Turner, Michelle Hayley (2010)
Clin.Psy.D. thesis, University of Birmingham.
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Volume I: Research Component
The literature review examines the high prevalence rate of posttraumatic stress disorder (PTSD) in people with a severe mental illness such as psychosis and discusses why such high rates may be found. There is anecdotal and empirical evidence that attests to the distressing nature of psychotic symptoms and treatment related experiences, including hospitalisation. The review looked at the contribution of such experiences in causing symptoms of PTSD. Interventions aimed at reducing symptoms of PTSD in people with a severe mental illness were then evaluated. It was concluded that the studies showed promising results in reducing PTSD symptoms, but the evidence base was still relatively small. Future research is needed to establish what interventions are effective and how established treatments for PTSD in other non-psychotic populations can be adapted to meet the needs of this vulnerable group.
The empirical paper presents a quantitative study that aimed to look at the relationship between post-psychotic trauma, shame and depression in a clinical sample of people with first episode psychosis. Symptoms of PTSD were assessed in relation to a traumatic event that had occurred during a previous psychotic episode. The study distinguished between different types of shame to look at their relationship with PTSD symptoms and depression, an area that had not been investigated before in this clinical sample. Participants were asked about their experiences of internal and external shame in relation to having a mental illness and general shame. Consistent with previous research a significant proportion of people had clinically significant levels of psychosis related PTSD symptoms and depression; with shame found to correlate with both. However internal shame was found to make a unique contribution to depression, whilst external and general shame made a unique contribution to PTSD symptoms. This has implications for future research by showing it is not enough to simply measure overall or global shame. It also highlights the need to develop interventions that address shame, depression and symptoms of trauma in people with first episode psychosis. The paper is prepared for the submission to the journal Clinical Psychology and Psychotherapy.
Volume II: Clinical Component
The second volume of the thesis presents five clinical practice reports. Firstly, a case formulation from a cognitive behavioural and a systemic perspective are presented for an eleven year-old boy with anxiety related difficulties referred to a child and adolescent mental health service (CAMHS). Secondly, an audit was carried out to assess how well a CAMHS service met the guidelines set out by the National Institute for Clinical Excellence (NICE) when intervening with young people and adolescents diagnosed with an eating disorder. Thirdly, a case study is presented from predominantly a narrative perspective for a young woman with a learning disability who had relationship and anxiety related difficulties. In the forth report a single case experimental design was used to evaluate the effectiveness of a cognitive behavioural intervention for paranoid delusions with a man diagnosed with a psychotic disorder, who was under the care of an Early Intervention Service. Lastly an abstract is presented for a case study where cognitive analytic therapy (CAT) was used with a woman who presented with depression within a primary care setting.
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