The importance of early intervention for positive outcomes following a first episode of psychosis (FEP) is recognised, however, there are still delays in young people seeking help. The aim of this qualitative study was to explore beliefs about help-seeking in young people who have recently experienced a FEP. Twelve participants were interviewed and transcripts were analysed using grounded theory. Five categories of beliefs were identified which contributed to the development of a preliminary model of beliefs about a need for help-seeking. Young people’s beliefs about their experiences as normal or abnormal, and about the process and outcome of help-seeking, influenced beliefs about needing help. Existing beliefs about mental health problems, and beliefs about the impact of experiences on the self were important to the meaning young people ascribed to beliefs about help-seeking. Social networks were important in the development of these beliefs. The study identified beliefs which promoted and inhibited young people’s help-seeking beliefs for FEP. Self-stigma was present prior to help-seeking. Implications for clinical interventions include education to promote help-seeking for distress and not abnormality, and to dispel myths about the help-seeking process and outcome. Further research is needed to determine which beliefs are most important to young people’s help-seeking for FEP.

This study aimed to determine the prevalence of anxiety specifically related to discharge in a group of 42 individuals who had sustained moderate to severe acquired brain injury and who were imminently due to return home following a period of inpatient neurorehabilitation. The study also aimed to explore differential relationships between psychological factors (self-efficacy and health control beliefs) alongside the relative influence of demographic (age, gender and ethnicity) and clinical (medical diagnosis and injury location) characteristics on discharge-anxiety. A cross-sectional, single-group design was employed, wherein correlational and multivariate analyses were used to explore relationships between variables. Data was obtained via self-report tools and retrospective reviews of medical files. While few participants (14%) reported markedly elevated trait-anxiety almost half (45%) of the sample reported levels of transient, state-anxiety which could be considered to be clinically significant. Notably, state-anxiety (appraised via the State-Trait Anxiety Inventory) was strongly associated with discharge-anxiety (appraised via the Patient Anxieties Questionnaire). Age, self-efficacy and internal health control beliefs made independent contributions to the level of discharge-anxiety reported, with perceived self-efficacy alone explaining 69% of the overall variance and mediating the effect of internal control beliefs. No other demographic or clinical characteristics examined were significantly related to discharge-anxiety. Although causality cannot be inferred, findings suggest that discharge-related anxiety is best predicted by poor perceptions of self-efficacy. Implications for clinical practice and directions for future research are discussed.

Section A reviews the literature from two areas: it looks first at empirical studies exploring self-stigma in psychosis and secondly at psychological flexibility in psychosis. In doing so, the review aims to consider the question as to whether the psychological flexibility model, as presented by Acceptance and Commitment Therapy, can help us to understand how and why self-stigma can have a detrimental impact on some individuals experiencing symptoms of psychosis. Section B reports on a quantitative study of self-stigma, psychological flexibility, psychological well-being and quality of life in a First Episode Psychosis population. Research suggests that individuals experiencing psychosis may self-stigmatise, whereby negative beliefs and stereotypes about mental health difficulties are internalised. This in turn has been found to impact negatively on a number of areas. The psychological flexibility model presented by Acceptance and Commitment Therapy may help us to understand this. This study aimed to explore self-stigma using both an explicit and implicit measure of self-stigma to see how these were related to psychological flexibility, quality of life and well-being. Twenty-six participants experiencing first episode psychosis were recruited. They completed self-report questionnaires pertaining to quality of life, psychological well-being, psychological flexibility and explicit self-stigma. In addition, they completed a computer based reaction-time task designed to measure implicit self-stigma. Significant relationships were found between explicit self-stigma and well-being, and between psychological flexibility, explicit self-stigma, quality of life and well-being. Explicit self-stigma was found to statistically mediate the relationship between flexibility and well-being. Implicit self-stigma was not related to any investigated variable. The findings suggest psychological inflexibility may lead to greater self-stigma, which in turn decreases psychological well-being. This implied that interventions geared towards increasing flexibility may not only improve well-being, but may also help address issues of self-stigma.

