Social Problem Social Problem Solving TherapySolving Therapy

Aim of the dayAim of the day

►To produce an action plan aimed at To produce an action plan aimed at consolidating social problem solving consolidating social problem solving therapy as one of the Trust’s core therapy as one of the Trust’s core therapies, with the view to achieving a therapies, with the view to achieving a sound base of practical skills that will sound base of practical skills that will permit research into the effectiveness permit research into the effectiveness of social problem solving therapyof social problem solving therapy

►Principles relate to other therapies, not Principles relate to other therapies, not only social problem solving therapyonly social problem solving therapy

ProgrammeProgrammeSocial problem solving – Past, present and futureSocial problem solving – Past, present and futureProfessor Mary McMurranProfessor Mary McMurranDivision of Psychiatry, University of NottinghamDivision of Psychiatry, University of Nottingham

New roles and new ways of working in mental health: The challenge for educationNew roles and new ways of working in mental health: The challenge for educationProfessor Ian BaguleyProfessor Ian BaguleyDirector, Centre for Clinical and Academic Workforce Innovation, University of Director, Centre for Clinical and Academic Workforce Innovation, University of

LincolnLincoln

To accredit or not to accredit?  That is the questionTo accredit or not to accredit?  That is the questionMr Lawrence WhyteMr Lawrence WhyteWorkforce Development Dept, Nottinghamshire Healthcare NHS TrustWorkforce Development Dept, Nottinghamshire Healthcare NHS Trust

Supporting applied clinical research in NHS therapies: Towards practice based Supporting applied clinical research in NHS therapies: Towards practice based evidenceevidence

Professor Chris EvansProfessor Chris EvansResearch Programmes Director, Nottinghamshire Healthcare NHS TrustResearch Programmes Director, Nottinghamshire Healthcare NHS Trust

Looking backwards in order to move forwardsLooking backwards in order to move forwardsProfessor Conor DugganProfessor Conor DugganChair of the Personality Disorder Institute, Division of Psychiatry & Chair of the Personality Disorder Institute, Division of Psychiatry &

Nottinghamshire Healthcare NHS TrustNottinghamshire Healthcare NHS Trust

Social problem Social problem solving:solving:

Past, present and Past, present and futurefuture

Mary McMurran Mary McMurran

University of Nottingham University of Nottingham

PlanPlan

►Developments of social problem Developments of social problem solving theory and therapy in East solving theory and therapy in East Midlands since mid 1990sMidlands since mid 1990s

►A collaboration between A collaboration between Nottinghamshire Healthcare NHS Trust Nottinghamshire Healthcare NHS Trust and University of Nottinghamand University of Nottingham

►How research and practice need to How research and practice need to develop in partnershipdevelop in partnership

ESRC Research Seminar ESRC Research Seminar GroupGroup

► Seminar Groups Seminar Groups multi-institutional multi-institutional academic researchersacademic researchers postgraduate students postgraduate students non-academic users non-academic users

► Meet regularly to exchange Meet regularly to exchange information and ideas with the aim information and ideas with the aim of advancing research within their of advancing research within their fieldsfields

Social problem solving and Social problem solving and personality disorderpersonality disorder

► 2004 -20062004 -2006► Award = £11,974 Award = £11,974

Meeting costsMeeting costs Speakers’ costsSpeakers’ costs Organisers’ costsOrganisers’ costs

► EventsEvents Research meetingsResearch meetings ConferenceConference Training eventTraining event Today’s eventToday’s event

Seminar GroupsSeminar Groups

► AcademicsAcademics►Psychology, Psychiatry, SociologyPsychology, Psychiatry, Sociology►Cardiff University, University of Nottingham, Cardiff University, University of Nottingham,

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

► PractitionersPractitioners ►Psychologists, Psychiatrists, Nurses, OTs, Social Psychologists, Psychiatrists, Nurses, OTs, Social

Workers, Probation OfficersWorkers, Probation Officers►Public and Private SectorsPublic and Private Sectors►Leicestershire, Lincolnshire, NottinghamshireLeicestershire, Lincolnshire, Nottinghamshire

► Qualified, trainees, post-graduatesQualified, trainees, post-graduates► Service UserService User

Past to PresentPast to Present

►Seminars built on a body of local Seminars built on a body of local knowledge and experienceknowledge and experience

►Maintained and developed an interest Maintained and developed an interest in the areain the area

►What was that body of local What was that body of local knowledge?knowledge?

►What is social problem solving What is social problem solving therapy?therapy?

