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Objectives: Self‐harm rates and clinical presentations differ by ethnicity. South Asian women are at risk of self‐harm. Previous research suggested investigating individuals' experiences with self‐harm with qualitative studies in developing self‐harm prevention strategies. This research aims to explore self‐harm experiences among South Asians in the United Kingdom. Design: Qualitative study. Methods: Participants were recruited via third‐sector organizations and online platforms. Semi‐structured interviews were conducted with 11 South Asian individuals with a history of self‐harm living in the United Kingdom. The data were analysed based on a reflective thematic analysis approach. Results: Results revealed four main themes: (1) reasons for self‐harm; (2) recovery journey; (3) culture and mental health; and (4) the transition to suicidal thoughts and behaviours. Reasons for self‐harm included negative life circumstances, social life difficulties, challenges faced during COVID‐19 and mental health problems. Participants described their recovery journey by acknowledging the role of professional help, self‐care, psychoeducation and personal growth, improving social relationships, and faith and spirituality. Cultural factors included generational differences and stigma. Culturally adapted psychological interventions were perceived as promising. The reported transition from self‐harm to suicidal behaviours was linked to experiencing major stressful life events and the use of severe methods of self‐harm. Conclusions: The findings suggest that socio‐cultural factors impact mental health and recovery processes among South Asians. Mental health services should consider improving culturally sensitive clinical practices in responding to self‐harm among South Asian communities. [ABSTRACT FROM AUTHOR]

Background: Women are likely to suffer from maternal depression due to childbirth difficulties and parenting responsibilities, leading to long‐term negative consequences on their children and families. British mothers of African/Caribbean origin uptake of mental healthcare is low due to the lack of access to culturally appropriate care. Methods: A mixed‐methods randomized controlled feasibility trial was adopted to test the appropriateness and acceptability of Learning Through Play plus Culturally adapted Cognitive Behaviour Therapy (LTP+CaCBT) for treating maternal depression compared with Psychoeducation (PE). Mothers (N = 26) aged 20–55 were screened for depression using the Patient Health Questionnaire (PHQ‐9). Those who scored >5 on PHQ‐9 were further interviewed using the Revised Clinical Interview Schedule to confirm the diagnosis and randomized into LTP+CaCBT (n = 13) or PE (n = 13) groups. Assessments were taken at baseline, end of the intervention at 3‐ and 6‐months post‐randomization. N = 2 focus groups (LTP+CaCBT, n = 12; PE, n = 7) and N = 8 individual interviews were conducted (LTP+CaCBT, n = 4; PE, n = 4). Results: The LTP+CaCBT group showed higher acceptability, feasibility and satisfaction levels than the PE group. Participants experienced the intervention as beneficial to their parenting skills with reduced depression and anxiety in the LTP+CaCBT compared to the PE group. Conclusions: This is the first feasibility trial of an integrated online parenting intervention for British African and Caribbean mothers. The results indicated that culturally adapted LTP+CaCBT is acceptable and feasible. There is a need to study the clinical and cost‐effectiveness of LTP+CaCBT in an appropriately powered randomized control trial and include the child's outcomes. Trial registration. www.ClinicalTrials.gov (no. NCT04820920). [ABSTRACT FROM AUTHOR]

Self‐disclosure of experiences of mental health difficulties is a complex process, particularly within the workplace. Research shows that a significant number of trainee clinical psychologists have lived experience of mental health difficulties and thus face the dilemma of whether to disclose and how to manage self‐disclosure during doctoral training. Grounded theory methodology was used to explore trainee experiences of self‐disclosure of mental health difficulties during training. Twelve trainee clinical psychologists from accredited doctoral programmes in the United Kingdom participated in semi‐structured interviews about their experiences of disclosure. Six core categories emerged relating to 'motivations', 'enablers', 'barriers', 'features of disclosure', 'responses' and 'impact', each of which were comprised of several further sub‐categories. The model that emerged is largely consistent with research on disclosure in healthcare professions and has implications for training programmes, supervisors and trainees when engaging in conversations about lived experience. [ABSTRACT FROM AUTHOR]

