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Title: Persecutory delusions and the internalising attributional bias for positive events : a systematic review and meta-analysis ; and, Training forensic mental health nurses in Cognitive Analytic Therapy (CAT) principles : a qualitative exploration of the impact on complex case conceptualisation and implications for practice
Author: Barker, David
ISNI:       0000 0004 7654 395X
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2018
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Purpose: A systematic review and meta-analysis tested the 'paranoia as a defence' model's original prediction that those experiencing persecutory delusions would take excessive credit for positive events as part of an attributional style that protects them from low self-esteem. The empirical project explored forensic mental health nurses' experiences of a Cognitive Analytic Therapy (CAT) training programme with an emphasis on complex case conceptualisation and implications for clinical practice. Methods: In relation to the systematic review and meta-analysis, those experiencing persecutory delusions were compared to those with non-paranoid psychosis, depression, and healthy controls, in terms of the magnitude of internalising attributional bias (IAB) for positive events. Correlation analysis also examined the association between magnitude of IAB and paranoia severity. In the empirical study, 10 forensic mental health nurses took part in semi-structured interviews to qualitatively explore their experiences and applications of CAT training. Results: Consistent with the model, an internalising attributional bias was present for those experiencing paranoid delusions when compared to individuals with depression. Contrary to the model, there were no differences between the other control groups and there was no significant correlation between IAB and paranoia severity. Internal attributions for positive events appear to be associated with depression, rather than paranoia. Analysis of the empirical data provided a rich account of nurses' experiences of the CAT training and how this helped them to conceptualise complex patients and promoted more positive ways of working. Conclusions: The findings from the systematic review and meta-analysis do not support the original model, but are consistent with the modified 'paranoia as a defence' model of persecutory delusions. Other cognitive models also help explain paranoia suggesting that refining the existing models further could be useful. The empirical findings suggest that CAT could be a valuable model of psychologically informed practice for nurses working in a forensic setting. Specifically, training appeared to help nurses develop a better understanding of their patients, greater self-reflection skills, and improved clinical care approaches.
Supervisor: Newman, Emily Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: systematic review ; persecution delusions ; Cognitive Analytic Therapy ; CAT training programmes ; internalising attributional bias ; paranoia ; clinical care