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Objectives: Problematic skin picking (SP) is a poorly understood experience characterised by a drive to pick the skin and related psychosocial impact. In the DSM-5, problematic SP is classified as ‘excoriation (skin picking) disorder’. The aim of this article is to present a rare qualitative perspective on the lived experience of problematic SP, prioritising participants' voices and sense-making. Design: An in-depth qualitative study of individuals who self-identified as picking their skin problematically and experienced related distress. Methods: Seventeen UK-based participants were recruited online and interviewed about their SP. Participants were given choice of interview modality, including instant messenger platforms, telephone, email and Skype, to maximise comfort and improve the accessibility of the study. Transcripts were analysed using thematic analysis. Results: Three themes offering novel insight into the phenomenology of participants' SP are highlighted and explored: (1) how cognitions and circumstances drove and permitted SP, (2) how participants ‘zoned out’ while SP and the escape or relief that this attentional experience offered and (3) participants' feelings of shame and distress in how they felt their SP may appear to others. Conclusions: This study contributes in-depth and novel ideas to the understanding of SP phenomenology and identifies how environmental factors, cognitions, contextual distress and shame may be considerations in therapeutic intervention. It presents the complexity of SP sense-making and demonstrates the need for individual formulation.

In light of climate change, wildfires are concurrently becoming more frequent and devastating worldwide. Though we have a good understanding of fire frequency changes in the past using charcoal analysis, records of the characteristics of these fires, such as fire severity, are lacking. This limits our ability to model how fire severity responds to climate change. Boron isotopes in clay minerals show promise as a novel fire severity proxy, where increased 𝛿B is correlated with higher fire severity. Through reacting boron leached from experimentally combusted plants with clays, we determine that the observed correlation with fire severity is likely caused by input of isotopically heavier boron from combusted leaves. In contrast, combusted barks lower the 𝛿B of clays upon reaction. Despite the different results, in both experiments with barks and leaves, similar boron isotope fractionation is observed during boron adsorption onto clays, where the lighter B is preferentially adsorbed. Therefore, the different results are likely caused by the different boron isotope composition of leaves and barks, where leaves have a much higher 𝛿B (~30 ‰) than bark (~9 ‰). Combustion temperature can also affect the 𝛿B of clays: changes to the 𝛿B of clays were observed only when reacting with bark combusted at >300 °C, or with leaves combusted at >550 °C. This could be because more boron can be leached into solution from materials combusted at higher temperatures, which in turn results in greater adsorption onto clays during reactions. Clays have higher 𝛿B in soils affected by high severity fires that consume tree crowns, because these fires combust more leaves that then deposit their isotopically heavier boron content into the soil. This relationship could help complete our fire record and improve our ability to predict future fire characteristics.

Background: Intrusive mental imagery is associated with anxiety and mood instability within bipolar disorder and therefore represents a novel treatment target. Imagery Based Emotion Regulation (IBER) is a brief structured psychological intervention developed to enable people to use the skills required to regulate the emotional impact of these images. Methods: Participants aged 18 and over with a diagnosis of bipolar disorder and at least a mild level of anxiety were randomly assigned (1:1) to receive IBER plus treatment as usual (IBER +TAU) or treatment as usual alone (TAU). IBER was delivered in up to 12 sessions overs 16 weeks. Clinical and health economic data were collected at baseline, end of treatment and 16-weeks follow-up. Objectives were to inform the recruitment process, timeline and sample size estimate for a definitive trial and to refine trial procedures. We also explored the impact on participant outcomes of anxiety, depression, mania, and mood stability at 16-weeks and 32-weeks follow-up. Results: Fifty-seven (28: IBER+TAU, 27: TAU) participants from two sites were randomised, with 50 being recruited within the first 12 months. Forty-seven (82%) participants provided outcome data at 16 and 32-weeks follow-up. Thirty-five participants engaged in daily mood monitoring at the 32-week follow-up stage. Retention in IBER treatment was high with 27 (96%) attending ≥7 sessions. No study participants experienced a serious adverse event. Discussion: The feasibility criteria of recruitment, outcome completion, and intervention retention were broadly achieved, indicating that imagery-focused interventions for bipolar disorder are worthy of further investigation.

Objectives: This study utilises a ‘helpful factors’ approach (Elliot, 2010) to explore the therapeutic processes occurring within community-based adult reading and writing for well-being groups in a large city in England. The groups are facilitated by a practitioner with diplomas in psychodynamic counselling, creative writing, and creative writing for therapeutic purposes. The study aims to develop an understanding of the therapeutic and group factors which participants have experienced as being most important in supporting their well-being. Method: Twelve individual, semi-structured interviews were conducted for this study. Participants were recruited purposively from three reading and writing for well-being groups. By conducting qualitative interviews, the researcher worked to initiate an open dialogue in which participants could freely share their experiences and themes could be developed. The interviews were analysed using thematic analysis, following the guidelines of Braun & Clarke (2006). Results: Four overarching themes and thirteen sub-themes were developed. The overarching themes were named utilising participant quotes that effectively reflected the central organising concept of the theme. Overarching themes were: “Hey look, here I am, this is what I’ve done”, "A space in which you are not only allowed to talk, but also to listen”, "It's a helpful tool that's not invasive, that's not trying to be a cure", and "But I don't want to put him on a pedestal!”. Conclusions: The potential contribution of this work lies in the hope of expanding access to community-based sources of non-pathologizing support—both for adults who identify as well and those experiencing mild to moderate mental health problems. Reading and writing for well-being groups are a cost-effective intervention that may have the potential to address the socio-political problem that is the scarcity of low-cost mental health services in the United Kingdom. The findings of this research support the findings of prior qualitative research on therapeutic creative writing and bibliotherapy groups (Fair et al., 2012; Dowrick et al., 2012; Gray et al., 2016) whilst additionally making a unique contribution to the literature.

