Peter Trower

University of Birmingham, Birmingham, England, United Kingdom

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Publications (53)128.49 Total impact

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    ABSTRACT: BACKGROUND: The role of support workers and other professionals in the psychotherapeutic process has been commented upon but not as yet been systematically investigated. METHOD: To explore their views and expectations of cognitive behaviour therapy (CBT) for adults with intellectual disabilities, eleven paid support workers and professionals were recruited and interviewed before the CBT sessions commenced for their service users and nine took part in the second interview that took place after nine sessions. RESULTS: Thematic Analysis of the interview transcripts indicates that staff members do not perceive CBT as a long-term solution for psychological problems have little knowledge of CBT and do not feel included in the process. Nevertheless, after nine sessions, most participants reported improved psychological well-being for their service users and expressed a wish for longer-term involvement of the therapist. CONCLUSIONS: The results suggest that for CBT to be effective in the longer term, the therapist is required to consider a wider systemic approach including staff training and supervision, staff and management consultancy and creating a delicate balance between confidentiality and sharing the psychological formulation with 'significant others' to ensure maintenance and generalisation of improved psychological well-being.
    Journal of Applied Research in Intellectual Disabilities 05/2013; · 1.38 Impact Factor
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    ABSTRACT: Background  Clinicians working with clients who have mild intellectual disabilities (IDs) have shown growing enthusiasm for using a cognitive behavioural approach, amid increasing evidence of good treatment outcomes for this client group. However, very little is known about the views and experiences of clients with IDs who have undergone cognitive behavioural therapy. This study aims to explore the perspective of these clients. Methods  Fifteen participants with borderline to mild IDs and problems of anxiety, depression and anger were interviewed regarding their experience of cognitive behavioural therapy (CBT). Two semi-structured interviews were carried out in the first phase of therapy between session four and session nine. An interpretive phenomenological approach was taken to seek out themes from participants' own personal accounts. Results  Participants valued the opportunity to talk about problems with their therapist and benefitted from therapeutic relationships characterised by warmth, empathy and validation. Participants identified areas of positive change; however, many thought that this may be short lived or not maintained beyond discharge. Conclusions  The supportive aspects of therapeutic relationships were particularly important to participants undergoing CBT. The clinical implications are considered.
    Journal of Intellectual Disability Research 04/2012; · 1.88 Impact Factor
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    ABSTRACT: OBJECTIVE. To test the proposal that 'poor-me' (PM) and 'bad-me' (BM) paranoia can be differentiated in terms of (1) current emotional experience and presence of grandiose delusions and (2) early caregiving and threats to self-construction. METHOD. Participants experiencing persecutory delusions were separated into PM (N= 21) and BM (N= 15) groups on the basis of perceived deservedness of the persecution. The groups were compared on measures examining grandiose delusions, shame and depression, parental care, and threats of alienation and insecurity. RESULTS. As predicted, BM patients scored higher on shame and depression, and lower on grandiose delusions, than PM patients. BM patients reported higher levels of parental overprotection, but PM patients were not characterized by neglect, and the groups did not differ in type of threat to self-construction. Conclusion. The two paranoia types were differentiated on symptomatic and emotional presentation, but predicted differences in early relationships and self-construction were not fully supported.
    British Journal of Clinical Psychology 06/2011; 50(2):211-6. · 1.90 Impact Factor
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    ABSTRACT: This paper presents the REBT Competency Scale which can be used in the evaluation of adherence to an REBT treatment model in clinical and research applications. The scale has been developed to map closely onto the REBT treatment protocol developed by Dryden et al. (A primer on rational emotive behaviour therapy, Research Press, Champaign, 2003). Based on this treatment protocol 21 core steps (tasks) were identified for effective REBT practice. Each step is operationally defined, the rater is reminded of how the step relates to REBT theory and practice and scoring criteria are established that enable a rating of the therapists performance of the task. The potential uses for and application of the scale in clinical and research settings are considered. KeywordsREBT-Therapeutic adherence-Therapeutic competence
    Journal of Rational-Emotive and Cognitive-Behavior Therapy 01/2010; 28(4):165-216.
