constructing shared understanding - a grounded theory exploration of team case formulation from multiple perspectives

Glasgow Theses Service http://theses.gla.ac.uk/ theses@gla.ac.uk Herhaus, Jenny (2014) Constructing shared understanding - A grounded theory exploration of team case formulation from multiple perspectives. D Clin Psy thesis. http://theses.gla.ac.uk/5726/ Copyright and moral rights for this thesis are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given i Constructing shared understanding - A grounded theory exploration of team case formulation from multiple perspectives & Clinical Research Portfolio VOLUME I (Volume II bound separately) Jenny K. Herhaus November 2014 Institute of Health and Wellbeing College of Medical, Veterinary and Life Science University of Glasgow 1st Floor, Admin Building Gartnavel Royal Hospital 1055 Great Western Road Glasgow G12 0XH Tel: 0141 211 3920 Fax: 0141 211 0356 J.herhaus.1@research.gla.ac.uk Submitted in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology (D. Clin.Psy.) ii TABLE OF CONTENTS VOLUME I (This Bound Volume) Acknowledgements iv Declaration of Originality Form v - vi Chapter 1: Systematic Review 1 - 38 A systematic review of randomized-controlled trials evaluating mindfulness-based psychological therapies for psychosis Figure 1: Flowchart of article selection process 9 Table 1: Study characteristics 12 – 19 Table 2: Risk of bias 29 Chapter 2: Major Research Project 39 – 73 Constructing shared understanding - A grounded theory exploration of team case formulation from multiple perspectives Table 1: Participant characteristics 47 Table 2: Example of line by line coding 50 Figure 1: Phased approach to data collection and analysis 51 Figure 2: Emerging model of team formulation 53 Chapter 3: Reflective Critical Account: Advanced Practice I 74 - 75 (Abstract only – For full account see Volume II) To say or not to say – When does communication become unethical? Chapter 4: Reflective Critical Account: Advanced Practice II 76 - 77 (Abstract only – For full account see Volume II) Increasing access to mental health services and offering choice to service-users - the challenge of putting psychology on the map in a multidisciplinary team iii Appendices Appendix 1 – Systematic Review 1.1: Guidelines for submission to Schizophrenia Research 78 - 79 1.2: Search strategy – example 80 1.3: Data extraction sheet – Study characteristics 81 - 82 1.4: Data extraction sheet – Risk of bias 83 - 84 1.5: Table of risk of bias judgements 85 - 103 Appendix 2 – Major Research Project 2.1: Guidelines for submission to Qualitative Research Journal 104 2.2: Evidence of Ethical Approval 105 - 107 2.3: Evidence of R&D Management Approval 108 –113 2.4. Information sheets and Consent forms 2.4.1: Staff Participant Information Sheet 114 - 116 2.4.2: Staff Participant Consent Form 117 2.4.3: Service-user Participant Information Sheet 118 - 120 2.4.4: Service-user Consent Form 121 - 122 2.5: Interview Schedules 2.5.1: Interview schedule Phase 1 – Clinical Psychologists 123 2.5.2: Interview schedule Phase 2 – non-psychology MDT staff 124 - 125 2.5.3: Interview Schedule Phase 3 – Service-users 126 2.6: Major Research Project Proposal 127 - 138 2.7: Plain English summary 139 - 140 iv ACKNOWLEDGEMENTS First and foremost, I like to express my deepest gratitude to Professor Andrew Gumley for supervising and supporting me in this endeavour. Thank you so much for all your time, effort, invaluable guidance and advice, tireless encouragement and for never letting me lose faith in my ability and this project. Your infectious enthusiasm and wealth of knowledge has made this an enjoyable and invaluable experience that has helped me grow in my professional development in many ways. I also like to thank Kelly Chung at the University of Glasgow, and my local collaborators in the teams at ESTEEM Glasgow for their help and guidance with this project. In particular I wish to express my gratitude and appreciation to the staff and service-users that have participated in my study. It has been a privilege to hear your stories. Further, I like to thank my clinical supervisors of the last three years and beyond who have each contributed so vitally to my development throughout the doctorate training by sharing their knowledge and skills and helping me to grow in confidence in my own practice. Special gratitude goes to Dr Janice Harper and Dr Nathan O’Neill for their patience, understanding, guidance and help throughout the intensity of the final year. I would have been unable to complete this research without the support and encouragement of my amazing family and friends. In particular I like to thank my loving parents, my siblings Sonja and Simon, and my good friends Jane, Lena, Joanna and Lynne. Thank you so much for always believing in me. Last but not least, I like to thank my fellow