A proportion of individuals given an eating disorder diagnosis describe the experience of an eating disorder 'voice' (EDV). However, methods for working with this experience are currently lacking. Voice Dialogue (Stone & Stone, 1989) involves direct communication between a facilitator and parts of the self to increase awareness, understanding, and separation from inner voices. Adapted forms of this method have shown promise in working with voices in psychosis. This study aimed to explore the experience and acceptability of Voice Dialogue amongst individuals with anorexia nervosa who experience an EDV. Nine women participated in a semistructured interview following a single Voice Dialogue session. Interview transcripts were analysed using interpretative phenomenological analysis (IPA). Three overarching themes were identified as follows: (i) "separating from the EDV"; (ii) "better understanding of the EDV"; and (iii) "hopeful, motivated, and afraid of recovery". The majority of participants found Voice Dialogue acceptable and helpful for exploring their EDV. Whilst preliminary, the results suggest that Voice Dialogue has potential in terms of helping individuals establish a more constructive relationship with their EDV and motivating change. Further research is needed to build upon these findings. Implications for addressing the EDV using voice‐focused interventions are explored. [ABSTRACT FROM AUTHOR]

Some theories (e.g. Jackson's Paradigm Shifting Hypothesis) and many personal accounts suggest that some psychotic crises, whilst distressing, can also be transformative, leading to growth and valued outcomes. However, little is known about the extent to which this idea informs mainstream mental health care. Clinical psychologists are influential advocates of psychosocial approaches more broadly: This study explored their use of transformative models. Twelve U.K. clinical psychologists were interviewed: Transcripts informed a grounded theory. No participants saw psychosis as a purely biological problem where the content of experiences is irrelevant. Two held a "biopsychosocial" model, viewing psychosis as an illness with psychosocial elements. Most either held a continuum view (i.e., schizotypy), in which psychosis proneness was also associated with positive attributes such as creativity or sensitivity, or a "fully psychological" view, seeing experiences as meaningful and/or as adaptive responses to events. Many believed that psychosis can be transformative in a broad sense, that is, lead to "post‐traumatic growth." Some went further, believing that it can be a purposeful (e.g., an attempt, albeit painful and sometimes unsuccessful, to solve problems) or even a spiritual phenomenon. Participants' perspectives influenced their therapeutic approach: Those who saw experiences as purposeful were more likely to facilitate direct engagement with them and to support clients to explore potentially transformative aspects. However, this represented an extension of conventional approaches rather than being qualitatively different. More research is needed to clarify how widespread this approach is, to explore its utility, and to establish for whom and when it may be appropriate. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioural therapy (CBT) is commonly used to treat cancer patients with psychological disorders such as depression. There has been little qualitative research exploring the experience of therapists delivering CBT to patients with advanced cancer and long‐term health conditions generally. Therapists' views may help identify difficulties in delivering therapy and how these may be overcome. The aim of this study was to inform practice by qualitatively exploring the experiences of therapists delivering CBT to patients with advanced cancer. Design: Sixteen semi‐structured interviews were conducted with therapists from Increasing Access to Psychological Therapy (IAPT) services in London, UK, who had delivered CBT to patients enrolled on the CanTalk trial. Interviews were recorded, transcribed, and analysed using framework analysis. Results: Therapists reported positive experiences when working with the target population. Flexibility, adaptability, and a consideration of individual needs were identified as important when delivering CBT, but the rigidity of IAPT policies and demand for services were perceived as problematic. Although therapists reported adequate training, specialist supervision was desired when delivering therapy to this complex population. Conclusion: IAPT therapists can deliver CBT to advanced cancer patients, given therapists positive experiences evident in the present study. However, it was concluded that additional service and modifications of therapy may be needed before positive outcomes for both therapists and patients can be achieved. [ABSTRACT FROM AUTHOR]

Mothers with severe post-natal mental illness can be admitted with their infant to a psychiatric mother and baby unit (MBU) in the UK. MBUs provide specialist assessment, management and support. Partners of women admitted to MBUs are integral to their recovery but may show reduced wellbeing themselves, yet their support needs have not been investigated. This study aimed to identify how fathers experience the MBU and how they felt supported. A qualitative design was adopted by using a purposive sample of 17 fathers, recruited from a MBU during their partner's admission. Semi-structured interviews were used, and responses were analysed using an inductive thematic analysis. Four main themes were developed: (1) 'double whammy', (2) understanding the admission and illness, (3) support for fathers, and (4) personal stressors and coping. We identified the emotional struggle that fathers experienced when coping simultaneously with the arrival of a baby and their partner's illness. Furthermore, fathers sought support from many sources, but their knowledge of psychiatric services and mental illness was limited. Fathers felt uncertain about their partners' progression and when their partner would return home with their baby. The provision of an information pack and regular one-to-one meetings between fathers and MBU staff are recommended. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Partners of mothers admitted to a psychiatric mother and baby unit have shown increased vulnerability to mental illness themselves; however, little is known about the support that these fathers need and receive during this time., Using interviews, this study sought to understand a) how fathers experienced the mental illness of their partner and the unit's services and b) how fathers could be better supported., Fathers face many emotional and practical challenges during their partner's admission and seek support from numerous sources, including the mother and baby unit., Fathers require more information from the mother and baby unit with regard to mental illness and the unit's services. Furthermore, the introduction of regular one-to-one updates between staff and fathers would provide an opportunity for fathers to understand how their partner is progressing and for staff to informally assess the father's wellbeing and outstanding support needs. [ABSTRACT FROM AUTHOR]

