The study aimed to examine the relative contribution to borderline personality disorder (BPD) symptom change of two potential effective therapeutic components in a manualized group psychotherapy (Systems Training for Emotional Predictability and Problem Solving; STEPPS): development of emotional/behavior regulation skills and group alliance. A repeated measures design assessed BPD symptom change over time, use of behavior and emotion regulation skills taught in STEPPS, and perceptions of global alliance within the group. Data were analyzed using hierarchical multiple regression. Additional qualitative feedback was analyzed using quantitative content analysis. Data were collected from 14 STEPPS groups across three NHS Trusts. Forty participants completed the study and were included in the final analysis. Self-reported skill acquisition throughout STEPPS treatment and satisfaction with intragroup relationships at the group midpoint were associated with improvement in BPD symptoms at the end of treatment, once symptoms at the start and mid-point of treatment had been controlled for. These two factors also emerged as the top two factors cited in qualitative feedback to explain subjective improvements observed as a result of STEPPS treatment. This is the first study to investigate and find support for acquisition of emotion and behavior regulation skills in STEPPS and satisfaction with intragroup relationships as potential effective therapeutic components in the treatment. Causal relationships cannot be concluded from this study. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Aim To explore the associations between mentalizing, positive and negative symptoms of psychosis, and traits of borderline personality disorder, in a sample of patients with first-episode psychosis, and in a non-clinical sample. Methods A quantitative cross-sectional design was employed. Thirty-two adults with first-episode psychosis and 148 non-clinical participants were assessed using the reflective functioning questionnaire. The questionnaire measures two dimensions of mentalizing, certainty and uncertainty about mental states. Traits of borderline personality disorder and symptoms of psychosis were measured using the self-report version of the Zanarini rating scale, the Community Assessment of Psychotic Experiences, and the Green et al., paranoid thought scale. Results Patients with first-episode psychosis reported increased mentalizing impairments, characterized as hypomentalizing tendencies, compared to the non-clinical group. Regression analysis showed significant associations between higher scores on the uncertainty about mental states scale and negative symptoms of psychosis in both groups. No associations were found between mentalizing impairments and traits of borderline personality disorder in the clinical sample, although associations were found in the non-clinical sample. Conclusions The present findings suggests that impairments in mentalizing may be associated with negative symptoms of psychosis across both clinical and non-clinical samples. Mentalizing impairments was found to be associated with traits of borderline personality disorder, but this finding was only confirmed in the non-clinical sample. Mentalizing should therefore be considered in the early assessment and treatment of patients experiencing difficulties with negative symptoms of psychosis.

Purpose People with a borderline personality disorder (BPD) diagnosis can require support from mental health services for managing risk behaviour. Current routine inpatient and community treatment can be unhelpful for this group. Positive risk taking has been developed to help community teams manage risk with people with a BPD. This study aims to explore experiences of risk management in an NHS Trust where positive risk taking is being implemented with people with a BPD. Design/methodology/approach Interpretative phenomenological analysis is the methodology of transcripts from semi-structured interviews. Nine adults with a diagnosis of BPD and current or previous experiences of risk management approaches were sampled from one NHS Trust. Findings Limited resources and interpersonal barriers had a negative impact on experiences of Positive risk taking. Participants experienced one-off risk assessments and short-term interventions such as medication which they described as “meaningless”. Traumatic experiences could make it difficult to establish therapeutic relationships and elicit unhelpful responses from professionals. Participants could only feel “taken seriously” when in crisis which contributed towards an increase in risky behaviour. Positive risk taking was contingent upon collaborative and consistent professional relationships which created a “safety net”, enabling open communication and responsibility taking which challenged recovery-relapse patterns of service use. Research limitations/implications Positive risk taking approaches to risk management may benefit people with a BPD. Findings complement those from other studies emphasising the importance of compassion and empathy when working with personality disorder. Training and increased resources are required to implement effective risk management with this group. Originality/value Findings expand upon the sparse existing research in the area of risk management using the Positive risk taking approach with people with a BPD diagnosis, and provide idiographic understanding which is clinically meaningful. Participants’ experiences suggest Positive risk taking may provide a framework for improving quality of life and decreasing service use for people diagnosed with BPD engaging in risk management with Community Mental Health Teams, which facilitates recovery and other benefits.

