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196
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Introduction
Applying patient monitoring to inpatient mental health settings with a view to improving outcomes by tracking change from day to day and also examining the ways that increased temporal precision of measurement can assist in the prediction and prevention of suicide and self-harm.
Additional affiliations
March 1990 - July 1993
Saint Vincent's Hospital
Position
- Medical Professional
July 1993 - present
January 1990 - June 1993
Publications
Publications (196)
Background
Self-harm is a significant public health issue, and both our understanding and ability to predict adverse outcomes are currently inadequate. The current study explores how preventative efforts could be aided through short-term prediction and modelling of risk factors for self-harm.
Methods
Patients (72% female, Mage = 40.3 years) within...
Tools to assess worry among adolescents exist but do not capture the content of worries. This study reports on the development of a brief, psychometrically sound measure of worry for use with adolescents. Phase 1 involved identification of 27 potential items from existing instruments as well as item generation identified in interviews with students...
Background
Identifying the interaction between dispositional and dynamic risk factors is necessary in understanding, predicting, and managing suicide risk. Interpersonal factors have consistently been linked to suicidal ideation over short-term periods. Additionally, distress tolerance may be a relevant dispositional protective factor against stres...
Suicide attempts are motivated by the desire to escape aversive states and circumstances, suggesting they may be regulated by the behavioral inhibition system (BIS). Suicide attempts are also associated with reward pursuit, however, implicating a role for the behavioral activation system (BAS). We hypothesized that the interaction of high BIS and B...
The purpose of this study was to produce a short-form measure of loneliness and assesses its prediction of depressive symptoms relative to a comprehensive measure. Western Australian adolescents completed the Friendship Related Loneliness and Isolation subscales of the Perth Aloneness Scale (PALs) three times over 18 months (T 1 n = 1538; T 2, n =...
We lack knowledge about the short-term predictors of suicide attempts (SAs) among treatment-seeking individuals. The current study evaluated whether (a) interpersonal difficulties, hopelessness, and affective states are associated with an increased risk of SAs on the same and the next day; (b) these daily states are interconnected differently over...
Intended for researchers and clinical leaders, this article suggests that embedded program evaluation is a good fit with the desired features of practice-oriented research. The systematic nature of evaluation that is built into the operational workflow of a practice setting may increase the diversity of methods available to explore processes and ou...
This study explored how theory-driven risk and protective factors influenced probability of suicide attempts from day-to-day. A sample of patients who attempted suicide during their stay at a psychiatric hospital completed questionnaires daily, with dynamic modelling used to identify concurrent and time-lagged predictors. Network modelling was used...
Objective:
Nonsuicidal self-injury (NSSI) is a major public health issue. Despite increased research efforts in clinical samples, we still have little understanding of the short-term correlates, predictors, and targets of NSSI among treatment-seeking individuals. The present study was designed to (a) evaluate how suicidal thoughts, interpersonal d...
Objective: Non-suicidal self-injury (NSSI) is a major public health issue. Despite increased research efforts in clinical samples, we still have little understanding of the short-term correlates, predictors, and targets of NSSI among treatment-seeking individuals. The current study was designed to (a) evaluate how suicidal thoughts, interpersonal d...
Background
Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression, yet few studies have mapped the trajectories of symptom change over treatment. Tracking clinical response during early treatment may be helpful to predict outcome, particularly non-response.
Methods
We used naturalistic data (N = 117) to examin...
Routine outcomes monitoring (ROM), combined with a psychotherapeutic intervention, can improve outcomes by assisting therapists in supporting patients who are off track to achieve a better treatment endpoint. While many ROM systems are suitable for particular clinical contexts, psychotherapy delivered in a hospital setting presents unique challenge...
Background
Screening for depressive symptoms during adolescence is of high clinical significance. The shorter 12-item version of the Children's Depression Inventory (CDI 2:SR[S]) was specifically developed for this purpose. Evaluations of the CDI 2:SR[S] psychometrics are limited, however. The purpose of this study was to validate the CDI 2: SR[S]...
