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Title: Compassion-focused therapy for individuals with antenatal mental health difficulties : a hermeneutic single-case efficacy design (HSCED) series
Author: Wicks, Sophie
ISNI:       0000 0004 8506 9727
Awarding Body: University of Lincoln
Current Institution: University of Lincoln
Date of Award: 2019
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Background: Perinatal mental health difficulties (MHD) affect between 10-20% of women in the United Kingdom (Bauer, Parsonage, Knapp, Iemmi, & Adelaja, 2014). Guilt and shame are now recognised as major contributors to a range of MHD (Gilbert, 2009; Gilligan, 2003) and frequently occur in new mothers, for example, due to concerns around motherhood 'performance' (Beck, Emery, & Greenberg, 1985), heightened responsibility (Oluyori, 2014), and societal expectations of a 'good mother' (Sutherland, 2010). However, this may be particularly prevalent in women experiencing clinical antenatal disorders (Beck & Barnes, 2006) due to fear of social services involvement arising from MHD and feeling shamed by society for not adhering to expectations of motherhood (Maimon, 2012). Guilt and shame can worsen symptoms of MHD due to the individual feeling unable to disclose symptoms and seek support during this time (Dennis & Chung-Lee, 2006). Compassion-Focused Therapy (CFT) is an integrative therapeutic model which emphasises affect regulation (Gilbert, 2005) and attachment principles (Bowlby, 1969). CFT attempts to reduce psychological distress by increasing compassion and reducing guilt and shame which often manifest as self-criticism (Gilbert & Miles, 2000). As CFT has a unique focus on the soothing Oxytocin system, it is particularly relevant in reducing maternal distress and positively impacting the mother-infant relationship (Cree, 2015) due to enabling attachment and bonding (Galbally, Lewis, Ijzendoorn, & Permezel, 2011). Method: This report starts with a systematic literature review exploring the experiences of women who have had postnatal psychosis, in order to gain a new understanding of the effects of this mental health difficulty. This report then details a study which employed an adjudicated hermeneutic single-case efficacy design series (HSCED; Elliott, 2002; Elliott et al., 2009) to investigate the effectiveness of CFT for antenatal women with MHD. This intended to answer three aims: (i) is there evidence of substantial change following a six week CFT intervention? (ii) are changes attributable to therapy processes, common factors, or other non-therapeutic explanations? (iii) are therapeutic processes CFT-specific? Three adult pregnant women with MHD were recruited from a National Health Service (NHS) community perinatal service and engaged in six individual sessions of CFT. A range of quantitative and qualitative clinical data were collated ('rich case records'), which included outcome measures, CFT-specific measures, and a participant change interview. The rich case studies were critically analysed by three independent clinical psychologists ('judges') who provided opinions regarding whether the client changed, whether change was due to therapy, and whether CFT-specific or generic therapeutic factors were most influential. Results: According to the judges' opinions only one participant changed at least 50% (ranging from 50-80% change). The judges generally believed change was more likely due to therapy than extra-therapeutic factors. The majority opinion was that any participant change was more likely due to generic or common factors, rather than CFT-specific factors. Helpful generic therapeutic factors included mindfulness practice, formulation, psychoeducation, and therapist attributes. Discussion: It is inconclusive whether six sessions of individual CFT are effective in reducing distress for antenatal women. CFT-specific measures did not consistently reflect subsequent changes in outcome measures, suggesting that CFT-specific processes were not predominantly responsible for any positive client change.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available