What are the key elements of cognitive analytic therapy for psychosis? A Delphi study

The key components of a clinical psychology formulation: A consensus study

OBJECTIVE

Psychological formulation is a key competency for clinical psychologists. However, there is a lack of consensus regarding the key components and processes of formulation that are hypothesized to contribute to poor reliability of formulations. The aim of this study was to develop consensus on the essential components of a formulation to inform training for clinical psychologists and best practice guidelines.

METHODS

A Delphi methodology was used. Items were generated from the literature and discussed and refined with a panel of experts (n = 10). In round one, 110 clinical psychologists in the United Kingdom rated the importance of components of formulation via an online questionnaire. Criteria for consensus were applied and statements were rerated in round two if consensus was not achieved.

RESULTS

Consensus was achieved on 30 items, with 18 statements regarding components of a formulation and 12 statements regarding formulation process. Items that clinicians agreed upon emphasized the importance of integrating sociocultural, biological, strengths and personal meaning alongside well-established theoretical frameworks. Consensus was not reached on 20 items, including whether a formulation should be parsimonious or adhere to a model.

CONCLUSION

Our findings provide mixed evidence regarding consensus on the key components of formulation. There was an agreement that formulation should be client-led and incorporate strengths and sociocultural factors. Further research should explore client perspectives on the key components of formulation and how these compare to the clinicians' perspectives.

Developing a consensus of recovery from suicidal ideations and behaviours: A Delphi study with experts by experience

BACKGROUND

Understanding recovery in mental health has received significant attention and consequently, recovery has been incorporated into health policy across many countries in the Global North. In comparison, the concept of 'recovery' from suicidal thoughts and behaviours has received little attention. However, the few studies in this area appear to suggest that recovery is a complex and an idiosyncratic process with many contributing factors. This can present a challenge for clinicians and services seeking to become more recovery focused. Thus, it seems of importance to develop a consensus on how recovery from suicidal thoughts and behaviours is conceptualised.

AIM

The study aimed to use the Delphi design to establish a consensus of how recovery is defined by those with lived experience of suicidal thoughts and behaviours. The Delphi method draws on the expertise of a panel, often involving clinicians, researchers and lived experience experts to develop consensus over a topic by inviting them to rate the importance of, often a series of statements to a given topic area.

METHOD

Lived experience experts were asked to complete two rounds of questionnaires distributed online to capture their views on recovery.

RESULTS

A total of 196 individuals gave their views on the first round of the study and 97 gave their views on the second round. A final list of 110 statements was developed that 80% or more of participants defined as essential or important. Statements covered items that were important in defining, facilitation and hindering the process of recovery.

CONCLUSION

Findings are consistent with the wider literature that suggests that recovery is an idiosyncratic process, but with many commonly shared features. Here we also show that a comprehensive definition of recovery must include factors that hinder the process of recovery. Implications and recommendations for practice, policy development and future research are discussed.

The acceptability of cognitive analytic guided self-help in an Improving Access to Psychological Therapies service

BACKGROUND

An Improving Access to Psychological Therapies (IAPT) service in England has implemented cognitive analytic therapy guided self-help (CAT-GSH) alongside cognitive behavioural guided self-help (CBT-GSH) in order to support enhanced patient choice. This study sought to explore the acceptability to psychological wellbeing practitioners (PWPs) of delivering CAT-GSH.

METHOD

This study used a qualitative design with semi-structured interviews and associated thematic analysis (TA). A sample of n=12 PWPs experienced in delivering CAT-GSH were interviewed.

RESULTS

Five over-arching themes (containing 12 subthemes) were identified and conceptually mapped: (a) the past-present focus (made up of working with clients' pasts and the different type of change work), (b) expanding the treatment offer (from the perspective of PWPs and clients), (c) the time and resources required to effectively deliver CAT-GSH (to enable safe and effective delivery for clients and personal/professional development for PWPs), (d) understanding CAT-GSH (made up of confidence, learning new therapeutic language/concepts and appreciating the difference with CBT-GSH) and (e) joint exploration (made up of therapeutic/supervisory relationships and enhanced collaboration).

CONCLUSION

CAT-GSH appears an acceptable (but challenging) approach for PWPs to deliver in IAPT services. Services should prioritise training and supervision for PWPs to ensure good governance of delivery.

Developing a competence framework for cognitive analytic therapy

OBJECTIVE

This paper describes the development and summarizes the content of a competence framework for delivery of cognitive analytic therapy (CAT).

DESIGN

The framework was developed using the evidence-based method developed by Roth and Pilling (2008, Behavioural and Cognitive Psychotherapy, 36, 129).

METHODS

A review of the CAT outcome literature identified where CAT interventions had evidence of efficacy. Standard texts on CAT were primary sources for details of theory and practice. This process was supported by an expert reference group (ERG). The role of the ERG was to provide professional advice on areas where the evidence base was lacking, but where CAT interventions were commonly used by therapists trained in the model.

RESULTS

A framework was produced and structured in terms of core knowledge, core skills, and meta-competences (which require therapeutic judgement rather than simple adherence to a treatment protocol).

CONCLUSIONS

The framework enables trainees, service users, service managers, and commissioners to better understand a) the core features of CAT and b) what competences need to be in place for CAT to be skilfully delivered in practice.

