: The meta-synthesis identified 10 themes, grouped into 3 domains. The first domain, "Areas of change," suggests that clients make changes in four main areas: developing self-acceptance and self-confidence; controlling difficult thoughts and emotions; practising new ways of relating to others; and implementing practical changes and developing hope. The second domain, "Helpful and unhelpful treatment characteristics," highlights treatment elements that either supported or hindered recovery: safety and containment; being cared for and respected; not being an equal partner in treatment; and focusing on change. The third domain, "The nature of change," refers to clients' experience of change as an open-ended journey and a series of achievements and setbacks. CONCLUSIONS: The meta-synthesis highlights areas of change experienced by individuals receiving treatment for BPD, and treatment characteristics that they value. However, further research is needed to better understand how these changes are achieved.

Effectiveness of one-to-one volunteer support for patients with psychosis: protocol of a randomised controlled trial.

INTRODUCTION: Social isolation is common in patients with psychosis and associated with a number of negative outcomes. Programmes in which volunteers provide one-to-one support-often referred to as befriending-have been reputed to achieve favourable outcomes. However, trial-based evidence for their effectiveness is limited. METHODS AND ANALYSIS: This is a randomised controlled trial comparing the effects of one-to-one volunteer support with an active control condition for patients with psychosis over a 1-year period. Patients in the intervention group will receive the support of a volunteer for 1 year, who will meet them weekly and engage them in social and recreational activities. Patients in the control group will not receive support from a volunteer. In both groups, patients will be given a booklet detailing locally available social activities and otherwise receive treatment as usual. Patients, volunteers, clinicians and researchers involved in the delivery of the intervention will not be blinded to group assignment, while researchers carrying out data collection will be blinded. Data collection will be conducted at baseline, at 6 and 12 months. The primary outcome is the amount of time spent engaging in social activities per day. Secondary outcomes include symptoms, quality of life, self-esteem and costs of care. Attitudes of volunteers towards mentally ill people will be assessed. Finally, in-depth interviews will be conducted with patients and volunteers. ETHICS AND DISSEMINATION: The study has been approved by the National Research Ethics Service (NRES) Committee London-Camden & Kings Cross (reference 15/LO/0674). The findings of the trial will be published in open access peer-reviewed journals and in the National Institute for Health Research (NIHR) journals library, and presented at scientific conferences. In addition, findings will be summarised for a lay audience and circulated to all relevant National Health Service (NHS) and voluntary organisations. TRIAL REGISTRATION NUMBER: ISRCTN14021839; Pre-results.

The experience of adolescent inpatient care and the anticipated transition to the community: Young people's perspectives.

This study explored adolescents' perspectives of inpatient mental health care, focussing on aspects of the inpatient environment they anticipated would help or hinder their transition back home. Semi-structured interviews were conducted with 12 adolescent inpatients; transcripts were analysed thematically. Participants experienced inpatient treatment as offering a mix of benefits (e.g., supportive relationships) and drawbacks (e.g., living in a "fake world"). They anticipated the transition home as providing opportunities for personal growth and consolidation of new coping skills, but also posing challenges concerning re-entering the "real world" after the experience of being "wrapped in cotton wool". Self-determination theory and attachment theory offer two potential frameworks for understanding these opportunities and challenges. Inpatient care has the potential to foster key mechanisms for adaptive development, creating a platform for developing positive future behaviours. Community teams should work closely with inpatient units to support the generalisation of the young person's newly acquired coping skills.

'You only have one chance to get it right': A qualitative study of relatives' experiences of caring at home for a family member with terminal cancer.

BACKGROUND: Relatives looking after a terminally ill family member at home face numerous challenges. Studies into relatives' experiences of home caregiving have been criticised for their descriptive nature and lack of theoretical underpinnings. AIM: To explore the emotional challenges faced by home caregivers, and their experiences of healthcare professionals, from the perspective of existential psychology. DESIGN: A qualitative study using semi-structured interviews. Transcripts were analysed thematically using the Framework approach. SETTING/PARTICIPANTS: The study took place within an inner-city London hospice. Participants (n = 15) were recently bereaved adult relatives of cancer patients who cared for their family member at home. RESULTS: Participants' experiences of being a caregiver and of professional support were highly varied. The analysis generated 15 themes which were organised into a framework based on Yalom's four 'existential conditions': responsibility (e.g. 'being the linchpin of care'; 'you only have one chance to get it right'), isolation (e.g. 'being on my own', 'being held in mind'), death (e.g. 'knowing but not knowing') and meaningfulness (e.g. 'giving something back', 'acceptance and gratitude'). Healthcare professionals were perceived as influential in both helping and hindering relatives in meeting the challenges they faced. CONCLUSION: Existential psychology provides a theoretical perspective from which to understand the psychological complexity of the emotional challenges home caregivers face and a framework which may usefully inform research and clinical practice. Professionals' attentiveness to caregivers' needs can have powerful effects in assuaging anxiety, reducing isolation and enabling relatives to connect with the meaningfulness of caregiving.