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    ABSTRACT: In this paper we describe an approach to training in Shared Action Planning that involves both plan coordinators and people with learning disabilities as equal participants. The training consists of five workshops which introduce Shared Action Planning and give staff and clients an opportunity to discuss preferences in home life, leisure and day activity or work. We present an evaluation of the training approach which indicates that it is well received by both staff and clients.
    British Journal of Learning Disabilities 08/2009; 23(3):98 - 101. · 0.26 Impact Factor
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    ABSTRACT: This article describes a pilot evaluation of a new day service in Solihull. The service provides individualised day care based on ordinary life principles. Activities occur both within and outside of the home and include the use of a network of community-based work, leisure and education resources. Extensive interviews with managers, direct care workers and people with mental handicaps themselves and analysis of activity data give a positive view of the service.
    British Journal of Learning Disabilities 08/2009; 21(2):54 - 58. · 0.26 Impact Factor
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    ABSTRACT: Cognitive behavioural therapy (CBT) is increasingly used to address the emotional and interpersonal problems of people with ID. There is a limited but promising evidence base supporting this activity. However, these individuals face real and continuing challenges in their lives that have implications for their self and interpersonal perceptions. These adversities have implications for the adaptation of CBT. First, it may mean that characteristically negative perceptions may be more common and may be the result of a complex interaction with a truly aversive environment and should not simply be considered as cognitive distortions. Secondly, clients may have limited control over their everyday lives, with limited opportunity to negotiate change with their informal and formal sources of support. This review suggests that it is important to consider the interpersonal context of therapy both to ensure effective work within sessions and to enable real change in clients' everyday lives. The review draws upon Vygotsky's theory of the zone of proximal development and ecological models of change to consider the challenges of establishing collaborative relationships and the potential to use CBT within a broad psychosocial model. The aim is to offer a helpful framework for practitioners and to identify directions for future research.
    Journal of Intellectual Disability Research 08/2009; 53(9):759-71. · 1.88 Impact Factor
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    ABSTRACT: Recent research has suggested that normal adolescent processes are important in understanding psychosis, and that young adult individuals with psychosis are often struggling to develop an individual and autonomous self (the "fundamental task" of adolescence). The current paper explores the utility of considering normative adolescent developmental processes in understanding anorexia nervosa. Data were collected from 31 female young-adults with symptoms of anorexia nervosa, 26 female comparison young-adults and 71 female adolescents on measures of adolescent egocentrism. A one-way ANOVA indicated that individuals with symptoms of anorexia nervosa scored more highly than both their peers and the adolescents on several dimensions of egocentric developmental beliefs. Correlations also showed that egocentrism was positively associated with eating concern in participants with symptoms of anorexia. The results suggest that young-adult women with symptoms of anorexia nervosa tended to feel physically invulnerable while also feeling both psychologically vulnerable to others and special or different. Together with the finding of excessive self-consciousness, this supports a notion that they may be experiencing exaggerated versions of normal self-developmental phenomena. Clinically, offering alternative ways of feeling unique other than dieting may be important in therapeutic approaches to anorexia nervosa. Similarly, strategies aimed at normalisation, such as facilitating healthy attachment to peers, may be useful for individuals with anorexia nervosa.
    Eating behaviors 02/2009; 10(1):10-5.
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    ABSTRACT: Establishing a collaborative relationship is a cornerstone of cognitive behavioural therapy (CBT). Increasingly CBT is being offered to people with intellectual disabilities who may have problems with receptive and expressive communication, and a history of disadvantage or discrimination in their relationships with those in positions of power. Consequently, they may have difficulty establishing a collaborative interaction with their therapist. This paper uses a novel method of interactional analysis to examine if collaboration increases as therapy progresses. Fifteen participants with borderline to mild intellectual disabilities and significant problems of depression, anxiety and anger were recruited from specialist clinical services to participate in this study. Verbatim transcripts of therapy sessions 4 and 9 were coded using an initiative-response method of analysing power distribution in dialogue, to investigate collaboration at the level of therapeutic interaction. The initiative-response scores indicated that power was relatively equally distributed between clients and therapists. On this measure there was no significant increase in collaboration as therapy progressed, as the dialogues were relatively equal from session 4. Analyses of the pattern of interaction showed that whilst the therapists asked most questions, the clients contributed to the flow of the analysis and played an active part in dialogues. The implications of these findings are discussed, along with the possible uses of such interactional analyses in identifying barriers to communication and ways of establishing effective therapeutic dialogue.
