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This paper focuses on the experiences of children and young people whose parents employ personal assistant(s) (PAs). It describes findings from a UK‐based qualitative doctoral research study which explored the significance, influence and meaning of the PA role in supporting family life. Ten children and young adults aged 8–28 years with lived experience were interviewed face to face as part of this study, which also explored the perspectives of disabled parents and PAs. Findings reveal that PA support can alter both the quality and nature of the parent/child relationship. The provision of personal assistance can support family life and prevent children from becoming 'young carers'; however, it can also create tension, anxiety and even destabilise family life. [ABSTRACT FROM AUTHOR]

Background. Cancer diagnosis is a complex and multifaceted process that can be stressful and anxiety-provoking for patients. Evidence-based tools and information aids that can be used for guiding and supporting patients during cancer investigations and after diagnosis are limited. This paper presents a user-centred codesign project that aims to develop a cancer pathway support tool for patients, carers, and healthcare professionals. Method. A mixed-method codesign approach was used including prototype development (January–March 2022), three online codesign workshops (April–June 2022), one-to-one feedback, and beta testing informed by the standardised Theoretical Framework of Acceptability (TFA) questionnaire (July–October 2022). Nine individuals with lived experience of cancer contributed to the project and are referred to as codesigners. Results. The codesigners valued the potential importance of a tool that can be used by the patients and carers if they want specific information about cancer investigations, diagnosis, and treatment. The ability to select what they need as opposed to long leaflets and generating their own questions for the healthcare providers were highlighted as important aspects of improving patient care. The tool was collectively designed to provide clear definitions of the cancer care pathway and easily accessible links from trusted resources and includes practical information to minimise the burden that can be experienced from preparation for appointments and tests. Beta testing results with a small sample of potential users including patients, carers, and healthcare providers (n = 23) showed high acceptability of the guide (range = 7–35, mean = 28.52, and standard deviation = 3.88) based on the TFA questionnaire. Conclusion. A cancer pathway support tool called "Your Cancer Pathway Support Guide (YCPSG)" was developed as a result of an iterative codesign process aiming to improve patient experience and outcomes for people referred on a suspected cancer pathway or who have been diagnosed with cancer. The tool provides information and support in both digital and PDF formats. Further studies are needed to evaluate the potential impact of "Your Cancer Pathway Support Guide" on patient outcomes and experience and the wider system. [ABSTRACT FROM AUTHOR]

Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to manage anxiety in adults with an autism diagnosis. However, their effectiveness and adverse effect profile in the autistic population are not well known. This trial aims to determine the effectiveness and cost-effectiveness of the SSRI sertraline in reducing symptoms of anxiety and improving quality of life in adults with a diagnosis of autism compared with placebo and to quantify any adverse effects. Methods: STRATA is a two-parallel group, multi-centre, pragmatic, double-blind, randomised placebo-controlled trial with allocation at the level of the individual. It will be delivered through recruiting sites with autism services in 4 regional centres in the United Kingdom (UK) and 1 in Australia. Adults with an autism diagnosis and a Generalised Anxiety Disorder Assessment (GAD-7) score ≥ 10 at screening will be randomised 1:1 to either 25 mg sertraline or placebo, with subsequent flexible dose titration up to 200 mg. The primary outcome is GAD-7 scores at 16 weeks post-randomisation. Secondary outcomes include adverse effects, proportionate change in GAD-7 scores including 50% reduction, social anxiety, obsessive-compulsive symptoms, panic attacks, repetitive behaviours, meltdowns, depressive symptoms, composite depression and anxiety, functioning and disability and quality of life. Carer burden will be assessed in a linked carer sub-study. Outcome data will be collected using online/paper methods via video call, face-to-face or telephone according to participant preference at 16, 24 and 52 weeks post-randomisation, with brief safety checks and data collection at 1–2, 4, 8, 12 and 36 weeks. An economic evaluation to study the cost-effectiveness of sertraline vs placebo and a QuinteT Recruitment Intervention (QRI) to optimise recruitment and informed consent are embedded within the trial. Qualitative interviews at various times during the study will explore experiences of participating and taking the trial medication. Discussion: Results from this study should help autistic adults and their clinicians make evidence-based decisions on the use of sertraline for managing anxiety in this population. Trial registration: ISRCTN, ISRCTN15984604. Registered on 08 February 2021. EudraCT 2019-004312-66. ANZCTR ACTRN12621000801819. Registered on 07 April 2021. [ABSTRACT FROM AUTHOR]

The importance of participatory autism research is discussed in relation to a project involving six autistic researchers and five non-autistic university researchers collaborating to investigate anxiety in autistic adolescents. The paper describes the process of establishing a research partnership and the values and philosophy behind this inclusive method of research. Lessons were learnt about neurodivergent thinking and the benefits it brings to the development of research questions and analysis of data. [ABSTRACT FROM AUTHOR]

In this paper, we use a UK case study to explore how the COVID-19 pandemic affected the mental health (emotional, psychological, social wellbeing) of farmers. We outline the drivers of poor farming mental health, the manifold impacts of the pandemic at a time of policy and environmental change, and identify lessons that can be learned to develop resilience in farming communities against future shocks. We undertook a survey answered by 207 farmers across the UK, focusing on drivers of poor mental health and the effect of the COVID-19 pandemic. We also conducted 22 in-depth interviews with individuals in England, Scotland and Wales who provide mental health support to farmers. These explored how and why the COVID-19 pandemic affected the mental health of farmers. These interviews were supplemented by 93 survey responses from a similar group of support providers (UK-wide). We found that the pandemic exacerbated underlying drivers of poor mental health and wellbeing in farming communities. 67% of farmers surveyed reported feeling more stressed, 63% felt more anxious, 38% felt more depressed, and 12% felt more suicidal. The primary drivers of poor mental health identified by farmers during the pandemic included decreased social contact and loneliness, issues with the general public on private land, and moving online for social events. Support providers also highlighted relationship and financial issues, illness, and government inspections as drivers of poor mental health. Some farmers, conversely, outlined positive impacts of the pandemic. The COVID-19 pandemic is just one of many potential stressors associated with poor farming mental health and its impacts are likely to be long-lasting and delayed. Multiple stressors affecting farmers at the same time can create a tipping point. Therefore, there is a need for long-term support and ongoing evaluation of the drivers of poor mental health in farming families. [ABSTRACT FROM AUTHOR]