trainees for playing a vital part in the positive experience of my training. I especially like to thank Ruth, Sonia, Diane, Andy and Mel for their unwavering peer support and humour. The library would have been a very dull place without you. v Declaration of Originality Form This form must be completed and signed and submitted with all assignments. Please complete the information below (using BLOCK CAPITALS). Name Jenny Herhaus Student Number 1106785 Course Name Doctorate in Clinical Psychology Assignment Number/Name Clinical Research Portfolio An extract from the University’s Statement on Plagiarism is provided overleaf. Please read carefully THEN read and sign the declaration below. I confirm that this assignment is my own work and that I have: Read and understood the guidance on plagiarism in the Doctorate in Clinical Psychology Programme Handbook, including the University of Glasgow Statement on Plagiarism  Clearly referenced, in both the text and the bibliography or references, all sources used in the work  Fully referenced (including page numbers) and used inverted commas for all text quoted from books, journals, web etc. (Please check the section on referencing in the ‘Guide to Writing Essays & Reports’ appendix of the Graduate School Research Training Programme handbook.)  Provided the sources for all tables, figures, data etc. that are not my own work  Not made use of the work of any other student(s) past or present without acknowledgement. This includes any of my own work, that has been previously, or concurrently, submitted for assessment, either at this or any other educational institution, including school (see overleaf at 31.2)  Not sought or used the services of any professional agencies to produce this work  In addition, I understand that any false claim in respect of this work will result  vi in disciplinary action in accordance with University regulations DECLARATION: I am aware of and understand the University’s policy on plagiarism and I certify that this assignment is my own work, except where indicated by referencing, and that I have followed the good academic practices noted above Signature Jenny Herhaus Date November 6 th , 2014 1 CHAPTER 1: SYSTEMATIC REVIEW A systematic review of randomized-controlled trials evaluating mindfulness-based psychological therapies for psychosis Jenny K. Herhaus Institute of Health and Wellbeing College of Medical, Veterinary and Life Sciences University of Glasgow For Submission to Schizophrenia Research Submitted in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology (D. Clin.Psy.) 2 TITLE A systematic review of randomized-controlled trials evaluating mindfulness-based psychological therapies for psychosis ABSTRACT Background: Mindfulness-based psychological therapies are increasingly used with people with psychosis-spectrum disorders. They have been suggested to have potential to improve outcomes for this group. A number of randomized-controlled trials (RCTs) have now been conducted to assess their effectiveness. Objective: To identify, summarize and evaluate RCTs comparing a mindfulness- based intervention to a control condition for people with psychosis-spectrum disorders to determine their efficacy for this population. Data sources: A systematic review of articles identified by searching MEDLINE, EMBASE, PsychINFO, PsychARTICLE, CINAHL, Google Scholar, and Clinical Trial Registers (e.g. Cochrane Central Register of Controlled Trials, Current Controlled Trials Ltd.) from < 1980 to May 2014. Additionally, relevant journals and reference lists were hand-searched and clinical experts contacted to identify eligible studies. Results: A total of 12 articles describing 11 studies were identified, comprising a total of 599 participants with affective and non-affective psychotic disorders, with a mean age of 36.5 years (range 25.8 – 43.2). 54.2% of the sample were male. The interventions included Mindfulness training, Mindfulness-based Cognitive Therapy, Acceptance and Commitment Therapy, Compassion Focused Therapy, Dialectical Behaviour Therapy, amongst others. The descriptive summary of study characteristics and outcomes indicated significant heterogeneity between studies. Furthermore, evaluation of risk of bias using the Cochrane Collaboration Risk of Bias tool indicated significant risk of bias amongst included studies, with only three being rated as low risk while the remaining eight studies were rated as having high risk of bias. 3 Conclusion: High levels of heterogeneity between and high risk of bias within individual studies make it difficult to determine efficacy of and draw conclusions about the use of mindfulness-based interventions for psychosis-spectrum disorders at this point. Further research comprising larger samples and more standardized use of interventions is needed to be able to compare studies more meaningfully in order to