Hannah Goodison - thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)

Critical Review of the Literature Abstract
Effectiveness of Dialectical Behaviour Therapy for Anger and Aggressive Behaviour in Adults: A Systematic Review and Meta-Analysis/p>
Anger and aggression have major health and safety implications, and effective treatment is critical. This review examined the effectiveness of Dialectical Behaviour Therapy (DBT) to reduce these outcomes in adults. Literature searches identified 16 eligible studies for the systematic review, of which 12 were included in meta-analyses. Pre-post evaluations showed small effects for DBT in reducing anger (g = -0.37; 95% CI [-0.65, -0.10]) and aggressive behaviour (g = -0.45; 95% CI [-0.60, -0.31]). DBT was superior to other active interventions in reducing anger (g = -0.29; 95% CI [-0.56, -0.01]) but no difference was found for aggressive behaviour (g = -0.04; 95% CI [-0.25, 0.16]). Little evidence was found for additional improvement when combined with medication. We conclude that DBT may be an effective treatment for both anger and aggressive behaviour. Limitations and future directions are discussed.
Service Improvement Project Abstract
Understanding and Improving the Experience of Young People and Families in The Oxfordshire CAMHS Crisis Service
Background: The Oxfordshire CAMHS Crisis service provides support for children and young people (CYP) experiencing acute mental health crisis. Since 2013 there has been no comprehensive evaluation of the service, nor any consultation with service users about their experience. This mixed-methods project aimed to understand service users’ experience of the service and priorities for crisis care, service performance against available standards for care, and how care could be improved.
Method: Survey data were received from 34 parents and eight CYP who accessed the service within a 13-month period. Semi-structured interviews were also conducted with nine parents and three CYP. Quantitative data were analysed using descriptive statistics and qualitative responses were thematically analysed.
Results: Service users particularly valued 24/7 access to support and most participants reported that staff were warm in interactions. There was some discrepancy between CYP and parents’ reports of what was received. Six themes were highlighted from qualitative data: staff warmth and understanding, parents need support, service access, need for improved liaison, clearer service information, and the importance of a long-term approach.
Conclusions: Several recommendations are made for how care could be improved. Further research is needed into crisis care for CYP to inform evidence-based practice. Limitations and future directions are discussed.
Theoretically Driven (Main) Research Project Abstract
Tell Me Something New: The Contribution of Self-Compassion to our Current Understanding of Hearing Voices
Objectives: This study aimed to test key predictions of the compassion model of voice hearing. It also aimed to assess whether self-compassion offers any additional understanding of voicerelated distress and voice content than mood and negative self-schema, which are central parts of established cognitive-models.
Design: A within-group observational design.
Methods: Fifty-six adults who currently hear voices completed an online survey. The survey included measures of self-compassion, negative self-schema, mood, voice-related distress, and soothing/critical voice content. Twenty-five of these participants also completed a follow-up measure of voice content. Correlation, hierarchical regression, and mediation analyses assessed relationships between variables.
Results: Higher self-compassion was associated with lower voice-related distress and critical voice content, with a large effect size. It was also the only variable significantly associated with soothing voice content. Critical voice content was found to mediate the effect between selfcompassion and voice-related distress. Self-compassion remained associated with voice-related distress and soothing voice content, even when mood and negative self-schema were controlled for; however, this was not significant when predicting voice content at follow-up.
Conclusions: These findings suggest that self-compassion offers an additional understanding of the variance in voice-related distress and soothing voice content than is already offered by mood and negative self-schema. Increasing self-compassion in therapy may lead to significant clinical benefits, including reduced voice-related distress and a switch from critical to soothing voice content. Further research is needed to assess directions of causality.

Advisor: Steele, H
Anderson, C
Lane, N