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"Kennerley, Helen"
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Cognitive behavioural approaches to the understanding and treatment of dissociation
\"The study of dissociation is relevant to anyone undertaking research or treatment of mental health problems. Cognitive Behavioural Approaches to the Understanding and Treatment of Dissociation uses a cognitive approach to de-mystify the processes involved in linking traumatic incidents to their effects. Kennedy, Kennerley and Pearson present a full and comprehensive understanding of mental health problems involving dissociative disorders and their treatment, bringing together an international range of experts. Each chapter addresses a single topic in full, including assessment of previous research from a cognitive perspective, recommendations for treatment and case studies to illustrate clinical approaches. Using an evidence-based scientific approach combined with the wisdom of clinical experience, the authors make the relevance of dissociation immediately recognisable to those familiar with PTSD, dissociative identity disorder, eating disorders, hallucinations and a wide range of psychological and non-organic physical health disorders. Designed to provide new perspectives on both research and treatment, Cognitive Behavioural Approaches to the Understanding and Treatment of Dissociation includes a wide range of material that will appeal to clinicians, academics and students\"-- Provided by publisher.
Book
‘Sometimes I cry with that child’: experiences and views of adult survivors of childhood sexual abuse on psychosocial treatment and support in India
The high prevalence of childhood sexual abuse (CSA) in India is a cause for concern. Survivors of CSA often experience psychosocial difficulties in their adult lives. Whilst their difficulties are partly recognised in India, there is a need for further exploration on the availability and access to support.
We explored the views and experiences of adult survivors of CSA in India on different types of treatment and support.
We conducted semi-structured interviews with adults who were sexually abused before the age of 18. The data were analysed using reflexive thematic analysis, followed by narrative analysis of two transcripts.
We interviewed 10 adult survivors of CSA in India. All participants were female with formal education. We conceptualised their recovery beginning with initial introspection and reliance, for example, on artistic and animal-assisted avenues. This is followed by seeking informal support, and, for some, seeking more formal support. Some also sought help through public figures, social media and Government initiatives and/or from their faith communities. We have further presented two narrative summaries explaining the genre, tone and core narrative of participants' experiences.
Our findings suggest that these adult female survivors of CSA in India predominantly relied on their own coping strategies in the absence of holistic support. This was pronounced due to the dearth of mental health and social care for those who have experienced CSA in India. Future research needs to focus on understanding the meaning and language of CSA to enable the development of culturally tailored interventions.
Journal Article
مقدمة في العلاج المعرفي السلوكي : المهارات والتطبيقات
إن الحديث عن العلاج السلوكي المعرفي كما لو كان علاجا نفسيا وحيدا يعتبر شيء مضلل، فالعلاج السلوكي المعرفي المعاصر ليس بناء واحدا، ولكن حركة واسعة ما زالت ف طور النمو والتطور ومليئة بالتناقضات، يقوم المدخل الذي تتبناه في هذا الكتاب على نموذج بيك Beck من الستينات والسبعينات ولقد ساد هذا المدخل في المملكة المتحدة خلال الثلاثين عاما الماضية ومن ثم نحن نرى أنفسنا في المجال الرئيس في العلاج السلوكي المعرفي في هذا البلد ومع ذلك قد يختلف المنظرون والإكلينيكيون الآخرون بطرق رئيسية وفرعية، كبيرة وصغيرة مع بعض المداخل التي نقدمها هنا.
BOOK
A Cognitive‐Behavioral Model of Apathy in Parkinson’s Disease
Apathy is recognized to be a common, disabling syndrome that occurs across a range of psychiatric and neurological conditions, including Parkinson’s disease. It can have a significant impact on quality of life, both for people affected and those around them. Currently, there are no established, evidence‐based treatments for this debilitating syndrome. Assessment and treatment have been complicated by overlaps with depression and anhedonia, as well as a lack of understanding of the underlying mechanisms. Emerging lines of evidence conceptualize apathy as a reduction of motivation associated with disordered effort‐based decision‐making and dysfunction of distinct neural circuitry between the basal ganglia and medial prefrontal cortex. Here, we introduce a novel cognitive‐behavioral framework that can inform a clinician’s conceptualization and treatment of apathy, using cognitive‐behavioral therapy (CBT) techniques. We focus on people with Parkinson’s disease in our model, but our approach is transdiagnostic and can be applied to other conditions. It considers both individual targets for therapy as well as maintenance and intervention at a systemic level. The generalizability and parsimony of the framework provides a structured assessment and formulation of apathy, while also allowing clinicians to remain sensitive to other neuropsychiatric symptoms that can occur alongside apathy, such as depression and anxiety.
Journal Article
Anticipating PTSD in severe COVID survivors: the case for screen-and-treat
Based on research from previous pandemics, studies of critical care survivors, and emerging COVID-19 data, we estimate that up to 30% of survivors of severe COVID will develop PTSD. PTSD is frequently undetected across primary and secondary care settings and the psychological needs of survivors may be overshadowed by a focus on physical recovery. Delayed PTSD diagnosis is associated with poor outcomes. There is a clear case for survivors of severe COVID to be systematically screened for PTSD, and those that develop PTSD should receive timely access to evidence-based treatment for PTSD and other mental health problems by multidisciplinary teams.
We anticipate that up to 30% of survivors of severe COVID will develop PTSD, yet PTSD is frequently undetected in primary and secondary care settings.
There is, therefore, a clear case for establishing systematic screening and ensuring timely access to treatment.
Journal Article
Cognitive Behavioural Approaches to the Understanding and Treatment of Dissociation
The study of dissociation is relevant to anyone undertaking research or treatment of mental health problems. Cognitive Behavioural Approaches to the Understanding and Treatment of Dissociation uses a cognitive approach to de-mystify the processes involved in linking traumatic incidents to their effects.
