Objective: Difficulties in regulating emotions have been implicated in the development and maintenance of anorexia. However, the empirical and theoretical literature lack explanations about how emotion processes change during the process of recovery. This study seeks to theorise about how people with anorexia perceive their experience of emotion regulation and the factors that influence this, including any therapy-related change. Method: A constructivist version of grounded theory was used to analyse data collected from semi-structured interviews with nine participants. The sample consisted of people attending an eating disorder service who were currently engaged in therapy. Results: The analysis produced ten categories reflecting different aspects of the emergent grounded theory of change. Participants described moving between positions of creating a sense of safety in a world of uncertainty, seeing through the façade of anorexia, and recovery and growth. A maintenance model of coping ‘badly’ is also suggested by the data. Discussion: Behaviours associated with anorexia are amongst the maladaptive strategies participants used to subjectively manage emotions and cope more generally. Positive change was experienced through developing awareness around such processes. The findings support an increased focus on emotions in the treatment of anorexia and offer suggestions about what may facilitate change, both in therapy and elsewhere.

Borderline Personality Disorder (BPD) is a distressing difficulty prevalent within UK secondary-care settings. Previous qualitative studies have examined individual experiences of long term Mentalization-Based Therapy (MBT) groups for people with BPD. However, the psychoeducational component of MBT has not yet been researched coherently. The current study explored lived experiences of manualised MBT-psychoeducation groups for people with BPD within NHS secondary care settings. Eight participants took part in interviews about their recent participation in these groups. Interpretative phenomenological analysis was used to interpret individual meaning-making of these experiences. While some accounts were characterised by contradictions, MBT-psychoeducation was generally viewed as a challenging but predominantly beneficial experience. Three main themes emerged, comprising eight sub-themes. These highlighted individuals’ attempts to manage complex group processes, strategies for personalising knowledge, and the power and fear of increased self-reflection. Participant’s felt the group had impacted their sense of self, their understanding of others and their impulsivity, particularly within interpersonal relationships. Research and clinical implications of these findings are discussed. Particular importance is given to the implications of some individual’s perceived need for additional support or coping, the desire for further MBT group therapy and the possibility that these findings support propositions that the groups provide a useful mechanism to stimulate mentalizing.

Objective: Clinicians working with individuals with eating disorders encounter unique emotional, cognitive and behavioural responses. Such responses may impact on clinician self-care and wellbeing, and are linked to clinician burnout and poor treatment outcomes. Supervision can protect against such deleterious consequences. At present there is limited theoretical literature and no empirical literature relating to the supervision of eating disorder clinicians. Method: A three round Delphi Methodology was employed to explore the experiences of clinicians from a range of professional backgrounds who work therapeutically with individuals with anorexia nervosa, along with the role of supervision and relevant key supervision requirements. Results: Positive experiences were more frequently reported than negative experiences. Key negative emotions comprised sadness, anxiety, frustration and inadequacy. The impact on clinicians thinking about food and their own body-image were divergent. A large number of statements reflecting the core elements of supervision including areas of discussion, reflection, outcomes, supervisor qualities, the supervisory relationship, barriers and facilitators reached consensus. No consensus was reached regarding discussing clinicians’ thoughts about food, body-image or personal eating disorder history. Discussion: Implications for clinical practice include using these findings to challenge persistent beliefs that individuals with anorexia nervosa are undesirable to treat, and to help identify appropriate support where challenging experiences arise. Results relating to supervision can form the basis of future supervision guidelines in this field. Study limitations and implications for future research are discussed.

OBJECTIVE: Person Based Cognitive Therapy (PBCT) is a promising group treatment for distressing psychosis. However, fostering engagement in group therapies can be challenging, and no theory of engagement in PBCT groups exists to guide practice or research. This study employed Grounded Theory Method (GTM) to build a theory of engagement in group PBCT. METHOD: Ten service-users and three therapists were interviewed about their experiences of participating in PBCT groups. GTM, following the procedures outlined by Corbin and Strauss (2008) was used to analyse the interview transcripts and build a theory of engagement. RESULTS: The model that was developed involves a recursive process of investing in change and continually evaluating its usefulness and safety. Barriers were often overcome through individual and group efforts, but sometimes compromised participants’ perceived safety to the point of dropout. For others, participating in the group, and incorporating learning into life, led to rewards, some of which were integrated beyond group termination. CONCLUSIONS: Group engagement can be encouraged by establishing universality around voice-hearing early, reducing uncertainty, communicating with clients between sessions and mapping group progress to create a cohering sense of collaboration on the tasks of therapy.

Adolescents have a high prevalence of mental health problems but are unlikely to seek help. Adults, including parents are important within this process. The study therefore aimed to develop a theory of the influence of parents upon adolescent help seeking. Method Eighteen semi-structured interviews were conducted with adolescents, their parents and clinicians working within Child and Adolescent Mental Health Services (CAMHS). A grounded theory analysis allowed for the in-depth exploration of participants’ experiences. Findings A model was developed identifying help seeking as a family journey. Parents were highly influential in the help seeking journey, and parents who were able to be more available to their adolescents tended to be more involved in the help seeking process. Other adults were utilised within the help seeking process. Once adolescents were engaged with the help seeking process they were often able to then seek further help independently. Conclusions The findings suggest that consideration should be given to making services accessible to adolescents. CAMHS services should explore ways with adolescents to give control over parental involvement, and ways with parents to develop availability. Future research should consider the experiences of older and younger adolescents separately, and the transition into adult services.

