Social Problem Solving Therapy

Aim of the day

► To produce an action plan aimed at consolidating social problem solving therapy as one of the Trust’s core therapies, with the view to achieving a sound base of practical skills that will permit research into the effectiveness of social problem solving therapy ► Principles relate to other therapies, not only social problem solving therapy

Programme

Social problem solving – Past, present and future Professor Mary McMurran Division of Psychiatry, University of Nottingham New roles and new ways of working in mental health: The challenge for education Professor Ian Baguley Director, Centre for Clinical and Academic Workforce Innovation, University of Lincoln To accredit or not to accredit? That is the question Mr Lawrence Whyte Workforce Development Dept, Nottinghamshire Healthcare NHS Trust Supporting applied clinical research in NHS therapies: Towards practice based evidence Professor Chris Evans Research Programmes Director, Nottinghamshire Healthcare NHS Trust Looking backwards in order to move forwards Professor Conor Duggan Chair of the Personality Disorder Institute, Division of Psychiatry & Nottinghamshire Healthcare NHS Trust

Social problem solving: Past, present and future

Mary McMurran University of Nottingham

Plan

► Developments of social problem solving theory and therapy in East Midlands since mid 1990s ► A collaboration between Nottinghamshire Healthcare NHS Trust and University of Nottingham ► How research and practice need to develop in partnership

ESRC Research Seminar Group

► ► Seminar Groups   multi-institutional academic researchers  postgraduate students  non-academic users Meet regularly to exchange information and ideas with the aim of advancing research within their fields

Social problem solving and personality disorder ► ► ► 2004 -2006 Award = £11,974  Meeting costs   Speakers’ costs Organisers’ costs Events  Research meetings  Conference   Training event Today’s event

Seminar Groups

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Academics

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Psychology, Psychiatry, Sociology

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Cardiff University, University of Nottingham, University of Wales Institute Cardiff, University of Sheffield, University of Liverpool, Drexel University Philadelphia

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Practitioners

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Psychologists, Psychiatrists, Nurses, OTs, Social Workers, Probation Officers

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Public and Private Sectors

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Leicestershire, Lincolnshire, Nottinghamshire Qualified, trainees, post-graduates Service User

Past to Present

► Seminars built on a body of local knowledge and experience ► Maintained and developed an interest in the area ► What was that body of local knowledge?

► What is social problem solving therapy?

Social problem solving

► The self-directed cognitive-behavioural process by which a person attempts to identify or discover effective or adaptive solutions for specific problems encountered in everyday living D’Zurilla & Nezu

Social problem solving

► The self-directed cognitive-behavioural affective process es by which a person attempts to identify or discover effective or adaptive solutions for specific problems encountered in everyday living D’Zurilla & Nezu & McMurran

Social problem solving skills

► Ability to recognise emotional cues ► Identify and define a problem ► Specify goal for change ► Generate options to attain goal ► Consequential thinking ► Selection of effective strategies ► Means-end action planning

Social problem solving and social adjustment ► Social problem solving deficits evident in      Aggressive children Suicidal prisoners Depressed people Personality disordered offenders Child sex offenders ► Social problem solving therapy reduces problems in these groups

Social problem solving therapy

► Teach skills of social problem solving  Problem recognition  Problem definition  Goal setting  Option generation  Consequential thinking    Means-end action planning Solution implementation Outcome evaluation

Arnold Lodge, 1995 - 1999

Pilot study

► ► ► ► Trainee psychologist looking for experience in delivering therapies Small scale social problem solving intervention Detained mentally disordered offenders  6 mentally ill + 3 personality disordered Showed pre- to post-intervention improvements on the Social Problem Solving Inventory – Revised (SPSI-R)

Pilot study

► SPSI-R       Positive Problem Orientation (PPO) Negative Problem Orientation (NPO) Rational Problem Solving (RPO) Impulsive/careless style (ICS) Avoidant style (AS) Social problem solving index (SPS)

Developments

► Began to use SPSI-R as part of general assessment of Arnold Lodge patients – database on MDOs ► Personality Disorder Unit (PDU) opened and adopted Social Problem Solving Therapy, Stop & Think!, as a core part of treatment

Arnold Lodge & Cardiff University, 2000-2005

Finding #1

► Personality disordered offenders are poorer at social problem solving, as measured by the SPSI-R, than prisoners and mature students.

