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Background: Caregivers of children with asthma are at higher risk of experiencing mental health difficulties and lower quality of life than caregivers of healthy children. Mentalizing is a psychological construct that defines the ability of understanding one’s own and others’ states of mind. Poor levels of mentalizing are strongly associated with a wide range of mental health difficulties such as depression, anxiety or emotional dysregulation. This cross-sectional study is the first to examine the associations between mentalizing and mental health in a sample of caregivers of children with asthma. Method: Caregivers of children (mean age=6.53, SD=3.72, ages 1 to 17) with asthma were recruited from social media support groups and the Asthma UK charity research bulletin. Participants completed self report measures of mentalizing, family functioning, mood and anxiety difficulties. Results: A total of 88 caregivers completed the full survey. Results indicated that poorer mentalizing capacity was significantly associated with poorer family functioning and increased mood and anxiety symptomatology. Poor mentalizing was significantly associated with increased levels of depression, hypomania and anxiety, explaining 16% of variance in depression and 10% of variance in anxiety. Family functioning was not a significant predictor after controlling for the effect of mentalizing. Conclusions: These findings suggest that mentalizing capacity might be a valued new treatment target to improve the mental health of caregivers of children with asthma. The results suggest that mentalizing could complement previously identified factors such as family functioning or asthma symptom severity in understanding caregivers’ mental health. Further investigation into the role of mentalizing in the mental health of this population is warranted.

Purpose: This study reviewed the evidence base status of Mentalisation Based Treatment (MBT), its quality, strengths and limitations. The aim was to pave the way for further MBT research. Method: An electronic database and reference lists search identified MBT outcome papers and these were systematically reviewed. The quality of the studies and the risk of bias were determined using two validated checklist tools. Results: Twenty-three studies were included in the review. This included nine randomised controlled trials, seven uncontrolled pre-post effectiveness studies, three retrospective cohort studies, two uncontrolled randomised trials and two case studies. The methodological quality of almost half of the papers was assessed as fair (43%), followed by good (34%) poor (17%) and excellent (4%) ratings. Nevertheless, the review identified risk of confounding bias across the majority of studies (60%) and fidelity to treatment was poorly reported in almost half of the studies (47%). Most of the studies focused on Borderline Personality Disorder (BPD), showing positive clinical outcomes for this population but the evidence base for other presentations was still developing. The treatment of adolescents who self-harm and at-risk mothers in substance abuse treatment showed particularly promising results, as these are client groups that have previously shown limited positive response to psychological interventions. Conclusions: MBT is a potentially effective method across a wide range of clinical presentations but further research should focus on increasing the quality and the quantity of the MBT evidence outside the treatment of BPD.

Background: Emerging evidence indicates effectiveness of dialectical behaviour therapy (DBT) for people with intellectual disabilities (PWID) in forensic settings; however, little is known about “what works” facilitating engagement and change. Methods: Eleven interviews were conducted with nine service users across two secure inpatient services. Grounded theory was used to develop a model of perceived engagement and change. Results: The model provides insights into how change occurs during DBT delivered in forensic settings. DBT constitutes a challenging journey, yet provides the motivation and means to address individual's intra-/interpersonal aggression and progress towards release. Participants experienced engaging with DBT as difficult and coercive, moving from compliance and avoidance to acceptance and change. Key factors included participants’ motivation, beliefs about safety and ability to change, and interactions with staff. Conclusion: Recommendations are made for increasing intrinsic motivation, reducing perceived coercion and distress, and for future research to address potential aversive elements and enhance effectiveness.

Background: Emerging evidence indicates effectiveness of dialectical behaviour therapy (DBT) for people with intellectual disabilities (PWID) in forensic settings; however, little is known about “what works” facilitating engagement and change. Methods: Eleven interviews were conducted with nine service users across two secure inpatient services. Grounded theory was used to develop a model of perceived engagement and change. Results: The model provides insights into how change occurs during DBT delivered in forensic settings. DBT constitutes a challenging journey, yet provides the motivation and means to address individual's intra-/interpersonal aggression and progress towards release. Participants experienced engaging with DBT as difficult and coercive, moving from compliance and avoidance to acceptance and change. Key factors included participants’ motivation, beliefs about safety and ability to change, and interactions with staff. Conclusion: Recommendations are made for increasing intrinsic motivation, reducing perceived coercion and distress, and for future research to address potential aversive elements and enhance effectiveness.

