Purpose This study aims to conduct an extended evaluation of the emotional resources group (ERG), a brief emotion regulation group intervention routinely delivered in a secondary care adult mental health setting in NHS Scotland. Design/methodology/approach The service evaluation used a within-subjects repeated measures design to assess change in emotional regulation, self-efficacy, well-being and functioning for those who attended the ERG. Findings Analysis of those who completed the programme found highly statistically significant improvements in measures of emotion regulation, self-efficacy, well-being and functioning. Large effect sizes were observed on all measures other than functioning, which was moderate to large. Analysis of a conservative intent to treat sample mirrored these findings with highly significant improvements on all measures. Moderate to large effect sizes were also observed on all measures other than functioning, which was moderate. In addition, good rates of reliable and clinically significant change were found for the primary measure of emotional regulation across both completers and the intent to treat sample. In addition, good rates of reliable and clinically significant change were found for the primary measure of emotional regulation across both completers and the intent to treat sample. Originality/value This evaluation builds on previous research by extending the evidence of ERG’s effectiveness in an extended real-world NHS clinical setting. It establishes the credibility and acceptability of the intervention in secondary care outpatient adult mental health service settings.

Purpose The primary objective of this study was to investigate the effects of 10-Hz binaural beat synchronization on cognitive flexibility and working memory in patients diagnosed with major depressive disorder (MDD). Cognitive impairments, particularly in working memory and cognitive flexibility, are significant challenges in MDD and affecting daily functioning and quality of life. This study aims to explore whether binaural beats could serve as a noninvasive, cost-effective intervention to address these deficits. Design/methodology/approach This quasi-experimental study included 60 patients diagnosed with MDD who were randomly assigned to either an intervention group exposed to 10-Hz alpha wave binaural beats or a control group listening to neutral sounds. The intervention consisted of daily 20-min sessions over four weeks. Cognitive flexibility was assessed using the Wisconsin Card Sorting Test (WCST), and working memory was evaluated using the N-back test. Data were analyzed using multivariate analysis of covariance with SPSS version 24, controlling for covariates such as age, gender and education level. Findings The results revealed that exposure to 10-Hz binaural beats significantly improved both cognitive flexibility and working memory in the intervention group compared to the control group (p < 0.05). Specifically, significant enhancements were observed in metrics such as total errors, residual errors and response times in the WCST, as well as in accuracy and processing speed in the N-back test. These findings suggest that binaural beats can effectively enhance executive function in MDD patients. Originality/value This study introduces a novel application of 10-Hz alpha wave binaural beats as a nonpharmacological intervention for addressing cognitive deficits in MDD. By demonstrating the potential of binaural beats in improving cognitive flexibility and working memory, this research highlights a promising adjunct to traditional treatments, offering practical implications for clinical practice and mental health rehabilitation.

PurposeThis discursive paper considers the use of restrictive practices in mental health inpatient settings and how these are often prioritised over relational approaches, especially where the diagnostic label of personality disorder intersects with risk.Design/methodology/approachKey concepts from Orwell’s 1984 are studied for their pertinence to mental health inpatient settings, supporting our argument that restrictive practices arise from dichotomous thinking and externalised fears.FindingsDrawing upon Orwellian themes of power, social control and digital surveillance from 1984, the authors highlight the role of fear in perpetuating restrictive practices under a guise of benevolent care in mental health inpatient settings, especially for those who are diagnosed with a personality disorder. A lack of preparedness to work with complexity in such environments, coupled with a deficit in self-reflexivity and critical thinking, can exacerbate challenges.Research limitations/implicationsTo transcend damaging dichotomies and reduce restrictive practices in inpatient settings, the authors make the argument for the adequate preparation and education of the mental health nurse and authentic, collaborative, user-involved care.Originality/valueThe authors use Orwell’s novel to support a critical discourse around those damaging dichotomies and inherent contradictions that contribute to restrictive practice in contemporary mental health settings and to question whose interests’ these restrictive practices serve.