This third edition provides a thorough real-world exploration of the scientist-practitioner model, enabling clinical psychology trainees to develop the core competencies required in an increasingly interdisciplinary healthcare environment. The book has been comprehensively revised to reflect shifts towards transdiagnostic practice, co-design princi...
After assessing a client a treatment plan is required. The chapter outlines the practical steps in proceeding from a case formulation to a treatment plan. Since many techniques are modified for application in many different clinical problems and psychological disorders, we will concentrate on providing a description of particular procedures that ar...
This third edition provides a thorough real-world exploration of the scientist-practitioner model, enabling clinical psychology trainees to develop the core competencies required in an increasingly interdisciplinary healthcare environment. The book has been comprehensively revised to reflect shifts towards transdiagnostic practice, co-design princi...
The chapter describes how the clinical psychologist can work in rural and remote settings. The specific rewards and challenges are outlined. The chapter reviews the effectiveness of therapy at a distance and developments in the delivery of clinical psychology services. Consideration is given to the relevant legislation and regulations, and provides...
This third edition provides a thorough real-world exploration of the scientist-practitioner model, enabling clinical psychology trainees to develop the core competencies required in an increasingly interdisciplinary healthcare environment. The book has been comprehensively revised to reflect shifts towards transdiagnostic practice, co-design princi...
Clinical psychology trainees embarking on a professional career are faced with the prospect of work that, daily, has ethical questions and challenges to respond to people from varied cultures and social groups. The chapter describes how to provide a culturally-sensitive clinical psychology practice. It evaluates the current evidence-base antecedenc...
Supervision is a critical opportunity for a clinical psychology trainee to receive feedback to develop their skills. The chapter begins by describing ways to make the most of this opportunity. Practical steps are outlined that include, goal setting for supervision sessions, planning agendas, ways to learn from sessions recordings, and accounting fo...
The chapter outlines an evidence-based approach for clinical psychologists to select and provide group treatments. The process begins with selecting the appropriate treatment programme and then selecting the appropriate patients for the group. The chapter will identify principles for selection and assessment as well as how the use of interpersonal...
The chapter describes how to manage ruptures in the therapeutic alliance. It opens by outlining a conceptual model to understand the ruptures and proceeds to consider the ways that ruptures may manifest at different points in psychotherapy. One way to respond to some ruptures in alliance in via enhancing motivation and therefore the technique of Mo...
Clinical psychologists may work in a variety of settings, but the challenges of working in private practice can be beyond the experience of a trainee. Thus the chapter outlines the conduct in a private practice. It describes the important role of promotion and community education to engage with key stakeholders. The chapter highlights the added val...
Clinical psychological practice is founded upon the therapeutic relationship. A science-informed practice then requires that the elements used to build that relationship have an evidence base. Thus, the chapter reviews the empirical foundations of the therapeutic relationship and what steps can be taken to build a therapeutic alliance that correlat...
Case formulation links the client and his or her problems with the treatment. It captures both the strengths and the weaknesses in a complete summary of the client. The chapter introduces case formulation by first describing a behavioural case formulation and how a functional analysis can be conducted. The illustration of a behavioural formulation...
Clinical psychology is at an exciting point in time. We describe the current state of clinical psychology, framing it in terms of a trajectory from the foundation of the scientist-practitioner model to present developments. The chapter outlines how the how core competencies of clinical psychology practice are framed by the question, “How would a sc...
The chapter outlines low intensity psychological Interventions (LIPIs). These are treatments that have low usage of a specialist’s therapist time (e.g., 5–8 sessions), or uses the time in a manner that reaches a large number of people. Low intensity does not refer to the client’s experience. Even though the contact with the specialist is less, the...
Clinical psychologists, even those who work in solo practices, are part of a larger health care delivery system. The chapter frames the evidence-based practice of a clinical psychologist in the broader context by outlining the evolving parameters of service delivery and how the field is aiming to provide integrated, patient-centred care that is com...
This third edition provides a thorough real-world exploration of the scientist-practitioner model, enabling clinical psychology trainees to develop the core competencies required in an increasingly interdisciplinary healthcare environment. The book has been comprehensively revised to reflect shifts towards transdiagnostic practice, co-design princi...
