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Title: Research portfolio submitted in part fulfilment of the requirements for the degree of Doctorate in Clinical Psychology
Author: Robinson, Paula
Awarding Body: University of Bath
Current Institution: University of Bath
Date of Award: 2016
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Main Research Project: People with brain injuries frequently experience anxiety and depression that may be underpinned by high levels of self-criticism. It has been suggested that attributions of responsibility for the injury may play a role in the development of self-criticism and thus contribute to psychological distress. Attributional style may be different in acquired brain injury (ABI) and traumatic brain injury (TBI) survivors due to hypothesised phenomenological differences linked to the circumstances in which they both tend to occur. Twenty-one ABI and 22 TBI survivors completed measures of 1) beliefs about brain injury (attributional style); 2) self-criticism; 3) anxiety; 4) depression; and 5) satisfaction with life. In addition, a general population sample of 23 participants completed the latter four questionnaires as a comparison group. ABI and TBI survivors did not differ in terms of scores on mood measures and measures of self-criticism/self-compassion, satisfaction with life and, crucially, attributional style in relation to their brain injury. This study found no evidence to suggest that ABI and TBI survivors psychologically react or respond differently, regardless of the circumstances, cause and type of brain injury sustained. Service Improvement ProjectObjective: Research studies show that experiences of repeated trauma and adversity are very common in patients with severe mental health problems, who are most likely to be admitted to an inpatient unit in crisis. Unfortunately, many professionals do not routinely ask about abuse, due to concerns about distressing clients and a lack of training in how to ask and respond. Currently, guidance for complex trauma treatment and training is limited. This project sought to identify the needs of inpatient staff and developed a tailor-made training package. Method: Two focus groups were organised, to develop a training program which was delivered to the team. A questionnaire was administered pre-, post-training and at three-month follow-up, to assess changes in staff knowledge, confidence and worries in the assessment and treatment of trauma. Results: 21 staff members completed pre-training questionnaires, 13 completed post-training questionnaires and 7 staff completed questionnaires at follow-up. Self-reported staff confidence and knowledge about working with complex trauma increased following the training, and worries about working with complex trauma decreased. The substantive and statistically significant change occurred between pre-and post-training. Conclusions: In order to sustain the benefits of training for longer, a number of recommendations were made to the service and included designating a "change champion" to promote staff "buy-in" to new practices. Making the provision for on-going training and supervision will form a crucial part of future service development as a trauma-informed service. The continued evaluation of tailor-made training is indicated as part of this development. Critical Literature Review: Background: Adults with long term neurological conditions can face complex challenges in daily living, including anxiety and depression. Emerging research suggests the use of third wave approaches in working therapeutically with these difficulties. Aims: This review sought to assimilate and appraise the quality of published empirical studies using Compassion Focused Therapy (CFT), Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Cognitive Therapy (MBCT) or Mindfulness-Based Stress Reduction (MBSR). Method: A narrative review was undertaken using systematic methods. Studies were appraised using The Newcastle-Ottawa Quality Assessment Scale for non-randomised research or the Cochrane Collaboration's tool for assessing risk of bias in randomised controlled trials. Results: 19 studies met the pre-determined criteria. 14 out of 16 studies reported a statistically significant reduction in emotional distress, anxiety and depression. Of the 13 studies that used model-specific process measures, 10 found statistically significant improvements in transdiagnostic factors. Discussion: The findings indicate that third wave therapies show promise in addressing transdiagnostic difficulties and enabling clients to live a better quality of life with their neurological condition. Clinical implications include consideration of intervention length and use of outcome measures. Research implications are discussed by drawing on the Stage Model of Behavioural Therapies (Rounsaville, Carroll & Onken, 2001).
Supervisor: Salkovskis, Paul ; Griffith, Emma ; Russell, Ailsa Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: brain injury ; attributions ; self-criticism ; psychological distress ; complex trauma ; abuse ; training ; service improvement ; systematic review ; third wave ; neurological condition