Purpose: A systematic review and meta-analysis tested the 'paranoia as a defence' model's original prediction that those experiencing persecutory delusions would take excessive credit for positive events as part of an attributional style that protects them from low self-esteem. The empirical project explored forensic mental health nurses' experiences of a Cognitive Analytic Therapy (CAT) training programme with an emphasis on complex case conceptualisation and implications for clinical practice. Methods: In relation to the systematic review and meta-analysis, those experiencing persecutory delusions were compared to those with non-paranoid psychosis, depression, and healthy controls, in terms of the magnitude of internalising attributional bias (IAB) for positive events. Correlation analysis also examined the association between magnitude of IAB and paranoia severity. In the empirical study, 10 forensic mental health nurses took part in semi-structured interviews to qualitatively explore their experiences and applications of CAT training. Results: Consistent with the model, an internalising attributional bias was present for those experiencing paranoid delusions when compared to individuals with depression. Contrary to the model, there were no differences between the other control groups and there was no significant correlation between IAB and paranoia severity. Internal attributions for positive events appear to be associated with depression, rather than paranoia. Analysis of the empirical data provided a rich account of nurses' experiences of the CAT training and how this helped them to conceptualise complex patients and promoted more positive ways of working. Conclusions: The findings from the systematic review and meta-analysis do not support the original model, but are consistent with the modified 'paranoia as a defence' model of persecutory delusions. Other cognitive models also help explain paranoia suggesting that refining the existing models further could be useful. The empirical findings suggest that CAT could be a valuable model of psychologically informed practice for nurses working in a forensic setting. Specifically, training appeared to help nurses develop a better understanding of their patients, greater self-reflection skills, and improved clinical care approaches.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:763988 |
| Date | January 2018 |
| Creators | Barker, David |
| Contributors | Newman, Emily |
| Publisher | University of Edinburgh |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://hdl.handle.net/1842/33170 |
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