Conference: Therapeutic Interventions: Actions not Words, 23rd October BPS London Offices

http://www.bps.org.uk/events/therapeutic-interventions-actions-not-words
 
This conference aims to be a refreshing, innovative and thought provoking conference that aims to highlight and enhance knowledge around culture, and black and ethnic minority issues for those involved in applied psychology.
Applied Psychologists have organised this conference. A range of speakers will address a wide range of topical issues. In addition, there will be a number of workshops. Please come along, listen, network, and contribute to the discussions of the day.
 
Dr Laura Cockburn, Educational Psychologist, working on the Doctoral Programme for Educational and Child Psychology in UEL is leading a workshop together with Ken Greaves, Educational Psychologist (and a student at UEL) and Paula Spencer, Counselling Psychologist. This workshop is about: The use of Narrative methods when trying to improve our engagement with culturally diverse populations: a workshop

Debating diagnosis and rethinking the way we teach about mental health

The recent publication of the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (or DSM5) has led to a fierce debate both in the academic literature and in the wider media about how best to conceptualise psychological distress.  For example, an article in the Observer about the recent BPS Division of Clinical Psychology’s position statement (which makes the case for a paradigm shift away from diagnosis) has already received over 1,000 comments from readers.  An ipetition about DSM5 has over 14,000 signatures. 

Whilst in some media outlets this debate is being seen as a turf war between psychologists and psychiatrists in fact many psychiatrists have problems with DSM5 too.  Indeed, one of the most prolific critics of DSM5 is Dr Allen Frances who led the task force which produced the previous edition of the DSM.  In the UK, the Critical Psychiatry Network (a grouping of psychiatrists critical of biomedical reductionism) recently published a statement critical of the DSM.

The problems with psychiatric diagnostic systems like the DSM were discussed in a series of open access articles in a special issue of the Psychologist which I co-edited with John Cromby (University of Loughborough) and Paula Reavey (London South Bank University) in 2007.  They are also summarised in a recent open access article in the journal Evidence-Based Mental Health (EBMH) by three professors of clinical psychology (Peter Kinderman, John Read and Richard Bentall) and psychiatrist and researcher Dr Joanna Moncrieff.  They note that “diagnostic systems in psychiatry have always been criticised for their poor reliability, validity, utility, epistemology and humanity”. 

Many people appear to think that problems with the reliability of psychiatric diagnosis lie in the past but a recent editorial in the American Journal of Psychiatry reporting the results of field trials of DSM5 criteria reveal they are not.  Of 20 adult disorders only three had kappa reliability values over 0.6 (even schizophrenia only had a kappa of 0.46).  Even worse, Allen Frances noted that the definition of acceptable reliability had been lowered:  “When DSM 5 failed to achieve acceptable reliability by historical standards, the DSM 5 leadership arbitrarily decided to move the goal posts in and lower the bar in defining what is 'acceptable'.”

Given the longstanding problems with psychiatric diagnostic systems it is surprising that the contents of most psychology textbooks on mental health (also titled ‘abnormal psychology’, ‘clinical psychology’ or ‘psychopathology’) are almost entirely structured by classificatory frameworks like the DSM – a point noted recently by psychologist and broadcaster Claudia Hammond on BBC Radio 4’s All in the Mind in an interview with psychiatrist Simon Wessely about DSM5.  It is quite unusual within psychology for its approach to a phenomenon to be predetermined by another discipline’s framework.  Usually, in psychology, phenomena are operationally defined and understood using psychological theory.  Indeed, Kinderman et al note that this approach can be adopted in mental health too:  “it is relatively straightforward to generate a simple list of problems that can be reliably and validly defined; for example, depressed mood, auditory hallucinations and intrusive thoughts. There is no reason to assume that these phenomena cluster into discrete categories or other simple taxonomic structure”

In a survey of psychology mental health modules in the UK a few years back John Cromby, Paula Reavey and I discovered that current teaching about mental health in the psychology undergraduate curriculum was a little dated.  For example, critiques of diagnosis tended to refer only to critics from the 1960s like Laing and Szasz rather than the more modern critiques noted above.  Moreover, teachers wished to have more involvement from clinical psychologists and other practitioners.  Perhaps because of this more recent developments within clinical psychology of psychotherapies for psychosis and alternatives to diagnosis like formulation do not seem to get as much coverage as they might in mental health modules on undergraduate psychology programmes.  The survey also found that although the mental health service user movement has become increasingly important in mental health practice, service users were barely involved with the teaching of students.