The paper reports on an empirical study of Chinese international students' experiences of personal safety and security at universities in a UK city. After locating these concerns in relation to current political, social and epidemiological contexts, it reviews the developments that have taken place in our understanding and theorisation of 'safety' and, in particular, 'security' of international students, noting the powerful implications of Marginson's most recent conceptualisation of the issues. The paper proposes the addition of Giddens's notion of ontological security to this developed conceptual framework. Findings from the empirical study make it clear that many students in the study remain concerned over their safety and security, and feel that their concerns are not fully appreciated by the 'authorities' to whom they might be expected to turn for support. For information and support on matters of personal safety, therefore, these Chinese students' first recourse is to compatriot fellow students, reinforcing a sense of inter-dependence based on shared subjective identities. Rather than treating this 'in-community' solidarity as potentially undermining wider cross-cultural contact and communication, this paper proposes that a strengthened sense of 'ontological security' provides a foundation for cross-cultural functioning that does not entail cultural assimilation and a 'subaltern' status. [ABSTRACT FROM AUTHOR]

Despite the apparent centrality of supervision to the effectiveness of social work practice, this topic remains largely under researched. The majority of studies to date have relied on self-reporting mechanisms to understand 'what happens' in supervision, with few accessing supervision directly, and none, to the writer's knowledge, attempting to analyse the impact of unconscious processes. This paper aims to contribute to this gap in the knowledge base by analysing the conscious and unconscious processes at play in two cohorts of systemic group supervision held in UK children's services, and how such processes, alongside the leadership styles of the supervisors, impacted on the nature of supervision practice. A psychoanalytically informed research methodology is employed to study the group supervision sessions, and the subsequent data analysed through a thematic analysis. This paper employs Bion's model of thought outlined in Learning from Experience to explore how each group developed its own unique ability to think in light of its capacity to contain anxiety. Implications for the nature of reflective practice in the supervision, and social work practice more broadly, are then discussed. [ABSTRACT FROM AUTHOR]

Research has shown that stress impacts on people's religious beliefs. However, several aspects of this effect remain poorly understood, for example regarding the role of prior religiosity and stress-induced anxiety. This paper explores these aspects in the context of the recent coronavirus pandemic (COVID-19). The latter has impacted dramatically on many people's well-being; hence it can be considered a highly stressful event. Through online questionnaires administered to UK (n = 140) and USA (n = 140) citizens professing either Christian faith or no religion, this paper examines the impact of the coronavirus crisis upon common people's religious beliefs. Anxiety about the coronavirus and prior religiosity showed an interaction effect upon change in religious beliefs (t(276) = 2.27, p =.024): for strong believers higher anxiety about coronavirus was associated with increased strengthening of religious beliefs (r =.249), while for non-believers higher anxiety about coronavirus was associated with increased scepticism towards religious beliefs (r = −.157). These observations are consistent with the notion that stress-induced anxiety enhances support for an individual's existing ideology already embraced before a stressful event occurs. This study sheds light on the psychological and cultural implications of the coronavirus crisis, which represents one of the most serious health emergencies in recent times. [ABSTRACT FROM AUTHOR]

Background: Teenagers represent a small proportion of patients on paediatric intensive care units (PICU) in the United Kingdom. During a time when their development is rapidly changing, an admission to PICU causes additional disruption. The impact of critical illness on psychological health after discharge has not been widely reported within this population. Aim and objectives: To measure anxiety that teenagers report 48‐96 hours and 4 weeks after discharge from PICU. To explore teenagers' experiences of being admitted onto PICU. Design: Two‐phase mixed methods, explanatory sequential design. Methods: This single‐site study was conducted between February and July 2018. An NHS Ethics committee approved the study. Teenagers were screened if they were aged 13‐18 years old and had an elective or emergency admission to PICU for longer than 24 hours. Hospital Anxiety and Depression Scale, Anxiety subscale (HADS‐A) was administered on paper and completed with the researcher present. Semi‐structured interviews were conducted in‐person and over the telephone, audio‐recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. Results: Nine of eighteen participants (50%) obtained scores indicating levels of anxiety which were mild (n = 3; 17%), moderate (n = 2; 11%), or severe (n = 4; 22%) 48‐96 hours after PICU discharge. Four weeks later, all participants scored below the clinically significant cut‐off level for the HADS‐A‐1 Teenagers described their experiences on PICU within three themes:Memories of treatments, side effects, and the PICU environmentLosing a sense of selfFeeling cared for Conclusions: Measured levels of anxiety had resolved in this small sample, 4 weeks after PICU discharge. This finding was not consistent with qualitative data that indicated that many experiences shared by participants were anxiety provoking. Relevance to clinical practice: Support for teenagers after PICU discharge should be available to meet individual needs; screening teenagers to identify support needs would be beneficial. [ABSTRACT FROM AUTHOR]

The stockpiling behaviors during the COVID‐19 pandemic emerged as an example for situations where cooperation is inhibited by lack of trust, media exposure, and increased anxiety. In this paper, I test the hypothesis that stockpiling results from social psychological factors that prevent psychological groupness and cooperation (e.g., low trust in governments and other citizens, high frequency of news exposure, high pandemic anxiety), rather than being an inherently selfish and uncontrollable panic behavior. Specifically, I hypothesized that lower levels of satisfaction with the governments' COVID‐19 policies, lower trust in people in following physical distancing rules, and more frequent media exposure would predict higher stockpiling behaviors through increased pandemic‐related anxiety. In a cross‐sectional survey study conducted in Turkey and the UK during the first‐wave of the pandemic (N = 5137), I tested a conceptual model via SEM. Findings showed that lower trust in people, lower satisfaction with governments' COVID‐19 policies, and high exposure to news predicted higher pandemic related anxiety which predicted higher stockpiling in both countries. I discussed that governments policies and media in both countries may be the reason for mass stockpiling behaviors by decreasing predictability and trust. [ABSTRACT FROM AUTHOR]

Higher education students' mental health has been a growing concern in recent years even before the COVID-19 pandemic. The stresses and restrictions associated with the pandemic have put university students at greater risk of developing mental health issues, which may significantly impair their academic success, social interactions and their future career and personal opportunities. This paper aimed to understand the mental health status of University students at an early stage in the pandemic and to investigate factors associated with higher levels of distress. An online survey including demographics, lifestyle/living situations, brief mental well-being history, questions relating to COVID-19 and standardised measures of depression, anxiety, resilience and quality of life was completed by 1173 students at one University in the North of England. We found high levels of anxiety and depression, with more than 50% experiencing levels above the clinical cut offs, and females scoring significantly higher than males. The survey also suggested relatively low levels of resilience which we attribute to restrictions and isolation which reduced the opportunities to engage in helpful coping strategies and activities rather than enduring personality characteristics. Higher levels of distress were associated with lower levels of exercising, higher levels of tobacco use, and a number of life events associated with the pandemic and lockdown, such as cancelled events, worsening in personal relationships and financial concerns. We discuss the importance of longer-term monitoring and mental health support for university students. [ABSTRACT FROM AUTHOR]