This study aimed to explore how the experience of previous mental-health problems affects clinical and counselling psychologists’ approach to practice. Semi-structured interviews were conducted with six clinical and four counselling psychologists who had experienced mental-health difficulties. Data was analysed using Interpretative Phenomenological Analysis. Analysis of the interviews highlighted five master themes: Use of the personal-self of psychologist; Ambivalence; Identity as a psychologist; Psychologists as agent of change; and Finding meaning in suffering. The results of this research showed that psychologists with a history of mental-health problems actively draw upon their experience. In managing their dual identity of service-user and professional, they reported a degree of ambivalence which influenced the way that they viewed themselves and their practice. Their personal experiences seemed to be closely tied up with their professional-identity, which either conflicted with their sense of self or complemented it through highlighting how fortunate they were compared to others. The interviews frequently highlighted how psychologists’ experiences can provide an impetus to speak out for patients’ rights to ensure that they are treated with respect and dignity. A number of psychologists with an experience of mental-health difficulties felt that they might not have pursued their career had they not had previous mental-health difficulties. There appeared to be mixed findings concerning whether the participants felt that their mental-health difficulties had helped or hindered their practice.

Research suggests that interpersonal difficulties are reported by those who experience grandiose beliefs, however the processes and the relationship with the belief have seen limited exploration and are poorly understood. The present study aimed to explore the perceptions of interpersonal relationships and self-esteem of people who have grandiose beliefs and to explore if these accounts are consistent with existing theory. A qualitative design was employed using interpretative phenomenological analysis (IPA) to explore participants' subjective understanding of experiences. Semi-structured interviews were carried out with eight individuals who were purposively sampled. Transcripts were analysed using IPA. Four superordinate themes emerged: ‘Others as disregarding’; ‘Fragile sense of self’; ‘Lost in a frightening world’ and ‘Surviving’. The study found that participants' accounts were characterised by difficult interpersonal relationships in both early and adult life. The participants' sense of self was complex and lacking in coherence, thus previously used measures of “self-esteem” may not adequately capture the subtleties of the experiences. The sense of self was set in a social context characterised by feelings of powerlessness isolation and lack of trust. In the context of limited resources the results suggest the beliefs function to make sense of experiences and to help the participants survive. These findings confirm that the belief may, in part, serve to protect participants from poor “social self-esteem”. These findings provide avenues to further exploration of processes and provide recommendations for clinicians and services.

The study aimed to examine the relationship between wellbeing, burden, distress and third-wave factors, including self-compassion and psychological flexibility, in caregivers of people with psychosis. The study secondly aimed to trial a new brief group intervention, combining Acceptance and Commitment Therapy (ACT) and Compassion-focused Therapy (CFT) for this population. Twenty-nine participants were assessed at baseline on primary measures of wellbeing, distress, psychological flexibility and self-compassion. Secondary factors including burden and mindfulness were also collected. Correlation analyses were used. Fourteen participants completed the group in intervention and follow-up measures, and pre-post investigations were employed. Lower levels of psychological flexibility and self-compassion were related to lower levels of wellbeing and higher levels of burden and distress. There was a potential mediating effect of psychological flexibility on the relationship between self-compassion and wellbeing. The group intervention was acceptable to caregivers, and there were significant positive changes in self-compassion, distress, burden and mindfulness. The study adds to the existing data regarding wellbeing and burden in caregivers of people with psychosis. This study provides new insights into the factors of self-compassion and psychological flexibility within this population. The ACT with Compassion intervention is a promising, brief intervention which would benefit from further application and evaluation.

There is a consistent research base that shows that class and inequality is associated with poorer mental health and experiences of distress. Various explanations for this link have been proposed, including psychological, social, structural, material and political factors. Experiences of powerlessness and oppression have also been implicated. Nevertheless psychology focuses predominately on explanations and interventions at the individual level. To explore this incongruence, a Foucauldian Discourse Analysis was completed of texts produced by Improving Access to Psychological Therapies (IAPT), related to the development and practice within IAPT and supervision sessions of high-intensity therapists practicing in IAPT. The emerging discourses are discussed.

