Working with people experiencing psychotic disorders and co-occurring nicotine dependence: Attitudes and reflections from psychologists on the Healthy Lifestyles research trial.

The combination of psychotic and substance use disorders compounds the well-documented challenges of treatment engagement, retention, and outcome for these single conditions. This study focuses on the formation of alliance among this important clinical group. Psychologists working on a research trial participated in qualitative interviews focused on their impression of delivering treatment to people with psychotic disorders and concurrent nicotine dependence. Utilizing Interpretive Phenomenological Analysis, the authors highlighted the complex and unusual experience of working with people with psychotic disorders and concurrent nicotine dependence, the importance of considering each client as an individual, and the many layers of interaction between therapist and client. The authors found that meaningful therapeutic relationships over the longer term are possible, even when active symptoms are present. There is also potential for telephone-based treatments to work well. Clinical supervision and support, tailored to the unique experience of therapists working with psychotic populations, is pivotal.

Therapeutic alliance in psychological treatment for depression and alcohol use comorbidity: The client's perspective.

This qualitative study explored the treatment experience and the therapeutic relationship of participants receiving an integrated psychological treatment for comorbid alcohol use problems and depressive disorders. Semistructured interviews targeting experience of therapy and the relationship with the therapist were carried out with seven participants. Transcripts were analyzed using Interpretive Phenomenological Analysis to reveal major themes. Four major themes were identified. "Nature of the relationship" describes the importance of the client's perception of the therapeutic relationship experienced, "Confidence in therapy" and "Acknowledgment of experience" address components assisting the development of a positive alliance, and "Meeting unmet needs for connection" illustrates the importance of a positive therapeutic relationship for this population. Participants thought that clinicians would benefit from a good understanding of the role the alliance relationship plays within comorbidity treatment, of the need this relationship meets for this population, and the importance of engendering confidence in therapy and recognizing client perspectives.

The psychological implications of a subsequent pregnancy outcome in couples with a history of miscarriage.

OBJECTIVES: The present study expands upon reproductive research by examining perinatal grief in couples following a miscarriage and throughout a subsequent pregnancy. The aim of the study was to address the question of whether the outcome of a successful live birth mitigates the negative impact of a previous miscarriage. METHOD: Participants were recruited through 20 general practice surgeries that provided antenatal care in the United Kingdom. The study comprised 128 couples; 64 couples who experienced two consecutive miscarriages, and 64 couples who experienced a live birth following a miscarriage. Participants completed the Perinatal Grief Scale across four Time points (T1: Six weeks following the first pregnancy outcome; T2: Six weeks following the second pregnancy outcome; T3: Six months following the second pregnancy outcome and T4: Twelve months following the second pregnancy outcome). RESULTS: The primary findings of the study demonstrated a significant mitigation effect with a decrease in perinatal grief over time. As predicted, couples who experienced a second miscarriage reported elevated perinatal grief; compared to couples who went on to have a successful live birth. CONCLUSION: The present study's findings contribute to our knowledge of the long-term implications of miscarriage and its influence on psychological health in terms of perinatal grief.

Perceived risk associated with tobacco, alcohol and cannabis use among people with and without psychotic disorders.

BACKGROUND: Perceived harmfulness of substances is a key concept of behavioural theories that have been used to explain substance use behaviours. However, perceptions of risk associated with substance use have rarely been examined among people with psychotic disorders. This study examined the relationship between perceived harm and patterns of substance use among people with and without psychotic disorders. It also aimed to identify the factors that may be associated with perceived harmfulness of tobacco, alcohol and cannabis use among these populations. METHODS: Participants were recruited via first year psychology courses, research databases and the social networking service 'Facebook'. Participants completed a self-report questionnaire either online or on paper which assessed substance use, perceived harmfulness of substance use, history of mental illness, current psychological distress, and exposure to and acceptance of anti-substance use campaigns. A series of linear regressions were conducted to examine key predictors of the perceived harmfulness of tobacco, alcohol and cannabis use. RESULTS: 1046 participants were recruited. Participants were aged 18 to 86years and 53.2% were female. For tobacco and cannabis, substance use was found to be inversely and significantly related to perceived harm of these substances. In addition, higher risk perceptions for tobacco and cannabis were associated with: being female, perceived effectiveness of anti-substance use campaigns, and less hazardous substance use. Increased age and negative psychosis status were also associated with higher risk perceptions for tobacco, while positive psychosis status was associated with higher risk perceptions for cannabis. Only perceived effectiveness of anti-drinking campaigns was found to be significantly related to perceived harmfulness of alcohol. CONCLUSIONS: These results suggest that demographic, substance use, mental health and public health campaign variables are associated with perceptions of the harmfulness of tobacco, cannabis, and to a lesser extent alcohol, among people with and without mental disorders. While messages regarding the negative consequences associated with cannabis use among people with psychotic disorders may be accepted, there is a continued need to highlight the negative consequences of smoking among people with psychotic disorders.

Reasons for substance use among people with mental disorders.