Purpose Coercive practices – which are used as means to manage violent/aggressive behaviour in secure forensic settings – have come under scrutiny in recent years due to their paradoxical effects on provoking further service user aggression and violence. Previous research has found relationships between increased service user aggression with both service users’ interpersonal styles and perceptions of staff coercion (i.e. staff limit setting). This paper aims to investigate whether forensic service users’ levels of interpersonal sensitivity to dominance increase levels of self-reported anger and rates of aggression towards staff through perceptions of staff coercion. Design/methodology/approach In a cross-sectional quantitative study design, 70 service users were recruited from one high and two medium secure forensic hospitals. Standardised measures were completed by service users and recorded incident data was collected within the past year. Correlation and mediation analyses were run to investigate the relationship between study variables. Findings A significant relationship was found between service users’ interpersonal sensitivity to dominance and self-reported rates of anger, where forensic service users’ who had higher levels of interpersonal sensitivity to others’ dominance were likely to report higher rates of anger. No significant relationships were found between all other study variables. Practical implications The findings from this study contradict previous research where coercive practices may not necessarily increase rates of aggression towards staff but, in the context of service users’ interpersonal sensitivities to dominance, it may be more useful to consider the way in which coercive practices are implemented. Originality/value There is a gap in the literature, which looks at the way in which forensic service users perceive coercive practices in relation to their interpersonal sensitivities and whether this too has an impact upon service user aggression.

Background Motivation and readiness to change are important drives for forensic patients accessing interventions. It is thought that guilt and shame influence these drives, but to date, their relationship has not been empirically tested. Aims and Hypotheses The aim of this study is to investigate associations between guilt, shame, and treatment motivation and readiness in a sample of men in a secure hospital. It was hypothesised that guilt would be positively correlated, and shame negatively correlated, with treatment motivation and readiness. Methods Sixty-six adult male patients detained in a secure hospital completed the assessments of experiences of guilt, shame, motivation, and readiness for treatment. Clinician-rated readiness ratings were also collected. Results Shame proneness showed no significant association with motivation for change or treatment readiness. Guilt proneness and offence-related shame were positively correlated with treatment readiness. Offence-related guilt was positively correlated with both motivation and readiness. Regression modelling indicated offence-related guilt had a significant level of explanatory power. Conclusions and Implications for Practice This first study of the impact of guilt and shame on motivation and readiness for change among offender hospital inpatients found that offence-related guilt may be helpful but did not replicate the potential disadvantage of shame. Further research would be warranted into whether the "newness" or the extent of shame may be more important than shame more generally. Given the probable importance of offence-related guilt, we recommend that guilt attribution is assessed in offender patients to optimise nature and timing of treatment.

This project evaluated the predictive validity of the Dynamic Appraisal of Situational Aggression - Inpatient Version (DASA-IV) in a high-secure psychiatric hospital in the UK over 24 hours and over a single nursing shift. DASA-IV scores from three sequential nursing shifts over a 24-hour period were compared with the mean (average of three scores across the 24-hour period) and peak (highest of the three scores across the 24-hour period) scores across these shifts. In addition, scores from a single nursing shift were used to predict aggressive incidents over each of the following three shifts. The DASA-IV was completed by nursing staff during handover meetings, rating 43 male psychiatric inpatients over a period of 6 months. Data were compared to incident reports recorded over the same period. Receiver operating characteristic (ROC) curves and generalized estimating equations assessed the predictive ability of various DASA-IV scores over 24-hour and single-shift timescales. Scores from the DASA-IV based on a single shift had moderate predictive ability for aggressive incidents occurring the next calendar day, whereas scores based on all three shifts had excellent predictive ability. DASA-IV scores from a single shift showed moderate predictive ability for each of the following three shifts. The DASA-IV has excellent predictive ability for aggressive incidents within a secure setting when data are summarized over a 24-hour period, as opposed to when a single rating is taken. In addition, it has moderate value for predicting incidents over even shorter timescales.

Purpose Previous research has indicated that helping professionals working with traumatised individuals are susceptible to adverse effects which can be recognised as secondary traumatic stress (STS). The purpose of this paper is to explore STS in police officer's investigating childhood sexual abuse (CSA) in the UK. Design/methodology/approach This study employed a cross-sectional, quantitative design. An online questionnaire was completed by 101 Child Abuse Investigation Unit (CAIU) police officers in England and Wales. STS, coping strategies, anxiety, depression and demographic information was collected for all participants. Findings It was indicated that increased exposure to CSA, measured by number of interviews in the past six months, was associated with higher levels of STS. Positive coping strategies, negative coping strategies, anxiety and depression all had a strong, positive relationship with STS. Research limitations/implications This paper is a first step to understanding STS in CAIU police officers in the England and Wales. This area of research remains under-developed and would benefit from further attention in the future. Originality/value This is the first known study of its kind in the UK.