In an article in the Psychologist on the teaching of mental health to psychology undergraduates John, Paula, Anne Cooke, Jill Anderson and I questioned the tendency for psychology educators to “jump ship” by giving psychiatric rather than consistently psychological explanations of mental distress and we suggested there was a need to consider the implications of recent developments in psychological theory and practice.   This raises the question of how we might teach differently about mental health.

In a recently published textbook entitled Psychology, Mental Health & Distress, John, Paula and I plus a range of additional contributors argue that a truly psychological approach to distress should be experience-based rather than diagnostic category-based.  By this we mean to focus on broad commonalities in experience.  The book is in two parts.  The first part deals with a number of conceptual issues which are often skipped over in many textbooks but which are crucial if we are to think clearly about distress.  The second part deals with five broad forms of distress.

To understand why we have the ideas we do today it is vital to look at how those ideas were developed, so in our chapter on history in Part 1 we provide a survey of the different ways that distress has been understood and treated over the centuries. History shows how there have always been competing strands of explanation and treatment for distress, some primarily implicating the body and its organs and some primarily implicating experiences, meanings, thoughts and feelings. 

Our chapter on culture looks at how distress differs between societies. It discusses some of the great variability in the forms of distress, the variability in the ways that it gets linked to other aspects of experience, and the variability in the outcomes associated with it. As we have already suggested, distress is thoroughly bound up with culture and this chapter illustrates the extent and consequences of this.

Our approach to biology treats it as an essential part of distress, but does not make the unfounded psychiatric assumption that it is always the ultimate source of people’s difficulties. In the chapter on biology in part 1, we explain why there are problems with ‘biopsychosocial’ accounts of distress, and in their place offer an alternative view of the role of biology based upon biologist Steven Rose’s notion of lifelines. We then summarise evidence that supports this approach, drawing upon studies of attachment as well as upon recent work in psychology and neuroscience.

In the chapter on classification Lucy Johnstone examines how psychiatric diagnosis is both similar to, and different from, diagnosis in general medicine and she discusses how adequate formulation is as an alternative to psychiatric diagnosis.  The issue of causality is extremely important and we devote a whole chapter to it in Part 1, exploring not only how we might understand the ways that different causal influences upon distress interact with each other but also the extent to which research into the causes of distress is helpful to clinicians.  The next  chapter is written by leading British mental health survivors Peter Campbell, Jacqui Dillon and Eleanor Longden who describe what the service user/survivor movement is and why it is important including a discussion of the approach taken by the Hearing Voices Network.  The last chapter in Part 1 examines three main mental health interventions:  medication, psychological therapies and community psychology.  Many mental health textbooks adopt a somewhat uncritical approach to the use of psychiatric medication but this section, authored by psychiatrist and researcher Joanna Moncrieff gives a clear explanation of research on the efficacy of medication and argues for a more pragmatic approach to understanding its effects.  Paul Kelly and Paul Moloney discuss psychological therapies whilst Rae Cox, Guy Holmes, Paul Moloney, Paul Kelly, Penny Priest and Mike Ridley-Dash examine key issues associated with community psychology interventions.

In the second part of the book we focus in detail on five main forms of distress-related experience formulated in everyday language:  sadness and worry; sexuality and gender; madness (authored by John Read and Richard Bentall); distressing bodies and eating; and personality disorder.  We have structured these chapters into broad classes of forms of distress where there is a commonality in the underlying phenomenology of an experience.  Thus the chapter on sadness and worry deliberately treats together aspects (e.g. ‘anxiety’ and ‘depression’) that would usually be treated separately in other books, because of their DSM classification.  Similarly the chapter on madness includes elements that, in other texts, would be treated separately like ‘schizophrenia’ and ‘bipolar disorder’.  Although the number of different kinds of distress we discuss is smaller than other texts, on average these difficulties will account for the majority of the referrals received by mental health services.