    British Journal of Clinical Psychology 11/2008; 48(Pt 1):63-77. · 1.90 Impact Factor
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    Chris Harrop, Peter Trower
    05/2008: pages 3 - 12; , ISBN: 9780470713327
  • Chapter: Frontmatter
    Chris Harrop, Peter Trower
    05/2008: pages i - xvii; , ISBN: 9780470713327
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    ABSTRACT: Previous research has proposed that there may be subtypes of paranoia with different patterns of performance on symptom and clinical measures. However, there has been little empirical examination of whether distinct subtypes actually exist. Recent research has suggested that paranoia can be found in normal individuals and exists on a continuum. Thus, it is possible that evidence for subtypes of paranoia can be derived from nonclinical samples. From a total of 723 participants, we identified 114 college students who showed elevated levels of paranoia as determined by two measures of paranoid ideation. The remaining sample of 609 persons served as the nonparanoid control group. All participants completed measures of depression, self-esteem, and social anxiety. Scores from the high subclinical group was subjected to cluster analysis to derive homogeneous subtypes. Participants also completed a measure of attributional style, the IPSAQ, which was used to validate the subtypes and was not used in the cluster analysis. Based on the cluster analysis, three subtypes were derived. Each subtype showed a different pattern of scores on measures of depression, self-esteem, and anxiety. There were also additional differences on the externalising and personalising bias scores from the IPSAQ between the subtypes. We conclude that there is preliminary evidence for the presence of subtypes among nonclinical samples and discuss the patterns of performance in relation to previous research on subtypes of paranoia. The implications of these subtypes for the study of paranoia are discussed.
    Cognitive Neuropsychiatry 12/2007; 12(6):537-53. · 1.68 Impact Factor
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    ABSTRACT: Social anxiety disorder (SaD) or social phobia is a co-morbid affective disorder in schizophrenia, present in up to one in three individuals. We employ 'social rank' theory to predict that one pathway to social anxiety in schizophrenia is triggered by the anticipation of a catastrophic loss of social status that the stigma of schizophrenia can entail. A group of 79 people with a first episode of psychosis were assessed for social anxiety: hypotheses were tested comparing 23 socially anxious and 56 non-anxious patients on measures of cognitive appraisals of shame/stigma of psychosis and perceived social status, controlling for depression, psychotic symptoms and general psychopathology. Participants with social anxiety experienced greater shame attached to their diagnosis and felt that the diagnosis placed them apart from others, i.e., socially marginalised them and incurred low social status. We propose a stigma model of social anxiety that makes testable predictions about how the shame beliefs may contaminate social interaction and thereby exacerbate and maintain social phobia.
    Behaviour Research and Therapy 06/2007; 45(5):1025-37. · 3.30 Impact Factor
  • Andrew Jahoda, Carol Pert, Peter Trower
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    ABSTRACT: We investigated whether aggressive individuals have an attributional bias of hostile intent compared to nonaggressive peers. We compared 43 frequently aggressive individuals who had mild to moderate intellectual disabilities with 46 nonaggressive controls on an attributional task. The aggressive participants attributed significantly more hostile intent to protagonists and indicated that they would respond more aggressively than did the controls to provocative scenes, but only when the threat was to themselves. Results suggest that differences in attribution of threat to self play a role in frequent aggression. These differences appear to be due, in part, to a positive bias of the nonaggressive participants on the self-referent scenes. Clinically, results highlight the importance of assessing and addressing aggressive individuals' interpersonal perceptions.
    American journal of mental retardation: AJMR 04/2006; 111(2):90-9. · 2.51 Impact Factor
  • Andrew Jahoda, Carol Pert, Peter Trower
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    ABSTRACT: Aggression in a proportion of people with intellectual disabilities is often assumed to be due to social-cognitive deficits. We reported on two studies in which we compared the emotion recognition and perspective-taking abilities of 43 frequently aggressive individuals and 46 nonaggressive peers. No difference was found between the groups' ability to label facial affect. The perspective-taking task required participants to distinguish between reactions of angry versus calm characters. Although both groups had similar success with elements of the task, the aggressive group proved better at predicting characters' attributions. Results suggest that deficits in emotion recognition and perspective-taking cannot be assumed to be causal or maintaining factors of frequent aggression. This has implications for assessment and treatment.
