Ali Smith

Alison Smith

Senior Teaching Fellow Integrated Care (Mental Health), Lead for Student Wellbeing
MSc., BSc (Hons), BA (Hons) RN (Mental Health) PGDip (Arts Psychotherapy) PGDip (Systemic Psychotherapy) PGCert (Teaching and Learning), PGCert Child and Adolescent Mental Health.
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Smith A (2016) A literature review of the therapeutic mechanisms of art therapy for veterans with post-traumatic stress disorder, International Journal of Art Therapy: Formerly Inscape 21 (2) pp. 66-74 Taylor & Francis
Post-traumatic stress disorder in combat veterans is often managed with the use of psychological intervention such as Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR). There is a body of evidence that suggests that some individuals do not respond as well as others to such interventions. Other strategies in use to support veterans in recovery include art-based therapies and anecdotal evidence suggests that these have therapeutic impact for veteran groups that do not benefit from the aforementioned psychological therapies. This article describes a review of the literature associated with art therapy with combat veterans, aiming to ascertain what the therapeutic mechanisms are for veterans in using art therapy to manage post-traumatic stress disorder symptoms. Themes became evident within the literature review that are discussed and analysed, with resultant ideas for future research possibilities identified.
Objectives The number of UK service personnel who have a diagnosis of PTSD is unclear, but there has been a recent increase in referrals to services for PTSD symptomology. It is imperative to understand the impact this may have on the children of affected service families. This review of literature aimed to explore and provide insight into the experiences of services children whose parent has a diagnosis of PTSD. Design. A comprehensive review of the literature. Data Sources. Online databases CINAHL, MEDLINE, psychARTICLES, The Psychology and Behavioural Sciences Collection and PILOTS were searched. Review Methods. The studies were chosen in keeping with a specified inclusion and exclusion criteria. The literature was critically analysed and key themes identified through the strategy of thematic analysis. Results Five studies met the inclusion criteria. Three key themes were identified from the five articles; secondary traumatisation; impact on the child's mental health; and impact on the child's adult relationships. Conclusion The findings highlighted the prevalence of secondary traumatisation and a potential negative impact on the child's mental health and relationships. However, literature used in the review was conducted in countries outside of the UK, therefore the comparison of results may be compromised. This review identifies the paucity of research on this topic and highlights the need for UK based research to be carried out in this area
Smith Alison, Fortune Z., Phillips Rachel, Walters Paul, Lee Geraldine A., Mann Anthony, Tylee Andre, Barley Elizabeth A. (2014) UPBEAT study patients' perceptions of the effect of coronary heart disease on their lives: A cross-sectional sub-study, International Journal of Nursing Studies 51 (11) pp. 1500-1506 Elsevier
Background: Patients can report positive effects of myocardial infarction. It is unknown whether these effects are sustained or what factors influence adaptation. Objectives: To explore primary care patients' perceptions of the effect of coronary heart disease and to identify possible modifiable predictors of adaptation. Design and setting: Cross-sectional, sub-study of UPBEAT cohort participants. Patients were recruited from coronary heart disease Registers in South London General Practices. Method: 548 participants were asked "Has having heart disease changed your life? If so, was that change for the better, worse, both or neither?" Participants were asked to explain their response; explanations were subjected to content analysis. Associations between response and lifestyle, demographic, mood and coronary heart disease variables were tested. Results: Respondents (394 male, 72%) were aged 27-98 years and had had heart disease for a mean of 12.4 SD ± 8.4 years. 120 (22%) reported that life was better and 200 (37%) said it was worse. The explanations of those who said 'better' were categorised as 'Healthier Living', 'Recognised Mortality' and 'Stress Reduction'. For those saying 'worse', categories were 'Restricted Lifestyle', 'Recognised Mortality', 'Loss and Burden'. More anxiety symptoms (RRR 1.56, 95% CI 1.12, 2.17), lower functional status (RRR 2.46, 95% CI 1.21, 4.98) and self-reported chest pain (RRR 2.24, 95% CI 1.34, 3.77) were associated with saying 'worse'. Conclusions: Many primary care patients are ambivalent to the effects of coronary heart disease, but some report positive effects. Negative perceptions are associated with reported functional impairment, chest pain and anxiety, but not illness severity or patient characteristics. Future work will track the implications of these perceptions, but nurses managing patients with coronary heart disease should consider these effects as they may be modifiable predictors of adaptation. © 2014.
