The role of shame and self-critical thinking in the development and maintenance of current threat in post-traumatic stress disorder

The role of shame and self-critical thinking in the development and maintenance of current threat in post-traumatic stress disorder, Clinical Psychology & Psychotherapy, 2010, Volume 17 Issue 1, Pages 13 – 24

Rachel Harman, Deborah Lee

Paediatric Psychology Service, Clare House, St George’s Hospital, London, UK
Sub-Department of Clinical Health Psychology, Torrington Place, London, UK


There is increasing recognition of emotions other than fear in post-traumatic stress disorder (PTSD), and recent research has looked at the role of shame. Cognitive theory suggests that PTSD is caused by traumatic experiences being processed in a way that causes ongoing current threat. In this paper we suggest that shame might contribute to the creation/maintenance of ongoing current threat as it attacks an individual’s psychological integrity. A correlational design was used to investigate some of the factors that might contribute to a shame response within a PTSD sample. It was hypothesized that individuals with PTSD who report higher levels of shame would be more prone to engage in self-critical thinking and less prone to engage in self-reassuring thinking than individuals with PTSD who report lower levels of shame. Data were gathered using self-report questionnaires, and results supported the hypotheses. It is suggested therapy for shame-based PTSD needs to incorporate strategies to help individuals develop inner caring, compassion and self-reassurance.

Lancashire Care staff can request the full-text of this paper, email:

The therapist-client relationship, computerized self-help and active therapy ingredients

The therapist-client relationship, computerized self-help and active therapy ingredients, Clinical Psychology & Psychotherapy, 2010, Volume 17 Issue 2, Pages 147 – 153

David F. Peck *
Clinical and Health Psychology, University of Edinburgh


There is strong evidence that a good relationship between therapist and client is associated with positive outcomes after all types of psychological therapy. There is also strong evidence that computer-guided cognitive behaviour therapy (CCBT), in which there may be little or no face-to-face contact, is associated with outcomes that are as good as outcomes after conventional therapy. These two sets of findings can be reconciled by reference to the common factors debate, in that common factors may be as important in CCBT as in conventional therapy; and by reconstruing the therapist-client relationship as a channel through which common and specific factors are brought into play

Lancashire Care staff can request the full-text of this paper, email:

Music therapy for autistic spectrum disorder

Music therapy for autistic spectrum disorder, Gold C, Wigram T, Elefant C. Music therapy for autistic spectrum disorder. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD004381

Click on the title above to access the full-text of this Cochrane review



The central impairments of people with autistic spectrum disorder (ASD) include social interaction and communication. Music therapy uses music and its elements to enable communication and expression, thus attempting to address some of the core problems of people with ASD.


To review the effects of music therapy for individuals with autistic spectrum disorders.

Search strategy

The following databases were searched: CENTRAL, 2005, (Issue 3); Medline, (1966 to July 2004); Embase, (1980 to July 2004); LILACS, (1982 to July 2004); PsycINFO, (1872 to July 2004); CINAHL, (1982 to July 2004); ERIC, (1966 to July 2004); ASSIA, (1987 to July 2004); Sociofile, (1963 to July 2004); Dissertation Abstracts International, (late 1960’s to July 2004). These searches were supplemented by searching specific sources for music therapy literature and manual searches of reference lists. Personal contacts to some investigators were made.

Selection criteria

All randomised controlled trials or controlled clinical trials comparing music therapy or music therapy added to standard care to “placebo” therapy, no treatment or standard care.

Data collection and analysis

Studies were independently selected, quality assessed and data extracted by two authors. Continuous outcomes were synthesised using a standardised mean difference (SMD) in order to enable a meta-analysis combining different scales, and to facilitate the interpretation of effect sizes. Heterogeneity was assessed using the I² statistic.