The practise of Focusing with images was the key element of six workshops held for postgraduate research students at the University of East Anglia, UK. Participants were invited both to respond to extant images (including those from the university's art galleries) as well as to create their own images through working with paint and other art materials. Changes in this highly anxious group's ability to access and manage inner experiencing as a result of their participation in these workshops was recorded and assessed both qualitatively and quantitatively. Participants completed the Focusing Manner Scale (FMS) at the beginning and at the end of their participation in the workshops and improvement (p = 0.063) was seen in 6 out of 7 participants, indicating a shift in their ability to find ways of processing difficult experiencing. The FMS findings are supplemented by reconstructions of Focusing sessions based on field notes taken during the workshops. Images not only offer external representations of inner experiencing but also provide material for experience to be carried forward. [ABSTRACT FROM AUTHOR]

Posttraumatic Stress Disorder (PTSD) may be a common issue in primary care in the UK, but there have been no studies of all-cause PTSD in general samples of attenders in this country. The current paper thus explores the extent and distribution of probable PTSD among patients attending general practices in England. Cross-sectional survey data from adult patients (n = 1058) attending 11 general practices in southwest England were analysed. Patients were recruited from waiting rooms and completed anonymous questionnaires, including measures of depression, anxiety and risky alcohol use. Current probable PTSD was measured using the 4-item Primary Care PTSD Scale (PC-PTSD). Results indicated 15.1% of patients that exhibited probable PTSD (PC-PTSD ≥ 3), with higher levels observed in practices from deprived areas. There were 53.8% of patients with probable PTSD that expressed the desire for help with these issues. The analyses suggested that rates were lowest among older adults, and highest among patients who were not in cohabitating relationships or were unemployed. Measures of anxiety and depression were associated with 10-fold and 16-fold increases in risk of probable PTSD, respectively, although there were no discernible associations with risky drinking. Such preliminary findings highlight the need for vigilance for PTSD in routine general practice in the UK, and signal a strong need for additional research and attention in this context. [ABSTRACT FROM AUTHOR]

The "Trojan Horse" scandal laid bare an anxiety at the heart of the British security establishment; an anxiety that brings together questions of identity, values, and security within the demand to manage radicalization. It is an anxiety that, I will argue, reveals a novel conceptualization of threat that has driven the UK's security and communities policies within the "war on terror." This conceptualization emerges within Prevent, the UK's counter-radicalization strategy. Yet, I argue, the extensive literature on Prevent has failed to adequately articulate this underlying, core logic. To date, the Prevent literature has effectively demonstrated the ways in which Muslim communities in the United Kingdom have been policed through British counter-radicalization policy. Yet, this analysis struggles to explain the expansion of Prevent into a wider range of "extremist" spaces. In this article, I contend that it is more useful to situate Prevent as a particular conception of power; a logic and an analysis of threat that demands new forms of government intervention. To do so, this article provides a genealogical reading of Prevent, locating it as a radical extension of state security ambitions to intervene early, making explicit a vision of security in which life as a process of becoming is produced as an object of management. The paper draws out the ramifications of this analysis to think through fundamental shifts in the principles and practices of contemporary security aspirations. [ABSTRACT FROM AUTHOR]

Objectives: Improving Access to Psychological Therapies (IAPT) is a national‐level dissemination programme for provision of evidence‐based psychological treatments for anxiety and depression in the United Kingdom. This paper sought to review and meta‐analyse practice‐based evidence arising from the programme. Design: A pre‐registered (CRD42018114796) systematic review and meta‐analysis. Methods: A random effects meta‐analysis was performed only on the practice‐based IAPT studies (i.e. excluding the clinical trials). Subgroup analyses examined the potential influence of particular methodologies, treatments, populations, and target conditions. Sensitivity analyses investigated potential sources of heterogeneity and bias. Results: The systematic review identified N = 60 studies, with N = 47 studies suitable for meta‐analysis. The primary meta‐analysis showed large pre‐post treatment effect sizes for depression (d = 0.87, 95% CI [0.78–0.96], p <.0001) and anxiety (d = 0.88, 95% CI [0.79–0.97], p <.0001), and a moderate effect on functional impairment (d = 0.55, 95% CI [0.48–0.61], p <.0001). The methodological features of studies influenced ESs (e.g., such as whether intention‐to‐treat or completer analyses were employed). Conclusions: Current evidence suggests that IAPT enables access to broadly effective evidence‐based psychological therapies for large numbers of patients. The limitations of the review and the clinical and methodological implications are discussed. Practitioner points: IAPT interventions are associated with large pre‐post treatment effect sizes in depression and anxiety measures.IAPT interventions are associated with moderate treatment effect sizes with regards to work and social adjustment.A reduction in dropout and also the prevention of post‐treatment relapse via the offer of follow‐up support are important areas for future development. [ABSTRACT FROM AUTHOR]

Objective: There is a growing trend whereby office workers refrain from taking breaks at work. Previous research has not explored how employees understand the enablers and barriers to taking breaks. This study explored how office-based workers describe their behaviour in relation to, and perceive the notion of, taking breaks. Design: Five focus groups were held with 27 employees of differing levels of seniority at a local authority in the UK. Inductive thematic analysis was employed with the researchers maintaining a deliberate stance of curiosity towards the data, allowing for reflexivity and awareness of preconceptions towards the research. Results: The analysis identified 5 key themes: the non-binary nature of taking breaks at work, the influence of social and work relationships, the superordination of work over breaks and health, contradictory feelings of guilt and anxiety and being 'fair game' for work related matters if you remain at your desk at break times. Conclusion: This paper suggests that the complex relationships that people have with taking breaks, with others and with their physical environment should be taken into account when trying to understand break-taking behaviour. Based on these findings, suggestions for further research and potential health-related policy and organisational changes are made. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: More people experience withdrawal symptoms when weaning off antidepressants than previously thought; particularly after taking them for a long time. What this paper adds to existing knowledge?: I explore my own experience of weaning off antidepressants; detailing conflicting advice I have received from healthcare professionals, and the mental and physical withdrawal symptoms I experienced.I relate my experiences to a growing body of research, which have important implications for improving care. What are the implications for mental health nursing?: Healthcare professionals should make patients aware of potential withdrawal symptoms they may experience before they wean off antidepressants; regularly review their progress; consider helping them access psychological support whilst weaning off; and engage in open and collaborative conversations with patients throughout.Clinical guidance needs to be updated to provide appropriate evidence‐based information/advice/recommendations for how best to support patients when coming off of antidepressants. A significant proportion of the UK population are taking antidepressants, and have been taking them for at least a year. Clinical guidelines have controversially stated that withdrawal symptoms when weaning off antidepressants are mild and resolve after one week, with the proviso that they can be severe only if the drug is stopped abruptly. However, recent evidence suggests this is not the case. I describe my own experiences of tapering the dose of my antidepressants after several years of taking them. I describe my encounters with healthcare professionals throughout this period, detailing conflicting advice I have received, along with describing the mental and physical withdrawal symptoms I have experienced. My experiences relate to a growing body of research, which have important implications for improving care. Potential learning outcomes are that healthcare professionals should make patients aware of potential withdrawal symptoms they may experience before they wean off antidepressants; regularly review their progress; consider helping them access psychological support whilst weaning off; and engage in open and collaborative conversations with patients throughout the process. Clinical guidance needs to be updated to provide appropriate evidence‐based information, advice, and recommendations for how best to support patients when coming off of antidepressants. [ABSTRACT FROM AUTHOR]

