Abstract

Background

Treating severe emotional dysregulation and co-occurring substance misuse is challenging. Dialectical behaviour therapy (DBT) is a comprehensive and evidence-based treatment for borderline personality disorder (BPD). It has been hypothesised that the skills training, which is a facet of the full DBT programme, might be effective for people with severe emotional dysregulation and other co-occurring conditions, but who do not meet the criteria for BPD. However, there is limited research on standalone DBT skills training for people with substance misuse and emotional dysregulation.

Methods

A mixed methods study employing an explanatory sequential design was conducted where participants with a dual diagnosis (n = 64) were recruited from a community-based public addiction treatment service in Ireland between March 2015 and January 2018. DBT therapists screened potential participants against the study eligibility criteria. Quantitative self-report measures examining emotion regulation, mindfulness, adaptive and maladaptive coping responses including substance misuse, and qualitative feedback from participants were collected. Quantitative data were summarised by their mean and standard deviation and multilevel linear mixed effects models were used to estimate the mean change from baseline to post-intervention and the 6-month follow-up period. Thematic analysis was used to analyse the qualitative data.

Results

Quantitative results indicated reductions in binge drinking and use of Class A, B and C drug use from pre-intervention (T1) to the 6-month follow-up (T3). Additionally, significant improvements were noted for mindfulness practice and DBT skills use from T1 to T3 (p < 0.001). There were also significant reductions in dysfunctional coping and emotional dysregulation from T1 to T3 (p < 0.001). Significant differences were identified from pre to post intervention in reported substance use, p = 0.002. However, there were no significant differences between pre-intervention and 6-month follow up reports of substance use or at post-intervention to 6 month follow up. Qualitative findings indicated three superordinate themes in relation to participants’ experiences of a DBT skills training programme, adapted from standard DBT: (1) new lease of life; (2) need for continued formal aftercare and (3) programme improvements. Participants described reductions in substance misuse, while having increased confidence to use the DBT skills they had learned in the programme to deal with difficult emotions and life stressors.

Conclusions

This DBT skills training programme, adapted from standard DBT, showed positive results for participants and appears effective in treating people with co-occurring disorders. Qualitative results of this mixed methods study corroborate the quantitative results indicating that the experiences of participants have been positive. The study indicates that a DBT skills programme may provide a useful therapeutic approach to managing co-occurring symptoms.

Research suggests clear associations between the severity of childhood trauma, levels of substance use and dissociation - the detachment or disruption to normal consciousness. Despite the apparent link, it remains unclear whether the level of substance use can, in some part, explain the relationship between trauma severity and the extent of dissociation.

A recent study, published in the Journal of Substance Use, has investigated whether substance use significantly influences the link between childhood trauma and the severity of depersonalization - a common symptom of dissociation involving changes in perception and emotion processing.

Participants completed online questionnaires that collected information about childhood abuse, depersonalization severity and substance use.

Results found that

• Dissociation severity, in the form of depersonalization, is predicted by both the severity of childhood trauma and the use of illicit substances.
• The link between traumatic childhood experiences and dissociation was not, however, moderated by the quantity of classic psychedelics or dissociatives used by participants.
• Differences in dissociation severity were explained more by childhood trauma than substance use.

Overall the study adds further evidence to support the link between childhood trauma and dissociation. The researchers suggest that it may be the context of substance use rather than the quantity of substance use that influence severity dissociation.

Abstract

Background

To facilitate decentralisation and scale-up of mental health services, Fiji’s Ministry of Health and Medical Services committed to implementing the World Health Organization’s mental health Gap Action Programme (mhGAP). mhGAP training has been prolific; however, it remains unclear, beyond this, how successfully Fiji’s national mental health program has been implemented. We aim to evaluate Fiji’s mental health program to inform Fiji’s national mental health program and to develop an evidence-base for best practice.

