Background: The relationship between interpersonal trauma (IPT) and substance misuse is complex and multi-factorial, but has not been examined fully in the existing few studies involving pregnant women who misuse substances. UK based midwifery education and practice is unique, but there is limited evidence regarding midwives experiences and perceptions of supporting this client group. Aims: The aim of this study was to chronologically map out pregnant women's past experiences of abuse and substance use, explore their experiences and perceptions of their journey to motherhood and explore midwives' experiences and perceptions of supporting this client group. Methods: A qualitative study was conducted. Five eligible pregnant women supported by specialist midwifery services in Central Scotland were recruited. Data were collected using a life history calendar (LHC), followed by an in-depth, semi-structured interview. Six eligible midwives were recruited from one NHS board in Central Scotland. In depth, semi-structured interviews were carried out. Findings: Individual LHCs were converted into chronological timelines. Transcribed interviews were analysed using Interpretative Phenomenological Analysis. The life history calendars revealed the pregnant participants' experiences of IPT and substance misuse as complex, interconnected and ongoing, including during pregnancy and motherhood. Three major overarching themes emerged from the pregnant participants' interview transcripts: “psychological trauma”, “dabbling to addiction” and “addiction and the identity of pregnancy and motherhood”. Three major overarching themes emerged from the midwifery participants' interview transcripts: “psychological trauma”, “stigma” and “managing unmanageable situations”. Conclusions: This study sheds new light on the lived experiences and perceptions of a previously under-researched and largely misunderstood group of vulnerable women. It highlights some of the challenges faced by midwives in clinical practice. Important areas for future research are highlighted, along with implications for multi-disciplinary education, policy and practice.

Transition to parenthood can be a stressful time for a couple, especially for couples at risk for substance misuse and intimate partner violence. Relationship satisfaction tends to decline in the first year of parenthood as the partners are adjusting to the demands of their new roles as parents. History of trauma and current symptoms of Post-traumatic Stress (PTS) have been associated with decreased intimacy, communication, and relationship adjustment, yet there is a lack of research on how PTS symptoms and trauma history affect parents and families. The current study investigated how PTS symptoms and trauma history affect new parents’ relationship satisfaction in the presence of substance misuse and intimate partner violence. Ninety eight heterosexual couples filled out questionnaires one year after the birth of their first child. Hierarchical multiple regression results indicated that PTS symptoms predicted relationship satisfaction over and above IPV victimization and substance misuse for men. However, for women, psychological IPV victimization was the only significant multivariate predictor for women. Additionally, for men, PTS symptoms interacted with harmful drinking to predict relationship satisfaction. The results suggest that women’s relationship functioning is particularly affected by psychological aggression while men’s relationship functioning is particularly susceptible to effects of harmful drinking and their own PTS symptoms. Implications are discussed. / Graduate

Parental bereavement has widely been considered, in the context of child development and well being, to be one of the most traumatic events that can occur in childhood. Parental bereavement through substance misuse is a previously unresearched aspect of bereavement research, and a previously unresearched aspect of ‘hidden harm.’ This qualitative research looks at the lived experiences of four girls who have been parentally bereaved through substance misuse, using interpretative phenomenological analysis (IPA). IPA serves the dual purposes of ‘giving voice’ to these previously unheard voices, and interpreting their experience of dealing with bereavements, through the lens of psychological theory and the wider canon of bereavement research. The information for the analysis was collected in individual meetings with each of the girls, gathered through semi structured interviews which took place over one to four meetings. Life for all the girls was difficult and complicated as a consequence of their parents’ troubled lives, and for all the girls their lives were marked by multiple losses and adverse childhood events both before and after their mother’s or father’s death. The analysis tries to capture the children’s narratives about their lives as a journey in which one girl is managing to stay ‘on track’, whilst the others have gone ‘off the rails.’ None of the girls had made a deliberate choice to be ‘off the rails’, yet the environment in which they live meant their life journey is a stormy one, with no safe haven, and their lives have not offered them the ‘lifelines’ they needed in order to stay ‘on track’, and navigate their way through this traumatic event. They feel shame for their disruptive manifestations of grief, for the ways in which they ‘cope ugly.’ They now have ‘spoiled identities’, and are struggling to achieve a sense of self that will help them to make the transition to adulthood. The experience of the fourth girl demonstrates the ways in which she works to achieve her personal identity, preserve her ‘reputation’, and the secure attachment she needed, in order to police her potentially disruptive manifestations of grief. In the context of this research ‘on track’ or ‘off the rails’ are positioned as more helpful constructs than ‘normal’ and ‘complicated’ grief. The findings of this small scale research demonstrate the risks and inaccuracies in accepting the conclusion of large scale research studies which seem to indicate parental bereavement is not a risk factor for child wellbeing when family variables are taken in to account. Instead it demonstrates the ways in which dealing with parental bereavement, especially when compounded by other complex life events and insecure attachments, can result in children being positioned as ‘bad’ rather than ‘sad’ as villains rather than victims, children for whom their troubled lives and loss offer ‘no excuse’ for their troubled grieving. More research is needed to understand more about the lives and experiences of this vulnerable sub group of parentally bereaved children.