The first cases of Coronavirus (COVID-19) were reported in Wuhan, China in December 2019. Globally millions of people have been diagnosed with the virus whilst thousands have died. As the virus kept spreading health and social care frontline workers (HSCFW) were faced with difficulties when discharging their duties. This paper was set out to explore the challenges faced by different frontline workers in health and social care during the COVID-19 pandemic. The research utilized an explorative qualitative approach. A total of forty (N = 40) in-depth one-to-one semi-structured interviews were undertaken with HSCFW who included support workers (n = 15), nurses (n = 15), and managers (N = 10). Health and social care workers were drawn from domiciliary care and care homes (with and without nursing services). All the interviews were done online. The data were thematically analyzed, and the emergent themes were supported by quotes from the interviews held with participants. Following data analysis the research study found that lack of pandemic preparedness, shortage of Personal Protective Equipment (PPE), anxiety and fear amongst professionals, challenges in enforcing social distancing, challenges in fulfilling social shielding responsibility, anxiety and fear amongst residents and service users, delay in testing, evolving PPE guidance and shortage of staff were challenges faced by frontline health and social care workers during COVID-19 pandemic. The results of the current study point to a need for adequate pandemic preparedness within the health and social care sector to protect both frontline workers and the individuals they look after. [ABSTRACT FROM AUTHOR]

Although research evidence supports the efficacy of cognitive behavioural therapy (CBT) for anxiety in children, it is important to examine practice-based evidence of effectiveness in typical clinical contexts. This study evaluated a CBT group intervention – 'Anxiety Gremlins' – for childhood anxiety. Participants were 36 children (19 boys, 17 girls) aged 8–13, referred for anxiety symptoms at a UK NHS service. The 8-session intervention included six child sessions (2 h) and two parent sessions (1 h). Self-report outcome measures of anxiety symptoms, life functioning and therapeutic relationships were used to measure change pre- and post-intervention. Semi-structured interviews were conducted with group facilitators and analysed through deductive content analysis to identify barriers and facilitators to change. No substantive differences were found between aggregated scores on pre- versus post-intervention outcome measures. Reliable change in anxiety symptoms was identified in 10 children (31%), with five improvers and five deteriorators. Interviews with facilitators identified disruption in group flow, lack of facilitator time to prepare and reflect, and the complexity of clients as hindering factors. Children meeting like-minded peers to share their stories and high engagement in the therapeutic process were helpful factors. Anxiety Gremlins did not demonstrate effectiveness on outcome measures, and this contrasted with clinical opinion. Recommendations were made for the service to revisit the intervention content and the method for recruiting children to the group – as complexity/co-morbidity was linked to poorer outcomes. Future research could explore fidelity to an adapted intervention and include interviews with children and their parents. Key learning aims: After reading this paper the reader should be able to: (1) Understand how instances of CBT practice can be robustly evaluated using a mixed-methods approach, including analyses of change at both group and individual levels. (2) Understand critical considerations when adapting 'evidence-based' CBT interventions for routine practice. (3) Appreciate that aggregative group-level analyses can mask clinically important differences in individual CBT outcomes. [ABSTRACT FROM AUTHOR]

Depression and anxiety are major contributors to growing healthcare costs in the UK, particularly with an increasingly ageing population. However, identification of mental health needs in older adults has been overshadowed by a tendency to focus on physical health issues, despite the established co-morbidity of depression, anxiety and physical health conditions. When older adults seek psychological support, treatment options may vary and may be time limited, either because of protocol guidance or due to the resource constraints of psychology services. Time-limited treatment, common in many adult services, may not best meet the needs of older adults, whose physical, cognitive and emotional needs alter with age. It is, therefore, important to identify treatments that best meet the needs of older adults who seek psychological support, but who may arrive with complex mental and physical health histories. This paper aims to explore how a case formulation-driven approach that draws on the theoretical underpinnings of cognitive behavioural therapy (CBT) and compassion-focused therapy (CFT) can be used to reduce anxiety and depression in an older adult with a complex multi-morbid mental and physical health history. This study employs a single-case (A–B) experimental design [assessment (A), CBT and CFT intervention (B)] over 28 sessions. Results suggest the greatest reductions in depression and anxiety (as measured using PHQ-9 and GAD-7) occurred during the CFT phase of the intervention, although scores failed to drop below subclinical levels in any phase of the intervention. This case highlights the value of incorporating CFT with CBT in case formulation-driven interventions. Key learning aims: (1) To consider the value of using case formulation approaches in older adult populations. (2) To demonstrate flexibility in balancing evidence-based interventions with service user needs by incorporating CBT and CFT to treat anxiety and depression in an older adult. (3) To present a clinical case to identify how assessment, formulation and treatment of anxiety and depression are adapted to best meet the needs of older adults with complex co-morbid mental and physical health conditions. (4) To appreciate the impact of contextual factors, such as austerity measures, on therapeutic work with individuals with long-standing mental and physical health difficulties. [ABSTRACT FROM AUTHOR]

In June 2011 the BBC Lab UK carried out a web-based survey on the causes of mental distress. The ‘Stress Test’ was launched on ‘All in the Mind’ a BBC Radio 4 programme and the test’s URL was publicised on radio and TV broadcasts, and made available via BBC web pages and social media. Given the large amount of data created, over 32,800 participants, with corresponding diagnosis, demographic and socioeconomic characteristics; the dataset are potentially an important source of data for population based research on depression and anxiety. However, as respondents self-selected to participate in the online survey, the survey may comprise a non-random sample. It may be only individuals that listen to BBC Radio 4 and/or use their website that participated in the survey. In this instance using the Stress Test data for wider population based research may create sample selection bias. Focusing on the depression component of the Stress Test, this paper presents an easy-to-use method, the Two Step Probit Selection Model, to detect and statistically correct selection bias in the Stress Test. Using a Two Step Probit Selection Model; this paper did not find a statistically significant selection on unobserved factors for participants of the Stress Test. That is, survey participants who accessed and completed an online survey are not systematically different from non-participants on the variables of substantive interest. [ABSTRACT FROM AUTHOR]