Psychopathy is a disorder that is partly defined by with maladaptive interpersonal behaviour and has significant effects on treatment outcomes. A previous study (Draycott et al., ) found that higher levels of psychopathy led to a specific interpersonal 'trajectory' amongst patients in a secure psychiatric treatment programme during the first 9 months of their admission. In that programme, more psychopathic patients became increasingly dominant over time, and less psychopathic patients became increasingly hostile. This study is a longer-term follow-up and extension of that study, extending the window of observation to 33 months of treatment. It was found that the more psychopathic patients' increased dominance returned to baseline levels by 33 months, as did the less psychopathic patients' increased hostility. This suggests that treatment for this group is not idiopathic but leaves unanswered the question as to what these divergent trajectories represent.

Objective: Sensitive biomarkers are needed to understand synovial response to therapy in osteoarthritis (OA). Dynamic, contrast-enhanced magnetic resonance imaging (DCE MRI) provides quantitative, novel measures of synovial inflammation. This exploratory study examined DCE-assessed synovial response to intra-articular corticosteroid (IACS).Methods: People with ACR clinical criteria OA knee underwent 3 T MRI pre- and 2 weeks post-IACS. Five MRI variables were assessed blindly: total synovial volume (semi-automated computer program), early enhancement rate (EER) and late enhancement ratio of the entire knee, synovial volume x late enhancement and a semi-quantitative (SQ) score (six sites scored 0-3). Clinical symptoms were assessed using pain visual analogue score (VAS) and WOMAC.Results: 13 participants (5 male, mean age 63, mean pain VAS 66 mm mean body mass index (BMI) 31.3 kg/m(2)) were included. The majority of MRIs demonstrated no change in SQ score although the DCE variables changed to some extent in all. There was generally a reduction in synovial volume ((Wilcoxon test) median (interquartile range (IQR)) reduction 14 cm(3) (-1, 29)), EER (0.2% (-0.3, 0.6)) and late enhancement ratio (8% (-0.5, 41)). Synovial volume x late enhancement ratio demonstrated a substantive reduction (2250 (-930, 5630)) as well as the largest effect size, r = 0.45. There was a median 26% reduction in EER in participants with good symptomatic response to IACS, contrasting with a 23% increase in those who responded poorly.Conclusions: DCE MRI may be more sensitive than a SQ score at detecting post-therapy synovial changes. The association between EER and symptomatic response to IACS may reflect a closer relation of this biomarker to synovial inflammation than with volumetric assessment. (C) 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

BACKGROUND:Encouraging engagement is a challenge in forensic services. A model of behaviour change suggests that dissatisfaction with the self may express itself either as resistance to or commitment to engagement in treatment, and that this expression may be moderated by the individual's attributional style.AIMS/HYPOTHESES:It was hypothesised that there would be relationships between measures of dissonance, resistance to treatment and commitment to treatment, and that these relationships would be moderated by locus of control.METHOD:Thirty-two patients from within a high secure dangerous and severe personality disorder service completed assessments measuring dissonance, locus of control, resistance and commitment. These measures were analysed for a moderated mediation using techniques outlined by Preacher et al. (2007).RESULTS:There were significant indirect relationships between dissonance and both resistance and commitment. These relationships were moderated by locus of control. However, the specifics of the relationships were not as expected - both internal and external locus of control interfered with therapy, but in different ways.CONCLUSIONS/IMPLICATIONS FOR PRACTICE:A patient who experiences dissonance may translate this into either commitment to or resistance to treatment, depending on features of the patient such as attributional style.

A key aim of the dangerous and severe personality disorder (DSPD) project is the assessment of the effectiveness of different treatment approaches with patients usually considered ‘untreatable’, i.e. dangerous offenders with personality disorders. We present outcome analyses for a small pilot sample of patients in the Broadmoor DSPD unit over their first two years of treatment. To assess the effectiveness of the treatment provided within the Broadmoor DSPD pilot unit in terms of risk reduction and clinical indicators of improvement, routine assessment data were collected for each patient on a six-monthly basis. Patient changes were assessed to determine if they were statistically reliable at the individual level using reliable change index analyses. This provides an idiographic assessment of changes for each patient.