Methods

The study design was guided by the National Implementation Research Network and adhered to the Consolidated Framework for Implementation Research. CFIR constructs were selected to reflect the objectives of this study and were adapted where contextually necessary. A mixed-methods design utilised a series of instruments designed to collect data from healthworkers who had undertaken mhGAP training, senior management staff, health facilities and administrative data.

Results

A total of 66 participants were included in this study. Positive findings include that mhGAP was considered valuable and easy to use, and that health workers who deliver mental health services had a reasonable level of knowledge and willingness to change. Identified weaknesses and opportunities for implementation and system strengthening included the need for improved planning and leadership.

Conclusion

This evaluation has unpacked the various implementation processes associated with mhGAP and has simultaneously identified targets for change within the broader mental health system. Notably, the creation of an enabling context is crucial. If Fiji acts upon the findings of this evaluation, it has the opportunity to not only develop effective mental health services in Fiji but to be a role model for other countries in how to successfully implement mhGAP.

Alcohol misuse in the UK armed forces is more than double than that of the general population, yet many of those who drink at harmful levels do not seek help. Preliminary research has shown how effective digital technologies can be used as a health intervention.

In a research project titled ‘Information about Drinking in Ex-serving personnel’ (InDEx), researchers and professionals from the University of Liverpool, King’s College London, Alcohol Research UK and Royal British Legion joined together to developed an app, to help people monitor and manage their alcohol consumption.

There has been increasing support for the engagement of people who use mental services in the process of policy improvement. It would seem to make sense that those most directly affected by policy responses should have their views represented. This brings in to question the alternate forms of ‘evidence’ that can be used as part of evidence-based practice.

A recent study, conducted in Australia, has analysed interviews with individuals involved in drug policy discussions.

The aim of the study was to see how the idea of “consumer” is considered in relation to the discussion around the development of ‘evidence-based policy’, as well as question how power may be seen as centred through evidence-based practice, which may be considered conservative in the way it values forms of knowledge.

Participants included policymakers, advocates, non-governmental organisation representatives, consumer representatives, researchers and clinicians.

The authors present their findings in relation to two overarching ideas: Enacting difference, constituting “consumers”, and Difference and resistance.

Enacting difference, constituting “consumers”:

• The drug policy ‘sector’ is viewed as a disjointed collection of different people with different perspectives and distinct interests in the policy process.
• It was almost universally assumed that ‘consumers’ would be less powerful than others engaged in the policy process
• It was clear the development of evidence-based policy privileges the ‘objective’ and ‘rational’ knowledge of clinicians and researchers

Difference and resistance:

• Considered, rational argument and objectivity instead of subjectivity  fit more easily  with  ‘evidence-based policy’
• Lived experience is devalued
• There was a lack of alignment between understanding through lived experience and knowledge through scientific or ‘evidence-based’ definition.

Overall, although there is a move towards service user participation in developing policy, there is clear tension between the concept of ‘evidence base’ and how the process can be made to be inclusive.

Abstract

Background

General practitioners (GPs) play an important role in the physical care of patients with severe mental illness, so our aim was to analyse the relationships between GPs’ sociodemographic status and worked-related variables and their perceptions about mental illness.

Methods

A descriptive, cross-sectional study was conducted in the Clinical Management Unit of Mental Health (CMU-MH) of the Regional Hospital of Malaga (Spain). The eligible population comprised all GPs working in the 13 primary care centres (PCCs) in the hospital’s catchment area during the study period. GPs were interviewed to collect data on their attitudes to and knowledge of mental illness, psychiatry and the local mental health team, as well as their sociodemographic status, professional qualifications and experience. Bivariate analysis was carried out.

Results

145 GPs answered the questionnaire (77%). ANOVA revealed that most of the PCCs with the best relationship with their mental health team and best attitude to mental illness were in the Central Community Mental Health Unit, which operated a collaborative model of care.

Conclusions

These results indicated that GPs who worked more closely with their specialist mental health team had a better perception of their relationship with the mental health centre and less stigmatisation in regard to mental illness.