Residential child care is an inherently distressing and multi-layered endeavour undertaken by staff who are often poorly trained and supported. In addition, the children, and the adults who care for them, can provide a convenient receptacle for the split off negative feelings of professionals, politicians and the public. The complexity and difficulty of this work is often unrecognised and a simplistic response based on a programmatic, behavioural framework, reinforced by performance-based management and an audit culture, is common. This paper argues for the usefulness of a different approach, drawing on psychoanalytic and open systems thinking, to provide a more nuanced understanding of what is happening in these volatile settings that can guide interventions which match the complexity of the work. Alongside advocating the use of key psychoanalytic and systems concepts to improve understanding, it argues for the importance of providing a containing and reflective environment for staff. [ABSTRACT FROM AUTHOR]

This paper describes a reflective space created between two Singaporean Chinese systemic psychotherapists and a British Chinese family – the Chans. The family attended the Marlborough Cultural Therapy Centre (MCTC) in London and was given two separate culture‐specific systemic treatments by different therapists, which were reflected upon collaboratively with the Chans. A brief literature review of British Chinese and mental health, culture and reflexivity is described. The authors discuss clinical implications including the impact of British Chinese cultures and the effect of mental health issues on the family. The process and outcomes of the treatment are explained using the frame of reflexivity. Clinical implications discussed include the impact of British Chinese cultures and the effects of schizophrenia and anxiety on the family. Practitioner points: Reflexivity is an interactional process creating change through repeated awareness, reflection and action related to our similarities and differencesThis process may helpfully guide practitioners through therapeutic journeysReflexivity is especially important when considering both similarities and differences – even when the therapist is working with clients from a similar (ethnic) cultureInvolving clients in the writing process enhances reflexivity for both therapists and clients and in itself can be thought of as a further intervention [ABSTRACT FROM AUTHOR]

This paper presents a community based participatory research project, which adopted a photovoice approach with seven unaccompanied asylum-seeking children (UASC) living in foster care in the United Kingdom. The project also included a focus group with six foster carers to explore their perceptions of caring for UASCs. At the end of the focus group we then shared the young people's images from the photovoice project. The purpose of this was to better inform the carers understanding of this group's needs and the reality of their lived experiences, to see if this would have any impact on their perceptions or willingness to offer these children a placement in the future. The young people then developed the photographs into posters, which were shown at community events and exhibited in community spaces during refugee week. Findings from the focus group show that some of these carers had anxieties and held misconceptions around caring for UASCs. This highlights the need for practitioners to engage in open conversations with foster carers, to discuss their perceptions and challenge any misconceptions. Furthermore, the project identified that some of these carers were concerned about being able to meet the cultural needs of the young people. Foster carers also seemed unaware of the available support in place to help with this. Therefore, it would be beneficial for foster care services and practitioners to ensure that carers are fully informed of the support and training available to them to assist in meeting UASCs cultural, religious and linguistic needs. The project also presents important lessons for researchers committed to finding ways to engage UASCs meaningfully in the research process. The action orientated approach of photovoice led to a wide range of public engagement activities, that allowed us to show important aspects of the young people's lived realities growing up in foster care. [ABSTRACT FROM AUTHOR]

Little is known about how children themselves understand their moves to and between foster homes. The data presented in this paper come from a study that sought children's views on becoming and being a foster child. A key finding of that study was how children's accounts of being fostered illustrated a high level of anxiety and concern about their moving to live with a foster family. This paper firstly explores the key issues about looked‐after children's moves. It then describes the research study undertaken, before exploring the data generated from children's accounts of their moves to a new foster home. Lastly, there is a discussion of the implications for social work practice in this area. [ABSTRACT FROM AUTHOR]

Aims To report a systematic review of the psychometric properties of self-report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument. Background Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed. Design Psychometric systematic review. Data sources A systematic literature search of the multiple databases (1990-September 2014). Review methods Identification of self-report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability. Results Thirty-two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category. Conclusion Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy. [ABSTRACT FROM AUTHOR]

This paper offers a historical and psychosocial account of ‘moral panics’ about child maltreatment in England over the last four decades, and proposes this perspective as additional to Munro's more systemic account of the same history. The formal child protection system is theorised in terms of an explicit and a covert dual primary task. The overt task is to actually protect vulnerable children and prevent abuse; the covert task is to protect the remainder of society from exposure to anxiety provoking ‘dangerous knowledge’ about the prevalence of child maltreatment. Episodes of public and political moral panic occur when the boundaries of containment provided by the official system and its processes are breached, propelling debate and contestation about child maltreatment into the public sphere, where public enquiries and other social mechanisms are called upon to ‘settle’ the contested issues. Sometimes these social settlements appear to be successful in resolving conflicts about the reality or otherwise of specific forms of abuse; in other cases, especially child deaths, the controversial and anxiety-laden nature of the problem is recurrently projected back into the public domain. The paper suggests that this may be associated with a difficulty about establishing a secure symbolic framework or discourse in society for the emotionally indigestible facts of child torture and murder. In turn, this may be associated with problems about the decline of public mourning rituals and the failure of the public enquiry format to facilitate this. In line with Munro, the paper argues for the importance of a tragic perspective on child maltreatment, to counter idealisations of the capacity of the formal system to protect children. [ABSTRACT FROM PUBLISHER]

Purpose – The purpose of this paper is to highlight the provision of therapy for witnesses who have a learning disability prior to and following a criminal trial. Authors will reflect on clinical practice whilst stressing that this area of work is in its infancy and both continue to learn through continued reflection and each new experience. Design/methodology/approach – The paper broadly describes the nature of pre-trial therapy followed by reflection by a Counsellor and Supervisor on their clinical practice. Findings – Authors describe some of the common themes that arise whilst providing pre-trial therapy. Social implications – The authors hope that the paper will encourage professionals involved in Safeguarding cases to fully consider the emotional needs of victims and to seek timely therapeutic support where the need presents. They also hope that it will encourage practitioners from various professions to consider providing this specialist and delicate type of therapy whilst highlighting the need for good supervision. Originality/value – There is a paucity of written information about this specific subject area. Although safeguarding of vulnerable adults has grown considerably over the last decade and investigations are now more likely to lead to legal action, the availability of emotional support for victims who have learning disabilities needs to be addressed. [ABSTRACT FROM AUTHOR]

