scholarly journals ‘Felt security’ as a means of facilitating imagery rescripting in psychosis: a clinical protocol and illustrative case study

2020 ◽  
Vol 13 ◽  
Author(s):  
Katherine Newman-Taylor
Keyword(s):  
Behavioural Therapy ◽  
Illustrative Case ◽  
Imagery Task ◽  
List Type ◽  
Short Term ◽  
Cognitive Behavioural ◽  
Imagery Rescripting ◽  
Illustrative Case Study ◽  
The Impact

Abstract People with psychosis do not have routine access to trauma-focused cognitive behavioural therapy (CBT) interventions such as imagery rescripting (IR), partly due to clinical caution. This case study describes the use of a simple imagery task designed to engender ‘felt security’, as a means of facilitating IR with a woman struggling with distressing memory intrusions, linked to her voices and paranoia. We assessed the impact of the felt security task, which was used before IR to enable Kip to engage in reprocessing of her trauma memories, and again after IR so that she would leave sessions feeling safe. The brief imagery task was effective in improving felt security before IR sessions. Felt security then reduced during IR, when distressing material was recalled and reprocessed, and increased again when the task was repeated. It is not yet clear whether trauma-focused interventions such as IR need to be routinely adapted for people with psychosis. In the event that individuals express concerns about IR, if the person’s formulation indicates that high levels of arousal may trigger an exacerbation of voices, paranoia or risk, or where clinicians are otherwise concerned about interventions likely to increase emotional arousal in the short term, the felt security task may facilitate safe and effective reprocessing of trauma memories. This in turn may increase access to trauma-focused CBT for people with psychosis. Key learning aims (1) To understand that people with psychosis need access to trauma-focused CBT. (2) To be familiar with a simple attachment-based imagery task designed to foster ‘felt security’. (3) To learn that this task may facilitate imagery rescripting in people with psychosis.

Client-led culturally responsive CBT – integrating familism in the treatment of chronic depression: a case study

2020 ◽  
Vol 13 ◽  
Author(s):  
Lilian Skilbeck ◽  
Christopher Spanton ◽  
Ian Roylance
Keyword(s):  
Cultural Adaptation ◽  
Treatment Plan ◽  
Behavioural Therapy ◽  
Cultural Responsiveness ◽  
Chronic Depression ◽  
List Type ◽  
Her Family ◽  
Psychological Therapies ◽  
Cognitive Behavioural

Abstract Britain has increasingly become a multi-cultural society. In order to improve access to primary care psychological therapy including cognitive behavioural therapy (CBT), there has been an increase in focus on cultural adaptation and cultural responsiveness. To date, these adaptations have focused on domains such as language, beliefs and values. In this case, familism was the focus for adaptation. The client was a 22-year-old female from a black African-British background. She presented with severe symptoms of chronic depression as measured on routine standard questionnaires and the interview. She had minimal success from previous interventions and was struggling to make progress. Therapy was guided by the client’s views on what issues had a bearing on her difficulties. The client hypothesised that familism factors with themes around ‘my parents’ culture’ and ‘family comes first’ were interacting with her cognitive behavioural factors to maintain her problem. She requested the involvement of her family in her treatment plan. In line with the Improving Access to Psychological Therapies–Black, Asian and Minority Ethnic service user Positive Practice Guide, this was integrated as part of her formulation. Upon involvement of her father in a single session, the client attained reliable improvement. She attributed her improvement to this involvement. By the end of therapy, she reached recovery, which was maintained at 3-month follow-up. This study was responsive to the client’s own perceived cultural needs through the integration of familism into her CBT formulation. It illustrates a client-led cultural adaptation of CBT to treat chronic depression. Key learning aims It is hoped that the reader will increase their understanding of the following from reading this case study: (1) Creating an environment where clients can freely discuss their perceived cultural factors from the outset. (2) Client-led cultural responsiveness to their expressed cultural needs. (3) Familism as a domain for adapting CBT.

scholarly journals A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland

2021 ◽  
Vol 14 ◽  
Author(s):  
Eliane Du ◽  
Ethel Quayle ◽  
Hamish Macleod
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Information Dissemination ◽  
Behavioural Therapy ◽  
Routine Care ◽  
Computer Assisted ◽  
List Type ◽  
Access To Treatment ◽  
Cognitive Behavioural ◽  
Qualitative Exploration ◽  
The Impact