Population comparisons

PPO NPO RPS ICS AS SPS PD (N=42) Prisoners (N=39) Mature students (N=70) ▼ ▼ ▼ ▼ ▼ ▼ ▼

Finding #2

► Personality traits are associated with social problem solving skills

Traits

► Mentally disordered offenders ► N=52; 38 MI and 14 PD ► Big Five      Neuroticism Extraversion Openness Agreeableness Conscientiousness

Traits

► High N associated with poor social problem solving in MDOs      Less positive More negative Less rational More impulsive/careless More avoidant

Impulsivity

► Studies with students   Impulsiveness (BIS) Social Problem Solving (SPSI-R)  Aggression (AQ)

Impulsivity

Impulsivity

Aggression

Impulsivity

Impulsivity Social problem solving Aggression

Finding #3

► Social problem solving therapy improves social problem solving, as measured by SPSI-R scores

Social Problem Solving Therapy

► PD Offenders 15 14 SPS score 13 12 11 10 Baseline 9m 15m 21m (N=42) (N=26) (N=15) (N=11)

SPS Conference, Nottingham 2001 ► ► ► ► ► ► James McGuire, University of Liverpool Liisa Keltikangas-Järvinen, University of Helsinki Steve Fyffe, Arnold Lodge PDU Linda Blud & Rosie Travers, HM Prison Service Debbie Fleck, Hutton Centre RSU Fiona Biggam, Glasgow Caledonian University ► Special issue of Criminal Behaviour & Mental Health, 2001, Vol. 11, No. 4 .

Book

► McMurran, M. & McGuire, J. (Eds) (2005). Social problem solving and offending: Evidence, evaluation and evolution.

Chichester: Wiley.

Contributors

Fiona Biggam Conor Duggan Vince Egan Theresa Gannon James McGuire Kevin Power

Contributors

Liisa Keltikangas-Järvinen Walter Matthys Friedrich Lösel Andreas Beelmann

Contributors

Robin Harvey Tony Ward Devon Polaschek

Contributors

Dan Antonowicz Shelley Brown Robert Ross Ralph Serin Laura Dreer Tom D’Zurilla Tim Elliott Warren Jackson John Lochman Christine Maguth Nezu Arthur M Nezu

Nottingham, 2006

Landscaped project

► Nick Huband et al. (2006) B J Psychiatry ► Randomised controlled treatment trial ► Stop & Think! + psychoeducation ► Community adults with PD ► Improved social problem solving (SPSI-R) ► Improved social functioning (SFQ)

Personality disorders & SPSI-R

Cluster A Paranoid Schizoid Cluster B Schizotypal Antisocial Borderline Histrionic Narcissistic Cluster C Avoidant Dependent Obsess/Comp SPSI-R predictors None None None None ↑ Impulsive ↓ Avoidant ↑ Impulsive ↑ Impulsive ↑ Positive ↓ Impulsive ↑ Negative ↑ Negative None

Problem solving model of personality disorder

Traits e.g., High N; impulsivity Poor social problem solving Dysfunction, e.g., Poor interpersonal skills; poor coping

Problem solving model of personality disorder

Traits e.g., High N; impulsivity Information processing biases Poor social problem solving Dysfunction, e.g., Poor interpersonal skills; poor coping

Problem solving model of personality disorder

Traits e.g., High N; impulsivity Information processing biases Maladaptive schemas Poor social problem solving Dysfunction, e.g., Poor interpersonal skills; poor coping

Problem solving model of personality disorder

Traits e.g., High N; impulsivity Information processing biases Maladaptive schemas Poor social problem solving Substance use Distress Dysfunction, e.g., Poor interpersonal skills; poor coping

A testable model

► Testable by whom?

► A glimpse of the future

SPS Conference, Nottingham 2006 Art Nezu, USA James McGuire, UK Chris Nezu, USA

Future

Drexel University, USA University of Liverpool University of Nottingham

Future

Drexel University, USA University of Liverpool University of Nottingham Nottinghamshire Healthcare NHS Trust

Future

Drexel University, USA University of Liverpool University of Nottingham Nottinghamshire Healthcare NHS Trust Personality Disorder Institute Nottingham Institute of Mental Health

Acknowledgements

► Research colleagues          Professor Conor Duggan Dr Nick Huband Professor Vince Egan Dr Jo Sellen Dr Lucy McCarthy Dr Shahla Ahmadi Dr Cathryn Richardson Dr Marie Blair Dr Gary Christopher ► ► Practitioner colleagues     Cathy Wray Steve Fyffe Andy Latham Claudia Gerald Funders  NHS National Programme on Forensic Mental Health R&D  Home Office