Numerous studies have linked the high rates of traumatic events experienced by refugees to the elevated rate of mental health problems in these populations. A growing body of evidence has also highlighted the importance of considering postmigratory stressors when making sense of displaced person distress. This study explored the relationship between mental health and postmigratory stress for asylum seekers and refused asylum seekers in Britain. The study further examined if those refused asylum experienced elevated distress and postmigratory stress compared to those awaiting the outcome of asylum applications. Results indicated that participants (N = 97) had endured a range of pre- and postmigratory stressors and had high scores on measures of anxiety, depression, and PTSD. A postmigratory factor comprising items associated with isolation, restrictive policies, and stressors associated with having an insecure immigration status, was significantly associated with PTSD scores. This relationship remained when controlling for the variance accounted for by premigratory trauma predictors. Being refused asylum was the strongest predictor of depression and anxiety. Those refused asylum scored higher on a factor associated with barriers to accessing services. Social materialist theories of distress are drawn upon to contextualise the heightened vulnerability of those refused asylum. The paper concludes by emphasising the problems associated with taking an exclusively trauma-focussed approach when working with asylum seekers and argues for community orientated interventions to support displaced people to cope with the various stressors endured in exile. [ABSTRACT FROM AUTHOR]

Aims Whilst there is a considerable body of literature examining the pharmacology of conscious sedation, the social tasks required to successfully provide conscious sedation have not been reported. This paper discusses data regarding the interpersonal work integral to effective conscious sedation provision, from a larger qualitative study exploring how patients and clinicians engage with secondary care conscious sedation provided within the UK. Method Semi-structured interviews were conducted with 13 conscious sedation providers and nine patients within UK-based secondary care sedation settings. Digital audio-recordings were transcribed verbatim and subsequently analysed using a constant comparative method within NVivo Data Analysis Software. Results Four main themes of interpersonal work were reported by participants: displaying care, containing emotions, demonstrating competence and maximizing the effect. Conclusion This study shows that performing conscious sedation requires more than technical delivery, and involves the projection of attributes in a literal 'performance.' The importance of managing outward emotional appearance reflects previous dental research. The need to manage outward appearance, and the emotional impact this has, is of relevance to all clinicians. [ABSTRACT FROM AUTHOR]

Child and family social workers are consistently found to have high levels of stress, and this has often been linked to burnout and retention problems in the profession. Local authorities in the UK have recently been under pressure to reform services, and one focus has been exploring how different organizational structures might reduce stress and increase well-being of workers. This paper presents data on 193 social workers from five local authorities in England. We examine the effects of different ways of organizing Children's Services on workers' well-being, with particular focus on the underlying relationship between organizational elements, workplace opportunities, and practitioners' work satisfaction. The primary outcome measure is the General Health Questionnaire (GHQ-12, Goldberg, 1978), a widely validated measure of stress. This data is presented alongside information exploring aspects of organizational structure and functioning. Results indicated significantly different levels of reported stress and general well-being in practitioners working in different local authorities. Implications for how local authorities might support staff to work productively in the stressful and challenging environment of child and family social work are discussed. [ABSTRACT FROM AUTHOR]

This paper discusses the effects of anxiety and depression on infertile people as they undergo infertility investigations and treatments, and explores what nurses may do to assist them to cope with this anxiety. There is an extensive literature on the psychosocial effects of infertility on couples, women and men separately and their children, but the nursing and midwifery literature lacks an in-depth exploration of the psychological and emotional consequences of infertility for infertile people. The paper concludes by arguing that nurses and midwives need to undertake research into their practice in fertility care, that is, caring for infertile people as they undergo assisted reproductive technologies and, to this end, suggests sources of research funding. [ABSTRACT FROM AUTHOR]

Accessible summary This paper highlighted some opportunities as well as challenges in relation to cognitive behavioural therapy, and examined a cognitive behavioural therapy awareness educational programme delivered by a blended learning approach at the University of Gloucestershire, UK., The challenges associated with initiation and running of such educational programmes included the time commitments for busy practitioners to complete the award, learners' motivation and engagement with the course, and some challenges associated with e-leaning., The paper concludes with suggestions for the way forward for such educational programmes., Abstract This paper examined the opportunities as well as challenges in relation to the use of cognitive behavioural therapy (CBT). The opportunities include the increased range of mental health conditions and other disorders where CBT (in isolation or with other interventions) could be effective to address them, as well as policies around workforce education and training that support the expansion of psychological therapies, particularly CBT services. The challenges include the urgent need of heightened awareness among the wider platform of health and social care workers about CBT principles, structure, framework, methods of delivery, wider applications, evaluation and appropriate referral of clients, and stepped model of care. In response to such needs, the paper described CBT awareness educational award at the University of Gloucestershire, UK: the Certificate of Professional Studies in Awareness of Cognitive and Behavioural Therapies Practice delivered at Level III and M level. The challenges associated with the initiation and running of such educational programmes are highlighted, as well as suggestions for the way forward considering the learners', employers' and educational providers' perspectives. [ABSTRACT FROM AUTHOR]

This paper is a reflective exploration of the emotional encounter between social workers and Irish Travellers in child safeguarding cases in the UK, the unconscious defences that may be triggered for social workers, unfamiliar with Travellers, and how these can impact on the relationship and outcomes. It raises concern about how pervasive societal disapproval towards Travellers may be absorbed by social workers, at the expense of a curiosity about historic marginalisation, the contemporary cultural and social context and a recognition of the strengths of the community. Drawing on psychoanalytical insights into ‘race’, it comprises a literature review which highlights themes of marginalisation in research on Irish Travellers in the UK. It also includes a narrative interview with a Traveller woman who reflects on the fear that social workers invoke in Travellers, and sets up the key question: what might the emotional state of the social worker be in this scenario. [ABSTRACT FROM PUBLISHER]

Purpose Research demonstrates that non-attendance at healthcare appointments is a waste of scarce resources; leading to reduced productivity, increased costs, disadvantaged patients through increased waiting times and demoralised staff. The purpose of this paper is to investigate non-attendance and implemented interventions to improve practice.Design/methodology/approach A mixed methods service audit took place in a primary care psychological therapies service. Existing service guidelines and reporting systems were reviewed. A cross-sectional design was used to compare a year’s cohort of completers of cognitive behavioural therapy (CBT) (n=140) and drop-outs (n=61).Findings Findings suggested contrasting guidelines and clinically inaccurate reporting systems. The overall service did not attend (DNA) rate was 8.9 per cent; well below rates suggested in the literature. The drop-out rate from CBT was 17 per cent. The most influential factor associated with CBT drop-out was the level of depression. The level of anxiety, risk ratings and deprivation scores were also different between completers and drop-outs. The main reasons given for non-attendance were forgetting, being too unwell to attend, having other priorities, or dissatisfaction with the service; again these findings were consistent with prior research.Originality/value A range of recommendations for practice are made, many of which were implemented with an associated reduction in the DNA rate. [ABSTRACT FROM AUTHOR]