Each of these chapters follows a similar structure, building on the insights of the first part of the book.  Given our wish to focus on experience, each chapter begins with a fictional case story describing key aspects of that particular form of distress.  Section headings in the chapters cover historical and cultural context; contemporary Western forms of distress (including prevalence and psychiatric diagnosis); causal processes  (social, psychological, biological and genetic) drawing on a lifelines approach; and the efficacy of a variety of mental health interventions including psychological therapies.  Personality disorder is a much contested category and it could be argued that many people receive this diagnosis not because of their distress but because of the reactions of others to their behaviour.  As a result a key question in this chapter is whether the notion of personality disorder is a helpful way of making sense of people’s difficulties in relating to others.

We see the book as an important step in teaching mental health differently but we appreciate that changing the content of teaching can feel challenging for many lecturers.  As a result, we aim to provide as much support as possible to lecturers wishing to take a different approach and, on the lecturer’s section of the publisher’s website for the book we’ve included an 18 page handbook answering key questions lecturers are likely to ask as well as powerpoint slides for each chapter.  The publisher’s website includes a range of other resources including a sample of the introductory chapter.

The debates about psychiatric diagnosis in the wake of the publication of DSM5 suggest this is a good time to rethink the way we teach about mental health.  Indeed, one enterprising teacher has even used the regular revision of the DSM as a way of imparting insights about the history of psychology.  Joshua Clegg (City University of New York) suggests that the revision process of DSM can be used in teaching to ‘demonstrate the evolving ways in which mental health and illness are conceptualized and can reveal the cultural, political, and economic forces that shape this process’.

David Harper

Bringing Coaching Psychology to Nursing

Workshop Report

Coaching 360 – preceptorship and leadership development for registered nurses in Hong Kong, 19th December 2012

135 registered nurses from different hospitals and Universities attended the above workshop, which was arranged by the Hong Kong College of Education and Research in Nursing. This was one of the direct outcomes from my keynote at the 3rd International Orthopaedic Nursing Conference in Malta last October, where I was invited to give a talk/workshop at The United Christian Hospital in Hong Kong (See the previous conference report). My aims were twofold: to promote coaching psychology (UEL MSc Programme in particular) in Hong Kong and in the health sector which forms part of a wider initiative of promoting coaching psychology for nursing. From the hospital’s perspective, the workshop aims to show how coaching psychology can be used to 1) train and develop preceptors to become more effective in coaching the preceptees in the preceptorship programme; 2) develop leadership quality in both junior and senior nurses so that they can readily implement new nursing initiatives.

Knowledge transfer - Opportunities for nurses to develop coaching skills

The preceptorship and leadership development were the two major aspects identified as potential coaching applications. Preceptors are registered nurses (with minimum two years of clinical experience) who are responsible to guide, teach and coach the preceptees ( nurses who have just graduated from the institute and is not familiar to the clinical environment). In this preceptor-preceptee relationship, different approaches may be used in coaching and mentoring the preceptee. Coaching psychology can also help junior staff to facilitate new nursing initiatives which may be applicable to their clinical area.

Outcome

1. Evaluation: User satisfaction survey – 135 evaluation forms were distributed after the workshop and 68 were returned. All participants (100%) agreed that the workshop had been run in a well organized manner; 97% agreed that materials in the workshop were presented clearly. Over 90% of participants agreed that the objectives of the workshop had been made clear. 91% of participants agreed that the overall subjects in the workshop were easy to understand and the workshop was practical for use in the workplace.

2. UEL student recruitment – 200 leaflets for the MSc Coaching Psychology Distance Learning (DL) Programme were distributed to the participating hospitals. After the workshop, one participant – Dr Iren Wong, Head of School of Nursing, The Hong Kong Sanatorium and Hospital (the former Associate Professor at City University of Hong Kong) came and thanked me for the workshop. She subsequently applied and enrolled onto the MSc Coaching Psychology (DL) Programme, just in time to start in Semester B. There were a number of enquiries shortly after the workshop. It is expected the number of applications will follow for Semester A this September. Overall for Semester B, 13 new applicants have enrolled onto the MSc Coaching Psychology (DL) Programme (in comparison with Semester B last year, when there were 6) – this represents an overall increase by more than 100% in the number of DL students (well above the School’s target)! Together with the existing DL students, this brings the total number to 48.

