Narrative therapy with an emotional approach for people with depression: Improved symptom and cognitive-emotional outcomes

Constructing and Preliminary Testing a Narrative Therapy Programme for Posttraumatic Growth in Chinese Patients With Inflammatory Bowel Disease-A Pilot Study

BACKGROUND

The research on posttraumatic growth (PTG) promotion programmes, particularly narrative therapy (NT), for patients with inflammatory bowel disease (IBD) remains limited. This pilot study aims to develop an NT programme to promote PTG and evaluate its feasibility, preliminary effectiveness, participants' experiences and improvement suggestions.

METHODS

The NT programme was initially developed through literature review, interviews with IBD patients and expert panel discussions. A randomized controlled pilot trial was conducted to assess the feasibility and preliminary effectiveness of the programme. Participants in the NT group received five consecutive weekly sessions of the programme, while the control group received standard care. Outcomes including PTG, anxiety, depression and quality of life were measured. Qualitative interviews were conducted to explore participants' experiences and suggestions for programme modifications.

RESULTS

The NT programme was developed with scientific rigour. The recruitment rate and retention rate were 62.5% and 96.7%, respectively. A significant reduction in anxiety levels was observed, and manifestations of PTG were reported in the NT group. Suggestions for improvement of the NT programme were received from the participants.

CONCLUSION

The NT programme was constructed to promote PTG in IBD patients in this study, further offering preliminary evidence for its feasibility and potential positive psychological change. However, large-scale research is needed to validate its effectiveness for broader applications.

Family Adversity and Relationship Quality for Pacific Islanders and the Mediating Role of Coming to Terms, Self-Esteem, and Depression

This study investigated the association between family of origin (FOO) adversities and relationship quality for Pacific Islanders as well as the potential intermediary role of coming to terms (CTT), depression, and self-esteem. The sample consisted of 226 self-identified Pacific Islanders who completed the RELATE assessment (see www.relate-institute.org). Results indicated that greater levels of FOO adversity predicted lower levels of CTT. However, higher levels of CTT in turn associated with higher self-esteem, and lower levels of depression. Results also indicated that greater FOO adversity associates with lower relationship quality indirectly. The clinical implications of these findings and directions for future research are discussed.

Outside-in or Inside-out? A Randomized Controlled Trial of Two Empowerment Approaches for Family Caregivers of People with Schizophrenia

Training-based intervention such as psychoeducational groups has become increasingly popular to empower family caregivers of people with schizophrenia, yet existing supportive programs for caregivers tend to focus more on the needs of the patients rather than the development of the caregivers. This study aimed to compare the outcomes of a skill-based empowerment psychoeducational group and an inner-resource enhancing empowerment narrative therapy group for family caregivers of people with schizophrenia. We conducted a randomized controlled trial with a longitudinal design. The sample consisted of 132 family caregivers who were randomly assigned to eight sessions of the two groups (i.e. a narrative-based group, or a psychoeducational group), or a control group with delayed treatment. Psychometric scales were administrated throughout the project. Both the psychoeducational group and the narrative group showed significant improvements in family relationships, caregiving burden, and coping skills compared with the control group across the three time points (pretest, posttest, and 2-month follow-up). A statistically significant advancement in coping skills was found in the psychoeducational group. The narrative group outperformed the psychoeducational group and the control group in the enhancement of inner resources, perceived control, and level of hope. The findings call for the need of an integrative empowerment approach that both values the inner strength and unique experiences of the caregivers and at the same time provides them with necessary skills and knowledge in taking care of their family members with schizophrenia.

Narrative therapy for depression and anxiety among children with imprisoned parents: A randomised pilot efficacy trial

This study aimed to determine the efficacy of narrative group therapy in reducing depression and anxiety among children with imprisoned parents. The study design was a randomised clinical trial with an experimental group, and waiting list group as the control group. Eighty-five children with imprisoned parents were selected by convenience sampling method. They were randomly assigned to the experimental and control groups. The experimental group received the narrative group therapy while the control group did not. The research measurement instrument comprised the Children's Depression Inventory (CDI) and the Revised Children's Manifest Anxiety Scale (RCMAS). Analysis of univariate covariance (ANCOVA) and independent t-test was employed to test the study hypothesis. The findings showed that depression and anxiety reduced among children with imprisoned parents with a high effect size (anxiety = 0.90 and depression = 3.05). Thus, the principle and techniques of narrative therapy and the benefits of group therapy reduced depression and anxiety among children with imprisoned parents. Therefore, this study showed that this intervention can be useful for children with imprisoned parents.