Kennedy, Kennerley and Pearson present a full and comprehensive understanding of mental health problems involving dissociative disorders and their treatment, bringing together an international range of experts. Each chapter addresses a single topic in full, including assessment of previous research from a cognitive perspective, recommendations for treatment and case studies to illustrate clinical approaches. Using an evidence-based scientific approach combined with the wisdom of clinical experience, the authors make the relevance of dissociation immediately recognisable to those familiar with PTSD, dissociative identity disorder, eating disorders, hallucinations and a wide range of psychological and non-organic physical health disorders.
Designed to provide new perspectives on both research and treatment, Cognitive Behavioural Approaches to the Understanding and Treatment of Dissociation includes a wide range of material that will appeal to clinicians, academics and students.
eBook
The why, what, when, who and how of assessing CBT competence to support lifelong learning
Assessment of cognitive behaviour therapy (CBT) competence is a critical component in ensuring optimal clinical care, supporting therapists’ skill acquisition, and facilitating continuing professional development. This article provides a framework to support trainers, assessors, supervisors and therapists when making decisions about selecting and implementing effective strategies for assessing CBT competence. The framework draws on the existing evidence base to address five central questions: Why assess CBT competence?; What is CBT competence?; When should CBT competence be assessed?; Who is best placed to assess CBT competence?; and How should CBT competence be assessed? Various methods of assessing CBT competence are explored and the potential benefits and challenges are outlined. Recommendations are made about which approach to use across different contexts and how to use these effectively to facilitate the acquisition, enhancement and evaluation of CBT knowledge and skills.
Journal Article
Mapping evidence-based interventions to the care of unaccompanied minor refugees using a group formulation approach
How we adapt treatment algorithms to complex, clinically untested, difficult-to-engage patient groups without losing evidence base in everyday practice is a clinical challenge. Here we describe process and reasoning for fast, pragmatic, context-relevant and service-based adaptations of a group intervention for unaccompanied minor asylum seekers (UASC) arriving in Europe. We employed a distillation-matching model and deployment-focused process in a mixed-method, top-down (theory-driven) and bottom-up (participant-informed) approach. Prevalence of mental disorders amongst UASC is extremely high. They also represent a marginalised and hard-to-engage group with limited evidence for effective treatments.
Content and process adaptations followed four steps: (1) descriptive local group characterisation and theoretical formulation of problems; (2) initial adaptation of evidenced treatment, based on problem-to-component grid; (3) iterative adaptation using triangulated feedback; and (4) small-scale pilot evaluation.
Based on evidence and participant feedback, adaptations included minimising verbal demands, facilitating in-session inductive learning, fostering social connectedness via games, enhancing problem-solving skills, accounting for multi-traumatisation, uncertainty and deportation. Quantitative evaluation suggested improved feasibility, with increased attendance, low drop-out and symptom improvement on depression and trauma scores.
By describing the principles under-pinning development of a group intervention for severely traumatised UASC, we contribute to the literature supporting dynamic adaptations of psychological interventions, without losing reference to evidence base. Complex and difficult-to-reach clinical groups are often those in most need of care, yet least researched and most affected by inequality of care. Pragmatic adaptations of proven programs are often necessary to increase feasibility.
Journal Article
Acceptability and mechanisms of change associated with group cognitive behavioural therapy using the Recovering from Childhood Abuse Programme among women with CPTSD: a qualitative analysis
Survivors of childhood trauma are at increased risk of complex post-traumatic stress disorder (CPTSD). The Recovering from Child Abuse Programme (RCAP) is a cognitive behavioural therapy (CBT) group promoting adaptive coping strategies which may help overcome CPTSD symptoms in adult survivors of childhood trauma. We sought to explore patient experiences of factors influencing treatment acceptability and potential mechanisms of therapeutic change in a sample of participants in the RCAP programme. As the group was delivered during the COVID-19 pandemic, necessitating a transition to remote therapy, we further aimed to capture experiences of the transition to telehealth delivery of the programme. A naturalistic sample of 10 women with CPTSD attending a specialist out-patient psychological trauma service participated in the study. Therapy sessions were recorded, transcribed verbatim and group members completed written feedback forms following each session. Reflexive thematic analysis was used to analyse the written feedback and transcripts. The RCAP was acceptable to group members and several themes were identified related to the experience of change in the group. Key themes centred on group solidarity; safety in the psychotherapeutic process; schema changes related to the self, others and future catalysed by the shifting of self-blame; increased emotional regulation to feel safer in the present; and increased future optimism. Therapeutic progress continued following the transition to telehealth, although face-to-face delivery was generally preferred. The programme was acceptable and led to cognitive change, enabling increased emotional regulation in the present and improved self-concept, thereby addressing key symptoms of CPTSD.
Journal Article
Developing and Maintaining a Working Alliance in CBT
The quality of the therapeutic relationship is an important aspect of successful treatment: it predicts compliance, satisfaction and outcome. The concept of the working alliance has been relevant to CBT since its inception, with Beck, Rush, Shaw, and Emery (1979) viewing the therapeutic relationship as more than just an instrument to alleviate suffering. They saw it as a vehicle to facilitate collaboration in carrying out tasks and achieving goals – hence the term “working alliance”. Both opportunities and ruptures can arise within this relationship and there is an onus on the therapist to strive to develop and maintain the working alliance and to address ruptures – it isn't a simple matter of going through the motions, it is an active, dynamic process.This chapter addresses the nature of the working alliance, reflects on how you might develop and maintain a good alliance and then considers how you can address therapeutic challenges that arise.
Book Chapter