Wider impact and future initiatives

1. Publication – the paper based on the Keynote at the Maltese conference was accepted and published by the International Coaching Psychology Review this Spring.

2. Esencija Sestrinstva First Nursing Symposium – I was invited to be a member of the Scientific Committee of the Symposium, and present a Keynote at the Symposium on 12 – 14 April 2013 at Marija Bistrica, Croatia.

3. The creative use of Moodle and the development of online learning project – In response to the above call, I have drafted two bids and sent them to the Subject Leader on Developing an online VLE Management System (VLE- MS) and Creation of a new Coaching Psychology short course for CPD to further advance the DL provision on Coaching Psychology and improve students’ learning experience. Further comments and support to take these forward are welcome.

4. Student Testimonials and future marketing - I have now received two testimonials from our former MSc students about the experience of their studies with UEL. I would welcome further advice from colleagues about how to take these forward and capitalise on this marketing opportunity.

Dr Ho Law PhD CPsychol CSci CMgr MISCP(Accred) AFBPsS; FCMI; FHEA

School of Psychology

Email: law2@uel.ac.uk

Date of the report: 09 February 2013

Collaboration, impact and media training event

I applied to attend an Open Central event named COLLABORATION, IMPACT AND MEDIA TRAINING at Senate House and was thrilled when I was allocated a place. I was less thrilled when I received the programme. The programme implied that the day would be mostly interactive with participants having to find partners to collaborate with and then form larger groups by marketing their ideas. This seemed quite a scary undertaking and I was nervous when I arrived at the event. However, the other participants, from a range of different universities, were all very friendly and warm. We soon got to know each other over the welcome coffee and I became less anxious. The first activity was to find a partner with whom we could develop a study idea. Initially there was a faint hint of desperation in the air as the chatting became more frantic but as most of the participants were social scientists it soon became apparent that we were all able to collaborate with the people sitting next to us. After spending some time expanding on our idea we then had to try and increase our group size from two to four. Although it sounded daunting it was in fact a really fun activity and a good insight as to how best to approach others when trying to build collaborative partnerships.

Following on from that we then had to complete different pathways to show the impact of our prospective study. This was a very informative exercise and I certainly considered lots of other pathways to impact that would not have occurred to me before. Lastly, we were shown how to create a podcast which was the chosen type of digital media because of the ease of which you can create a professional sounding product quickly and cheaply.  Podcasts are now becoming popular with lecturers who are able to record their sessions for students but, in addition, it was explained to us how podcasts can be put onto the internet to allow a much wider audience access to our work which is an important aspect when trying to increase impact by engaging the public with academic work. This activity was really enjoyable and we finished the afternoon by listening to each group’s podcast.  The ideas were wide ranging and fascinating, the podcasts humorous and lots of hilarity ensued. It was a great way to end a Friday afternoon.

I will remember this course as not only was it very informative and interesting but because it was a nice way to meet fellow PhD and Postdoc students from other institutions. Lunchtime was spent swapping experiences and ideas as well as admiring the unique interior of Senate House. Furthermore, this was one of the most fun courses that I have attended.

 Paula Booth

The impact of nicotine on cognitive functions

Within the field of smoking research, there is debate on the impact of nicotine on cognitive functions such as memory and attention. The most intricate part of the cognitive system is the 'executive functions' which generally co-ordinate a host of other functions and standard behaviour. The executive functions are the last to develop in adolescence and the first to start deteriorating in healthy ageing; they are also implicated in a range of other disorders such as Autistic Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). Since 2004, we have been developing and refining a new test of executive functions using the School's virtual reality expertise (aka Tony Leadbetter). This new test known as JEF (the Jansari assessment of Executive Functions), looks like a computer game with the participant moving around an office environment completing tasks that an office temp might be asked to perform. These tasks have been designed to tap various aspects of the executive system and provide a profile of abilities that currently available clinical tests are unable to provide. In a collaborative study with an MSc student Dan Froggatt and two experts in smoking research, our own Lynne Dawkins and Trudi Edginton from Westminster University, we used JEF to look at smokers and nonsmokers who were either given a nicotine gum or a placebo gum to see the impact on their executive functions. The results demonstrated quite categorically, that without the nicotine, smokers perform relatively poorly and that with the nicotine gum, there is an improvement in performance which is generally to the level of non-smokers on a placebo gum. The effects were particularly marked for 'prospective memory' which is the ability to remember to do things in the future (e.g. turning the oven on in ten minutes time). This new paper will hopefully make a useful addition to our understanding of the impact of nicotine on cognitive functions. Further, the paper nicely adds to three other papers published by a collaborator, Cathy Montgomery at Liverpool John Moores University who has used JEF to look at the impact of ecstasy, alcohol and cannabis in three separate studies.