Background Emetophobia (fear of vomiting) is an anxiety disorder in which individuals report clinical levels of fear that they may vomit or be exposed to the vomit of others. The prevalence of comorbidity of emetophobia with other conditions has previously only been investigated using self-report instruments. Method Sixty-four adults with emetophobia participated in an online structured clinical diagnostic interview assessing the presence of emetophobia and other conditions. Results Higher comorbidity for depression, generalized anxiety disorder, panic disorder, social anxiety disorder and obsessive-compulsive disorder were found in participants compared with general population norms. Conclusions Emetophobia is commonly comorbid with other anxiety and depressive disorders. Comorbidity rates, when assessed using a structured clinical interview, were lower than previously reported using self-report alone. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Emetophobia (specific phobia of vomiting) is a clinical fear of vomiting., Individuals with emetophobia show high comorbidity with other anxiety and mood disorders., The most common comorbid conditions were generalized anxiety disorder, panic disorder, hypochondriasis and obsessive-compulsive disorder., Clinicians should ensure that they assess for the presence of comorbid conditions when treating emetophobia. [ABSTRACT FROM AUTHOR]

To offer insight into how cognitive-behavioural therapy (CBT) competence is defined, measured and evaluated and to highlight ways in which the assessment of CBT competence could be further improved, the current study utilizes a qualitative methodology to examine CBT experts' ( N = 19) experiences of conceptualizing and assessing the competence of CBT therapists. Semi-structured interviews were used to explore participants' experiences of assessing the competence of CBT therapists. Interview transcripts were then analysed using interpretative phenomenological analysis in order to identify commonalities and differences in the way CBT competence is evaluated. Four superordinate themes were identified: (i) what to assess, the complex and fuzzy concept of CBT competence; (ii) how to assess CBT competence, selecting from the toolbox of assessment methods; (iii) who is best placed to assess CBT competence, expertise and independence; and (iv) pitfalls, identifying and overcoming assessment biases. Priorities for future research and ways in which the assessment of CBT competence could be further improved are discussed in light of these findings. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message: A qualitative exploration of experts' experiences, opinions and recommendations for assessing the competence of CBT therapists., Semi-structured interviews were conducted and analysed using interpretive phenomenological analysis., Themes identified shed light on (i) what to assess; (ii) how to assess; (iii) who is best placed to assess; and (iv) common pitfalls., Priorities for future research and ways in which the assessment of CBT competence could be further improved are discussed in light of these findings. [ABSTRACT FROM AUTHOR]

There is a growing interest into how attachment theory can inform psychotherapeutic practice with adults. This study aimed to explore how a group of therapists with an interest in attachment theory use it in their work with adult clients. A cross-sectional qualitative design was adopted. Sampling, data collection and analysis procedures were guided by grounded theory principles. Semi-structured telephone interviews were conducted with 12 therapists from a variety of training backgrounds. Data were coded and developed into thematic categories. Six primary themes were identified to describe how attachment theory influenced the clinical practice of the sample through the following: (i) complementing other therapeutic models; (ii) providing a framework to understand the development of clients' mental health problems; (iii) working with different attachment styles; (iv) thinking about the therapeutic relationship as an attachment relationship; (iv) influencing the different stages of the therapeutic process; and (vi) influencing clinical service design and delivery. It is concluded that attachment theory can play a significant role in influencing the practice of therapists and can be usefully adopted to complement therapeutic processes irrespective of the therapist's dominant clinical orientation. Further research is needed to explore the views of clinicians from different theoretical orientations and to investigate the security of the client-therapist attachment within the context of therapeutic change processes. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Attachment theory may have implications for practice across a range of different types of therapy and may help therapists to bridge apparent differences between modality-specific formulation and techniques., Attachment theory can be used to understand the development of mental health problems. Therapists should assess and formulate clients' attachment styles, and these formulations should guide therapeutic approaches., Attachment theory provides a comprehensive framework for facilitating the therapist's attentiveness to relational issues and use of the therapeutic relationship as a fulcrum for change., The principles of attachment theory can be used to inform all stages of the therapeutic process, as well as the design and delivery of mental health services. [ABSTRACT FROM AUTHOR]