The science-informed approach to clinical practice is founded upon ongoing quality improvement and involves key skills that allow clinical psychologists to confidently provide services in a competitive health care market. Thus, programme evaluation is a core clinical psychology competency but needs to be provided via a co-design framework. The chap...
The evidence-based practice of clinical psychology may begin with a review of efficacy studies, but it cannot end there. It needs to translate these data to the patient who presents for treatment. The chapter begins with a discussion of the principles whereby a clinical psychologist can seek to match evidence-based treatments to a client’s clinical...
Case management skills are critical to the effective, efficient and ethical delivery of clinical psychological services. The chapter will outline how case management involves the combination of practice-based evidence with management and documentation tasks. We outline the key management and documentation tasks associated with specific phases of th...
Objective:
Loneliness is a well-established risk factor for suicide in young adults, but the mechanisms involved are still unclear. Drawing on the Interpersonal Theory of Suicide, the Evolutionary Model of Loneliness, and Prospect Theory, we examined if high and low levels of loneliness are associated with different patterns of response to losses...
Objectives:
A key feature of blood-injection-injury (BII) phobia is activation of disgust responses, in addition to fear. Yet, standard treatments have largely neglected addressing disgust responses. The disorder is further complicated by fainting in 75% of sufferers. Moreover, treatments have been traditionally delivered in an individual format,...
Distress tolerance may be important to consider when examining the dynamic relationships between suicidal ideation and proximal factors. Psychotherapy that specifically targets distress tolerance may be effective in reducing reactivity to interpersonal stressors.
Introduction
Brief versions of Dialectical Behaviour Therapy (DBT) may enhance patient outcomes in diverse service settings. This study examined the effectiveness of two DBT-informed treatments for diagnostically heterogeneous groups in routine practice: 5-day group training in DBT skills (DBT-5) and a 12-week DBT program (DBT-12).
Methods
: Depre...
The application of Cognitive Behavioural Therapy (CBT) skills are believed to be a mechanism of therapeutic change in treatment. Research has shown that the application of CBT skills affects outcomes, however, the way these relationships may change during treatment has not been explored. In this study, a naturalistic observational approach is used...
Suicide is a leading cause of morbidity, yet a significant challenge to receiving adequate support is an unwillingness to disclose mental health issues. The current study explores reasons for nondisclosure among emergency personnel, a population at risk of developing mental health problems. Twenty-nine police, ambulance, and fire and rescue agencie...
Objective
This study presents rates of suicide thoughts and behaviours of police and emergency services personnel around Australia. In addition, it examines personal (i.e. mental health, substance use) and working environment risk and protective factors.
Method
A stratified random sample of personnel from 33 Australian emergency services organisat...
A core aspect of Dialectical Behaviour Therapy (DBT) is the acquisition and use of DBT skills to replace maladaptive behaviours. However, it is unclear whether DBT skill use is associated with differential reductions in psychological distress across individuals with varying severities of borderline personality disorder (BPD) symptoms. In the curren...
Alternatives to Suicide: Beyond Risk and Toward a Life Worth Living demonstrates how fostering resilience and a desire for life can broaden and advance an understanding of suicide. The book summarizes the existing literature and outlines a new focus on the dynamic interplay of risk and resilience that leads to a life-focus approach to suicide preve...
Objective: The study evaluated the use and effectiveness of a progress monitoring system routinely operational in a private mental health care setting. Method: In a nonrandomized trial in which 778 consecutively admitted patients underwent a 2-week cognitive behavioral therapy intervention, the effectiveness of therapists choosing to use progress m...
In this introductory chapter to the edited volume "Alternatives to Suicide: Beyond Risk and Toward a Life Worth Living" the authors call for a new approach to suicide. This chapter provides a review and critique of the current risk-centric approach to understanding suicide. It highlights the stark mismatch between conventional risk-centric approach...
Given suicide risk is dynamic, research needs to identify the factors responsible for these changes. This can be achieved through experimentally manipulating putative causal risk factors. Two studies experimentally manipulated a change in interpersonal risk factors (thwarted belongingness and perceived burdensomeness) to assess the influence on par...