Ashok Jansari

A potential new clinical test of accelerated long-term forgetting

Patients with significant memory problems are assessed with a range of standard memory tests which generally demonstrate that, while the individual can retain the information for a few seconds or minutes, within half an hour, there has been substantial forgetting. However, a class of patients has recently been reported in the literature who pass these standard tests but complain of memory problems with the forgetting becoming obvious a few days or weeks later. This disorder has been termed 'Accelerated Long-Term Forgetting' or ALF and to date there is no clear clinical test to objectively demonstrate and quantify this phenomenon. In 2010, we published a single case study of a patient who shows a classic ALF profile and this new paper is a follow-up one in which we describe a memory test that we have developed that captures our patient's forgetting within an hour of first learning any information. This work came out of Terry McGibbon's Graduate Diploma dissertation and is potentially very important because due to time and financial constraints, most clinicians might see a patient only once rather than being able to reevaluate them a few days or weeks later. If our patient is representative of other ALF patients, then with this new test, a clinician can therefore test for forgetting within one clinical testing session. This may have significant implications for the patient’s diagnosis and subsequent treatment.

Ashok Jansari

Does drinking water help you Wii ?

Previous research has shown that cognitive performance declines in adults that are dehydrated. More recently, studies into the effects of water consumption have shown that cognitive performance improves in schoolchildren after having a drink. However, as this research area is still in its infancy, it is not yet possible to determine which cognitive skills are consistently sensitive to water consumption. Therefore, we did a small pilot study looking at the effect of water consumption in schoolchildren on a range of cognitive and motor skills. 

A group of 15 children between the ages of 8 and 9 years old were given tasks to complete on two occasions. On one occasion they were not given a drink and on the other occasion they were given a 250ml bottle of water to drink, twenty minutes before the testing began. In the ‘no water’ condition none of the children had a drink and in the ‘water’ condition 7 of the 15 children drank the entire 250ml of water whilst the rest drank varying amounts. The mean amount that they drank was 168ml. The children were tested in small groups of 3 or 4 and the conditions were counterbalanced. The children all completed a letter cancellation task, a ball catching task, step-ups and a Wii game. The Wii game called ‘Ravin Rabbids’ was a whack-a-mole style game in which the children had to whack a rabbit every time it stood up using a downward motion with the Wii control. The game required hand eye coordination skills.

The results showed that in the ‘water condition’ the children were less thirsty but no happier. In the letter cancellation task the children performed significantly better in the ‘water’ condition than the ‘no water’ condition; they correctly identified more targets. The children also got a significantly higher score in the ‘ Ravin Rabbids’ Wii game in the ‘water’ condition. There was no immediately apparent benefit of drinking water in the ball throwing and step-up tasks although exploratory analysis showed that children drinking more than 200ml of water did significantly better in the ball throwing and ‘Ravin Rabbid’ Wii game than those who drank less than 100ml. None of the children drank between 100 and 200ml of water.

The results show that children’s performance improves in tasks requiring motor skills and visual attention and these results are consistent with previous studies of school children. What is still to be determined is whether it is purely the motor skills, purely the visual attention, a combination of both or indeed some underlying skill such as speed of processing that is sensitive to water consumption.

This study was published in Education and Health and presented at the Natural Hydration Council annual meeting. There has also been some media interest and Caroline Edmonds has recently completed a round of radio interviews about the effects of water consumption in children.

Full article reference Booth, P., Taylor, B. and Edmonds, C. J. (2012) 'Water supplementation improves visual attention and fine motor skills in schoolchildren'. Education and Health, 30(3), pp. 75-79.

Paula Booth