Unlike traditional media, our interactions with political parties via social media are generally public, subject to scrutiny by others and, consequently, a self-presentation concern. This paper contributes to theory on impression management within social network sites (SNSs) by providing an understanding of the effect of visible affiliation on page ‘Liking’ behavior in the context of political parties; specifically, the possible association with social anxiety and the use of protective impression management. We predict that while users may be motivated to ‘Like’ a political party, some may feel socially anxious about the impressions their friends may derive from this action, and so ultimately choose to refrain from ‘Liking’ the party. Furthermore, we propose a new function of ‘Secret Likes’ (i.e. ‘Likes’ that others cannot see) as a means to increase gateway interactions. A survey of eligible voters ( n = 225) was conducted in the month prior to the 2015 UK general election, examining behavior associated with the Facebook pages of the two largest political parties. Results support that conspicuous affiliation with political parties indeed hinders intention to ‘Like’ political pages and is associated with social anxiety. ‘Secret Likes’ were found to be a successful method to increase gateway interactions. In addition to the theoretical contribution, implications for political party communications and site designers are considered. [ABSTRACT FROM AUTHOR]

This paper examines the impact of a key source of wealth (the stock market) on road traffic collisions. Using data on over 2 million road accidents we do not find a linear relationship between stock prices and road crashes (fatal or otherwise) in Great Britain. However, we do find a V-shaped effect – collisions respond to the absolute change in stock market returns. The results are robust to a series of falsification exercises that potentially support a causal interpretation. We also examine another source of wealth that has not previously been examined – house prices. Similarly, we do not find that changes in monthly house prices have an impact on accidents, but a symmetric V-shaped is also shown for slight and serious accidents. • We examine the impact of stock price changes on road collisions in Great Britain. • We use administrative data on road collisions by type: fatal, serious and slight. • There is not a linear relationship between stock prices changes and collisions. • Collisions instead respond to the absolute change in stock market returns. • Using another source of wealth, house prices, we find a similar V-shaped effect. [ABSTRACT FROM AUTHOR]

The past decade has seen substantial changes in the configuration of services for children and families in the UK. Most notably, the inquiry into the death of Victoria Climbié raised serious questions about the professional systems designed to safeguard children and the importance of professionals working effectively together to protect children. The research informing this paper was undertaken with a group of childcare social work practitioners and explored their everyday work experiences of the post-Climbié introduction of the Every Child Matters agenda and Integrated Children's Services. Through the application of psychodynamic and systemic concepts to the research findings, the paper identifies new perspectives on barriers to effective integrated working and makes suggestions for working practices that may overcome them. [ABSTRACT FROM AUTHOR]

This paper (originally presented as the Cultural Geographies 2009 annual lecture) reflects on the agenda set out in Maps of meaning 20 years ago which sought to chart a series of new directions in cultural geography. At the core of that project was an argument about the politics of culture and the idea of cultural politics. Today, that agenda might be re-cast as an attempt to map the intersection of culture and economy or, more precisely, of political and moral economies. This paper will apply these ideas to the geographies of food where, despite relative affluence and food security, consumers in the West (and particularly in Britain) are often described as living through an 'age of anxiety'. Consumer anxieties about food have been provoked by a range of food scares and farming crises. As a result, manufacturers and retailers have struggled to re-establish consumer trust in food and governments have urged a re-connection between food producers and consumers. The paper explores the concept of consumer anxiety and draws on a series of consumer interviews and life histories with people in the British food industry to illustrate the nature of contemporary anxieties about food. The paper concludes with some reflections on the intersection of public and private anxieties as illustrated by these personal and corporate food stories. [ABSTRACT FROM AUTHOR]

In this paper I revisit Isabel Menzies's classic 'nursing paper' (I.E.P. Menzies [1960]. A case-study in the functioning of social systems as a defence against anxiety: A report on a study of the nursing service of a general hospital. Human Relations, 13, 95-121). I outline the main findings of the paper and connect it to the major theoretical developments made by the Tavistock Institute of Human Relations and consider the current relevance of the paper in the contemporary field of health and social care. [ABSTRACT FROM AUTHOR]

This paper takes its point of departure from the importance for stable democracy of citizens' confidence in the probity of public office holders and from the growing public concerns in this area since the early 1990s. Against this background, the paper seeks to offer, for the British case, an 'inventory' of (a) what is currently known about citizens' perceptions and attitudes in this area and (b) the legislative responses which, since the early 1990s, have responded to public concerns. Starting with a series of reflections on the possible causes of growing public anxieties, the paper explores what we know about how these anxieties have been articulated, and then suggests some possible ways in which, paradoxically, attempts to address the anxieties may actually have served to enhance them. [ABSTRACT FROM AUTHOR]

In 2003 the British Association for Counselling and Psychotherapy (BACP) commissioned a systematic review of the research evidence relating to counselling older people. This paper reports on some of the findings of this review, particularly those which address the effectiveness of counselling with this population. Electronic searches of the research literature spanned six databases and were supplemented by hand-searches of reference lists and key journals, along with an extensive search of the “grey” literature. The location of papers testing interventions which fall within a definition of counselling set out by the BACP, with samples aged 50 years of age or above resulted in the inclusion of 47 relevant studies. Studies investigated a variety of mental health problems in older people, particularly depression, anxiety, dementia and the psychological impact of physical conditions such as chronic obstructive pulmonary disease. Of the 47 studies, eight tested counselling as a generic treatment, 15 tested cognitive behavioural therapy, 13 tested reminiscence therapy, and 11 tested various other specific approaches. The review concluded that counselling is efficacious with older people, particularly in the treatment of anxiety and depression and outcomes are consistent with those found in younger populations. Evidence as to the efficacy of counselling interventions in the treatment of dementia is weak. [ABSTRACT FROM AUTHOR]

Interprofessional and inter-agency working are important features of UK government initiatives, such as Sure Start local programmes for children under 4 years old and their families. Part of the vision for Sure Start was that providers of services and support would work together in new ways that cut across old professional and agency boundaries and focus more successfully on family and community needs. This paper describes the development and functioning of a Referral and Allocation Project in one trailblazer Sure Start local programme. The Programme employs staff with backgrounds that include health, social work, education and clinical psychology who work in a shared location. The Referral and Allocation Project sought to develop, through regular meetings, a whole-team inter-agency focus on discussing the needs of families who had been referred, or had referred themselves, to Sure Start and on suggesting ways in which support or advice could be offered and accessed in order to meet their needs. The paper examines issues that arose during the development of the Project, in particular psychodynamic dimensions such as emotional impact and professional anxiety. These may have implications for the format and culture of interprofessional team meetings and for training and professional development. [ABSTRACT FROM AUTHOR]

This paper argues that the anxieties being expressed in the UK and elsewhere about the lack of impact that philosophy now has on education are nothing other than the inevitable manifestation of a fundamental intellectual disorder deeply rooted in our contemporary understanding of the philosophy of education. In trying to substantiate this claim, the paper offers an historically informed philosophical analysis of how philosophy is related to education and education to philosophy that concludes by clarifying how any debates about the current problems and future development of the philosophy of education ought to proceed. [ABSTRACT FROM AUTHOR]