PRACTITIONER POINTS

It is possible to define the core competences of CAT. Whilst generic competences are important, there are five CAT-specific domains of competence. The CAT-specific competences reflect the three-phase structure of the therapy: reformulation, recognition, and revision.

Identifying Suicide and Self-Harm Research Priorities in North West England

Background: Understanding and effectively managing self-harm and suicide require collaborative research between stakeholders focused on shared priorities. Aims: We aimed to develop a consensus about suicide and self-harm research priorities in the North West of England using the Delphi method. Method: Items for the Delphi survey were generated through group discussions at a workshop with 88 stakeholders and subsequent thematic analysis of key themes. A total of 44 participants who were experts-by-experience, researchers, and clinicians based within health services including third-sector organizations completed the Delphi survey. Results: A three-round survey reached consensus on 55 research priority items identifying key priorities in each of the following groups: offenders, children and young people, self-harm in community settings, and crisis care in the community. Limitations: The pool of delegates at the workshop and subsequent self-selection into the Delphi may have introduced bias into the study. Conclusion: The current paper highlights specific actionable priorities were identified in four areas that can be used to inform research efforts and future policy and practice, based on shared areas of perceived importance and concern. Future work is needed to confirm the significance of these priority areas, including the use of evidence synthesis approaches to ascertain the extent to which these priorities have already been investigated and where gaps in understanding remain.

Cognitive Analytic Therapy for psychosis: A case series

OBJECTIVES

Cognitive Analytic Therapy (CAT) is an effective psychological intervention for several different mental health conditions. However, whether it is acceptable, safe, and beneficial for people with psychosis remains unclear, as is the feasibility of providing and evaluating it within a research context. The aim of this study was to begin to address these questions and to obtain for the first time a rich and detailed understanding of the experience of receiving CAT for psychosis.

DESIGN

A mixed-methods case series design.

METHOD

Seven individuals who experienced non-affective psychosis received CAT. They completed assessments at the start of CAT, 16 weeks, and 28 weeks post-baseline. Qualitative interviews were completed with four individuals following completion of or withdrawal from therapy.

RESULTS

Six participants attended at least four sessions of therapy and four went on to complete therapy. There were no serious adverse events, and self-reported adverse experiences were minimal. Qualitative interviews suggested CAT is acceptable and provided a way to understand and work therapeutically with psychosis. There was limited evidence of change in psychotic symptoms, but improvement in perceived recovery and personality integration was observed.

CONCLUSIONS

The results suggest that CAT is a safe and acceptable intervention for psychosis. Personality integration, perceived recovery, and functioning are relevant outcomes for future evaluations of CAT for psychosis.

PRACTITIONER POINTS

It is feasible to conduct research evaluating CAT for people with psychosis. Within this case series, CAT appears acceptable and safe to individuals with psychosis. Within this case series, clients reported that CAT was a positive and helpful experience. There is a mixed picture with regard to secondary outcomes, but the design and aims of this case series limit conclusion that can be drawn from this data.

Disentangling data discrepancies with integrated population models

A common challenge for studying wildlife populations occurs when different survey methods provide inconsistent or incomplete inference on the trend, dynamics, or viability of a population. A potential solution to the challenge of conflicting or piecemeal data relies on the integration of multiple data types into a unified modeling framework, such as integrated population models (IPMs). IPMs are a powerful approach for species that inhabit spatially and seasonally complex environments. We provide guidance on exploiting the capabilities of IPMs to address inferential discrepancies that stem from spatiotemporal data mismatches. We illustrate this issue with analysis of a migratory species, the American Woodcock (Scolopax minor), in which individual monitoring programs suggest differing population trends. To address this discrepancy, we synthesized several long-term data sets (1963-2015) within an IPM to estimate continental-scale population trends, and link dynamic drivers across the full annual cycle and complete extent of the woodcock's geographic range in eastern North America. Our analysis reveals the limiting portions of the life cycle by identifying time periods and regions where vital rates are lowest and most variable, as well as which demographic parameters constitute the main drivers of population change. We conclude by providing recommendations for resolving conflicting population estimates within an integrated modeling approach, and discuss how strategies (e.g., data thinning, expert opinion elicitation) from other disciplines could be incorporated into ecological analyses when attempting to combine multiple, incongruent data types.

The Challenge to Foster Foreign Students’ Experiences for Sustainable Higher Educational Institutions

While most companies are developing strategies that focus on responsibility and sustainability, recent discussions in higher educational institutions query the contribution of university social responsibility. Based on the theory of stakeholders and the new strategic paradigm of universities becoming sustainable corporations, the purpose of this paper is to determine Erasmus students’ opinions on their experiences abroad, as they relate to the importance they attribute to their emotions, and their relationship with and loyalty to their host university’s country as a tourism destination. The method inquired into Erasmus students’ impressions when studying in Spain through an ad hoc questionnaire based on academic literature and the Delphi technique. Survey data was analyzed through an exploratory factor analysis and partial least squares structural equation modeling. The study is a first attempt at analyzing experiential marketing in Erasmus students, who we considered tourists. The results support experiential marketing as a key approach for achieving sustainability in universities. The paper draws attention to the need for institutions to be more aware of the needs of foreign students as important stakeholders when designing mobility programs, as well as suggestions on how this awareness can be cultivated, in order to contribute to the consolidation of the selected country as a tourism destination.