There is a great deal of empirical evidence to support the efficacy and effectiveness of cognitive therapeutic approaches such as cognitive behaviour therapy (CBT) and motivational interviewing (MI). In addition to this, research has identified several mechanisms of change thought to underlie these approaches. However, there has been little exploration of the specific cognitive and emotional processes that may underlie change in CBT and MI, or indeed their interactions. This thesis specifically explored the role of reasoning and emotion in relation to MI and CBT.In the first paper, the initial sections provided a narrative review whereby the roles of reasoning and emotion in CBT and MI were critically evaluated in context of existing empirical evidence. Further to this, the literature examining the effects of emotion on deductive reasoning was systematically reviewed. A total of 19 papers were identified and the implications of the studies’ findings discussed in relation to the clinical practice of CBT and MI. The studies varied noticeably in terms of the quality of the methodologies employed. Overall the studies considered, suggested that the effects of emotion on reasoning were complex, and yet to be well understood. However, through extrapolating the findings from the experimental study of cognition and emotion to the clinical practice of CBT and MI, the review demonstrated the potential relevance of such findings, and indicated the need for research exploring the role of reasoning and emotion in these approaches.The second, empirical paper examined the extent to which statements reflecting informal reasoning and the emotional state of the client affected the generation of positive behaviour change statements and positive behaviour change in the context of MI with individuals with psychosis and alcohol use disorders. Participants (n=26) were clients selected from a large randomised controlled trial of integrated MI and CBT for psychosis and substance use. One audio recorded therapy session was selected for each participant. Reasoning and emotion statements were subsequently identified and categorised for each therapy session. It was found that the total number of reasoning statements generated positively predicted the total number of positive behaviour change statements generated. It was also found that negative emotional statements relating to the present, positively predicted the total number of reasoning statements generated. The results suggested that informal reasoning may be a specific cognitive process underpinning the production of behaviour change statements in MI with individuals with psychosis and alcohol use disorders, and provided support for the central role of discrepancy in producing change in MI. The final section provided a critical reflection of the research process. This included a rationale for the development of the literature review and the empirical paper, followed by a critical reflection on the study context and its’ implication to the study methodology. Finally the theoretical and future implications for research in this area were discussed along with the implications to clinical practice.

No description available.

Drug and alcohol addiction is a nationwide epidemic with an increasing number of Americans being affected. Individuals who seek treatment for their addiction often face barriers, such as costs, waiting time, and available support, and those who are able to receive treatment are likely to experience or anticipate stigma from others. Existing literature has found that many employers have negative perceptions of individuals in addiction recovery. However, there is limited research that has analyzed whether these negative perceptions affect hiring decisions. We predicted that employers would have negative perceptions of those in recovery, would be less likely to hire individuals in recovery, and that those with previous substance misuse would perceive stigma from employers. A survey was completed by 53 employers using the REDCap web platform. There were 23 respondents who had a history of substance misuse. The survey contained items from the Addiction Attitudes and Beliefs Scale (AABS) and the Tobacco, Alcohol, Prescription medication, and other Substance use Tool (TAPS). The AABS contained modified items from the Substance Use Stigma Mechanisms Scale (SU-SMS) and the Perceived Stigma Addiction Scale (PSAS). Results indicated that the majority of employers had negative perceptions of people in addiction recovery, but employers were willing to hire those individuals. Results suggested that those with a history of addiction perceived stigma from their employers. Limitations of this study include lack of generalizability due to the small sample size and limited geographic area. Participants may have reported in a way that would make them appear socially desirable.

No description available.

No description available.

Awareness of sexual exploitation has increased over the past decade. However, physical and psychological health needs, risks, health seeking behaviour and use of health services by sexually exploited young people have been inadequately explored. Methodology/method Phase 1: descriptive, phenomenological, approach to encourage young people involved in or vulnerable to sexual exploitation to describe their personal accounts of health, risks, health seeking and support. Phase 2: quantitative methodology consisting of a questionnaire survey with professionals supporting young people involved in or vulnerable to sexual exploitation. Data analysis Phase 1: phenomenological approach to data analysis (Giorgi, 1985). Phase 2: questionnaire data were analysed using software S.P.S.S. and thematic content analysis (Burnard, 2006). Results/findings Intentional self harm and substance misuse were concordant themes from phase 1 and 2. Novel themes that emerged from this study included a taxonomy of risk behaviours related to health, and the use of youth offending teams for health support Conclusion A significant range of physical and psychological health problems were reported alongside risks to health and barriers to health support for sexually exploited young people. Psycho-social vulnerability factors undermine health and impact on health seeking behaviour. / University of Bradford

Awareness of sexual exploitation has increased over the past decade. However, physical and psychological health needs, risks, health seeking behaviour and use of health services by sexually exploited young people have been inadequately explored. Methodology/method Phase 1: descriptive, phenomenological, approach to encourage young people involved in or vulnerable to sexual exploitation to describe their personal accounts of health, risks, health seeking and support. Phase 2: quantitative methodology consisting of a questionnaire survey with professionals supporting young people involved in or vulnerable to sexual exploitation. Data analysis Phase 1: phenomenological approach to data analysis (Giorgi, 1985). Phase 2: questionnaire data were analysed using software S.P.S.S. and thematic content analysis (Burnard, 2006). Results/findings Intentional self harm and substance misuse were concordant themes from phase 1 and 2. Novel themes that emerged from this study included a taxonomy of risk behaviours related to health, and the use of youth offending teams for health support Conclusion A significant range of physical and psychological health problems were reported alongside risks to health and barriers to health support for sexually exploited young people. Psycho-social vulnerability factors undermine health and impact on health seeking behaviour.