Meghan Nicholson - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)

Systematic Review of the Literature
Background: Firefighters are frequently exposed to potentially traumatic incidents at work and are at risk of developing post-traumatic stress disorder (PTSD). However, research has demonstrated high levels of resilience amongst firefighters and their experiences of coping following trauma is under-explored in the literature. The aim of this paper was to undertake a qualitative synthesis of studies exploring firefighters’ experiences of coping following traumatic events, particularly in terms of peer support. The literature was viewed through the lens of the Social Identity Model of Traumatic Identity Change (SIMTIC).
Method: Twenty-five relevant qualitative research papers were identified through systematic searching of databases (Medline, PsychINFO, Web of Science, Scopus). The papers were synthesised using a meta-ethnography approach.
Results: Meta-ethnography generated eleven third-order concepts, grouped into three overarching themes. The first theme outlined firefighters’ subjective experiences of traumatic incidents. The second theme outlined firefighters’ experiences of peer support, its facilitators, and barriers. The final theme outlined other ways of coping adopted by firefighters following a traumatic event, including further training and the enlisting of social support and formal support services.
Discussion: Peer support amongst firefighters facilitates resilience and posttraumatic growth following traumatic incidents. Barriers to seeking this support include masculine ingroup norms and vulnerability associated with sharing emotions with peers. SIMTIC is a helpful model for considering how the firefighter identity can be both a facilitator and barrier to positive coping following a traumatic event.

Service Improvement Project
Background: Restrictive practices (RP) are used by healthcare professionals on psychiatric inpatient units to protect the safety of patients, staff, and visitors. The factors relating to its use are poorly understood and no study has yet explored the experiences and views of patients. This project aimed to understand young people’s experiences of RP, explore patterns around its use, and make recommendations towards reducing RP.
Procedure: Interviews were conducted with 10 current or recent inpatients from the Highfield Adolescent Inpatient Unit (HFU). Interviews were analysed with Thematic Analysis. A retrospective audit analysed data collected over a 12-month period to explore the type, frequency, and duration of RP, as well as patterns, such as patient and staff characteristics.
Main findings: Three key themes were identified; i) the nature of restrictive practice, ii) the impact of restrictive practice, and iii) a changing relationship to restrictive practice. Audit data were used to contextualise the findings. Recommendations were made to support RP reduction.
Conclusion: The findings highlight the impact of RP use on patients, and the need for idiosyncratic formulation of patients’ needs within the inpatient environment.

Theoretically Driven Research Project
Background: Dissociation has been associated with a wide range of mental health needs and can occur following traumatic experiences. This study aimed to develop understanding of dissociation in adolescents by exploring the utility of a model proposed by Schauer & Elbert (2015), the 'Defence Cascade Model', which proposes that dissociation is an adaptive, evolutionary reaction in response to certain types of traumatic events (i.e., those including fixation, proximity, penetration, and contamination).
Procedure: 111 young people aged 11-24 under mental health services completed an online questionnaire exploring experiences of trauma, dissociation, post-traumatic stress, depression, and anxiety. The dissociation levels of those whose trauma involved aspects outlined by the Defence Cascade Model were compared to those whose trauma experience did not include these aspects. These scores were compared against a benchmark group of adolescents in services who had not experienced trauma.
Main findings: Results were not in line with the assertion of the Defence Cascade Model that traumas with fixation, proximity, penetration, and contamination lead to dissociation, as there were no significant differences in dissociation between the two trauma groups. PTSD explained a large proportion of variance in dissociation. Exploratory analysis found that age at the onset of the trauma, and time since trauma, were significantly associated with dissociation.
Conclusion: This suggests that features of trauma events are not predictive of dissociation. Clinical implications are considered, as well as directions for future research.

Keywords: peer support
segregation
post-traumatic stress disorder
trauma
adolescents
restrictive practice
dissociation
traumatic events
qualitative synthesis
seclusion
inpatient
restraint
firefighters
Advisor: Anderson, C
Stratford, H
Chan, C