PurposeMental health staff often experience significant levels of stress working in the acute psychiatric inpatient setting. Team-building interventions can mitigate stress in health-care settings, via improvements in team-cohesion, staff interactions and communication skills. The “Tree of Life” (ToL) is a specific narrative therapy approach which uses the metaphor of a tree to facilitate the construction and sharing of strength-based stories. This study aims to describe the development of and evaluate the feasibility, acceptability and staff experiences of the “Team Tree”, an adapted Professional ToL (PToL) intervention.Design/methodology/approachA one-hour, Professional ToL intervention was designed for multidisciplinary acute inpatient staff teams working within a psychiatric hospital in London, UK. A mixed methods approach was used to evaluate the feasibility, acceptability and staff experiences of the session.FindingsParticipants were 46 multidisciplinary staff (33 women; 13 men) working across four acute psychiatric wards. The intervention was feasible to deliver and was acceptable to participants. Results showed significant improvements in self-reported mental well-being and team-cohesiveness scores post-session.Practical implicationsPsychologists face myriad barriers in working with staff teams in the acute inpatient setting. The “Team Tree” intervention was both well received by staff and practical to deliver within the challenging environment of the acute ward.Originality/valueThis adaptation of the original PToL emerged from the author’s work with distressed inpatient teams with limited time resources. To the best of the authors’ knowledge, this is the first description of this intervention using a single tree metaphor to facilitate a reflective and creative session with health-care teams.

PurposeThe transtheoretical model (TTM) has been applied to varying areas of physical health, e.g. diabetes. However, research into its applicability to psychotherapy is mixed. The TTM is applied through the University of Rhode Island Change Assessment (URICA). Investigating the utility of the URICA is needed to improve patient care and outcomes. This study aims to assess whether the URICA scores relate to patient outcomes; patient attendance; practitioner ratings of patient readiness, appropriateness, insight, motivation and potential for improvement; and to explore practitioner’s perspectives on the URICA.Design/methodology/approachCorrelational methods were used to assess the relationship between the URICA and therapeutic outcome, attendance and practitioner-rated areas. Content analysis was used to analyse practitioner qualitative data.FindingsThe URICA did not correlate with either therapeutic outcome or attendance. A significant negative correlation was found between the URICA and practitioner-rated appropriateness of the referral. This means practitioners perceived individuals with lower URICA scores to be a more appropriate referral, despite the score indicating a reduced readiness to change. Qualitative categories included positive views, negative views, ambivalence and changes to measure and process. To conclude, the URICA does not explain a patient’s outcome or attendance. The URICA may not be appropriate to use in its current format in mental health services; therefore, assessing the TTM verbally may be more helpful.Originality/valueThis study provides research into suitability of using the URICA to assess the TTM and its applicability to attendance and outcome in psychological therapies.

PurposeAttention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental condition with community prevalence globally of 2%–7% (M = 5%; Sayal et al., 2018). Clinicians are routinely encouraged to explain to children and young people the benefits of a healthy lifestyle, including exercise (NICE NG87, 2018). Exercise has been proposed as a safe and low-cost adjunctive approach for ADHD and is reported to be accompanied by positive effects on several aspects of executive functioning (EF). The purpose of this narrative review was to synthesise the contemporary randomised control trial (RCT) studies that examine the effect of sport, physical activity and movement on EF in children and adolescents with ADHD.Design/methodology/approachA narrative review approach with a systematic literature search using PRISMA guidelines for screening and selecting relevant systematic reviews was used. The final review included four peer-review systematic reviews (>2019).FindingsThe results identified four RCT meta-analyses and findings showed that children and adolescents with lower baseline cognitive performance demonstrated greater improvements in functioning after physical activity interventions, particularly for tasks with higher executive function demands, where baseline performance reaches an optimal level. Findings suggest that 10–20 min of acute moderate-high-intensity exercise interventions (cycling/running) appeared to have positive effects on indices of inhibitory control. Preliminary evidence suggests that as little as 5 min of jumping exercises improved inhibitory control. Sixty to eighty minutes of moderately intense, repeated (chronic) exercise appeared to demonstrate the greatest beneficial impact on selective attention.Originality/valueTo the best of the authors’ knowledge, this review is the first to present the extant literature on the effect of physical activity and sport on symptoms of young people with ADHD. It presents evidence to suggest that exercise with progressively increasing cognitive demands may have positive effects for children with ADHD, specifically in terms of improving cognitive flexibility. Further large-scale clinical trials are needed to confirm the positive effects of physical exercise on cognitive functioning in children with ADHD.