Background: Recovery has become a central concept in mental health service delivery, and several recovery-focused measures exist for adults. The concept's applicability to young people's mental health experience has been neglected, and no measures yet exist. Aim: The aim of this work is to develop measures of recovery for use in specialist child and adolescent mental health services. Method: On the basis of 21 semi-structured interviews, three recovery measures were devised, one for completion by the young person and two for completion by the parent/carer. Two parent/carer measures were devised in order to assess both their perspective on their child's recovery and their own recovery process. The questionnaires were administered to a UK sample of 47 young people (10-18 years old) with anxiety and depression and their parents, along with a measure used to routinely assess treatment progress and outcome and a measure of self-esteem. Results: All three measures had high internal consistency (alpha = 0.89). Young people's recovery scores were correlated negatively with scores on a measure used to routinely assess treatment progress and outcome (r =0.75) and positively with self-esteem (r = 0.84). Parent and young persons' reports of the young person's recovery were positively correlated (r = 0.61). Parent report of the young person's recovery and of their own recovery process were positively correlated (r = 0.75). Conclusion: The three measures have the potential to be used in mental health services to assess recovery processes in young people with mental health difficulties and correspondence with symptomatic improvement. The measures provide a novel way of capturing the parental/caregiver perspective on recovery and caregivers' own wellbeing. [ABSTRACT FROM AUTHOR]

Theory and existing research suggest that emotion regulation capabilities develop during the formative years. Emotion dysregulation is associated with psychological distress and may contribute towards difficulties such as personality disorder and self-harm. This study aimed to explore the contexts in which individuals' narratives of emotional experience and self-harm developed. Eight participants who cut themselves and were seen by a personality disorder service were recruited. Semi-structured interviews were carried out, and interview transcripts were analysed using a narrative approach. Five temporal themes were generated: 'Seen and not heard', 'A big release ... to get rid of all the pain and hurt', 'A vicious circle', 'A different world' and 'Trying to turn my life around'. The findings highlight how early experiences may have led participants to perceive emotions as unacceptable and subsequently suppress emotion in adulthood. Suppression of emotions appeared to be related to appraisals of emotions and to secondary emotional distress. Furthermore, cutting was linked to suppression of emotions as well as negative self-beliefs formed during childhood and reinforced through subsequent experiences. The study emphasizes the need for therapeutic approaches to focus on emotions when working with individuals who self-cut. Furthermore, the findings indicate the need for compassionate and validating health services that may help service users develop more optimistic future narratives. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Focusing on emotions in therapy rather than self-harming behaviour per se may be beneficial for individuals who self-cut., Encouraging abstinence from cutting, without first helping clients learn emotion regulation skills, may lead to more serious self-cutting. [ABSTRACT FROM AUTHOR]

Background Reflective practice groups have been recommended for improving staff wellbeing and team functioning in inpatient psychiatric services, and clinical psychologists have been identified as potential leaders in this type of work. Research is limited with little information about reflective practice group guidelines, prevalence and effectiveness. Aims The aims of this study were to describe clinical psychologists' practice in reflective groups for staff in inpatient psychiatric services and to explore how such groups are conceptualized and implemented. Methods Online questionnaires and follow-up interviews were used to gain broad descriptions of practice and in-depth information about participants' experiences. The sample consisted of 73 clinical psychologists working in the UK, six of whom were interviewed. Data were analysed using descriptive statistics, content analysis and thematic analysis. Results Clinical psychologists regularly facilitate reflective staff groups in inpatient psychiatric settings in the UK. Common outcomes related to staff wellbeing, service culture and teamwork. Engagement, group dynamics and lack of management support were common challenges. Group experiences were influenced by the organizational context. Conclusions Clinical psychologists' practices regarding reflective staff groups were in line with recent professional developments. Several difficulties were described, which may be indicative of both a difficulty inherent to the task and a training gap in reflective staff group process. The study had methodological limitations but offers a useful contribution to the literature, and enables practice and training implications to be drawn. The need for further research exploring facilitator characteristics, views of group participants and the impact of reflective staff groups on patients is indicated. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The term 'reflective practice group' encompasses a range of practices, but a typical group structure was found with common aims, outcomes and challenges., Reflective staff groups are regularly facilitated by clinical psychologists in inpatient psychiatric settings in the UK and are influenced by practitioner experience as well as psychodynamic, systemic and group process theories., The safety required for reflective groups to function is influenced by the organizational context, and groups can contribute to shifts in culture toward including psychosocial perspectives., Reflective staff groups represent one type of contribution to an inpatient psychiatric service and team relationships; other processes to encourage alternative professional perspectives and values might also support change., More research is recommended to explore facilitator characteristics, the views of staff teams on reflective staff groups and the impact of these groups on patients. [ABSTRACT FROM AUTHOR]