Section A reviews the clinical and risk implications of dual diagnosis along with the treatment context. The value of gathering firsthand accounts of service users to inform the planning and delivery of healthcare is touched on. The second part of the paper centres on theories of motivation and how they might be applied to help explain low rates of dual diagnosis treatment uptake and engagement. Finally, gaps in the literature are highlighted with recommendations for further research. Section B There is an emerging evidence base to support the use of integrated approaches that treat co-existing mental health and substance use disorders simultaneously. However, low rates of treatment uptake and engagement remain a concern. To address this, it would seem important to understand dual diagnosis treatment motivation and engagement, an area that has received little attention from the research community. The aim of this study was to explore service users’ and clinicians' understandings of how treatment motivation and its relationship with treatment engagement relate specifically to people with dual diagnosis. Transcripts from semi-structured interviews with four service users and four clinicians were analysed using narrative methodology. The study suggests that the factors underpinning treatment motivation and engagement among people viewed as having dual diagnosis are similar to those thought to be associated with addictions and mental health disorders generally although their relative influence and interaction effect might be different. It is suggested that negative perceptions of services, difficulties with trust, and therapeutic relationship are particularly important issues among dual diagnosis populations. Clinical and theoretical implications of the study are discussed in relation to the literature as well as recommendations for future research. Section C: Critical Appraisal. This paper provides a general overview of narrative research, including strengths and limitations as they relate to this study. With reference to the literature, clinical and theoretical implications are elaborated along with recommendations for future research. The author’s critical self-reflections regarding the process of initiating, carrying out and completing the study are highlighted. Following this, there is a section on the ethical considerations of the study. Finally, the measures taken to ensure the quality of the study and maximise internal consistency are presented.

Section A is a review of the literature on Community Treatment Orders (CTOs) in the context of their recent introduction in England and Wales. A critical review of the literature in relation to CTOs’ effectiveness is presented, followed by available evidence on service users’ perceptions of CTOs. Consideration of ethical issues that surround compulsory community treatment is also offered. The review highlights gaps in the literature regarding CTOs’ impact on service users’ interpersonal relationships and on how service users who are based in the UK perceive CTOs. Further qualitative research is recommended. Section B describes a qualitative study investigating male service users’ perceptions of their CTOs and the impact of this intervention on their interpersonal relationships. Grounded Theory was used to analyse interview data from 15 participants. Five higher-order categories and 15 categories were identified which contributed to a preliminary model of how service users develop their CTO perceptions. The factors that appeared to influence participants’ perceptions of their CTOs were: i) past and present social living conditions, ii) view of self in relation to mental health, iii) view of the CTO service, i.e. view of medication and mental health professionals. Finally, the model showed that CTOs had a limited or no impact on participants’ views of their relationships with their families, friends, partners and local communities. Results are discussed with reference to potentially relevant psychological theories. Clinical implications, including raising professionals’ awareness about the impact of coercion on the therapeutic relationship, and directions for future research are also presented. Section C is a critical appraisal of the study presented in Section B. It provides reflective responses to four questions in relation to the following areas: research skills acquired through conducting the study; what improvements could be made if repeating the study; clinical implications; and directions for future research.

Section A provides an overview of the literature investigating the relationship between parental mental health and child physical health within populations of children with chronic childhood illness. Evidence for whether this relationship definitively exists, as well as the potential pathways through which this relationship could operate, is evaluated. Carers of children with Chronic Kidney Disease (CKD) can experience burden and psychological distress, which has been shown to impact on the child's physical health. Section B is an empirical study aiming to assess the validity and reliability of the Paediatric Renal Carer Burden Scale (PR-CBS) , a 51 item psychometric measure designed to assess carer burden in carers of children with CKD. Factor analysis indicated retention of 21 items representing 5 factors; Illness worries (8 items), Impact on self (5 items), Impact on child (3 items), Responsibility (3 items) and Institutional burden (2 items). Together they explain 53% of the total variance. Internal reliability for both the full scale and sub-scales were acceptable. Convergent validity was demonstrated using the Hospital Anxiety and Depression Scale and Caregiver Strain Questionnaire and the scale was reported by respondents as being acceptable to complete. The PR-CBS has been shown to be a valid and reliable scale and as such is a clinically relevant tool with which to identify burdened carers and provide additional psycho-social support so as to ensure best outcomes for both carer and child. Section C provides a critical evaluation of the research process and reflections from the researcher on learning throughout the process of the study as well as clinical implications and future research directions.