Does it help to talk about tics? An evaluation of a classroom presentation about Tourette syndrome.

BACKGROUND: Tourette syndrome (TS) is a poorly understood condition characterised by motor and vocal tics. It may affect children's social functioning at school. This study examined the impact of a psychoeducational intervention (classroom presentation) from multiple perspectives. METHOD: We used a mixed-methods, multiple case-study design with interviews, focus groups and self-report questionnaires. Four children with TS, their parents, teachers and classmates (n = 100) took part. RESULTS: Questionnaire data showed an increase in classmates' knowledge and positive attitudes about TS postintervention. Qualitative data revealed two overarching themes: the impact on classmates in terms of enabling prosocial behaviours, and the impact on the child in terms of their embracing having TS. CONCLUSION: A brief psychoeducational intervention enhances knowledge and attitudes of classmates towards children with TS, and improves how children with TS feel about the condition. Further research is needed to evaluate this approach with larger samples of children and to identify mechanisms of change.

Police officers' experiences of supportive and unsupportive social interactions following traumatic incidents.

BACKGROUND: Police officers are routinely exposed to potentially traumatic incidents yet the majority do not develop post-traumatic stress disorder (PTSD). Social support has been identified as one factor that may maintain wellbeing in this population, although what constitutes supportive or unsupportive interactions is unclear. OBJECTIVE: To explore police officers' experiences of supportive and unsupportive interactions following distressing incidents. METHOD: Semi-structured interviews were conducted with 19 police officers. Transcripts were analysed using Braun and Clarke's (2006) thematic analysis approach. RESULTS: Participants described a range of supportive interactions with colleagues, friends, and family, as well as social constraints that hindered interactions. Ambivalence about talking about the impact of distressing events was striking throughout the accounts. The context and source of available support, as well as beliefs about talking, influenced their interactions. Humour was a central feature of interactions with colleagues; more emotional talk occurred with partners and close family, albeit with officers limiting details in order to protect others. CONCLUSIONS: The findings provide tentative insights into the processes of social support that may contribute to the resilience of police officers following traumatic incidents. Further research is needed to examine whether the experiences of supportive and unsupportive interactions differ for those with and without PTSD.

Telephone peer support for women with gynaecological cancer: benefits and challenges for supporters.

OBJECTIVE: Despite the prevalence of one-to-one peer support programmes for people with cancer, little research has examined its impact on the supporters themselves. This qualitative study examined a telephone-delivered one-to-one peer support intervention for women with gynaecological cancer, focussing on supporters' subjective experiences of benefits or costs to themselves and challenges arising in the support process. METHODS: Semi-structured interviews (N = 24) were conducted with 16 women who provided peer support for 24 patients. Transcripts were analysed thematically using the Framework approach. RESULTS: Participants described significant personal benefits of providing support, including enhanced self-esteem and well-being, and gaining a new perspective and closure on their cancer experience. They experienced no adverse consequences, but several challenges arose, for example, finding a balance between emotional involvement and detachment, and supporting someone with a poor prognosis or high levels of negative emotion. Their accounts indicated resourcefulness in managing the challenges. CONCLUSIONS: Providing peer support has a valuable role to play in cancer survivorship; it can facilitate the final stages of moving away from the role of patient and help to promote a more confident post-cancer sense of self. However, readiness to provide support and the availability of backup from health-care professionals appear essential. The findings have implications for the selection, training and supervision of peer supporters. Future studies should routinely measure outcomes for peer supporters.

Non-clinicians' judgments about asylum seekers' mental health: how do legal representatives of asylum seekers decide when to request medico-legal reports?

