The role of social problem solving in improving social functioning in therapy for adults with personality disorder

2008 ◽  
Vol 2 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Mary McMurran ◽  
Nick Huband ◽  
Conor Duggan
2007 ◽  
Vol 190 (4) ◽  
pp. 283-284 ◽  
Author(s):  
M. J. Crawford

SummaryResearch evidence is beginning to emerge that social problem-solving can improve the social functioning of people with personality disorder. This approach is particularly important because it may be relatively easy to train healthcare workers to deliver this intervention. However, the costs and cost-effectiveness of social problem-solving need to be established if it is to be made more widely available.


2016 ◽  
Vol 20 (52) ◽  
pp. 1-250 ◽  
Author(s):  
Mary McMurran ◽  
Mike J Crawford ◽  
Joe Reilly ◽  
Juan Delport ◽  
Paul McCrone ◽  
...  

BackgroundIf effective, less intensive treatments for people with personality disorder have the potential to serve more people.ObjectivesTo compare the clinical effectiveness and cost-effectiveness of psychoeducation with problem-solving (PEPS) therapy plus usual treatment against usual treatment alone in improving social problem-solving with adults with personality disorder.DesignMultisite two-arm, parallel-group, pragmatic randomised controlled superiority trial.SettingCommunity mental health services in three NHS trusts in England and Wales.ParticipantsCommunity-dwelling adults with any personality disorder recruited from community mental health services.InterventionsUp to four individual sessions of psychoeducation, a collaborative dialogue about personality disorder, followed by 12 group sessions of problem-solving therapy to help participants learn a process for solving interpersonal problems.Main outcome measuresThe primary outcome was measured by the Social Functioning Questionnaire (SFQ). Secondary outcomes were service use (general practitioner records), mood (measured via the Hospital Anxiety and Depression Scale) and client-specified three main problems rated by severity. We studied the mechanism of change using the Social Problem-Solving Inventory. Costs were identified using the Client Service Receipt Inventory and quality of life was identified by the European Quality of Life-5 Dimensions questionnaire. Research assistants blinded to treatment allocation collected follow-up information.ResultsThere were 739 people referred for the trial and 444 were eligible. More adverse events in the PEPS arm led to a halt to recruitment after 306 people were randomised (90% of planned sample size); 154 participants received PEPS and 152 received usual treatment. The mean age was 38 years and 67% were women. Follow-up at 72 weeks after randomisation was completed for 62% of participants in the usual-treatment arm and 73% in the PEPS arm. Intention-to-treat analyses compared individuals as randomised, regardless of treatment received or availability of 72-week follow-up SFQ data. Median attendance at psychoeducation sessions was approximately 90% and for problem-solving sessions was approximately 50%. PEPS therapy plus usual treatment was no more effective than usual treatment alone for the primary outcome [adjusted difference in means for SFQ –0.73 points, 95% confidence interval (CI) –1.83 to 0.38 points;p = 0.19], any of the secondary outcomes or social problem-solving. Over the follow-up, PEPS costs were, on average, £182 less than for usual treatment. It also resulted in 0.0148 more quality-adjusted life-years. Neither difference was statistically significant. At the National Institute for Health and Care Excellence thresholds, the intervention had a 64% likelihood of being the more cost-effective option. More adverse events, mainly incidents of self-harm, occurred in the PEPS arm, but the difference was not significant (adjusted incidence rate ratio 1.24, 95% CI 0.93 to 1.64).LimitationsThere was possible bias in adverse event recording because of dependence on self-disclosure or reporting by the clinical team. Non-completion of problem-solving sessions and non-standardisation of usual treatment were limitations.ConclusionsWe found no evidence to support the use of PEPS therapy alongside standard care for improving social functioning of adults with personality disorder living in the community.Future workWe aim to investigate adverse events by accessing centrally held NHS data on deaths and hospitalisation for all PEPS trial participants.Trial registrationCurrent Controlled Trials ISRCTN70660936.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 52. See the NIHR Journals Library website for further project information.


2007 ◽  
Vol 190 (4) ◽  
pp. 307-313 ◽  
Author(s):  
Nick Huband ◽  
Mary McMurran ◽  
Chris Evans ◽  
Conor Duggan

BackgroundSocial problem-solving therapy may be relevant in the treatment of personality disorder, although assessments of its effectiveness are uncommon.AimsTo determine the effectiveness of a problem-solving intervention for adults with personality disorder in the community under conditions resembling routine clinical practice.MethodParticipants were randomly allocated to brief psychoeducation plus 16 problem-solving group sessions (n=87) or to waiting-list control (n=89). Primary outcome was comparison of scores on the Social Problem Solving Inventory and the Social Functioning Questionnaire between intervention and control arms at the conclusion of treatment, on average at 24 weeks after randomisation.ResultsIn intention-to-treat analysis, those allocated to intervention showed significantly better problem-solving skills (P < 0.001), higher overall social functioning (P=0.031) and lower anger expression (P=0.039) compared with controls. No significant differences were found on use of services during the intervention period.ConclusionsProblem-solving plus psychoeducation has potential as a preliminary intervention for adults with personality disorder.


2020 ◽  
Vol 21 (8) ◽  
pp. 1104-1113
Author(s):  
Emily E. Tanner-Smith ◽  
Lindsey M. Nichols ◽  
Christopher M. Loan ◽  
Andrew J. Finch ◽  
D. Paul Moberg

Author(s):  
John S. Dryzek

This chapter examines administrative rationalism, a discourse of environmental problem solving which captures the dominant governmental response to the onset of environmental crisis. Administrative rationalism emphasizes the role of the expert rather than the citizen or producer/consumer in social problem solving, and which stresses social relationships of hierarchy rather than equality or competition. The chapter first considers the manifestations of administrative rationalism in various institutions and practices, including environmental impact assessment, planning, and rationalistic policy analysis techniques, before discussing the discourse analysis of administrative rationalism. It then explains the justification of administrative rationalism and problems of administrative rationalism, caused in part by its association with bureaucracy. It also explores the implications of the transition from government to governance for administrative rationalism.


Author(s):  
Khadijeh Abolmaali Al-Husseini ◽  
Fazeleh Mirghafoorian ◽  
Sara Razian

The aim of this study was to provide a structural model for explaining social problem solving skill in teachers based on organizational culture and religious orientation with the mediating role of intellectual property. The research method was of correlation type. The statistical population of the study was the teachers employed in the academic year 2017-2018 in two regions 1 and 6 of Tehran province. The statistical sample included 250 male and female teachers who were selected by the cluster random sampling method. For data collection, 4 questionnaires of social problem solving skill (De Zorilla et al., 2002), religious orientation (Bahrami, 2001), intellectual property questionnaire (Bonitz (1998), and organizational culture questionnaire with the Islamic approach of Attaran et al. (2017) were used. Data were collected using structural equation modeling (SEM) and analyzed at two levels of descriptive statistics and inferential level using AMOS and SPSS-22 software. The results showed that effective religious orientation predicts the adaptive skills of social problem solving in a positive and meaningful way and also intellectual property predicts adaptive skills of social problem solving in a positive and meaningful way in teachers. On the other hand, the findings indicated that intellectual property mediates the relationship between organizational culture and adaptive problem solving skills in a positive and meaningful way. But intellectual property does not significantly mediate the relationship between effective religious orientation and maladaptive social problem-solving skills. According to the research results, adaptive social problem solving skills of teachers are predicted based on organizational culture and religious orientation mediated by intellectual property.


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