Researching the stigma associated with less common mental health conditions: an update from the Time to Change campaign

Purpose The purpose of this study is to explore mental health difficulties, including risk and protective factors, which may impact on symptom severity after exposure to crisis situations (war, terrorism and/or natural disasters), among first responders from uniformed services. Design/methodology/approach Peer-reviewed journal articles published in English between January 2012 and March 2022 were searched in ProQuest, Wiley, Google Scholar and PubMed databases. In total, 12 articles were obtained from an original screening of 94,058 articles. Full article texts were screened for content and quality by two reviewers, with high agreeability. Findings Post-traumatic stress disorder and depression were the most common diagnoses. Risk factors identified were pre-deployment factors of overweight, low cognitive ability and social support, existing emotional difficulties, negative childhood experiences and stressful life events; during crisis situations factors of higher frequency and subjective severity of combat, increased rates of combat stress reaction, high levels of concerns for life and family, more stressful mission position, threat of death/severe injury and high rate of killing the enemy; and post-deployment factors, such as low social support and physical health, lack of coping mechanisms and use of avoidance strategies and social stigma. Protective factors increasing resilience and lessening symptom severity were reported as pre-deployment cognitive ability, high social support, stable physical health, effective coping, post-traumatic growth and high levels of perceived adequacy in pre-deployment preparation and training. In addition to main findings, data about author(s), publication type, population, age, type of crisis and evaluation measures were extracted. Key findings and related theories, gaps in literature and recommendations are discussed. Originality/value As yet, however, research into the factors that could serve as risk and/or protective factors are not clearly indicated in terms of post-crisis recovery. As per the authors’ knowledge, this study is an initial approach to considering this area.

Purpose Despite government and national health service demands for equality within mental health (MH) services, racial inequalities remain. South Asian (SA) women underutilise MH services, yet research regarding their experiences and the cultural sensitivity (CS) of services is sparse. The purpose of this study was to explore the experiences of SA women who have used MH services and the cultural sensitivity of the latter. Design/methodology/approach Thematic analysis was used for data analysis of semi-structured interviews carried out with 16 SA women. Findings Analysis yielded an overarching theme of “degree of understanding” and three main themes: “shared background and understanding” “humanity” and “cultural factors” and their subsequent subthemes. Results demonstrated mixed experiences, illustrating varied levels of CS and the impacts of this upon experiences. Cultural understanding underpins CS: participants’ experiences demonstrated the benefit of significant understanding and the detriment of limited understanding. Research limitations/implications All participants were well educated, English-speaking and from psychology, health or research backgrounds. SA culture is nuanced; thus, the demographic of “South Asian” could be too broad. However, because current understanding is limited, this research provides fundamental empirical knowledge. Practical implications Clear recommendations were co-produced with participants, highlighting strong impacts for service development and best practice. Social implications The research provides valuable insight into SA women’s experiences of MH services and wider understanding of CS. This raises cultural awareness in a field lacking understanding. Findings and recommendations can, therefore, provide foundational knowledge for broader societal issues experienced by people from this demographic and challenge preconceptions. Originality/value This research offers unique recommendations for more culturally sensitive practice, co-produced with participants.