Quantitative research based on diagnostic classification has been limited in developing an understanding of ADHD and its related behaviour among children who have experienced Developmental Trauma, including neglect and abuse. Clinical practice may not attend sufficiently to the emotional experiences of these children with a diagnosis of ADHD, due to the dominance of biomedical discourse. This study utilised discourse analysis to examine discourses, of Therapeutic Community staff, about ADHD and its related behaviour among looked after children who have had experiences of Developmental Trauma. Non-medical and environmental discourses were dominant in this setting. A Biopsychosocial discourse legitimised multi-disciplinary collaboration between Therapeutic Community and mainstream practice for complex difficulties among this population of children. Children’s understanding of ADHD and stimulant medication prescribed for this diagnosis, along with clinical and research implications, were considered.

Parents who experience psychosis experience challenges in addition to those associated with being a parent. Their children are at risk for a range of negative outcome. Family interventions for psychosis have been found to be helpful in mitigating some of these outcomes and have a strong evidence base. Systemic literature has provided a raft of techniques to facilitate the inclusion of children in family therapy, though these are largely absent from the literature on family interventions for psychosis. This study used a three- round Delphi survey to investigate what is considered best practice when deciding whether, and how, to include children in their parents' family intervention for psychosis amongst a group of experts. Findings demonstrated support for including children and suggested methods of facilitating their involvement in assessment, areas that should be attended to in sessions, adaptations that should be made, and organisational factors that support their inclusion. Their responses suggested that adult mental health services were well placed to meet some of the needs of these children. Consideration is given to items which did not have consensus and the clinical and research implications are described.

Acceptance and Commitment Therapy (ACT) is transdiagnostic therapy, found to be effective for both mental and physical health conditions. To date, much of the research has focused on evaluating ACT groups within single health conditions. This study used a grounded theory methodology to develop an understanding of the therapeutic processes within liaison psychiatry ACT groups where individuals present with long-term physical health conditions (LTCs) and accompanying psychological difficulties. Interview data from thirteen participants who had either attended or facilitated these groups was analysed. In line with the methodology, data analysis ran concurrent to data collection. As categories emerged theoretical sampling was used to facilitate the generation of a theory. This grounded theory model presents an explanatory framework of 'the individual journey through a transdiagnostic ACT group'. The theory suggests a combination of group processes and ACT processes enabled learning, which led to increased awareness. Learning extended beyond the group setting, but change was only maintained for some post group, with expectations and relationships to ACT appearing to influence longer term gains. In conclusion, participants appeared to gain more therapeutically if they had low expectations and connected with values-based action. Implications for future research and clinical practice are discussed.

Objectives. This study investigated the experience of neuropsychological assessment from the patient’s perspective. It sought to gain an understanding of how the patient viewed the purpose of assessment and how the patient experienced the assessment process. It explored the impact of the assessment of the patient’s sense of self and elicited patients’ views about what was particularly helpful or unhelpful about the assessment process. Design. A within-group qualitative design was employed to investigate the experiences of nine men and women who presented for neuropsychological assessment in the context of an outpatient assessment clinic or as part of an evaluation for a rehabilitation programme. Method. Verbatim transcripts of semi-structured interviews were analysed using interpretative phenomenological analysis. Results. Six master themes were identified: Expectations of assessment, context of referral, experience of process, impact on self, components of a good assessment and experience of illness/disability. The findings indicated that patients are poorly prepared for assessment but come with positive expectations for information that will help them understand and cope with their impairments. Their relationship with the psychologist is central in determining the quality of their experience and in facilitating improved self-esteem, coping and better awareness of cognitive strengths and deficits. Conclusions. It is concluded that neuropsychological assessment can have an educative and therapeutic function that should be further exploited in a diagnostic and rehabilitation context. The findings are considered in relation to the literature on sharing a diagnosis, coping with illness and the client-clinician relationship. The implications of the research findings for clinical training and neuropsychology service provision are discussed and consideration given to future research opportunities.

Progress in mindfulness-based interventions (MBIs) and research for adults with severe and enduring mental health problems has been gradual, held back in part by a belief that mindfulness may be harmful for this client group. Adapted MBIs have shown promise in the treatment of two commonly presenting problems in secondary care services; psychosis and borderline personality disorder, and emerging evidence suggests that this approach is both safe and therapeutic. Effectiveness of a transdiagnostic MBI is relatively unexplored, therefore a feasibility study is needed. A mixed-method, randomized controlled trial and observational study explored feasibility, acceptability, and preliminary efficacy of a brief MBI in a naturalistic setting. Study feasibility was demonstrated through good rates of recruitment (n=26 in three months) and retention. However, rates of outcome measure completion fell just shy of target. Intervention feasibility and acceptability was demonstrated through good attendance and positive feedback. Content analysis of post-intervention interviews (n=15) suggests most participants found the intervention helpful, albeit challenging at times. Four overarching themes emerged from responses; effects on wellbeing, change processes, internal factors, and practicalities. A trend towards improvement was observed for both groups on standardized measures of mindfulness, compassion, anxiety, and depression (Cohen’s d ranged from 0.31 to 1.05). A trend towards deterioration was observed on a measure of wellbeing for the control group only. Findings point to the potential benefits of a brief MBI in this setting, and warrant further testing in a larger trial with an active control.