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ObjectivesThis study aimed to determine the feasibility of recruiting, implementing and delivering an acceptance and commitment therapy (ACT) intervention for mild traumatic brain injury (mTBI) (ACTion-mTBI) within a multidisciplinary outpatient mTBI rehabilitation services. The study also aimed to conduct a preliminary investigation of group differences between ACTion-mTBI and an equivalent cognitive behavioural therapy (CBT) intervention on various outcome measures and psychological treatment targets.DesignA two-arm quasiexperimental feasibility study.SettingFive mTBI rehabilitation clinics throughout New Zealand.InterventionPsychologists working in mTBI rehabilitation clinics throughout New Zealand were trained to deliver ACTion-mTBI or CBT. Eligible participants were assigned to either of these interventions based on the psychologist available at the clinic they were referred to. ACTion-mTBI is a five sessions intervention that incorporates all six components of the ACT model. The CBT intervention is an equivalent intervention and incorporating all four components of the CBT model. Both interventions are adapted for an mTBI context.Primary outcome measuresThe primary outcomes were related to the feasibility of ACTion-mTBI. This included recruitment, retention and treatment adherence of participants, study procedure and fidelity of treatment delivery.Secondary outcome measuresTo explore group differences between ACTion-mTBI and CBT on functional disability, postconcussion symptoms, mental health, valued living and psychological flexibility.ResultsThe intervention proved feasible to implement with community-based mTBI rehabilitation services. Attrition rates were comparable between the two psychological interventions and fidelity to the treatments was high. At post-treatment, when covarying pretreatment scores, ACTion-mTBI had a significantly greater improvement in functional disability than CBT (moderate effect). ACTion-mTBI also had a significantly greater reduction in postconcussion symptoms, anxiety and stress. Promisingly, significant improvements in psychological flexibility was also found post-treatment. There were no group differences on depressive symptoms and valued living.ConclusionWe conclude that a full clinical trial of ACTion-mTBI for individuals with mTBI is feasible and warranted.Trial registration numberACTRN1262100059482.

This article reports the findings of a service-user evaluation project undertaken in response to the local uro-oncology clinical nurse specialist position coming under threat. A focus group and telephone interviews were conducted with service users who had experienced support from the uro-oncology nurse, to highlight the value of the role. Patients were positive about their experiences of the nurse in post, and the function and support the role provided. Ideas around gender and the importance of information giving emerged, providing useful recommendations for services, health professionals, and future research.

Critical Literature Review: A systematic ethnographic meta-synthesis was conducted that aimed to provide an account of the lived experience of a spouse/partner caring for their partner with multiple sclerosis. Twenty studies met the eligibility criteria for inclusion into the synthesis and six themes emerged. A line of argument synthesis is presented as a model and suggestions for further research and clinical implications are discussed. Research Report: Multiple sclerosis commonly presents within middle age and disproportionately effects women, meaning male partners adopt caring roles. Studies indicate men's attitudes towards help-seeking are influenced by their beliefs about idealised gender behaviours, and commonly the need to uphold an ideal of independence and stoicism acts as a barrier to engaging support. It was hypothesised gender constructs could predict attitudes to help-seeking and level of carer burden. Results indicated they explained significant variance in carer burden but not help-seeking. A model of the influence of gender role constructs on aspects of the carer experience is presented. Recommendations are made for engaging male informal carers in aspects of self-care and sourcing support. Reflective Critique: A critique of both the systematic meta-synthesis and the research project are presented. Reflections and learning points are discussed, with particular reference to aspects of recruitment and methodology. Service Evaluation: NICE guidance recommends cancer patients receive assessment of psychological distress and a tiered pathway for psychological care. This service evaluation focused on the implementation of these recommendations. Initially, an audit of the current screening for psychological distress was conducted within an oncology department. A pilot study was then conducted to assess the implementation of using psychological distress screening tools within the breast cancer team. The successful pilot study necessitated developing recommendations for broadening the use of screening tools and developing a pathway for psychological care.

Why you should read this article• To ensure your knowledge of the use of mindfulness in clinical practice is up to date and based on the latest evidence• To enhance your understanding of the components of mindfulness-based therapies• To recognise the potential benefits of a mindfulness-based stress reduction group programme on family carersBackground Mindfulness-based stress reduction (MBSR) is an evidence-based intervention that teaches participants skills in reducing stress and managing challenging emotions in a group setting. Mindfulness-based therapies have demonstrated effectiveness in various populations, and therefore may be beneficial for family carers.Aim To deliver and appraise a pilot MBSR group programme for family carers of adults and children with a mental health condition, physical health condition or learning disability.Method This was a mixed-methods study in which an eight-week MBSR group programme was delivered to 13 family carer participants. Quantitative data were collected using a questionnaire before and after completion of the programme and at two-month follow up. The measures used were carers’ mental well-being, ability to use core mindfulness skills, quality of life and happiness. Quantitative and qualitative data were also collected from six of the participants two years after completion of the group using the questionnaire measures and semi-structured interviews.Findings The MBSR group programme led to a significant improvement in participants’ ability to use mindfulness skills. There was also a positive trend in measures of carers’ mental well-being and quality of life, but this did not reach statistical significance. Some family carers continued to experience beneficial effects of mindfulness in their roles as carers and in other aspects of their lives two years after completing the programme.Conclusion This study focused on family carers, which is a group that has received little research attention. It identified that the MBSR group programme was effective in improving participants’ ability to use mindfulness skills, with some of them also experiencing long-term benefits of mindfulness.