ABSTRACTPsychopathy is a vital construct in the treatment of mentally disordered offenders, and it is arguable that at the heart of psychopathy is a deviant interpersonal style. The present study analysed the changes in perceived dominance and warmth (as rated by staff using the Chart of Interpersonal Reactions in Closed Living Environments) of 34 male psychopathic patients admitted to the Dangerous and Severe Personality Disorder Service of a high‐security hospital in the UK. Results showed that the level and direction of change in dominance and warmth were dependent on the level of psychopathy; patients with a higher level of psychopathy increased significantly in dominance but did not decrease in warmth, whereas patients with a lower level of psychopathy decreased significantly in warmth but did not increase in dominance. These results are discussed in terms of possible implications for the treatment and management of patients with varying levels of psychopathy. Copyright © 2011 John Wiley & Sons, Ltd.

The Dangerous and Severe Personality Disorder (DSPD) programme was introduced to assess, manage and treat severely personality disordered individuals who present a high risk of serious offending. We describe the clinical and risk characteristics of the first 241 patients admitted to the high-security DSPD service for assessment. Eighty-four percent of patients were regarded as meeting the DSPD criteria. Clinically, the DSPD patients demonstrated high levels of psychopathy, with 78% scoring 25 or more on the Psychopathy Checklist. The most commonly diagnosed personality disorders were antisocial, borderline and paranoid. The risk assessments indicated the DSPD patients exhibited a broad range of risk factors for future offending, suggesting that these patients had extensive treatment needs. The DSPD service had been relatively successful in retaining patients, with 82% of those admitted to treatment remaining within the high-security DSPD service. The clinical mix of the patients may have implications for treatment outcome, and future challenges for the service are highlighted.

Purpose. The aim of this article is to demonstrate the utility of the concept of cognitive dissonance in clinical psychology by showing how it may underlie an existing intervention. The technique of motivational interviewing (MI) is taken as an example of an area where the literature on cognitive dissonance can find such an application. The further aim of this exercise is to utilize insights from cognitive dissonance to suggest possible modifications to the intervention as it currently stands.Method. A mapping is undertaken of principles of cognitive dissonance as found in Draycott & Dabbs (1998) onto the description of nature, principles and techniques of MI as set out by Miller & Rollnick (1991). Following this, areas where insights from cognitive dissonance are ignored or underutilized are drawn out and used to suggest modifications to MI.Results. The nature, principles and techniques of MI are, without exception, found to relate to one or more of the principles of cognitive dissonance. Criticisms and amendments to the technique of MI can be offered with the aim of making this mapping of cognitive dissonance more exact. Several practical suggestions can be made and a more structured approach offered.Conclusions. The concept of cognitive dissonance can clearly be seen to be of use in understanding the mechanism of action of MI. It can further be of use in guiding modifications to this existing intervention. This concept, and others available through the experimental psychological literature, can be of use in all branches of clinical psychology.

Purpose. Clinical psychology may not be making full use of the experimental psychological research available to it. The purpose of this article is to review the literature on cognitive dissonance in order to assess its usefulness in developing and deconstructing clinical psychological therapies and practice.Methods. Experimental, theoretical and review articles were examined in relation to their possible clinical implications, and included in this review if they related to the arousal, maintenance and reduction of the state termed cognitive dissonance. Well replicated findings based on experimentally sound paradigms were integrated to produce an overall view of the evidence in favour of the existence of these processes, and of the principles behind them.Results. It is concluded that there is an effect on attitudes and behaviour of creating inconsistency in individuals, and that this is not explained away by alternative theories, which in many cases refer to special conditions which maximally arouse dissonance. The dissonant state lasts for a few minutes, but its effects can last for up to two weeks, and might be reinstated by reintroducing the original. inconsistency. Individuals can react to dissonance through a variety of cognitive alterations which reinstate consistency. The choice of response is a function of its salience and the difficulty in its execution.Conclusions. The literature supports the existence of the phenomenon termed cognitive dissonance, and one can distil the principles underlying its production, maintenance and reduction. This body of literature may provide insights into the conduct of therapy generally, as well as into the mechanisms of specific therapies which may guide modifications or development of alternative interventions.