This thesis examines the health seeking practices of the mentally ill in Sylhet, Bangladesh. Previous work has suggested that in the Islamic world local traditional healing is being undenriined by the encroaching global forces of biomedicine and orthodox Islam. However, in Sylhet, traditional healing is thriving. Traditional healing may survive for different reasons. For local women, traditional healers may offer a space for ventilating complaints which is not available elsewhere for affluent ex-pats the opportunity to reassert their Bengali identity. Western biomedicine poses less of a threat to traditional healing as it has become incorporated as a Bangladeshi product and perceived as inefficacious, corrupt and hannful. Conversely, the endurance of traditional healing may lie in its ability to adapt and incorporate Western biomedicine. Muslims do not see anything inconsistent in visiting Hindu healers as any healer is simply the medium through which Allah works.

No description available.

No description available.

No description available.

There is widespread, popular belief that contact with companion animals can be beneficial for people across the lifespan. However, a review of the evidence-base reveals that this is not as straightforward as might be expected; with over four decades of human-animal interaction research reporting mixed findings regarding benefits of pet ownership. Whilst it has been hypothesised that pets may be of particular benefit for people who experience social exclusion and therefore isolation; there is a notable lack of research exploring the role of companion animal ownership in people with experience of mental health difficulties. Furthermore, the concept of recovery from mental health difficulties has been redefined; with an emphasis on personal recovery as a means of living a fulfilling life alongside any mental health challenges. Accordingly, a qualitative grounded theory methodology was used to explore what role, if any, companion animals can play in their owners' recovery from mental health difficulties. Semi-structured interviews with ten service users, all of whom currently owned pets and were recruited through mental health charity support groups, were used to generate a theory of the influence companion animals can have on recovery. A triangular interaction between three core concepts constructed from the data: responsibility, reciprocity and relating, together with two overarching categories: recovery and identity, offered an explanation as to how companion animals can influence recovery. These findings are discussed in the context of current literature, clinical implications for mental health service providers, in particular the need to acknowledge the potential importance and complexity of human-animal relationships, and lastly future research directions.

The National Improving Access to Psychological Therapies (IAPT) programme aims to train 6000 Psychological Wellbeing Practitioners (PWPs) and High intensity therapists (HIs) to deliver evidence based Low and High intensity psychological treatments to patients suffering with depression and anxiety disorders. The studies reported within this thesis were conducted to ascertain whether training led to improved therapist competence, and to better understand relationships between training and patient outcomes. A secondary objective was to explore the influence of therapist characteristics on training and patient outcome. Competence was measured through a series of clinical and academic assessments. Clinical skill, measures by Observed Standardised Clinical Examination (OSCE) for PWPs and ratings of therapy sessions using the Cognitive Therapy Scale Revised (CTS-R) for HIs improved over the duration of the respective courses. No tests of clinical knowledge improved over training. Training outcome was best predicted by past performance, trainees achieving higher undergraduate degree grades were more likely to perform well clinically and academically. Demographic variables (age, gender and experience), personality and cognitive-ability were not consistently related to training outcome. Patient outcome was unrelated to performance on the PWP or HI training programmes, and did not differ according to whether patients were treated during, or after training. However, differences emerged in the outcomes of patients treated by the most and least competent therapists. More patients than expected treated by PWPs in the top quartile of OSCE performance reliably improved and recovered, the reverse was true of patients treated by the poorest performing PWPs. Similarly, more patients treated by the most competent HI therapists showed a reliable improvement in symptoms of anxiety, and reached recovery than expected. Therapist characteristics were unrelated to patient outcome. The implications of these findings are discussed, and directions for future research proposed.

The concept of self-compassion has become increasingly popular in the mental health literature due to its associations with well-being and psychological health. Compassion Focused Therapy is a relatively new therapeutic model which uses a range of techniques, such as compassionate imagery, to enhance self-compassion. Researchers and clinicians have, however, found that individuals can be fearful of compassion, from others and/or towards themselves. This can cause a block to the development of self-compassion and can inhibit the effects of the therapeutic techniques of Compassion Focused Therapy. Objective The present study was designed to explore the relationship between attachment and fear of compassion and the role of different compassionate imagery tasks in reducing fear of compassion and improving affect. Method The study used an experimental between-participants design, in order to explore differences between different imagery tasks on the reduction of fear of compassion and improvement of affect. 189 students and staff were randomly allocated to one of three imagery tasks - a compassionate self imagery task ('self-self’), a compassion from others to the self imagery task ('other-self’), and a control imagery task. Results Findings showed that: 1) avoidant attachment was the strongest predictor of fear of compassion towards the self and fear of compassion from others; 2) that the 'self-self’ task was significantly better than the control task at reducing fear of compassion to the self, but that there were no differences between the imagery tasks at reducing fear of compassion from others, and 3) individuals with high fear of compassion from others and towards the self benefitted more from 'self-self’ imagery than 'other-self’. Implications The results highlight the need for clinicians to consider attachment when working with individuals who fear compassion, and to be aware of the effects of that different compassionate imagery tasks may have on individuals who fear compassion.

Background: Antipsychotic medication is given in first episode psychosis in a prophylactic sense and also as a treatment. Young people experiencing their first episode of psychosis are generally the most responsive to pharmacological treatment. They are also the most susceptible to adverse events. Avoiding adverse events when individuals first start treatment is particularly important as the person's initial clinical experience may colour their attitude to medication thereafter. What it is like to take antipsychotic medication from the perspective of young people experiencing their first episode of psychosis has received relatively little attention, yet non-adherence in this population is reported to be as high as 50%. Objective: The aim of this study was to determine the experience of taking antipsychotic medication from the perspective of young people experiencing their first episode of psychosis. Methods: A purposive sample of young people with first episode psychosis responded to open-ended questions regarding their experience of taking antipsychotic medication. A thematic analysis was undertaken. Results: Twenty young people reported their experiences of taking antipsychotic medication. Eight themes were identified: [1] it does what is says on the tin; [2] impact on mood; [3] the drugs don't work; [4] side effects; [5] acceptability of medication; [6] weighing up the costs and benefits; [7] impact on activities of daily living; [8] there has to be something else. Conclusion: Young people with psychosis reported a mix of both positive and negative views about antipsychotic medication. Sedation was the most frequently reported and troublesome side effect. Hopes that with the advent of atypical antipsychotics adherence would improve with a less severe side effect profile have clearly not come to fruition. It is important to pay attention to young people's uncensored accounts of what it is really like to take antipsychotic medication. Key words: first episode psychosis, antipsychotic agents, patient satisfaction, qualitative research, patient experience, adherence, adverse events

No description available.

User definitions of recovery from psychosis consider recovery to be an idiosyncratic process where internal factors such as hope and empowerment are important. Furthermore, unlike 'clinical' recovery, 'user-defined' recovery suggests that absence of 'symptoms' is not necessary for recovery to occur. The current study examined whether subjective factors such as hope and empowerment are linked to recovery fi*from psychosis and whether these factors are important in predicting user-defined recovery.