A systematic review exploring adolescents’ experiences of Dialectical Behaviour Therapy, and, an empirical study on the relationship between psychological flexibility, self-compassion, trauma history, and voice hearing distress, in clinical and non-clinical voice hearers

Pyne, Aaron 2024. A systematic review exploring adolescents’ experiences of Dialectical Behaviour Therapy, and, an empirical study on the relationship between psychological flexibility, self-compassion, trauma history, and voice hearing distress, in clinical and non-clinical voice hearers. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

The thesis comprises two papers; a systematic review and an empirical study. The systematic review explores the experiences of adolescents who have undertaken Dialectical Behaviour Therapy for adolescents (DBT-A). The empirical study explores the relationship between ‘psychological flexibility’, ‘self-compassion’, trauma history, and voice hearing distress in ‘clinical’ and ‘non-clinical’ voice hearers. The studies are described in further detail below. Systematic Review: Self-injury and suicidal behaviour are significant health concerns, and research over the last two decades has found these risks have been increasing in adolescents. This is particularly true for adolescents who have faced adverse early life experiences, including: maltreatment, physical abuse, emotional abuse, and neglect. From the research, we have learned that these adverse life experiences make adolescents particularly vulnerable to having difficulties with managing their emotions and experiencing a lack of safety and security within their interpersonal relationships and interactions. Understandably, these vulnerabilities make it much more challenging to effectively manage difficult feelings and navigate interpersonal situations, and consequences can include self-injury and suicidal behaviour. These difficulties often present earlier in adolescence and, without early intervention, have long-term developmental consequences and impacts on a persons’ life trajectory. DBT-A has been found to be a helpful psychological therapy to support adolescents with regulating their emotions, managing interpersonal relationships, and with self-harm and suicidal behaviour. A core aim of the systematic review was to bring together the direct experiences of adolescents who have undertaken DBT-A in community mental health settings; to consider the impact of the therapy for them, and what aspects they found helpful or hindering. This process helped raise some interesting clinical implications for therapy teams offering DBT-A. The literature is growing, and ten relevant studies were identified for the current review. A thematic synthesis, integrating the findings from these studies, helped identify three major themes; ‘perceived impact of DBT-A’, ‘facilitators of change’, and ‘barriers to change’. Perceived impacts for adolescents related to: improvements in self-esteem, resilience, and self-efficacy in managing their mental health; improvements in friend and family relationships; and improvements in emotional, social and occupational functioning. These benefits were gained through the support of relationships in DBT-A (family, individual therapist, peers), skills development, and through individual motivation for change. Some barriers to change however were process challenges, and difficulties seen in the relationships with family members and with the individual therapist. The paper provides recommendations for DBT-A teams to ensure that adolescents and families can get the most out of the therapy. Future research directions were also shared, noting the need for further research in more culturally diverse samples, and on the role of family involvement in DBT-A. Empirical Paper: Hearing voices is a relatively common experience; seen not just in people experiencing mental health conditions, but also in approximately 5-15% of people in the general population who do not meet criteria for psychiatric conditions. Research supports the idea of there being a ‘continuum’; increasing in severity of voice hearing experiences and need for mental health care. Within this continuum, people who hear voices without need for clinical care are defined as ‘non-clinical’ voice hearers, and voice hearers with a need for clinical care are defined as ‘clinical’ voice hearers. Clinical voice hearers often feel more distressed by their voice hearing experiences compared to non-clinical voice hearers. This is understandable when learning that clinical voice hearers describe their voices are more negative in content, feel less controllable, and feel more threatening and powerful. While trauma has also been found to be linked with both clinical and non-clinical voice hearing, clinical voice hearers often report greater trauma exposure, and trauma seems to be linked with negative voice content, likely resulting in more distressing voice hearing. Cognitive behaviour therapy for psychosis (CBTp) is considered the first line psychological therapy for supporting people who hear voices. However, growing attention has been directed to “third wave” CBT approaches, such as Acceptance and Commitment Therapy (ACT) and Compassion-Focussed Therapy (CFT), which show promising results. Their respective treatment mechanisms focus on building ‘psychological flexibility’ (PF) and ‘self-compassion’ (SC); involving developing an accepting attitude towards voice hearing, rather than overidentification, as well as cultivating self-kindness and wisdom about the human experience. The empirical study aimed to enhance our understanding of PF, SC, trauma history, and voice hearing distress may be differentiated in clinical and non-clinical voice hearers. The study identified that non-clinical voice hearers experienced significantly lower voice hearing distress, and higher PF and SC than clinical voice hearers. Acceptance and self-judgment were significant predictors of voice hearing distress in both the clinical and non-clinical groups individually, whereby greater acceptance and lower self-judgment was related to lower voice hearing distress. The groups did not seem to differ in terms of their experiences of trauma history; nor was trauma history associated with voice hearing distress, PF or SC. The current study suggests there may be a role for an integrative approach of ACT and CFT skills in supporting voice hearing populations in clinical practice. Some limitations and future research considerations are noted around methodological challenges in capturing trauma history and the need for clearer definitions of clinical and non-clinical voice hearing to capture the diversity of experiences within these groups.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	3 September 2024
Last Modified:	04 Sep 2024 09:32
URI:	https://orca.cardiff.ac.uk/id/eprint/171768

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