Main results

Three small studies were included (total n = 24). These examined the short-term effect of brief music therapy interventions (daily sessions over one week) for autistic children. Music therapy was superior to “placebo” therapy with respect to verbal and gestural communicative skills (verbal: 2 RCTs, n = 20, SMD 0.36 CI 0.15 to 0.57; gestural: 2 RCTs, n = 20, SMD 0.50 CI 0.22 to 0.79). Effects on behavioural problems were not significant.

Authors’ conclusions

The included studies were of limited applicability to clinical practice. However, the findings indicate that music therapy may help children with autistic spectrum disorder to improve their communicative skills. More research is needed to examine whether the effects of music therapy are enduring, and to investigate the effects of music therapy in typical clinical practice.

Lancashire care staff can either click on the link above, or email:

Supporting the dementia family caregiver: the effect of home care intervention on general well-being

Supporting the dementia family caregiver: the effect of home care intervention on general well-being, Aging & Mental Health, 2010 Jan; 14 (1): 44-56

Schoenmakers B; Buntinx F; DeLepeleire J;


Although high volumes of literature have been written on interventions in dementia home care, only a poor efficiency has been proved. Nevertheless, caregivers often express strong feelings of satisfaction about the proposed support. In this meta-analytic review, a quantitative analysis of the effect of the different types of professional dementia home care interventions was made. Method: A systematic literature search, covering the years 1980 until 2007, was performed using Medline, Embase, Cochrane DSR, Dare, CCTR, and ACP Journal Club). Limitations on publication type were determined as randomized controlled trial and controlled trial. Results: Psychosocial intervention in dementia home care was found to be beneficial in a non-significant way on caregivers’ burden. An almost negligible decrease in depression was found in the psychosocial intervention arm while multidisciplinary case management contributed to a larger though insignificant decrease of depression in caregivers. Respite care was responsible for an increase in burden. Conclusion: This review demonstrated, in accordance with other qualitative reviews, the weak evidence that supporting family caregivers could be beneficial. Although the rather small benefits of formal support, supporting family caregivers is an indispensable issue in dementia home care. Professional caregivers should keep in mind that family caregivers highly appreciate the intervention and that they feel less burdened or depressed in the short time follow up but that premature home care remains more rule than exception.


Lancashire care staff can request the full-text of this article, email:

Developing the role of advanced nurse practitioners in mental health

Developing the role of advanced nurse practitioners in mental health, Maria Gilfedder, Derek Barron, Eddie Docherty. Nursing Standard. Harrow-on-the-Hill: Mar 31-Apr 6, 2010. Vol. 24, Iss. 30; pg. 35, 6 pgs


This article describes the development of an advanced nurse practitioner (ANP) service in mental health. The ANPs worked within an existing hospital at night team based at Crosshouse Hospital, a district general hospital in Kilmarnock. Set against the agenda of Modernising Nursing Careers and Modernising Medical Careers, the article describes the professional and organisational background to the development, broad training requirements and skills set of this new team of ANPs. The role played by mental health ANPs in replacing junior psychiatric doctors in the out-of-hours period is of significant importance. In addition, these mental health ANPs covered the general wards in the hospital alongside their general ANP colleagues. The competency framework that the ANPs need to complete is discussed as well as the challenges faced in developing the service.
Advanced practice, mental health, nurse specialists, out-of-hours care
These keywords are based on subject headings, from the British Nursing Index. All articles are subject to external double-blind peer review and checked for plagiarism using automated software. For author and research article guidelines visit the Nursing Standard home page at For related articles visit our online archive and search using the keywords.


MENTAL HEALTH NURSES in Scotland appear to have been slow to take up the challenge of advanced practice. Without a clear definition of advanced practice, nurses might struggle to see where the role fits into the way they provide services and work alongside service users. The Nursing and Midwifery Council (2006, 2007) has endorsed advanced practice as a means of enabling nurses to assess, diagnose, treat and refer patients. In addition, NHS Education for Scotland’s (2008) Advanced Nursing Practice Toolkit can be used to enhance nurses’ understanding and application of advanced practice.