Purpose: This study reviewed the evidence base status of Mentalisation Based Treatment (MBT), its quality, strengths and limitations. The aim was to pave the way for further MBT research. Method: An electronic database and reference lists search identified MBT outcome papers and these were systematically reviewed. The quality of the studies and the risk of bias were determined using two validated checklist tools. Results: Twenty-three studies were included in the review. This included nine randomised controlled trials, seven uncontrolled pre-post effectiveness studies, three retrospective cohort studies, two uncontrolled randomised trials and two case studies. The methodological quality of almost half of the papers was assessed as fair (43%), followed by good (34%) poor (17%) and excellent (4%) ratings. Nevertheless, the review identified risk of confounding bias across the majority of studies (60%) and fidelity to treatment was poorly reported in almost half of the studies (47%). Most of the studies focused on Borderline Personality Disorder (BPD), showing positive clinical outcomes for this population but the evidence base for other presentations was still developing. The treatment of adolescents who self-harm and at-risk mothers in substance abuse treatment showed particularly promising results, as these are client groups that have previously shown limited positive response to psychological interventions. Conclusions: MBT is a potentially effective method across a wide range of clinical presentations but further research should focus on increasing the quality and the quantity of the MBT evidence outside the treatment of BPD.

This systemic review investigates the current evidence for the effectiveness of anger and/or aggression interventions for people with intellectual disabilities (ID) in receipt of forensic mental health services. Due to the prevalence within this population of difficulties with anger and aggression, and the associated substantial individual and societal consequences, the provision of psychological interventions has become increasingly common. However, no critical synthesis of the empirical evidence relating to their effectiveness has previously been conducted. Sixteen peerreviewed controlled trials or case series designs published between 2001 and 2016 met the inclusion criteria. The results highlight an emerging evidence base for the use of CBT in improving anger regulation, and for a range of psychological therapies in reducing aggressive behaviour. However, consistent methodological shortcomings limit the generalisability of findings and currently preclude firm conclusions on effectiveness. Recommendations are made for future research to address these shortcomings, including clearly-defined adaptations, adequately powered sample sizes, carefully designed baselines and follow-up periods. Despite the current status of evidence, the review provides an accessible and objective foundation to inform decision-making by service commissioners and clinicians providing anger and aggression interventions to people with ID.

Difficulties with emotion regulation are reported as commonly experienced by people with intellectual disabilities (PWID). These difficulties can lead to the involvement of PWID with forensic services, and the requirement for them to undertake psychological therapies aimed at improving their regulation of emotion. This thesis firstly provides a critical review of the quantitative evidence for the effectiveness of interventions addressing the most prevalent form of emotion dysregulation for PWID in community-based and inpatient forensic services: anger and outwardly-directed aggression. Sixteen studies met the inclusion criteria and offered promising evidence for the effectiveness of a range of psychological approaches in improving anger and reducing aggression. However, firm conclusions and generalisability of findings were precluded due to the pervasive methodological shortcomings across studies, and accordingly, recommendations for future research and service providers were made. Second, this thesis empirically explores the process of engagement and perceived change for PWID in forensic services attending dialectical behaviour therapy (DBT). The perspectives on “what works” in DBT are gathered via interviews with nine participants and analysed using a constructivist grounded theory-informed methodology. The resultant model highlighted a temporal process within which participants encounter a difficult and coercive journey from compliance and avoidance, to acceptance and integration of change. The model was discussed in relation to current theory on the process of change, and clinical implications were made in respect of improving the support provided to PWID attending DBT in forensic settings. Future research is encouraged to explore and address perceived coercion and aversive elements within psychological interventions for PWID, to enhance treatment experience, effectiveness and evaluation. Finally, reflections were offered in the critical appraisal section of thi

This report is the work of the Birmingham Undergraduate Internship Programme (BUIP) Intern in Library Services during the summer of 2019. This report seeks to explore the experience of postgraduate researchers at the University of Birmingham.

Presentation from the UXLibs V conference (2019): What are the benefits of allowing students to lead your UX research, and how can they contribute to your understanding of the lived experience of your users? Our intern took control of a cultural probe into the PGT experience at Birmingham, which also investigated and analysed various UX techniques.

Difficulties with emotion regulation are reported as commonly experienced by people with intellectual disabilities (PWID). These difficulties can lead to the involvement of PWID with forensic services, and the requirement for them to undertake psychological therapies aimed at improving their regulation of emotion. This thesis firstly provides a critical review of the quantitative evidence for the effectiveness of interventions addressing the most prevalent form of emotion dysregulation for PWID in community-based and inpatient forensic services: anger and outwardly-directed aggression. Sixteen studies met the inclusion criteria and offered promising evidence for the effectiveness of a range of psychological approaches in improving anger and reducing aggression. However, firm conclusions and generalisability of findings were precluded due to the pervasive methodological shortcomings across studies, and accordingly, recommendations for future research and service providers were made. Second, this thesis empirically explores the process of engagement and perceived change for PWID in forensic services attending dialectical behaviour therapy (DBT). The perspectives on “what works” in DBT are gathered via interviews with nine participants and analysed using a constructivist grounded theory-informed methodology. The resultant model highlighted a temporal process within which participants encounter a difficult and coercive journey from compliance and avoidance, to acceptance and integration of change. The model was discussed in relation to current theory on the process of change, and clinical implications were made in respect of improving the support provided to PWID attending DBT in forensic settings. Future research is encouraged to explore and address perceived coercion and aversive elements within psychological interventions for PWID, to enhance treatment experience, effectiveness and evaluation. Finally, reflections were offered in the critical appraisal section of thi