Interventions delivered by nurses in adult outpatient psychiatric care: An integrative review

WHAT IS KNOWN ON THE SUBJECT?: In many countries, the majority of psychiatric care is being delivered in an outpatient setting and the proportion of outpatients is increasing on a global level. Nurses are the largest workforce in psychiatric care, but their role has been said to be difficult to define. According to our knowledge, there are no previous reviews focusing on nurse-delivered interventions in the adult psychiatric outpatient setting. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This review summarizes nurse-delivered interventions identified in the research literature and describes these systematically. Analysing all the identified interventions using the Nursing Interventions Classification, we conclude that the emphasis of nurse-delivered interventions in psychiatric outpatient care is on interventions aiming at improving the functioning of both patients and their family members by building on their own strengths. These findings differ from those presented in a review on inpatient psychiatric nursing. There are several clinical trials describing nurse-delivered evidence-based treatments, such as psychoeducation for patients and their family members in the case of patients diagnosed with schizophrenia and bipolar disorder. The quality of randomized controlled trials was higher than in earlier reviews describing psychiatric nursing interventions in general or in connection with a specific patient group. Further clinical trials are needed to describe the role of nurses in the care of patients diagnosed with depression and in the use of web-based interventions. Additionally, it would be important to study what supports, and on the other hand hinders, the role of nurses in delivering evidence-based treatments at the clinical level. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can play a central role in responding to the growing demand for evidence-based practices in adult outpatient psychiatry, by delivering treatments for patients and family members. It is important that both nursing education and clinical practices recognize and support this role. Abstract Introduction According to our knowledge, there are no previous reviews on nurse-delivered interventions in the adult psychiatric outpatient setting. Aim To identify and systematically describe and analyse nurse-delivered interventions based on research literature. Method An integrative review. Results This review included 60 studies, of which 46 were intervention studies, including 40 clinical trials. The most common patient groups were patients diagnosed with schizophrenia and bipolar disorder. The nursing interventions described in the studies resembled a total of 68 interventions from the Nursing Interventions Classification. The treatment delivery methods varied and treatments often lacked a clear theoretical background. Implications for practice The core of nurse-delivered interventions identified in research literature in psychiatric outpatient care is on interventions aiming at improving the functioning of both patients and their family members by building on their own strengths. These findings differ from the interventions identified in a review describing nursing in the inpatient setting. There are high-quality clinical trials describing nurse-delivered treatments for patients diagnosed with schizophrenia and bipolar disorder. These include evidence-based treatments such as psychoeducation. Understanding of how these treatments are transferred in clinical practice is missing. Clinical trials describing nurse-delivered web-based interventions and interventions for patients diagnosed with depression are needed.

Genetic Counselling and Narrative Practices: A Model of Support following a "Negative" Predictive Test for Huntington's Disease

BACKGROUND

Predictive testing for Huntington's disease (HD) has been available for individuals at risk of HD by direct mutation analysis since 1993. International Predictive test guidelines recommend that support is offered following the result regardless of test outcome. However, there is lack of an evidence base regarding what this support should look like and how it might work in practice.

OBJECTIVE

A service improvement initiative looked at the feasibility of offering a narrative group session co-facilitated by a genetic counsellor and clinical psychologist, to individuals who had tested mutation negative for HD. The narrative session was evaluated from the perspective of group participants.

METHODS

Individuals who tested mutation negative at a genetic centre in the North of England over a 5-year period were invited to attend a narrative group session. 52 people were contacted and 9 people agreed to participate. Participants completed standardised questionnaires (PHQ-9 and GAD-7) before and after the session and a detailed written evaluation. Participants' comments were analysed thematically.

RESULTS

Participants were overwhelmingly positive about the narrative session finding it a safe and enjoyable way to explore difficult life experiences. Reported benefits included feeling less isolated, being inspired by other people's stories and connecting as a group. All 9 participants said they would recommend the narrative session to anyone impacted by HD.

