Social Problem Solving Therapy

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Social Problem Solving Therapy
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Aim of the day

• To produce an action plan aimed at consolidating
  social problem solving therapy as one of the
  Trusts 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

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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

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Social problem solvingPast, present and future

• Mary McMurran
• University of Nottingham

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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

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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

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Social problem solving and personality disorder

• 2004 -2006
• Award 11,974
• Meeting costs
• Speakers costs
• Organisers costs
• Events
• Research meetings
• Conference
• Training event
• Todays event

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Seminar Groups

• Academics
• Psychology, Psychiatry, Sociology
• Cardiff University, University of Nottingham,
  University of Wales Institute Cardiff, University
  of Sheffield, University of Liverpool, Drexel
  University Philadelphia
• Practitioners
• Psychologists, Psychiatrists, Nurses, OTs, Social
  Workers, Probation Officers
• Public and Private Sectors
• Leicestershire, Lincolnshire, Nottinghamshire
• Qualified, trainees, post-graduates
• Service User

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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?

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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
• DZurilla Nezu

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Social problem solving

• The self-directed cognitive-behavioural-affective
  processes by which a person attempts to identify
  or discover effective or adaptive solutions for
  specific problems encountered in everyday living
• DZurilla Nezu McMurran

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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

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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

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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

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Arnold Lodge, 1995 - 1999
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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)

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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)

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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

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Arnold Lodge Cardiff University, 2000-2005
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Finding 1

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

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Population comparisons
PD (N42) Prisoners (N39) Mature students
(N70)
PPO NPO RPS ICS AS SPS
?
?
?
?
?
?
?
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Finding 2

• Personality traits are associated with social
  problem solving skills

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Traits

• Mentally disordered offenders
• N52 38 MI and 14 PD
• Big Five
• Neuroticism
• Extraversion
• Openness
• Agreeableness
• Conscientiousness

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Traits

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

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Impulsivity

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

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Impulsivity
Impulsivity
Aggression
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Impulsivity
Social problem- solving
Impulsivity
Aggression
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Finding 3

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

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Social Problem Solving Therapy

• PD Offenders
• SPS
• score
• Baseline 9m 15m
  21m
• (N42) (N26) (N15)
  (N11)

15 14 13 12 11 10
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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 .

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Book

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

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Contributors
Fiona Biggam Conor Duggan Vince Egan Theresa
Gannon James McGuire Kevin Power
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Contributors
Liisa Keltikangas-Järvinen
Walter Matthys
Friedrich Lösel Andreas Beelmann
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Contributors
Robin Harvey Tony Ward Devon Polaschek
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Contributors
Dan Antonowicz Shelley Brown Robert Ross Ralph
Serin Laura Dreer Tom DZurilla Tim
Elliott Warren Jackson John Lochman Christine
Maguth Nezu Arthur M Nezu
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Nottingham, 2006
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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)

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Personality disorders SPSI-R
SPSI-R predictors Cluster A Paranoid
None Schizoid None Schizotypal
None Cluster B Antisocial None Borderline
? Impulsive ? Avoidant Histrionic ?
Impulsive Narcissistic ? Impulsive ? Positive
Cluster C Avoidant ? Impulsive ? Negative
Dependent ? Negative Obsess/Comp None
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Problem solving model of personality disorder
Traits e.g., High N impulsivity
Dysfunction, e.g., Poor interpersonal skills
poor coping
Poor social problem solving
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Problem solving model of personality disorder
Traits e.g., High N impulsivity
Information processing biases
Dysfunction, e.g., Poor interpersonal skills
poor coping
Poor social problem solving
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Problem solving model of personality disorder
Maladaptive schemas
Traits e.g., High N impulsivity
Information processing biases
Dysfunction, e.g., Poor interpersonal skills
poor coping
Poor social problem solving
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Problem solving model of personality disorder
Maladaptive schemas
Substance use
Traits e.g., High N impulsivity
Information processing biases
Distress
Dysfunction, e.g., Poor interpersonal skills
poor coping
Poor social problem solving
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A testable model

• Testable by whom?
• A glimpse of the future

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SPS Conference, Nottingham 2006
Art Nezu, USA
James McGuire, UK
Chris Nezu, USA
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Future
University of Liverpool
Drexel University, USA
University of Nottingham
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Future
University of Liverpool
Drexel University, USA
University of Nottingham
Nottinghamshire Healthcare NHS Trust
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Future
University of Liverpool
Drexel University, USA
University of Nottingham
Nottinghamshire Healthcare NHS Trust
Personality Disorder Institute
Nottingham Institute of Mental Health
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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
  RD
• Home Office