determine clinical implications. Keywords: psychosis, mindfulness, RCT, systematic review INTRODUCTION There is now consistent evidence that Cognitive Behavioural Therapy for psychosis (CBTp) is associated with robust small to moderate effects on outcomes including overall psychiatric symptoms (Jauhar et al., 2014), positive symptoms (Wykes et al., 2008), delusions and hallucinations (van der Gaag et al., 2014). Recent guidance from the National Institute for Health and Care Excellence (NICE, 2014) recommends CBT as an individual treatment in psychosis particularly where there are persisting positive and negative symptoms. Since these pioneering studies of CBTp, there has been increasing interest in mindfulness-based psychological therapies. Mindfulness-based Cognitive Therapy (MBCT, Segal et al., 2002), Mindfulness-based Stress Reduction (MBSR) therapy (Kabat-Zinn, 1990), Acceptance and Commitment Therapy (ACT, Hayes et al., 1999), Compassion Focused Therapy (CFT, Gilbert, 2009), Loving-kindness meditation (Salzberg, 1995), and Dialectical Behaviour Therapy (DBT, Linehan, 1993) can be seen as falling under the category of mindfulness-based psychological therapies. These approaches vary in their components and main foci (e.g. meditation-based, acceptance-based or compassion-based) but what they all have in common is an emphasis on alleviating psychological distress by changing one’s relationship to thoughts and feelings (as opposed to challenging them as in traditional CBT) by cultivating a mindful, non-judgemental attitude to one’s experiences. For this purpose, they all tend to include some form of meditation practice (e.g. retraining [...]... Voices Acceptance and Action Scale (VAAS) to assess change in acceptance-based attitudes and actions associated with auditory hallucinations but no significant differences between groups were found They also explored the impact of ABCT with regards to level of involvement with auditory command hallucinations and beliefs about the omnipotence of voices as measured by subscales on the SHER and BAVQ-R No... Katz (2013); White, Gumley, McTaggart, Rattrie, McConville, Cleare & Mitchell (2011) The included studies are summarized in Table 1 Study/participant characteristics Combined the studies comprised a total of 599 adult participants (before attrition rates), with an average of 54 participants per study (range 2 2-1 07) Based on data from ten studies, the mean age of the participants was 36.5 years (range... The last search was run on May 18th 2014 In addition, 5 Clinical Trial Registers (Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.Gov, Current Controlled Trials Ltd., and the Australian and New Zealand Clinical Trials Registry) were also searched The following search terms were used: Mindfulness or meditat*; Mindfulness-based; acceptance and commitment therapy; acceptance-based;... - 4 5-5 0 min each 4 Hospitalisation rate; Self-rating of psychotic symptoms (frequency, distress and believability of symptoms) ACT group had significantly lower rate of rehospitalisation at 4 month follow-up and showed significantly higher symptom reporting and lower symptom believability when compared to TAU - North American Bach et al (2012) (n=51 of original n=80 available for 1 year FU) Braehler... the Cochrane Collaboration Risk of Bias tool (Higgins et al., 201 1a) to ascertain the validity of estimated treatment effect The use of this tool is recommended by The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions (Liberati et al., 2009) This involved assessing the studies for potential sources of bias in areas that have been... Acceptance-based cognitive-behavioural therapy; BDG = Dialectical Behaviour therapy-based psychoeducational group; CFT = Compassion-focused therapy; CP = conventional psychoeducation programme; ETAU = enhanced treatment as usual; MBCT = Mindfulness-based cognitive therapy; MBPP = Mindfulness-based psychoeducation programme; MT = Mindfulness training; TAU = treatment as usual; WL = Waiting list 19 Five of the included... compared caseness of depression and anxiety pre and post-intervention and found that a significantly smaller number of individuals in the ACT group met caseness for depression post treatment (from 8 to 2 individuals) compared to TAU (likelihood ratio χ²=5.00, p . – 73 Constructing shared understanding - A grounded theory exploration of team case formulation from multiple perspectives Table 1: Participant characteristics 47 Table 2: Example of line. comprised a total of 599 adult participants (before attrition rates), with an average of 54 participants per study (range 2 2-1 07). Based on data from ten studies, the mean age of the participants was. Glasgow Theses Service http://theses.gla.ac.uk/ theses@gla.ac.uk Herhaus, Jenny (2014) Constructing shared understanding - A grounded theory exploration of team case formulation from