    American journal of mental retardation: AJMR 04/2006; 111(2):77-89. · 2.51 Impact Factor
  • Max Birchwood, Peter Trower
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    ABSTRACT: Some 20 trials of cognitive - behavioural therapy (CBT) for psychosis have re-established psychotherapy as a credible treatment for psychosis. However, it is not without its detractors and problems, including uncertainty about the nature of its active ingredients. We believe that the way forward is to abandon the neuroleptic metaphor of CBT for psychosis and to develop targeted interventions that are informed by the growing understanding of the interface between emotion and psychosis.
    The British Journal of Psychiatry 03/2006; 188:107-8. · 6.61 Impact Factor
  • Peter Trower, Paul Chadwick
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    ABSTRACT: Developments in cognitive therapies and theories for paranoid psychosis have constituted a significant breakthrough in our understanding of this disorder, offering a valid psychological alternative to biomedical approaches, which have been criticized on scientific, pragmatic, and ethical grounds. However, we have recently found evidence for two types of paranoia which, together with other conceptual and empirical work, show these cognitive theories to be insufficient. We propose an interpersonal theory of the self, which places the cognitive, emotional, and behavioral aspects of paranoia within a broader context of the person. In this article, we (a) survey cognitive theories and the alternative Interventions they imply; (b) describe new findings on two types of paranoia, which imply the need for significant theoretical adjustments; and (c) propose and describe a modified theory of paranoid threat and defense of the self, which, we argue, more adequately explains the phenomena.
    Clinical Psychology Science and Practice 01/2006; 2(3):263 - 278. · 2.92 Impact Factor
  • Max Birchwood, Peter Trower
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    ABSTRACT: Command hallucinations (CH) are a distressing and high-risk group of symptoms that have long been recognised but little understood, with few effective treatments. In this paper we report and discuss the efficacy of cognitive therapy (CT) modified in accordance with ‘social rank theory,’ in a single blind randomised controlled trial. 38 patients with command hallucinations were randomly allocated to CT or treatment as usual and followed up for 6 then 12 months. Large reductions in compliance behaviour were obtained (effect size = 0.97) favouring the CT group. Other significant differences were found and maintained at 6 months follow up.
    Journal of Contemporary Psychotherapy 01/2006; 36(1):1-7.
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    ABSTRACT: There are few evaluated psychological interventions or theoretical approaches which are specifically aimed at reducing problems related to adjustment and adaptation following a first episode of psychosis. The present study tests the efficacy of a form of CBT (Cognitive Recovery Intervention; CRI) in reducing trauma, depression and low self esteem following a first episode of psychosis, in a single-blind randomised controlled trial. A total of 66 patients who had recently experienced a first episode of psychosis were randomly assigned to CRI or treatment as usual (TAU) and followed up at 6 and 12 months. People receiving CRI tended to have lower levels of post-intervention trauma symptoms and demonstrated greater improvement than those receiving TAU alone. This was especially the case at 6 months for those with high pre-treatment levels of trauma. There was, however, no advantage for the CRI group with regards to reduced depression or improved self esteem. In conclusion, CRI appears to be an effective intervention to help young people adapt to the traumatic aspects of a first episode of psychosis although further evaluation in a larger study is warranted.
    Behaviour research and therapy 01/2006; · 3.00 Impact Factor
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    ABSTRACT: This study is of a grounded theory analysis of the transcripts of young men talking about their experience of psychosis. Six young men were interviewed twice during the critical period of 3-5 years following their first psychotic episode. The young men were asked to reflect on themselves and their lives before, during, and after having psychotic experiences. The transcripts were considered to have a phenomenological status, in that they represented the participants' perspectives on their experiences. Four themes emerged that were common to all the accounts: experience of psychosis, immediate expression of psychotic experiences, personal and interpersonal changes, and personal explanations. These themes are explored in detail, and their links with existing research and clinical implications are considered.
    Psychology and Psychotherapy Theory Research and Practice 07/2005; 78(Pt 2):249-70. · 1.69 Impact Factor

Publication Stats

1k Citations
128.49 Total Impact Points

Institutions

  • 1997–2012
    • University of Birmingham
      • School of Psychology
      Birmingham, England, United Kingdom
  • 1998–2009
    • University of Glasgow
      • Institute of Health and Wellbeing
      Glasgow, Scotland, United Kingdom
  • 2001
    • Birmingham and Solihull Mental Health NHS Foundation Trust
      Birmingham, England, United Kingdom
  • 1996
    • University of Southampton
      Southampton, England, United Kingdom