Research into cognitive behaviour therapy can be viewed through a contemporary framework of psychotherapy delivery. This model divides psychotherapy decision-making into two phases: selection and adaptation. In the first, selection phase, clinicians consider the evidence-base of therapies for a clinical presentation and choose which to implement fi...
Few studies have assessed factors which may influence an individual's risk of acting on their suicidal thoughts. The current study explores whether affective, behavioural or interpersonal factors are effective in discriminating between adolescents who only think about suicide, and those who attempt suicide. From a sample of 2,655 families randomly...
Background:
A limited amount of research has assessed how suicide risk changes over time, and how changes can be predicted. The current study assessed suicidal ideation and risk factors throughout inpatient visits to a psychiatric facility to refine prediction of suicide risk.
Method:
In total, 491 patients (73% Female; mean age = 39.21) at a ps...
Mental health research among asylum seekers and refugees has largely focused on effects of pre-migration trauma on post-migration wellbeing. While emerging literature highlights the importance of post-migration factors, we do not yet understand how addressing these factors may influence change in psychological distress. This study uses archival cli...
People often continue to rely on misinformation in their reasoning after they have acknowledged a retraction; this phenomenon is known as the continued-influence effect. Retractions can be particularly ineffective when the retracted misinformation is consistent with a pre-existing worldview. We investigated this effect in the context of depressive...
People remember events and materials better when these are congruent with their mood at retrieval; this is known as the mood-congruent memory bias. This effect is largest when the materials are self-referential and this is known as the self-reference effect. We present two word rating studies, to create a list of self-referential valenced words tha...
Background and Objectives: The interpersonal theory of suicide proposes that perceived burdensomeness and thwarted belongingness (PB-TB) are proximal causes of suicidal desire. Here we test whether experimentally induced perceptions of meaningfulness can confer resilience against interpersonal adversity and enhance persistence, the erosion of which...
Objectives
This study investigated the role of individual differences in neuroticism in conferring increased reactivity to the interpersonal antecedents for suicide proposed by the interpersonal theory of suicide.
Method
Undergraduate students (N = 113) were screened and selected to form high (n = 58) and low (n = 55) neuroticism groups and an exp...
One obstacle potentially hindering research on suicide is the assumption that assessing suicide may make individuals more likely to engage in suicidal thoughts or behaviours; a concern expressed by ethics committees, researchers, and clinicians. However, decisions which are overly cautious and restrictive when approving research proposals will hind...
People continue to rely on retracted misinformation in their reasoning after they have acknowledged a retraction. This phenomenon is known as the continued influence effect. There is evidence that retractions can be particularly ineffective when the retracted misinformation is consistent with a person’s pre-existing attitudes. The current study inv...
Objective:
The study assessed suicidal ideation and interpersonal variables to explore the extent to which (a) changes in interpersonal factors predicted future suicidal ideation and (b) changes in either predicted nonsuicidal self-injury.
Method:
In total, 1,044 patients (72.3% Female; mean age = 41.95) at a psychiatric inpatient facility were...
Objective:
Routine outcome monitoring benefits treatment by identifying potential no change and deterioration. The present study compared two methods of identifying early change and their ability to predict negative outcomes on self-report symptom and wellbeing measures.
Method:
1467 voluntary day patients participated in a 10-day group Cognitiv...
Whilst feedback is demonstrated to improve therapy outcomes, little attention has been given to the relative benefits of the form in which feedback is given. The present study aimed to compare patients’ perceptions of feedback graphs with and without expected treatment response trajectories. In a counter-balanced design, patients in 2-week CBT prog...
Background: Consumer perceptions of care are a key measure of service quality. The Consumer Perceptions of Care (CPoC) survey is often used to assess patients’ evaluations of the quality of services received. Aims: The study explored the factor structure of the CPoC, the relationships between perceived quality of care, empowerment, perceived treatm...
Background: Mindfulness is a trainable skill that may enhance resilience to suicidality among
vulnerable groups such as young people. The current study examined whether mindfulness
protects against suicidal desire in the face of heightened risk and adversity by increasing zest for
life in a sample of university students.
Methods: In a prospective d...