CONCLUSIONS

The narrative group session was considered an interesting and useful approach to facilitating adaptation following a negative predictive test result for HD.

Treatment efficacy of narrative family therapy for children and adolescents with diverse psychiatric symptomatology

Background:

Little research has been undertaken on children and adolescents with psychiatric co-morbidity and this group is seldom subject to evidence-based treatment. Equally, there has been little research on creating an evidence base for Narrative Therapy, which means that narrative family therapy (NFT) is seldom available to children and adolescents with a psychiatric disorder.

Objective:

A single group clinical design was used to examine the efficacy of NFT for children and adolescents with different diagnoses.

Method:

Families receiving NFT from the Family Therapy Team (FTT) at the Child and Adolescent Mental Health Services (CAMHS) of the Capital Region of Denmark filled out psychometric measurements before and after treatment. Patients evaluated the burden of symptoms using Beck’s Youth Inventory (BYI), and parents evaluated their personal agency in relationship to their child’s psychiatric disorder using Parent Activation Measurement (PAM).

Results:

We analyzed data from 48 patients and found a significant increase in median BYI measures of Self-Concept (40.5 to 46.0, p = 0.002) with an effect size of 0.60, decreases in BYI Depression Index (58.0 to 54.0, p = 0.030) with an effect size of –0.41, decreases in BYI Disruptive Behaviour Index (48.0 to 43.0, p = 0.030) with an effect size of –0.38, and a significant increase in PAM from 56.4 to 68.5, p = 0.001 with an effect size of 0.61.

Conclusion:

Results from this study suggest that NFT has a direct positive effect on patients’ own evaluation of the burden of symptoms, and parents’ perceived personal agency regarding their child’s distress.

Medical Students' Attitudes and Beliefs towards Psychotherapy: A Mixed Research Methods Study

Background: Research findings suggest that attitudes towards psychotherapy predict willingness to seek therapy. However, understanding how medical students think about using and referring their patients for psychotherapy is limited. Aims: The aims of this study are to measure medical students’ attitudes towards professional help seeking, and to investigate the reasons for whether or not they would refer their patients to psychotherapy in their future role as doctors. Method: The participants were 127 medical students in their first and second year of the MBBS4 programme at the Cyprus campus of St George’s University of London, who completed a self-report measure of attitudes towards psychotherapy and a semi-structured interview. Findings: Participants showed general positive attitudes towards psychotherapy, but were reluctant to use or refer their patients, largely due to perceived stigma and accessibility. Conclusions: Medical students should be further trained in order to become more confident in using psychotherapy and referring their patients.

Content Validity of a Psychotherapeutic Intervention Model in Nursing: A Modified e-Delphi Study

AIM

To estimate the content validity of a psychotherapeutic intervention model in nursing.

BACKGROUND

Mental health nurses encounter great extrinsic difficulties when it comes to providing psychotherapeutic interventions due to the fact that they are not allowed to perform such practice in some countries. In this light, the pursuit of a psychotherapeutic intervention model in nursing seems germane to guide the professionals' psychotherapeutic practice, contributing hereof to increase mental health nurses' professional autonomy.

DESIGN

Modified e-Delphi.

METHODS

Data were collected from October 2015 to January 2016 by means of three rounds of online questionnaires. The initial questionnaire was structured into five sections: general structure of the model, patients' exclusion criteria, assessment framework, nursing diagnoses, and nursing psychotherapeutic interventions. From the 42 experts invited, at least twenty (20) participated in each round.

RESULTS

The experts achieved consensus with regard to the conclusion that nursing psychotherapeutic interventions should always seek to address a nursing diagnosis. These defined furthermore that a psychotherapeutic intervention model in nursing should be exercised by means of 3 to 12 sessions using Nursing Interventions Classification (NIC) as a resource. Finally, experts deemed that the model should follow the principles of integrative psychotherapy, so that techniques from different schools of psychotherapy could therefore be used in conjunction to promote the resolution of a nursing diagnosis.

CONCLUSION

Achieving consensus about the structure of a psychotherapeutic intervention model in nursing is imperative to guide nurses in the provision of nursing psychotherapeutic interventions and to enable an effective evaluation of the health gains associated with its implementation.