BACKGROUND: Procedures for determining refugee status across Europe are being speeded up, despite the high prevalence of mental health difficulties among asylum seekers. An assurance given is that ''vulnerable applicants'' will be identified and excluded from accelerated procedures. Although experts have recommended assessments to be undertaken by experienced clinicians, this is unlikely to happen for political and financial reasons. Understanding how non-clinically qualified personnel perform assessments of mental health issues is timely and crucial. Misrecognition of refugees due to the inappropriate use of accelerated procedures involves the risk of returning the very people who have the right to protection from further persecution. OBJECTIVE: To examine the decision making of immigration lawyers, who are an example of a group of nonclinicians who decide when and whether to refer asylum-seekers for psychiatric assessment. METHOD: Semi-structured interviews were conducted with 12 legal representatives working with people seeking refugee or human rights protection in the United Kingdom. The resultant material was analysed using Framework Analysis. RESULTS: Themes clustered around the legal case, the client, the representative and the systems, all with sub-themes. A mapping exercise integrated these themes to show how representatives brought together questions of (1) evidential reasons for a report, influenced by their legal, psychological and case law knowledge, and (2) perceived evidence of mental distress, influenced by professional and personal experiences and expectations. CONCLUSIONS: The legal representatives interviewed were well-informed and trained in psychological issues as well as clearly dedicated to their clients. This helped them to attempt quasi-diagnoses of common mental health problems. They nonetheless demonstrated stereotypical understanding of post-traumatic stress disorder and other possible diagnoses and the role of subjectivity. The study has implications for other groups - particularly those less trained and compassionate - who are required to make clinical judgments without the necessary expertise.

Multisystemic therapy for young offenders: families' experiences of therapeutic processes and outcomes.

Multisystemic Therapy (MST) has been found to be effective in reducing youth antisocial behavior, but little is known about the process and impact of MST from the perspective of families themselves. This qualitative study explored parents' and young people's experiences of MST, focusing on aspects of the intervention that promoted or limited change. Thirty-seven semistructured interviews were conducted with a consecutive sample of 21 families (21 parent interviews, 16 young people) who had participated in a randomized controlled trial of MST for young offenders in the United Kingdom. Thematic analysis yielded 10 themes, organized into two domains: (a) engagement in MST and initial processes of change captures the central importance of the therapeutic relationship and the MST engagement model in families' positive experiences of MST; and (b) outcomes are complex reflects the range of positive outcomes reported (notably increased parental confidence and skills, improved family relationships, a return to education, and greater reflection and aspiration on the part of the young person) and mixed behavior outcomes. Even when the young person had reoffended, respondents indicated a range of other benefits for the family. The findings support the MST theory of change as well as point to some outcomes not usually measured in MST outcome studies. They also suggest some adaptations that may increase the impact of the intervention, including more attention to the influence of deviant peers, and ongoing support for families struggling to maintain strategies beyond the prescribed treatment period.

High-functioning autism and Asperger's disorder: utility and meaning for families.

We used framework analysis to investigate the utility of pervasive developmental disorder diagnoses, interviewing young people (aged 9-16 years) with high-functioning autistic disorder (AD) and Asperger's disorder (AsD), and their parents. Twenty two participants from ten families described both gains and costs resulting from diagnosis. Perceived advantages of AD and AsD diagnosis were increased understanding and practical support, and parental empowerment. Disadvantages included the effects of stigma and concerns about validity. Participants tended to consider AsD and AD as interchangeable terms. Findings suggest that the utility of AD and AsD depends upon both their validity and how these diagnoses are received in their cultural, economic and legislative context. Improvement of post-diagnostic services will improve the utility of AD and AsD.

Telephone peer support for women with gynaecological cancer: recipients' perspectives.

OBJECTIVE: Peer support is much valued by cancer patients. Previous research has focused on support groups, typically for women with breast cancer; little has addressed one-to-one support. This qualitative study examined a telephone-delivered one-to-one peer support intervention for women with gynaecological cancer, focusing on recipients' experiences of process and outcome. METHODS: Semi-structured interviews were conducted with 24 women recently treated for gynaecological cancer who had received peer support for up to a 3-month period. Transcripts were analysed thematically using the 'Framework' approach. RESULTS: Six key components of the peer support process were identified: an emotional bond, empathy, talking openly, reciprocity, information and guidance, and humour. Their importance was highlighted by cases in which they were absent or problematic. Participants described several benefits, for example hope and confidence, making sense of the illness experience and rebuilding one's life. However, one-third reported limited or no benefits, although there was no evidence of adverse outcomes. CONCLUSIONS: One-to-one telephone peer support shares common features with support groups but is uniquely dependent on an effective working relationship between the support provider and recipient. Peer support can address the disease- and treatment-specific concerns of women with gynaecological cancer, as well as the adaptive tasks of recovery faced by cancer survivors. Further research needs to examine who is more or less likely to benefit from one-to-one peer support and which parameters of the intervention, such as duration and matching, influence its effectiveness. Patient-relevant outcomes should be included in future controlled trials.