According to the interpersonal theory of suicide, perceived burdensomeness and thwarted belongingness are proximal causal factors underlying suicidal desire. The current study examined whether a brief mindfulness intervention can attenuate the deleterious effects of these interpersonal factors on desire to escape, a potential antecedent to suicide...
The interpersonal theory of suicide posits that failed interpersonal needs for efficacy and belongingness cause suicide ideation (Joiner, 2005). To distinguish whether their mechanism of action is interpersonal or via failure per se, an experimental paradigm was used. In Study 1 (n = 98), participants were randomly allocated to high or low perceive...
We present evidence that dysphoric rumination involves a working memory (WM) updating deficit. Sixty-one undergraduates—pre-screened with rumination and depression scales—completed a novel task providing a specific measure of WM updating. This task involved the substitution of emotionally-valenced words, and provided an online measure of the time t...
Background:
Routine symptom monitoring and feedback improves out-patient outcomes, but the feasibility of its use to inform decisions about discharge from in-patient care has not been explored.
Aims:
To examine the potential value to clinical decision-making of monitoring symptoms during psychiatric in-patient hospitalisation.
Method:
A total...
Background
Reporting of the clinical significance of observed changes is recommended when publishing mental health treatment outcome studies and is increasingly used in routine outcomes monitoring systems. Since recovery rates vary with the method chosen, we investigated the validity of classifications of clinically significant change when the Jaco...
Suicide research can be enhanced by an ability to safely manipulate putative causal variables. The present studies developed an experimental task to modify risk factors identified by the interpersonal theory of suicide (perceived burdensomeness and thwarted belongingness) and examine their hypothesized suppressive effect on persistence in adversity...
Background:
Whereas therapist effects on outcome have been a research topic for several years, the influence of therapists on premature treatment termination (dropout) has hardly been investigated. Since dropout is common during psychological treatment, and its occurrence has important implications for both the individual patient and the healthcar...
The interpersonal theory of suicide proposes that acquired capability facilitates transformation of suicidal desire into lethal self-destructive behavior (Joiner, 2005). A new measure, the Acquired Capability With Rehearsal for Suicide Scale (ACWRSS), was devised to capture the key facets of acquired capability—pain tolerance and fearlessness of de...
Background:
Depression and anxiety disorders exhibit comorbidity, and the same relationships have been observed in postpartum samples. The tripartite model posits that anxiety and depression overlap due to shared and unique symptom components. The present study tested whether a one-factor model, or a three-factor model consistent with the triparti...
While cross-sectional correlates of deliberate self-harm, such as psychological distress, have been identified; it is still difficult to predict which individuals experiencing distress will engage in deliberate self-harm, and when this may occur. Therefore, this study aimed to explore the ability of longitudinal measurements of psychological distre...
Objective: The interpersonal theory of suicide argues that suicidal ideation predicts self-injury. We hypothesized that distinct patterns of suicidal ideation could be identified and these ratings could allow early identification of self-injury. Method: The sample consisted of 562 psychiatric inpatients who reported suicidal ideation. Results: Late...
Thoroughly revised, and fully updated for DSM-5, the new edition of this practice-focused book guides clinical psychology trainees through a field which is rapidly evolving. Through real-world exploration of the scientist-practitioner model, the book helps readers to develop the core competencies required in an increasingly interdisciplinary health...
Thoroughly revised, and fully updated for DSM-5, the new edition of this practice-focused book guides clinical psychology trainees through a field which is rapidly evolving. Through real-world exploration of the scientist-practitioner model, the book helps readers to develop the core competencies required in an increasingly interdisciplinary health...
The Edinburgh Postnatal Depression Scale is the most widely used measure for screening for depression in perinatal populations. A weakness is that the factor structure of the scale is inconsistent across studies. It is unclear the degree to which this inconsistency results from variability arising from the Edinburgh Postnatal Depression Scale (EPDS...
Objective:
Progress monitoring and feedback reduces the number of patients deteriorating in psychotherapy. The current study examined the effects of providing treatment progress information to therapists and patients using individual feedback of both wellbeing and affective psychological distress compared to feedback of wellbeing alone.
Method:...