Abstract Computerised cognitive behavioural therapy (CCBT) has been made available within the National Health Service (NHS) across Scotland as an alternative treatment for mild to moderate anxiety and depression. However, the provision of CCBT services is still limited in the NHS, possibly affecting delivery of this computer-aided therapy to patients and inhibiting acceptance and uptake of this intervention. This paper reports on the qualitative exploration of patients’ experiences and acceptance of one CCBT programme delivering computer-assisted therapy (Beating the Blues: BTB), examining particularly the point of referral, access to treatment, and support. Thematic analysis was conducted on semi-structured face-to-face and email interviews with 33 patients at different NHS organisations across Scotland. Data analysis generated six key themes which illustrated patients’ experiences relating to referral and access to the treatment, and the challenges they faced: (1) information dissemination; (2) expectations and the impact of waiting for BTB; (3) impact of locations on experience of BTB; (4) preference for home access; (5) desire for better human support; and (6) desire for additional application support features. The findings highlighted that better methods of implementing and delivering such CCBT services together with the design of the technological interventions are vital to the success of these services. Key learning aims (1) To understand the service models and methods of implementing and delivering one CCBT programme (BTB) in routine care; (2) To learn about user experiences of accessing and using BTB; and (3) To learn about the implications and factors that might have influenced uptake and understand the implications.

Populism and Secularism in Turkey

2006 ◽  
Vol 23 (2) ◽  
pp. 20-36
Author(s):  
Eren Tatari
Keyword(s):  
Historical Institutionalism ◽  
The State ◽  
Freedom Of Religion ◽  
The Political ◽  
Illustrative Case ◽  
Cultural Approach ◽  
Modern Turkey ◽  
Illustrative Case Study ◽  
The Impact

This article analyzes the impact of two key components of Kemalist ideology, populism and secularism, on the policymaking process of modern Turkey by utilizing historical institutionalism and the political-cultural approach. The Headscarf Ban Policy, which has been implemented discretionarily since 1981 and intensively since 1997, provides an illustrative case study of the broader debates over freedom of religion, secularism, and democracy, and helps to uncover the influence of populism and secularism, as well as the interaction between these two principles. The analysis reveals the principle of populism, which has been much overlooked in the literature, as a key determinant of state-centric reforms as well as a method of legitimizing the undemocratic version of secularism advocated by the state.

Transition to cognitive behavioural therapy from different core professional backgrounds: three grounded theory studies

2020 ◽  
Vol 13 ◽  
Author(s):  
Matthew D. Wilcockson
Keyword(s):  
Grounded Theory ◽  
Clinical Practice ◽  
Coping Strategies ◽  
Cognitive Behavioural Therapy ◽  
High Intensity ◽  
Behavioural Therapy ◽  
List Type ◽  
Cognitive Behavioural ◽  
Mandatory Requirement ◽  
The Impact

Abstract Aim: Transition between roles is widely recognised to be a complex process that involves training, socialisation into the new culture, exiting a previous role culture, and dealing with the transition process itself, and dealing with loss of identity and initial incompetence in the new role. Moving from core profession to high intensity (CBT) therapist is an example of such a role transition. As a result, complete transition is not guaranteed, which may affect completeness of learning, and how CBT is practiced post qualification. It is recognised in a number of studies that professional cultures are present in professions such as nursing and counselling, and these professions may have different filters for viewing CBT, and different training needs. Method: A grounded theory analysis (Glaserian) of each of three core professions’ (mental health nurses, counsellors, and an unprofessionalised group) reflective reports (7 per profession) was undertaken, incorporating information from their learning journals throughout the year independently of each other. The reflective reports incorporate reflections on the process of transition and learning, and is a mandatory requirement of the course. Through an inductive process described in the article, a theory of transition was developed for each group. Results: Three different theories of transition are presented. Nurses absorbed knowledge but resisted practice changes, especially being clinically observed. Practice changes occurred through behavioural consequences and cognitive dissonance and reflection is structured and compartmentalised generally. The conflict between counselling and CBT is felt more deeply emotionally but resolved through experiencing ‘self as client’ for most counselling participants. Practice conflicts are mostly resolved with this group, but some ideological ones are not. The KSA group have a relatively smooth transition unaffected by previous experiences. Inability to use previous coping strategies for dealing with distress is influential, inducing crises for the nursing and counselling groups. Implications: Learning is delayed by trying to avoid clinical practice, and excessive identification only with the aspects of CBT that fit with existing identity and practice with nursing and counselling groups. Adaptations to training may be beneficial to enforce observation of practice at an earlier stage to drive change. The nursing role does appear to undermine learning. Reflection does eventually drive the learning process as noted in other studies, but this does not occur spontaneously with nurses or counsellors. Identification with the new role appears influential in a relatively complete change, which is consistent with theory. Recommendations to adopt CBT coping strategies early in the training are made, as is a session of individual support to address profession-based conflicts. Potential implications for the evidence base are noted. Transitional models provide a framework for educators and students. Key learning aims (1) To appreciate the importance of successful role transitions and their effect on future practice. (2) To become familiar with the key issues in transitioning between different core professions and an IAPT high-intensity role. (3) To critically reflect on personal experience in transitioning to cognitive behavioural therapy, and the impact it has had on clinical practice.