Women’s anxieties surrounding breast disorders: a systematic review of the literature A systematic review of the research literature published in English between 1990 and 1999 was carried out to discover whether women with benign breast disorders suffer similar amounts of anxiety to women with breast cancer in the time between discovery of the problem and receiving a diagnosis, to include the immediate postdiagnosis phase. The study was limited to primary research papers with explicit methodology applicable to hospital specialist breast clinics where the main focus of the papers was anxiety and/or psychological distress. Studies focusing exclusively on routine breast screening or exclusively on women with previously diagnosed breast cancer were omitted. A protocol for the review was agreed at the outset, addressing selection criteria, search procedures, methods of data extraction and analysis, and dissemination. Search terms were refined as the study progressed. A data extraction tool was constructed based on Benton and Cormack’s framework (, pp. 80–81). An initial search revealed 89 papers. Fourteen papers were found to meet the criteria for inclusion. The main findings were that women with benign breast disorders and those with breast cancer suffered from similar levels of anxiety and psychological distress in the period from first being aware of the problem up to the time of receiving a diagnosis. Anxiety levels were found to fall more quickly in women with benign disorders postdiagnosis. Methodological flaws were detracted from the rigour of many of the studies. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

Aim The aim of this paper is to report on the role of an action researcher in a study investigating the change process in a health service context where a new assessment clinic was developed to manage the excessive waiting list for that service. Background For effective organisational change in health, there is a suggestion that change agents need to be emotionally intelligent; recognising the emotional state of individuals, reconciling that with the organisational drivers and making an assessment of readiness for organisational change. Anxiety features throughout this literature and there is a suggestion that being aware of anxiety and managing anxiety is within the emotionally intelligent change agent's repertoire, but there is a gap in the literature that explains this relationship in detail. Methods Data were generated to investigate the discrete nature of the role of the action researcher during this organisational change that spanned two years, through three methods: participant observations in the field captured in field notes ( n = 72); observations of team meetings that had been recorded and transcribed ( n = 13); interviews with key informants pre- and postintervention ( n = 14); a reflexive diary one document of 8920 words ( n = 1). Findings The data illuminating the interaction between the action researcher and participants were synthesised into two broad themes: how the action researcher introduced anxiety into the system; how the action researcher facilitated the participants to tolerate change anxiety. Discussion/relevance to clinical practice The findings from this study can be applied in clinical practice where change in practice is planned. Part of the requirement of a change agent in the NHS might be to be sufficiently emotionally literate to understand anxiety in the participant system and manage it to effect change. [ABSTRACT FROM AUTHOR]

Caesarean section by maternal request (CSMR) is the provision of a caesarean section when requested by the mother, with no medical indication. This paper aims to provide a narrative overview of CSMR to inform clinicians about the pertinent issues. It will examine current provision of CSMR in the UK and contextualise it among prevailing social and societal factors. It will explore in detail the reasons why women may choose caesarean section, and provide arguments for and against the provision of CSMR on the NHS. [ABSTRACT FROM AUTHOR]

Presenteeism refers to the phenomenon whereby employees continue to attend work while unwell. Existing research suggests that presentee workers may suffer consequences to their health and mental strain. In this paper, we investigate whether such consequences also have downstream effects in terms of the errors people make at work. We studied the effects of presenteeism among a large sample of pharmacists (N = 1,205), an occupation in which errors made can be safety critical, with implications for patient health. Seventy-six percent of the pharmacists in our sample were classed as presentee, having attended work while unwell enough to have taken time off on at least two occasions over the previous year. Presentee pharmacists made significantly more minor errors and serious mistakes, such as dispensing errors, compared to nonpresentee pharmacists. They also experienced greater feelings of anxiety and depression. Mediation analyses suggested that higher arixiety rates explained why presentee employees made more errors at work. Presenteeism therefore has significant health costs for both workers and their beneficiaries and can be classed as an important work-related stressor. [ABSTRACT FROM AUTHOR]

Since the closure of the UK asylums, ‘the community’ has become short hand for describing a variety of disparate and complex spaces, in which service users manage their experiences of distress. An examination of such spaces here forms the basis of an analysis of the way in which service users move through and within space, to establish agency and dis/order while distressed. Seventeen participants, with various experiences of mental distress took part in a qualitative study, and a further textual analysis was conducted on eight published autobiographies. In the context of the interviews, participants presented drawings of the spaces they occupy during times of crisis, wellbeing and recovery. All texts were analysed using a thematic approach, informed by theories of embodiment and relational space. In this paper, the focus is directed towards two key patterns of movement, in order to explore ways in which participants experiencing various forms of mental health crisis used space in order to maintain and manage feelings of agency. Firstly, incidents where participants described moving towards fluid, outside spaces are explored, with agency being established through seeking, and utilising, greater possibilities for action and engaging others. In addition, the opposite pattern of movement is also explored, using incidents where participants described moving indoors, using the private space of the home to establish order and restore feelings of agency and strength, in contrast to overwhelming experiences in public space. Connections between these patterns of movement and particular forms of distress are discussed. It is argued that community and private spaces are integral to the ways in which selfhood, agency and action is experienced in mental distress, which in turn has implications for policy, treatment and community action. [ABSTRACT FROM AUTHOR]

Background Mindfulness-based interventions have been shown to be effective in the treatment of a range of health and psychological disorders in adults and young people without intellectual disabilities ( ID). Clinical studies are emerging reporting on the efficacy of mindfulness-based interventions as a stand-alone treatment for common clinical disorders in adults with ID. Method This paper aims to evaluate the efficacy of an innovative structured mindfulness-based cognitive therapy ( MBCT) group programme adapted for adults with ID with a diagnosis of either recurrent depression, anxiety or both clinical conditions and a history of deliberate self-harm behaviour. Two groups ran consecutively consisting of a total of fifteen participants and seven carers. All participants were recorded as having either a borderline, mild, or moderate ID. The group programme ran over a period of 9 weeks with a follow-up session at 6 weeks post group intervention. Outcome measures included the Hospital Anxiety and Depression Scale and two sub-scales from the Self- Compassion Scale administered at baseline, post therapy and at 6-week follow-up. Results The evaluation showed that participants reported an improvement in their experience of depression, anxiety, self-compassion and compassion for others. The most significant impact was in the reduced levels of anxiety reported. Improvements across all outcomes were maintained at 6-week follow-up. Conclusion The results of the evaluation suggest that people with intellectual disabilities benefit from a structured MBCT group intervention and the results are maintained at 6-week follow-up. [ABSTRACT FROM AUTHOR]