Social problem solvingSocial problem solving

►The self-directed cognitive-behavioural The self-directed cognitive-behavioural process by which a person attempts to process by which a person attempts to identify or discover effective or identify or discover effective or adaptive solutions for specific adaptive solutions for specific problems encountered in everyday problems encountered in everyday livingliving

D’Zurilla & NezuD’Zurilla & Nezu

Social problem solvingSocial problem solving

►The self-directed cognitive-The self-directed cognitive-behaviouralbehavioural-affective-affective process processeses by by which a person attempts to identify or which a person attempts to identify or discover effective or adaptive solutions discover effective or adaptive solutions for specific problems encountered in for specific problems encountered in everyday livingeveryday living

D’Zurilla & Nezu D’Zurilla & Nezu & & McMurranMcMurran

Social problem solving skillsSocial problem solving skills

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

Social problem solving and Social problem solving and social adjustmentsocial adjustment

►Social problem solving deficits evident Social problem solving deficits evident in in Aggressive childrenAggressive children Suicidal prisonersSuicidal prisoners Depressed peopleDepressed people Personality disordered offendersPersonality disordered offenders Child sex offendersChild sex offenders

►Social problem solving therapy Social problem solving therapy reduces problems in these groups reduces problems in these groups

Social problem solving Social problem solving therapytherapy

► Teach skills of social problem solvingTeach skills of social problem solving Problem recognitionProblem recognition Problem definitionProblem definition Goal settingGoal setting Option generationOption generation Consequential thinkingConsequential thinking Means-end action planningMeans-end action planning Solution implementationSolution implementation Outcome evaluationOutcome evaluation

Arnold Lodge, 1995 - 1999Arnold Lodge, 1995 - 1999

Pilot studyPilot study

► Trainee psychologist looking for Trainee psychologist looking for experience in delivering therapiesexperience in delivering therapies

► Small scale social problem solving Small scale social problem solving interventionintervention

► Detained mentally disordered offendersDetained mentally disordered offenders 6 mentally ill + 3 personality disordered 6 mentally ill + 3 personality disordered

► Showed pre- to post-intervention Showed pre- to post-intervention improvements on the Social Problem improvements on the Social Problem Solving Inventory – Revised (SPSI-R)Solving Inventory – Revised (SPSI-R)

Pilot studyPilot study

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

DevelopmentsDevelopments

►Began to use SPSI-R as part of general Began to use SPSI-R as part of general assessment of Arnold Lodge patients – assessment of Arnold Lodge patients – database on MDOsdatabase on MDOs

►Personality Disorder Unit (PDU) Personality Disorder Unit (PDU) opened and adopted Social Problem opened and adopted Social Problem Solving Therapy, Solving Therapy, Stop & Think!, Stop & Think!, as a as a core part of treatmentcore part of treatment

Arnold Lodge & Cardiff Arnold Lodge & Cardiff University, University, 2000-20052000-2005

Finding #1Finding #1

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

Population comparisonsPopulation comparisons

PPO

NPO

RPS

ICS

AS

SPS

PD (N=42) Prisoners (N=39) Mature students (N=70)▼

▼

▼

▼▼

▼ ▼

Finding #2Finding #2

►Personality traits are associated with Personality traits are associated with social problem solving skillssocial problem solving skills

TraitsTraits

►Mentally disordered offenders Mentally disordered offenders ►N=52; 38 MI and 14 PDN=52; 38 MI and 14 PD►Big FiveBig Five

NeuroticismNeuroticism ExtraversionExtraversion OpennessOpenness AgreeablenessAgreeableness ConscientiousnessConscientiousness

TraitsTraits

►High N associated with poor social High N associated with poor social problem solving in MDOsproblem solving in MDOs Less positiveLess positive More negativeMore negative Less rationalLess rational More impulsive/careless More impulsive/careless More avoidantMore avoidant

ImpulsivityImpulsivity

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

ImpulsivityImpulsivity

Impulsivity Aggression

ImpulsivityImpulsivity

Impulsivity Social problem-solving

Aggression

Finding #3Finding #3

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

Social Problem Solving Social Problem Solving TherapyTherapy

►PD Offenders PD Offenders

SPSSPS

scorescore

Baseline 9m Baseline 9m 15m 15m 21m 21m

(N=42) (N=26) (N=15) (N=11)(N=42) (N=26) (N=15) (N=11)

15

14

13

12

11

10

SPS Conference, Nottingham SPS Conference, Nottingham 20012001

► James McGuire, University of LiverpoolJames McGuire, University of Liverpool► Liisa Keltikangas-JLiisa Keltikangas-Järvinen, University of Helsinkiärvinen, University of Helsinki► Steve Fyffe, Arnold Lodge PDUSteve Fyffe, Arnold Lodge PDU► Linda Blud & Rosie Travers, HM Prison ServiceLinda Blud & Rosie Travers, HM Prison Service► Debbie Fleck, Hutton Centre RSUDebbie Fleck, Hutton Centre RSU► Fiona Biggam, Glasgow Caledonian UniversityFiona Biggam, Glasgow Caledonian University

► Special issue of Special issue of Criminal Behaviour & Mental Criminal Behaviour & Mental Health, 2001, Vol. 11, No. 4 .Health, 2001, Vol. 11, No. 4 .