Collusion in clinical supervision: literature review and case study in self-reflection

2009 ◽  
Vol 2 (2) ◽  
pp. 106-114 ◽  
Author(s):  
Derek L. Milne ◽  
Caroline Leck ◽  
Nasim Z. Choudhri
Keyword(s):  
Clinical Supervision ◽  
Behavioural Therapy ◽  
The Self ◽  
Short Term ◽  
Interpersonal Dynamics ◽  
Related Literature ◽  
Self Reflection ◽  
Cognitive Behavioural

AbstractInterpersonal dynamics are a recurring impediment to effective clinical supervision and can lead to phenomena like collusion between the supervisor and supervisee. Collusion involves both supervisor and supervisee engaging in safety behaviours that serve to conveniently avoid and escape from difficult topics and challenging methods. Whilst minimizing the short-term threat to supervisor and supervisee, collusion will tend to undermine the effectiveness of supervision and limit significantly its long-term value to patients. In order to consider how best to address collusion, we review the cognitive-behavioural therapy (CBT) and related literature on collusion, focusing on how it has been formulated and managed. We then provide a case study featuring a supervisor who was colluding with the supervisee's avoidance behaviours (i.e. filling supervision sessions with superficial reflections on his casework) by not challenging these reflections or moving to another learning mode (e.g. experimenting). We develop a CBT formulation of this pattern of supervision as part of the self-reflection process, led by a consultant. Self-reflection appeared to be a useful tool for improving the supervisor's understanding of this dysfunctional process, and strengthened the supervisor's confidence in utilizing relevant skills in the future.

Helping clients ‘restart their engine’ – use of in-session cognitive behavioural therapy behavioural experiments for engagement and treatment in persistent depression: a case study

2020 ◽  
Vol 13 ◽  
Author(s):  
Lilian Skilbeck ◽  
Christopher Spanton ◽  
Ian Roylance
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
List Type ◽  
Perceptual Field ◽  
Major Depressive ◽  
Cognitive Behavioural ◽  
Persistent Depression ◽  
Recommendations For Practice ◽  
Behavioural Experiments

Abstract Behavioural experiments (BEs) are a major cognitive ingredient in the cognitive behavioural therapy (CBT) model which can be applied in-session or between-sessions. In-session BEs are particularly effective and widely demonstrated in anxiety disorders, yet they remain under-utilised in depression. Clients presenting with persistent depression are often difficult to engage due to the chronicity of their symptoms and their learnt self-perpetuating demoralised states. Research to date demonstrates the effectiveness of in-session BEs in engagement and treatment in depression. This case study details the treatment of a client presenting with persistent major depressive disorder (MDD) with hopelessness and how in-session BEs effected engagement and treatment. This case study is discussed with reference to strengths, limitations, clinical implications and recommendations for practice and development. Key learning aims It is hoped that the reader of this case study will increase their understanding of the following: (1) Using BEs to help engagement and treatment in persistent MDD. (2) Instilling hope by starting in-session BEs during the assessment stage. (3) When to plan or seize opportunities for off-the-cuffin-session BEs. (4) Setting no-lose BEs to enable clients to widen their perceptual field. (5) The importance of repeated BEs to consolidate experiential learning.

An Optimization Framework for Job Rotation to Better Assess the Impact on Overall Risk

2018 ◽  
Vol 62 (1) ◽  
pp. 843-847 ◽  
Author(s):  
Alexander Vinel ◽  
Amir Mehdizadeh ◽  
Mark C. Schall ◽  
Sean Gallagher ◽  
Richard F. Sesek
Keyword(s):  
Risk Evaluation ◽  
Worker Safety ◽  
Illustrative Case ◽  
Failure Model ◽  
Job Rotation ◽  
Optimization Framework ◽  
Illustrative Case Study ◽  
Job Pool ◽  
The Impact

We aim to study the potential of job rotation schemes to improve worker safety. To this end, we developed a novel optimization framework based on a recently proposed fatigue-failure model for musculoskeletal disorder (MSD) risk evaluation. We then employed it to conduct an illustrative case study. We demonstrate that the effect of job rotation is highly dependent on the composition of the job pool. Namely, if the job pool contains high-risk tasks (e.g., those carrying greater than 90% probability of developing a disorder), then it may be impossible to observe any risk improvement with rotations alone. On the other hand, if all jobs are already relatively low-risk, then a rotation may be very helpful in achieving risk equity.

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