With a few exceptions, the subject of social class has rarely been addressed in counselling and psychotherapy research. This study seeks to contribute to redressing this omission by exploring therapists’ accounts of how social class operates within therapy, its impact on the therapeutic relationship, and the relationship between social class and mental health. Eighty-seven practicing psychologists, counsellors and psychotherapists, from trainees to experienced practitioners, completed an online qualitative survey about social class in therapy. Critical thematic analysis was used to analyse the data and explore the therapists’ sense-making around social class. One (smaller) group of therapists located individuals’ mental health difficulties within the wider socio-political context and positioned class differences in therapy as something that cannot be transcended by the therapeutic relationship. Another (larger) group of therapists framed psychological distress in individual and psychological terms and as separate from the wider socio-political context and constructed class differences as something that can be transcended in therapy. We take a political stance in interpreting this analysis and argue that the dominance of ‘oppression-blind’ sense-making arguably points to a need for a change in class-consciousness at the heart of counselling, psychotherapy and psychology, so that therapists are more cognisant of the relationship between mental health and clients’ socio-political context, and their own social power in the therapeutic relationship.

Background Among opioid-exposed infants, psychiatric medication co-exposure is common. Our objective was to compare Neonatal Abstinence Syndrome (NAS) outcomes based on individual psychiatric medication co-exposures. Methods A retrospective study of 744 opioid-exposed mother-infant dyads from a single institution was performed. Mothers on pharmacotherapy with methadone or buprenorphine at delivery were included. Data were collected on maternal demographics, psychiatric medication use, and NAS outcomes, including any medication treatment, adjunctive medication treatment, length of hospital stay (LOS), and opioid treatment days. The extent to which individual psychiatric medication and polypharmacy exposure were associated with NAS outcomes was assessed using multivariable regression. Results Fifty-four percent of the mothers were on ≥1 psychiatric medication, with 32% on ≥2 or psychiatric medications (polypharmacy group). In adjusted models, polypharmacy exposure was associated with longer LOS (β = 4.31 days, 95% CI 2.55–6.06) and opioid treatment days (β = 3.98 days, 95% CI 2.24–5.72) and more treatment with adjunctive medication for NAS (aOR = 2.49, 95% CI 1.57–3.95). Benzodiazepines were associated with longer LOS (β = 4.94, 95% CI 2.86–7.03) and opioid treatment days (β = 4.86, 95% CI 2.61–6.75), and more adjunctive medication treatment (aOR = 2.57, 95% CI 1.49–4.42). Gabapentin was associated with longer LOS (β = 2.79, 95% CI 0.54–5.03), more NAS medication treatment (aOR = 2.96, 95% CI 1.18–7.42) including more adjunctive medications (aOR = 1.92, 95% CI 1.05–3.53). Conclusion For infants of mothers with OUD who are also on concurrent psychiatric medications, polypharmacy was associated with worse NAS severity. When medically indicated, limiting use of multiple psychiatric medications, particularly benzodiazepines and gabapentin, during pregnancy should be considered to improve NAS outcomes.

Background Internationally, the UN reports that an estimated 1 in 3 women experience physical/sexual violence during their lifetime. These rates vary across cultures, age, gender and sexual identity. However, what does not vary is that the majority (UK, 83%) will not report this. It is likely that many will attend mainstream sexual health services for crisis STI screening or emergency contraception. It is clear that a range of psychological and health impacts may be suffered by this group including triple the risk of depression and half survivors not attending cervical screening programmes. Getting the correct help earlier is likely to reduce psychological/physical harm but there is no little or no research around victims interaction with both specialist but importantly mainstream sexual health services. Methods A population in which sexual assault is high (students) were anonymously surveyed to establish rates of sexual assault/harassment. Participants were asked about reporting behaviour in relation to attendance at SH services. Follow up qualitative interviews examined barriers to services. Qualitative data from a parallel study of actual and potential users of a specialist sexual assault service (Sexual Assault Referral Centre) in which attempts were made to recruit from multiply vulnerable populations at high risk of sexual violence (through support projects around homelessness, drug use, sex workers etc.) were examined for information around barriers to services and disclosure rates. Results The data around rates of self-reporting victim/survivors attending mainstream sexual health services but not disclosing that assault will be presented and examined for patterns. Analysis of qualitative interview data will be presented in order to establish why rates are low and what might improve reporting. Conclusion What does a mainstream SH service need to do to in order to show victims of sexual assault that disclosure will be supported and further help is available. Disclosure No significant relationships.

This feature considers the legitimate peripheral participation model in developing professional competencies in health librarianship. It is described how this model was used in the development of a framework for mapping and recognising the competencies gained by new health librarians at the Royal Free Hospital Medical Library. HS.

Introduction to the journal's special issue, 'Women as Wives and Workers: Marking Fifty Years of The Feminine Mystique '

This feature considers the legitimate peripheral participation model in developing professional competencies in health librarianship. It is described how this model was used in the development of a framework for mapping and recognising the competencies gained by new health librarians at the Royal Free Hospital Medical Library. HS.