BookBook

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

ContributorsContributors

Fiona BiggamConor DugganVince EganTheresa GannonJames McGuireKevin Power

ContributorsContributors

Liisa Keltikangas-Järvinen

Walter Matthys

Friedrich LöselAndreas Beelmann

ContributorsContributors

Robin Harvey

Tony WardDevon Polaschek

ContributorsContributors

Dan AntonowiczShelley BrownRobert RossRalph Serin

Laura DreerTom D’ZurillaTim ElliottWarren JacksonJohn LochmanChristine Maguth NezuArthur M Nezu

Nottingham, 2006Nottingham, 2006

Landscaped projectLandscaped project

►Nick Huband et al. (2006) B J Nick Huband et al. (2006) B J PsychiatryPsychiatry

►Randomised controlled treatment trial Randomised controlled treatment trial ►Stop & Think! + psychoeducation Stop & Think! + psychoeducation ►Community adults with PDCommunity adults with PD► Improved social problem solving (SPSI-Improved social problem solving (SPSI-

R)R)► Improved social functioning (SFQ)Improved social functioning (SFQ)

Personality disorders & SPSI-Personality disorders & SPSI-RR

SPSI-R predictorsCluster A

Paranoid NoneSchizoid NoneSchizotypal None

Cluster BAntisocial NoneBorderline ↑ Impulsive ↓ AvoidantHistrionic ↑ ImpulsiveNarcissistic ↑ Impulsive ↑ Positive

Cluster CAvoidant ↓ Impulsive ↑ Negative Dependent ↑ NegativeObsess/Comp None

Problem solving model of Problem solving model of personality disorderpersonality disorder

Traitse.g., High N;impulsivity

Poor socialproblem solving

Dysfunction, e.g.,Poor interpersonal skills; poor coping

Problem solving model of Problem solving model of personality disorderpersonality disorder

Traitse.g., High N;impulsivity

Poor socialproblem solving

Dysfunction, e.g.,Poor interpersonal skills; poor coping

Information processing

biases

Problem solving model of Problem solving model of personality disorderpersonality disorder

Traitse.g., High N;impulsivity

Poor socialproblem solving

Dysfunction, e.g.,Poor interpersonal skills; poor coping

MaladaptiveschemasInformation

processing biases

Problem solving model of Problem solving model of personality disorderpersonality disorder

Traitse.g., High N;impulsivity

Poor socialproblem solving

Dysfunction, e.g.,Poor interpersonal skills; poor coping

Substance use

Distress

MaladaptiveschemasInformation

processing biases

A testable modelA testable model

► Testable by whom?Testable by whom?► A glimpse of the A glimpse of the

futurefuture

SPS Conference, Nottingham SPS Conference, Nottingham 20062006

Chris Nezu, USA

Art Nezu, USAJames McGuire, UK

FutureFuture

University of Nottingham

Drexel University, USAUniversity of Liverpool

FutureFuture

University of Nottingham

Nottinghamshire Healthcare NHS Trust

Drexel University, USAUniversity of Liverpool

FutureFuture

University of Nottingham

Nottinghamshire Healthcare NHS Trust

Drexel University, USAUniversity of Liverpool

Personality Disorder Institute

Nottingham Institute of Mental Health

AcknowledgementsAcknowledgements

► Research colleaguesResearch colleagues Professor Conor DugganProfessor Conor Duggan Dr Nick HubandDr Nick Huband Professor Vince EganProfessor Vince Egan Dr Jo SellenDr Jo Sellen Dr Lucy McCarthyDr Lucy McCarthy Dr Shahla AhmadiDr Shahla Ahmadi Dr Cathryn RichardsonDr Cathryn Richardson

Dr Marie BlairDr Marie Blair Dr Gary ChristopherDr Gary Christopher

► Practitioner colleaguesPractitioner colleagues Cathy WrayCathy Wray Steve FyffeSteve Fyffe Andy LathamAndy Latham Claudia GeraldClaudia Gerald

► FundersFunders NHS National Programme NHS National Programme

on Forensic Mental on Forensic Mental Health R&DHealth R&D

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