Using the NMC documents and the toolkit as a guide, the authors, mental health nurses in NHS Ayrshire and Arran, planned to lead mental health nurses into advanced practice in what may be considered a unique way. Hurley et al (2009) suggested that mental health nurses frequently adopt approaches from other disciplines as the profession evolves. They caution that the ‘jack of all trades’ label may prevent them from being identified with any one particular role. The authors aim to demonstrate, however, that advanced nursing practice requires a wide range of skills, while developing an additional in-depth skill set.

Lancashire Care staff can request the full-text of this paper, email:

Do we know when our clients get worse? an investigation of therapists’ ability to detect negative client change

Do we know when our clients get worse? an investigation of therapists’ ability to detect negative client change, Clinical Psychology & Psychotherapy, 2o1o, Volume 17 Issue 1, Pages 25 – 32

Derek Hatfield, Lynn McCullough, Shelby H. B. Frantz, Kenin Krieger


Routine clinical judgment is often relied upon to detect client deterioration. How reliable are therapists’ judgments of deterioration? Two related studies were conducted to investigate therapist detection of client deterioration and therapist treatment decisions in situations of deterioration. The first study examined therapists’ ability to detect client deterioration through the review of therapy progress notes. Therapist treatment decisions in cases of client deterioration were also explored. Therapists had considerable difficulty recognizing client deterioration, challenging the assumption that routine clinical judgment is sufficient when attempting to detect client deterioration. A second study was a survey of therapists asking how they detect client deterioration and what treatment decisions they make in response. Symptom worsening was the most commonly stated cue of deterioration

Lancashire Care staff can request the full-text of this paper, email: 

A Systematic Review and Meta-Analysis of Ethnic Differences in Use of Dementia Treatment, Care, and Research

A Systematic Review and Meta-Analysis of Ethnic Differences in Use of Dementia Treatment, Care, and Research, The American Journal of Geriatric Psychiatry.  Mar 2010. Vol. 18, Iss. 3; p. 193 (11 pages)

Claudia Cooper, Alec Robert Tandy, Thana B S Balamurali, Gill Livingston

Department of Mental Health Sciences, University College London, Holborn Union Building, Archway Campus, Highgate Hill, London N19 5LW, United Kingdom


The number of people with dementia from minority ethnic (ME) groups in western countries is projected to rise dramatically, and they may be less able to access dementia services. To compare the use of health and social services, treatments for dementia and dementia research between different ethnic groups. A systematic review of 33 articles fitting predetermined criteria. Compatible results were pooled in a meta-analysis. ME people with dementia were more cognitively impaired, and Hispanic people reported a longer duration of memory loss than non-ME people, at the time of referral to diagnostic dementia services in the United States and Australia {pooled weighted mean difference on Mini-Mental State Examination = 3.48 (95% confidence interval [CI]: 2.87-4.09); z = 11.19, p <0.0001; N = 2,090}. These differences remained after controlling for premorbid level of education. The use of community social services did not vary between ME and non-ME people with dementia, but African Americans were 30% less likely to be prescribed cholinesterase inhibitors {odds ratio (OR) 0.7 [0.6-0.9]; z = -3.1, p = 0.002; N = 175}, and ME groups were underrepresented in U.S. dementia drug trials. ME people with dementia were 40% less likely to enter 24-hour care (pooled hazard ratio 0.59 [95% CI: 0.52-0.69]; z = -7.15, p <0.0001; N = 12,053). The authors found consistent evidence, mostly from the United States, that ME people accessed diagnostic services later in their illness, and once they received a diagnosis, were less likely to access antidementia medication, research trials, and 24-hour care. Increasing community engagement and specific recruitment strategies for ME groups might help address inequalities, and these need to be evaluated. More research is also needed to evaluate ME access to dementia services outside the United States.

Lancashire Care staff can request the full-text of this paper, email: