Humber Teaching NHS Foundation Trust

There is evidence that over one quarter of patients return to National Health Service (NHS) talking therapies (TT) services, and the needs of these patients are poorly understood and catered for. This project investigated the acceptability and effectiveness of delivering cognitive analytic therapy (CAT) for patients with depression returning to a TT service with childhood trauma and associated relational difficulties. A case-controlled pilot study using TT sessional outcome measures. A 16-session CAT was offered to N = 76 patients who had previously received a high-intensity intervention (mainly cognitive-behavioural therapy; CBT) in the same TT service. Dropout rates, recovery rates and when recovery occurred during the CAT treatment episode were calculated. CAT outcomes were compared against the previous treatment episodes (n = 47) and also benchmarked against the evidence base. Patients were followed up after receiving CAT (n = 16) to assess the durability of change. The number then returning to the TT service after receiving CAT was also tracked. The dropout rate for CAT was 16.9% and the reliable recovery rate was 40%. Reliable and/or clinically significant reductions in depression tended to occur during early CAT sessions. At a group level, there were significant reductions in depression during CAT. There was no evidence of relapse at follow-up. The return rate to the service following CAT was 28.94%. CAT appears useful to consider in the offer for patients returning to TT services. Clinical trials now need to focus on the treatment return patient group in TT services across the stepped care model.

Self-harm in adults is a complex and highly prevalent problem. The Relational Approach to Treating Self-Harm (RELATE, ISRCTN code: ISRCTN75661422) trial investigated the feasibility, acceptability and safety of 8-session cognitive analytic therapy (CAT) for self-harm, compared with treatment as usual. This qualitative evaluation explored participants' experiences of study processes and of brief CAT. Semi-structured one-to-one interviews were carried out with N = 24 participants and reflexive thematic analysis explored participants' experiences. Five themes were identified supporting the perceived acceptability of the trial and the therapy. Being responsible to accept uncertainty was the concern prior to and at the start of the CAT and centred on a sense of vulnerability during the therapy itself. Self-acceptance through more understanding and taking ownership illustrated understandings of how CAT worked. Living with urges was seen as the impact of the CAT on impulsivity, and being prepared for the end of treatment was a key factor in the overall view of brief CAT. Brief CAT for self-harm appears acceptable in terms of intervention coherence, self-efficacy and perceived effectiveness. Anticipation of increased vulnerability (i.e., affective attitudes) and the energy required (i.e., burden) in talking through difficulties and trauma suggest a need to manage patient expectations before brief CAT is started.

BackgroundRecognising how human factors shape workplace behaviour and patient safety, as well as appreciating their medicolegal consequences, is essential for the modern medical graduate.This study examines medical students' and resident doctors' practices, attitudes, and experiences in relation to patient safety and human factors. MethodsA national cross-sectional survey of UK medical students and resident doctors was done between April and June 2025.Results were compared with a pilot group of students from underrepresented backgrounds who participated in a tailored human factors and medico-legal workshop. ResultsOf 1,274 survey respondents, 942 (74.0%) were medical students and 332 (26.0%) were resident doctors.Human factors frequently reported were time pressures (57.0%), fatigue (56.2%) and ineffective handover (43.8%).Preparedness to manage human factors (mean 3.2/5) and confidence to speak up (mean 3.2/5) were significantly lower among comprehensive/state-educated respondents (confidence-adjusted odds ratio 0.70, 95% confidence interval 0.57-0.87,vs grammar/private/international schools).Most respondents lacked clear institutional guidance on the legal implications of error (62.2%), and nearly half did not know where to seek support.Workshop participants (n=21) reported higher preparedness to recognise and manage human factors and confidence raising concerns (p<0.001). ConclusionsDespite frequently encountering patient safety related human factors, UK resident doctors and medical students are only moderately prepared and supported to address them.In a healthcare environment with increasing workloads, resource limitations, and errors, greater training and exposure to key concepts is required.Educational interventions could be drawn from other high-reliability organisations such as aviation to reduce the incidence of patient safety and medical errors.

There is currently a dearth of psychological support available to clients who self-harm in the NHS and there is a need to develop brief, targeted interventions to better fill this treatment gap. Cognitive analytic therapy (CAT) is a relational psychotherapy that holds promise for helping people who self-harm. A brief version of CAT has been developed and now requires evaluation. To evaluate the feasibility of evaluating 8-session CAT to adult outpatients accessing community services who self-harm in a subsequent definitive trial. A feasibility randomised controlled trial evaluating 8-session CAT for self-harm in adult outpatients. Participants were randomly allocated (1:1) to brief CAT plus treatment as usual (TAU) or TAU alone. Rater-blind assessments occurred at baseline, 12-weeks and 18-weeks. Pre-specified study progression criteria concerning recruitment (n = 60 recruited over 12 months), retention (92 %), missing data on clinical outcomes (< 7 %) and engagement with therapy (90 % attended ≥ 4 sessions within a 10-week window) were all met. Urges to self-harm and psychological distress declined in the CAT arm and to a greater extent than the TAU arm (self-harm urges: 80 % CI:6.22 -1.68; psychological distress: 80 % CI:5.95, -2.22). The results support the feasibility of evaluating brief CAT for self-harm and so progression to larger-scale definitive efficacy trial is warranted. CAT shows initial promise as a treatment for self-harm in adults but this now requires evaluation within a definitive trial. The trial was pre-registered (21/10/22) on ISRCTN (ISRCTN code: ISRCTN75661422).

Fire and rescue services in England routinely carry out Home Fire Safety Visits which aim to reduce risk of fire, support independent living and improve quality of life. The visits include a person-centred assessment and providing general advice on health-related topics such as preventing falls. To assess the effectiveness and cost-effectiveness of Home Fire Safety Visits (also known as Safe and Well Visits) to reduce falls and improve quality of life in older adults living in the community. We designed a multicentre, randomised controlled trial with economic and qualitative evaluations, involving two fire and rescue services in England, to recruit 1156 community-dwelling adults aged 65 years and over. All participants could continue to access routine care from healthcare professionals and were provided with a falls prevention leaflet as part of the trial. The intervention group were additionally offered a Home Fire Safety Visit. The usual care group were offered a visit after they had completed the trial. Blinding was not possible. Participants were randomised 1 : 1 using a secure web-based system. The primary outcomes were (1) the number of falls per participant and (2) health-related quality of life (EuroQol-5 Dimensions, five-level version) over 12 months from randomisation. Secondary outcomes included fire risk-taking behaviours, loneliness, fear of falling and time to first fall. The planned economic evaluation comprised cost-utility and cost-effectiveness analyses. The qualitative study was designed to examine intervention fidelity and acceptability. It proved impossible to conduct the trial as planned in the current research landscape. We faced significant delays in setting up and starting recruitment, in large part due to this coinciding with the start of the COVID-19 pandemic. Obtaining regulatory approval took longer than anticipated. Additionally, we were unable to access general practitioner registration data to identify participants as planned and so we had to use Consumer Classification Platform data to identify potential households to send study invitations to. This resulted in a less targeted and non-personalised mail-out as this is not patient-level data so the householder names were unavailable. Ultimately, recruitment was much lower than expected. In total, 237 participants were assessed for eligibility and 63 randomised (intervention, n = 32; usual care, n = 31). The Home Fire Safety Visits were delivered as planned to both groups; however, the planned statistical and health economic analyses could not be conducted due to the limited data. Data from the qualitative evaluation indicated the intervention was largely acceptable to staff and service users. Conducting trials in this setting is currently extremely challenging. To facilitate future research, we recommend an urgent review of research governance issues related to the types of personal data that can be accessed and used for research. This review should aim to provide support and avoid creating additional obstacles to research in this area. The evidence for the effectiveness and cost-effectiveness of Home Fire Safety Visits remains inconclusive. Research governance in local authorities needs urgent review. This trial is registered as Current Controlled Trials NCT04717258. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128341) and is published in full in Public Health Research; Vol. 13, No. 7. See the NIHR Funding and Awards website for further award information.

Background and clinical significance: Functional/dissociative seizures (FDSs) in adolescents are paroxysmal events which superficially resemble epileptic seizures or syncope. This study evaluated the effectiveness of brief cognitive analytic therapy (CAT). Case presentation: The patient was a 17-year-old white cisgender male with a diagnosis of non-epileptic attack disorder. The functional/dissociative seizures were treated with 8-session CAT, with follow-up at 5 weeks. Two target problems (TPs) and associated target problem procedures (TPPs) were rated for recognition and revision at each session and at follow-up. An A-B-C-FU single-case experimental evaluation of the TP/TPPs was conducted. Nomothetic outcome measures (DES-2 and RCADS) were administered at session 1, session 8, and at follow-up, and the YP-CORE and the Session Rating Scale were completed at each session. The patient was independently interviewed using the Change Interview 13 weeks after completing therapy. The results show that CAT effectively increased the recognition and revision of TPs/TPPs, four specific changes occurred (including cessation of functional seizures). There were pre-post reliable and clinically significant improvements to psychological wellbeing, but these were not maintained at follow-up. Conclusions: This study indicates that CAT was a partially effective intervention. The use of CAT as a treatment for FND in adolescents holds promise, but more research is needed.