Monday, 9 January 2017

Psychological approaches to understanding & promoting recovery in psychosis and bipolar disorder

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Southampton (UK): NIHR Journals Library;

Abstract

Background:

Recovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.

Objectives:

To facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.

Method:

There were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.

Results:

Measurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total; p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78; p < 0.006).

Conclusions:

This research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.

Funding:

The National Institute for Health Research Programme Grants for Applied Research programme.  

Plain English summary

Psychosis (including disorders such as schizophrenia, which are characterised by hearing voices or paranoid beliefs) and bipolar disorder (BD) (characterised by mood swings) are common forms of serious mental health problems. Clinical services typically define recovery in terms of absence of symptoms. In contrast, service users conceptualise recovery as a unique process rather an end point, with key themes including hope, rebuilding self and rebuilding life. Our research aimed to understand and promote recovery in psychosis and BD, in a manner that is acceptable to and empowering of service users. Six linked projects were conducted using a variety of methods to develop new ways of measuring recovery; to understand what recovery means to service users and what factors promote recovery; to understand how recovery, symptoms and psychological well-being are related; to examine what sort of factors predict recovery; and to test three new interventions. All projects were conducted in collaboration with service users and the research team included two service user researchers. Our research has made significant additions to our understanding and promotion of recovery, including the development of two new measures which were shown to be valid and acceptable to service users. We have shown that we can measure recovery, that factors such as reduced negative emotions, increased self-esteem and hope are predictive of recovery judgements and that the new interventions tested showed promising benefits to people with psychosis and suicidal thinking and people with BD. These findings have important implications for future research and for clinical practice.




Wednesday, 28 December 2016

swimming exploits in Scotland & London; keeping fit, action research, testing the water

After my health scare summer of 2015 when I had reached the end of my tether, no justice after the psychiatric abuse Feb12 and many years of being excluded for speaking out with a survivor voice, I got back to swimming.  And joined Fife Sports and Leisure Trust, when I still had a car, visiting a number of their swimming pools.  It wasn't a positive experience on the whole, at times very negative, so I began to try out other pools in different Scottish areas and in London Nov15 and Jul16 when down there.  Action research, mystery shopper sort of a thing, testing out the waters.

The pools I swam at in Fife, from September to December 2015 were in: Cupar, St Andrews, Glenrothes, Kirkcaldy, Dunfermline and Burntisland; Bowhill was closed at the time and I didn't get to Cowdenbeath or Levenmouth pools although I'd used them back in the 1990's when a student at Fife College, found them OK for leisure swimming not for doing lengths.  

Cupar was closest but had slippy old tiled flooring and psychiatric nurses from Stratheden using the facilities, one of whom had assaulted my son 1Feb12.  St Andrews East Sands leisure centre changing rooms were in need of refurbishment, broken lockers and hairdryers, pool didn't have enough room for proper length swimming.  Kirkcaldy and Glenrothes were new pools funded by Sport Scotland.

The Kirkcaldy pool I found to be risky, safety wise, and males swimming aggressively.  There weren't enough lifeguards on duty one Saturday, electric sockets at toddler height near hairdryer tables with no safety plugs, mixed gender changing rooms unsupervised, teenagers running wild.  I reported my concerns at the time to NE Fife MSP Roderick Campbell who acted on my behalf, writing to the Fife Trust. Glenrothes pool seemed to have been taken over by swimming clubs, especially at weekends and through the week public swimming wasn't always available.  On speaking to local folk they didn't seem happy about this.

at Burntisland Beacon Centre Dec15

I enjoyed swimming at the Burntisland and Dunfermline Carnegie centre pools.  The former had helpful staff, nice views out large windows surrounding the pool, the latter also had friendly staff, many different facilities on offer.  But both centres were difficult to access by public transport from where I live.  A bus then two trains or two buses and a distance to walk.  In addition there weren't fitness options available to suit.

at Tollcross pool Glasgow Dec15
By December 2015 I had ceased using the Fife leisure centres and started travelling to the Olympia in Dundee, getting an over-60's offer, just £15/month, including free swim and some classes Mon-Frid daytime, free gym anytime including weekends.  At the same time I tried out other pools when visiting Edinburgh, Glasgow and Perth, to see what they were like, compared to the Fife swimming experience.  I'd often swam in Perth Leisure Centre pool, Glasgow Rd, 2000-2 when working with PKAVS at the Gateway, NMethven Street, and did fitness at the Rodney Centre, Bridgend.  It was still a positive swimming experience.


London Olympic pool Nov15
In Glasgow Dec15 I swam in the Commonwealth pool at Tolcross International Swimming Centre and the Whitehill pool at Dennistoun.  Both had very helpful staff although the Tolcross pool had much newer facilities, larger pool geared towards length swimming.  In Edinburgh I visited the Leith Victoria with changing rooms around the side of the pool in a lovely setting, the Portobello Swim Centre which also had a Victorian pool, and the Royal Commonwealth Pool.  Again very helpful staff and a pleasant experience.

after swim London Fields Lido Jul16
I was in London November 2015 for the Carers UK Summit and visited the Olympic pool at Stratford, deep water, large changing areas, helpful fellow swimmers and staff.  Similar positive experiences in July this year when in London and swimming at the London Fields Lido outdoor pool and the Kensington Leisure Centre pool, only about a year old.  Had no complaints about the way I was
at Kensington pool London Nov16
treated at these facilities.  Didn't see any risky situations or behaviour.


I've been a member now at the Olympia Dundee for over a year, travelling via two buses, and have found swimming there to be very therapeutic, relaxing and safe.  Lane swimming and hot showers, useful when recovering from a hamstring injury after a bike fall in September.  Having taken up cycling early in the year, on and off road, I don't use the gym as much, do dumbbell exercises at home.  There's only so much gear I can carry in my rucksack at the one time!

Summing up, it was useful to try out other swimming pools and I will continue to do so when visiting new areas, if possible.  It was like a mini action research project, testing out the waters, building up confidence while getting fitter.   All grist to the mill for a psychiatric survivor, adventurer and PhD student.

after swimming at The Olympia Dundee 5 December 2016


Sunday, 25 December 2016

Unconditional Offer Accepted: Admission to PhD Clinical Psychology - 3 Years; University of Edinburgh

Today I accepted the unconditional offer of admission, undertaking a PhD in Clinical Psychology over 3 years at the University of Edinburgh, starting September 2017:

"PhD proposal title 'Investigating alternative crisis house and safe haven models from the perspective of lived experience: evidencing how the journey through psychoses and severe emotional states may be made safer and more secure by avoiding hospital treatment'

This action research PhD will employ a range of methods to investigate crisis houses and safe havens which exist in the UK and abroad, seeking good practice models and positive recovery outcomes, testimonies from people who have used alternative (to hospital) crisis services, hearing from staff working in these resources. To build up a picture, a map of what services exist, how they have been developed, any challenges along the way, the budgeting structure, the involvement of people with lived experience and their Carers or family members, collaborations and partnerships, and any other details which will help to evidence the benefits of safe haven crisis houses.
"


Co-supervisors: Prof Matthias Schwannauer and Dr Rosie Stenhouse



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Letter received from Scottish Government regarding PhD funding: 






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Letter received from Stephen Gethins MP wishing me good luck with PhD:


#GroundedTheory tweets on Christmas Eve 2016; watching #bbc2 #TOTP2

Reading 'Constructing Grounded Theory' by Kathy Charmaz late Christmas Eve while listening to 'Christmas TOTP2 Special' on BBC2:










Thursday, 22 December 2016