Acceptability, feasibility and preliminary efficacy of a compassion-based cognitive behavioural intervention for low self-esteem in sexual minority young adults.

Low self-esteem can impair daily functioning and is a risk or maintenance factor for several mental health problems. Sexual minority young adults, for example, those identifying as lesbian, gay or bisexual, on average have lower self-esteem than their heterosexual peers. Compassion-based interventions for low self-esteem might be especially beneficial for sexual minority young adults, whose higher levels of shame and self-criticism are likely to be contributing to maintenance of their low self-esteem. This study explored the acceptability, feasibility and preliminary efficacy of a new compassion-based cognitive behavioural intervention for low self-esteem tailored to sexual minority young adults. Participants were a community sample of 24 sexual minority young adults aged 16-24 experiencing clinically significant low self-esteem. An uncontrolled pre-/post-design was used with qualitative feedback and quantitative outcomes. Self-report standardised measures were completed at baseline, pre-intervention, intervention mid-point, post-intervention and 2-month follow up. Preliminary efficacy was examined through post-intervention changes in self-esteem, functioning, anxiety and depression. Potential mechanisms of change were examined through changes in self-compassion, self-criticism and unhelpful coping responses to minority stress. Results showed good acceptability and feasibility and preliminary evidence of intervention efficacy for improving self-esteem, functioning, depression and anxiety. There was evidence for improvement in self-compassion and reduction in self-criticism, and these constructs could be investigated in future studies as treatment mediators. Randomised controlled studies are needed to further examine efficacy of the intervention.

A cognitive behavioural intervention for low self-esteem in young people who have experienced stigma, prejudice, or discrimination: An uncontrolled acceptability and feasibility study.

OBJECTIVES: Stigma has been found to be associated with lower self-esteem, which increases the risk of difficulties across life domains including vulnerability to mental health problems. There are no previous studies of interventions for people experiencing low self-esteem in the context of different stigmatized characteristics. This study evaluated feasibility, acceptability, and preliminary outcomes of an intervention targeting low self-esteem in stigmatized people aged 16-24 years. DESIGN: An uncontrolled study with repeated measures. METHOD: People with a range of stigmatized characteristics, who had low self-esteem and associated impaired daily functioning, were recruited from the general population. The individual six-session cognitive behavioural intervention had modules chosen according to participants' formulations. The CBT included compassion-focussed therapy methods and was informed by stigma research. Feasibility was assessed in relation to recruitment, retention, and protocol adherence. Acceptability was assessed through participant feedback. Questionnaires assessing self-esteem, functioning impairments, depression, anxiety, self-criticism, self-compassion, and responses to prejudice and discrimination were administered at baseline, pre-, mid-, post-intervention, and two-month follow-up. RESULTS: Forty-four people completed screening; 73% were eligible. Of these, 78% consented and 69% (N = 22) started the intervention. Eighteen (82%) participants completed, and four dropped out. Follow-up measures were completed by all treatment completers. Treatment completers reported the intervention was useful, improved their self-esteem and coping, and would recommend it. Ratings of usefulness and frequency of use of intervention components were high at post-treatment and follow-up. CONCLUSIONS: The intervention was feasible and highly acceptable to treatment completers. This suggests the intervention warrants investigation in a randomized-controlled trial. PRACTITIONER POINTS: Young people with low self-esteem whom have been negatively affected by stigma may wish to access support and be willing to engage in psychological interventions. Cognitive behavioural therapy may be helpful for young people with low self-esteem who have experienced stigma, prejudice, or discrimination. Cognitive behavioural techniques such as self-compassionate thought records and behavioural experiments were considered acceptable and helpful by young people whose self-esteem has been affected by stigma. Addressing responses to stigma in therapy, such as rumination, avoidance, and perfectionism, appears to be feasible and acceptable.

Quantitative and thematic analysis of burns surgeons' attitudes, beliefs and surgical decision-making in self-harm burn injuries: The use of a questionnaire and hypothetical cases.

BACKGROUND: Self-harm injuries represent a significant minority of attendances within burns services. However, there is minimal research exploring burns surgeons' attitudes and beliefs about self-harm and how treatment decisions are made. METHOD: Burns surgeons (n=37) completed a questionnaire which measured attitudes and beliefs about self-harm. Surgical decision-making was also explored by prompting surgeons to make treatment decisions for hypothetical case scenarios, and describe their rationale behind their decisions. RESULTS: The majority of surgeons reported positive attitudes about self-harm. However, around one in ten judged patients who self-harm more negatively, around a fifth offer surgery less frequently and almost a quarter believed that surgery should only be offered a limited number of times in repeated self-harm. Unhelpful or inaccurate beliefs (e.g. self-harm is 'attention seeking,' surgery would reinforce the self-harm, and that patients who self-harm tamper with skin grafts) were evident in some surgeons. Thematic analysis of qualitative data describing surgical decisions identified five themes: Equal Access to Care; Multidisciplinary Working; Old or Unhelpful Stories; Concerns about Tampering; and Repeated vs. First Time Self-Harm Episodes. More experienced surgeons were less judgmental, more likely to offer surgical interventions, and less likely to hold unhelpful or inaccurate beliefs compared to junior surgeons. CONCLUSIONS: Some surgeons are not acting in line with UK guidance on the management of self-harm injuries. Education on the topic of self-harm is essential in burns services and this may be particularly important early on during surgical careers. Prospective research regarding surgical treatments and outcomes following self-harm is required.

A comparison of two psychological screening methods currently used for inpatients in a UK burns service.

Various types of psychological screening are currently used in the UK to identify burn patients who are experiencing psychological distress and may need additional support and intervention during their hospital admission. This audit compared two types of psychological screening in 40 burn inpatients. One screening method was an unpublished questionnaire designed to explore multiple areas of potential distress for those who have experienced burns. The other method was an indirect psychological screen via discussions within multi-disciplinary team (MDT) meetings where a Clinical Psychologist was present to guide and prompt psychological discussions. Data was collected between November 2012 and September 2016. Results suggested that both screening methods were similar in identifying patients who benefit from more formal psychological assessment. Indeed, statistical analysis reported no difference between the two screening methods (N=40, p=.424, two-tailed). In conclusion, measuring distress in burns inpatients using a burns-specific questionnaire and psychological discussions within MDT meetings are similar in their ability to identify patients in need of more thorough psychological assessment. However, both screening methods identified patients who were in need of psychological input when the other did not. This suggests that psychological screening of burns inpatients, and the psychological difficulties that they can present with, is complex. The advantages and disadvantages of both methods of screening are discussed.

Configural and component processing in simultaneous and sequential lineup procedures.

Configural processing supports accurate face recognition, yet it has never been examined within the context of criminal identification lineups. We tested, using the inversion paradigm, the role of configural processing in lineups. Recent research has found that face discrimination accuracy in lineups is better in a simultaneous compared to a sequential lineup procedure. Therefore, we compared configural processing in simultaneous and sequential lineups to examine whether there are differences. We had participants view a crime video, and then they attempted to identify the perpetrator from a simultaneous or sequential lineup. The test faces were presented either upright or inverted, as previous research has shown that inverting test faces disrupts configural processing. The size of the inversion effect for faces was the same across lineup procedures, indicating that configural processing underlies face recognition in both procedures. Discrimination accuracy was comparable across lineup procedures in both the upright and inversion condition. Theoretical implications of the results are discussed.