Tylee Andre, Ashworth Mark, Barley Elizabeth, Brown June, Chambers John, Farmer Anne, Fortune Zoe, Haddad Mark, Lawton Rebecca, Mann Anthony, Mehay Anita, McCrone Paul, Murray Joanna, Leese Morven, Pariante Carmine M., Rose Diana, Rowlands Gill, Smith Alison, Walters Paul (2011) Up-Beat UK: A programme of research into the relationship between coronary heart disease and depression in primary care patients, BMC FAMILY PRACTICE 12 58 BIOMED CENTRAL LTD
Background: Coronary heart disease and depression are both common health problems and by 2020 will be the two leading causes of disability worldwide. Depression has been found to be more common in patients with coronary heart disease but the nature of this relationship is uncertain. In the United Kingdom general practitioners are now being remunerated for case-finding for depression in patients with coronary heart disease, however it is unclear how general practitioners should manage these patients. We aim to explore the relationship between coronary heart disease and depression in a primary care population and to develop an intervention for patients with coronary heart disease and depression. Methods/design. This programme of research will consist of 4 inter-related studies. A 4 year prospective cohort study of primary care patients with coronary heart disease will be conducted to explore the relationship between coronary heart disease and depression. Within this, a nested case-control biological study will investigate genetic and blood-biomarkers as predictors of depression in this sample. Two qualitative studies, one of patients' perspectives of treatments for coronary heart disease and co-morbid depression and one of primary care professionals' views on the management of patients with coronary heart disease and depression will inform the development of an intervention for this patient group. A feasibility study for a randomised controlled trial will then be conducted. Discussion. This study will provide information on the relationship between coronary heart disease and depression that will allow health services to determine the efficiency of case-finding for depression in this patient group. The results of the cohort study will also provide information on risk factors for depression. The study will provide evidence on the efficacy and feasibility of a joint patient and professional led intervention and data necessary to plan a definitive randomised controlled trial of the intervention. © 2011 Tylee et al; licensee BioMed Central Ltd.
Tylee Andre, Haddad Mark, Barley Elizabeth, Ashworth Mark, Brown June, Chambers John, Farmer Anne, Fortune Zoe, Lawton Rebecca, Leese Morven, Mann Anthony, McCrone Pual, Murray Joanna, Pariante Carmine, Phillips Rachel, Rose Diana, Rowlands Gill, Sabes-Figuera Ramon, Smith Alison, Walters Paul (2012) A pilot randomised controlled trial of personalised care for depressed patients with symptomatic coronary heart disease in South London general practices: the UPBEAT-UK RCT protocol and recruitment, BMC Psychiatry 12 58 BioMed Central
Background: Community studies reveal people with coronary heart disease (CHD) are twice as likely to be depressed as the general population and that this co-morbidity negatively affects the course and outcome of both conditions. There is evidence for the efficacy of collaborative care and case management for depression treatment, and whilst NICE guidelines recommend these approaches only where depression has not responded to psychological, pharmacological, or combined treatments, these care approaches may be particularly relevant to the needs of people with CHD and depression in the earlier stages of stepped care in primary care settings.Methods: This pilot randomised controlled trial will evaluate whether a simple intervention involving a personalised care plan, elements of case management and regular telephone review is a feasible and acceptable intervention that leads to better mental and physical health outcomes for these patients. The comparator group will be usual general practitioner (GP) care.81 participants have been recruited from CHD registers of 15 South London general practices. Eligible participants have probable major depression identified by a score of âý¥8 on the Hospital Anxiety and Depression Scale depression subscale (HADS-D) together with symptomatic CHD identified using the Modified Rose Angina Questionnaire.Consenting participants are randomly allocated to usual care or the personalised care intervention which involves a comprehensive assessment of each participant's physical and mental health needs which are documented in a care plan, followed by regular telephone reviews by the case manager over a 6-month period. At each review, the intervention participant's mood, function and identified problems are reviewed and the case manager uses evidence based behaviour change techniques to facilitate achievement of goals specified by the patient with the aim of increasing the patient's self efficacy to solve their problems.Depressive symptoms measured by HADS score will be collected at baseline and 1, 6- and 12 months post randomisation. Other outcomes include CHD symptoms, quality of life, wellbeing and health service utilisation.Discussion: This practical and patient-focused intervention is potentially an effective and accessible approach to the health and social care needs of people with depression and CHD in primary care.Trial registration: ISRCTN21615909. © 2012 Tylee et al.; licensee BioMed Central Ltd.

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