See Heng Yim - Thesis submitted in partial fulfilment of doctor of clinical psychology (DClinPsych)
Keywords: Internet interventions
eating disorders
Cognitive behavioural therapy
conflict
Social anxiety
PTSD

The effectiveness and feasibility of psychological interventions for populations under ongoing threat: A systematic review
Current views of psychological therapies for trauma typically assume the traumatic event to be in the past. Yet individuals who live in ongoing organised violence or experience intimate partner violence (IPV) may continue to be (re)exposed to related traumatic events or have realistic fears of their recurrence. This review considers the effectiveness, feasibility and the requirement for adaptations of psychological interventions for individuals living with ongoing threat. Eighteen papers featuring 15 trials were included (12 on organised conflict, three on ongoing IPV). For political violence, most studies showed moderate to large effects in reducing trauma-related symptoms when compared to waitlists. For IPV, findings were varied. Most studies found providing psychological interventions were feasible. The findings, albeit preliminary with mixed methodological quality, showed psychological treatments can be beneficial and should not be withheld in context of ongoing organised conflicts and IPV. Clinical and research recommendations are outlined.
Patients’ experiences of clinical team meetings (ward round) at an adult inpatient eating disorders ward: a mixed-method service improvement project
Aims
Ward rounds are key to treatment-related decision making but are often stressful for patients. This project aimed to explore and improve patients’ experiences of the clinical team meeting (CTM, historically known as ward round) in an adult inpatient eating disorders unit. A mixed-method approach was adopted using in-vivo observations, two focus groups, an interview, and a staff survey. Six patients participated. Two former patients contributed to data analysis, co-production of service improvement initiatives and write-up.
Results
The mean CTM duration was 14.3 minutes. Patients spoke half of the time, followed by psychiatry colleagues. ‘Request’ was the most-spoken category. Thematic analysis identified (1) CTMs are important but impersonal, (2) CTMs generate a sense of palpable anxiety; (3) divergent views between staff and patients.
Clinical implications
The findings and implementation of co-produced changes to CTMs improved patients’ experiences despite COVID-19 challenges. Factors beyond CTMs including the ward’s power hierarchy, culture and language need addressing to facilitate shared decision-making.
Sudden Gains in internet cognitive therapy for social anxiety disorder in routine clinical practice
Background
Research on sudden symptom improvements (sudden gains) in internet-delivered psychological interventions are limited in routine practice.
Objective
This was a study on sudden gain and its relationship to outcome and cognitive processes. The intervention examined was a therapist-guided internet Cognitive Therapy intervention for social anxiety disorder (iCT-SAD) delivered in primary mental health services in the UK. The aim was to replicate the approach of a previous exploratory study (Thew et al., submitted) where the data were drawn from a randomised controlled trial (Clark et al., 2022).
Methods
The study used data from a larger implementation study (N = 193). Liebowitz Social Anxiety Scale was the primary outcome measure. Process variables examined included negative social cognition measured by the Social Cognition Questionnaire, self-focused attention (Social Phobia Weekly Summary Scale) and depressed mood (Patient Health Questionnaire).
Results
Seventy sudden gains were found among 57 participants. The occurrence rate of sudden gain was 39%. Individuals who experienced sudden gains had a larger reduction in social anxiety symptoms at end of intervention and at three-month follow-up. There was evidence of a reduction in the frequency of negative social cognitions prior to the gain, whereas change in self-focused attention occurred simultaneously with the gain. Depressed mood did not show significant changes over these timepoints.
Conclusions
Sudden gain was found in routine practice and was found to be related to meaningful symptom improvement.