BACKGROUND: Comorbidity of mental disorders and substance use continues to be a major problem. To inform the development of more effective interventions for these co-existing disorders, this paper aimed to determine if there are clear variations in the reasons for tobacco, alcohol or cannabis use across people with different mental disorders. METHODS: Data from five randomized controlled trials on co-existing disorders that measured reasons for tobacco, alcohol or cannabis use using the Drug Use Motives Questionnaire, Reasons for Smoking Questionnaire or via free response are reported and combined. Two studies involved participants with depression, two involved participants with a psychotic disorder and one involved participants with a range of mental disorders. A series of logistic regressions were conducted to examine differences in reasons for tobacco, alcohol or cannabis use and to compare these reasons between people with psychotic disorders or depression. RESULTS: Participants had a mean age of 38 (SD=12) and just over half (60%) were male. Forty-six percent of participants had a psychotic disorder and 54% experienced depression. Data from 976 participants across the five studies were included in the analyses. Tobacco and alcohol were primarily used to cope, while cannabis was primarily used for pleasure. People with psychotic disorders were more likely than people with depression to use tobacco for coping, pleasure and illness motives. People with depression, in contrast, were more likely to use alcohol for these reasons and social reasons. CONCLUSIONS: It may be important to tailor interventions for co-existing mental disorders and substance use by substance type and type of mental disorder. For example, interventions might be improved by including alternative coping strategies to tobacco and/or alcohol use, by addressing the social role of alcohol and by helping people with mental disorders using cannabis to gain pleasure from their lives in other ways.

Reasons for substance use among people with psychotic disorders: method triangulation approach.

Substance use disorders (SUD) are common among people with psychotic disorders and are associated with many negative consequences. Understanding the reasons for substance use in this population may allow for the development of more effective prevention and intervention strategies. We examined reasons for tobacco, alcohol, or cannabis use among people with psychotic disorders. Sixty-four participants with a diagnosed psychotic disorder completed a self-report reasons for use questionnaire. A subset of eight participants completed semi-structured qualitative interviews. Both the qualitative and quantitative data indicated that reasons for use of tobacco, alcohol, and cannabis differed considerably. Tobacco was primarily used for coping motives, alcohol for social motives, and cannabis for pleasure enhancement motives. Prevention and intervention strategies targeting coexisting psychotic disorders and SUD may improve in effectiveness if they address the perceived beneficial effects of tobacco use, the strong social pressures influencing alcohol use and if they encourage cannabis users to seek alternative pleasurable activities.

The impact of miscarriage on women's pregnancy-specific anxiety and feelings of prenatal maternal-fetal attachment during the course of a subsequent pregnancy: an exploratory follow-up study.

This study assesses the implications a miscarriage history has on women's pregnancy-specific anxiety and feelings of prenatal maternal-fetal attachment during the 1st and 3rd trimesters of a subsequent pregnancy. Thirty-five pregnant women (N = 10 with a history of miscarriage) volunteered participation completing the Pregnancy Outcome Questionnaire (POQ), the Maternal Antenatal Attachment Scale (MAAS and a demographic/reproductive history questionnaire during the first trimester of pregnancy. Of these, 24 participants completed the measures again during the third trimester of pregnancy. Women with a miscarriage history reported significantly higher pregnancy-specific anxiety at trimester 1 than women with no miscarriage history; even when the effects of parity were controlled. All expectant mothers, irrespective of miscarriage history, scored similarly at trimester 1 on the MAAS scales. By the 3rd trimester, pregnancy-specific anxiety had significantly decreased for women with a miscarriage history whose mean scores on the POQ were now similar to women with no history of miscarriage. Maternal-fetal attachment had significantly risen by the 3rd trimester for all women. These findings suggest that having a miscarriage history may not have a long-lasting adverse effect on woman's psychological adaptation during the course of a subsequent pregnancy.

Implications of coping repertoire as predictors of men's stress, anxiety and depression following pregnancy, childbirth and miscarriage: a longitudinal study.

The long-term implication of how men cope during a partner's pregnancy, at childbirth or following miscarriage has not received attention. This study aims to examine if men's coping response during pregnancy, at childbirth, or miscarriage predict psychological outcomes at the time of childbirth/miscarriage or 1 year later, and to establish whether there are any changes in men's coping repertoire. Utilizing a longitudinal design, 384 volunteer expectant fathers, participated by completing measures of stress, anxiety, depression and coping during their partner's pregnancy, following childbirth or miscarriage, and 1 year later. Findings indicated, at the time of childbirth/miscarriage, increases on all psychological outcomes compared to during the pregnancy, which then decreased at 1-year. During pregnancy, men relied more on approach-orientated coping, changing at pregnancy outcome to avoidant-orientated strategies. Regression revealed the best predictor of psychological outcome, in the long-term, was coping response at pregnancy outcome. However each psychological outcome had its own predictive path, varying depending on pregnancy outcome; supporting the concept that coping responses are situationally specific, changing depending on the event examined. How men cope with each aspect of their reproductive experiences may have implications for the provision of support they offer their partner, and the support they themselves need.

Apocalyptic thinking, autonomy, and sociotropy.

As the millennium approached there was a unique opportunity to examine beliefs about impending apocalyptic events. In March, 1998 60 English participants, 20 to 35 years of age, including 20 Jehovah's Witnesses, 20 Roman Catholics, and 20 Methodists, completed a four-dimension scale of Positive and Negative Autonomy and Positive and Negative Sociotropy and a questionnaire, Apocalyptic Thinking, on the millennium containing questions on apocalyptic beliefs. The aim of the study was to investigate the apocalyptic beliefs of a number of Christian denominations and examine the relationship between scores on apocalyptic thinking about the millennium and group cohesion. Jehovah's Witnesses scored highest on all scales except Positive Autonomy, and the Catholics had higher Negative Sociotropy and Apocalyptic Thinking scores than the Methodists. Negative Sociotropy scores correlated positively with Apocalyptic Thinking scores for all groups. These data suggest significant positive relationship between these Christian endorsements of the likelihood of apocalyptic events at the millennium and the extent to which they perceive nonmembers of their denomination as 'outsiders'.