How can a Compassion Focused Model help Felindre Ward?

by Baz Van de Vegte – Wards' Psychology Student

The Felindre Ward is an acute facility in Bronllys Hospital perched on the hills of Brecon’s countryside. The ward welcomes patients to its beds who maybe experiencing a significant crisis in their mental health. The staff who dedicate their time to supporting the patients vary from nurses, doctors, occupational therapists, health care support workers, domestics, clinical psychologists and students. Time and care go into interventions such as nursing assistance, community support, psychological therapies and engagement with activities towards the improvement of well-being.

The Journey of Psychology on Felindre

Felindre introduced its first dedicated psychologist on the ward in September 2021. I was fortunate to be given the opportunity to join the psychologist within Felindre Ward in October 2021. At this point we were just starting to build relationships across the teams and establish the potential role for psychology on the ward. It was clear from the start that staff and patients alike were tired and weary from the ongoing Covid-19 pandemic, which drastically impacted the processes in place for patient and staff safety.

Getting to know the Team

We wanted to find out what staff most appreciated whilst working on the ward. We shared a survey with staff, asking questions such as ‘what do you most like and dislike about your role on the ward?’. The overwhelming response was that staff mostly loved spending time with patients and caring for their needs. 

It also highlighted that staff mostly disliked it when tasks got in the way of this time with patients. This told us that interacting with patients played a vital role in staff wellbeing and role satisfaction. However, it felt as if we were all on autopilot and somehow that core passion was worn out from the ongoing tiredness of the pandemic. We wondered ‘how we could reintroduce that important sense of connection between staff and patients?’.

Introducing Mindfulness

Shortly after our research, we developed daily mindfulness sessions that are now being run for patients and staff to explore breathing techniques, notice bodily sensations and engage in group activities. 

Mindfulness is a way to focus one’s mental state on the here and now and away from memories in the past or anxieties in the future. It expands awareness of what we are doing, how we are feeling and what’s going on around us. By practicing techniques that helps ground oneself to the present, anxiety levels can reduce creating feelings of calm and wellness. Daily mindfulness sessions have proven to be well received by patients who started to practice calming techniques when under stress. 

However, whilst staff also engaged in the sessions we noticed that they some seemed to struggle to allow themselves this luxury on their shifts.

A Compassion Focused Model enabled us to understand why this could be.

Baz Van de Vegte – Wards' Psychology Student

A Compassion Focused understanding

We used a Compassion Focused Model to help us understand why staff showed some resistance to practicing mindfulness. According to a Compassion Focused Model, there are three systems in the brain that are in sync helping us makes sense of how and why our brain triggers the arousal of emotions - we call these the threat, drive and soothe systems.

Our drive system is what we depend on to keep ourselves motivated to achieve, complete that short-term goal or stay active with our hobbies. We then get rewarded for such activities by the release of dopamine which in turn drives us to keep motivated. 

The soothe system is what we rely on to keep relaxed when we get overstressed or full of anxiety. The system regulates any feelings of threat and keeps us relaxed so that we can think rationally to reduce levels of anxiety. 

Our threat system tells us when we feel under threat so that we can try and self-protect from a given situation. It’s closely linked with our flight, fright and freeze responses when under stress - causing hormones like adrenaline to be rushed through the body. As a result, this activates as a safety mechanism to help us avoid any immediate danger.

How does this apply to Felindre Ward?

Ideally for our emotions to be regulated efficiently, all three systems need to be evenly active in our everyday lives. As staff go through ongoing stressors, the threat system can grow out of proportion and tower over the soothe and drive systems. The threat system can be activated by perceived threats as well as actual threats. Therefore factors such as staff shortages, environmental noise, too many demands, could act as possible threats. 

Prolonged periods in threat mode can result in burnout, reducing energy and motivation. In order to reduce the threat system it is essential to increase the soothe system. This can be done by mindfulness for example, which can increase self-compassion and rekindling energy for the drive system. 

We knew that if staff were able to increase their own self-compassion and self-care, this could have a direct influence on patient care. The idea of introducing the Compassionate Focused Model to Felindre could be an opportunity to establish compassionate thinking and keep an evenly balanced soothe, drive and threat system amongst our fantastic team.

Our Pathway to Compassion

Now that we are starting to understand how compassion has an incredibly important role in the lives of our patients and staff alike, we can start to build towards a more compassionate focused direction. By allocating tasks to staff members which are closer in line with their interests and values, tasks could be more rewarding than stressful. 

Introducing staff training to help with these tasks could help drive our team to expand their knowledge and bring the best services to their patients. More time spent on reflecting with patients and staff would also help us understand ongoing changes in attitudes and passions so that we can adjust to accommodate all. Taking the time to join mindfulness sessions would also really ground staff members who may benefit from a moment of self-compassion or who generally need to destress from a busy morning. 

By introducing the more compassionate focused practices to the ward, we could help guide our patients and staff to think and reason compassionately by behaving caringly and kindly to themselves and others.

Psychology Notice Board – Felindre Ward

“Compassion is the courage to descend into the reality of human experience.”

Paul Gilbert - founder of Compassion Focused Model

To DBT or not to DBT? That was the question...

This was the intriguing title of one of the key presentations at the recent Powys Research, Therapies and Health Sciences Conference: Inspiration and Innovation to Drive Patient Centred Care. I attended the conference last November and subsequently wrote How is telehealth working in Mid Wales? The day was packed full of inspiring talks and workshops on all aspects of innovative health work and research going on in the county – do go this year if it’s on again and you get chance.

Anyway, Dr Kathryn Walters, Consultant Clinical Psychologist and Dr David Pyle, Associate Specialist Psychiatrist, told us all about a relatively new service that has been developed in South Powys, to deliver Dialectical Behaviour Therapy (DBT) for the first time in the county. They were joined by Richard, who has been through the programme in Powys and was able to tell us what it was like for him.

Dr Kathryn Walters

First things first. What exactly is DBT? Over to Kathryn and David: 

“DBT is a cognitive behavioural treatment that was originally developed in the United States to treat chronically suicidal individuals diagnosed with borderline personality disorder and is now recognised as the gold standard psychological treatment for clients with this diagnosis. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post traumatic stress disorder and eating disorders.” 

Apparently 20% of mental health inpatients have been diagnosed with BPD/ Emotionally Unstable Personality Disorder.

And so this is my next question: what is borderline personality disorder? 


We’re not very keen on psychiatric labels on this blog, but this one is used routinely by the mental health services in the UK, including here in Powys. Kathryn referred to the DSM V definition (the Diagnostic and Statistical Manual of the American Psychiatric Association) which is extremely detailed. There is a good description on the mental health charity Mind’s website, where people have also posted about what it feels like for them: “having BPD is like the emotional version of being a burn victim. Everything in the world hurts more than it seems to for everyone else and any 'thick skin' you are supposed to have just isn't there”. First thing on a Monday morning and probably most people would meet the criteria for BPD… but for those where difficulties continue and go on to become very extreme, and when people self harm often or attempt suicide, then they are very likely to come into contact with mental health services.

Kathryn explained more about the biosocial theory of BPD – that some people are born experiencing emotions more acutely, and have difficulties managing their emotions. This could be reinforced by the responses of family, friends and services, and ultimately it can be very difficult to change behaviours.

So, why DBT? Dialectics is about balancing opposites: balancing acceptance and change. It incorporates elements of mindfulness and radical acceptance, and helps people to accept the world as it is rather than battle against it. In other parts of the UK it had already been shown to be successful as a kind of “mental health gym” to improve the lives of people with a BPD diagnosis. A study in South West Wales where DBT is provided by Hywel Dda Health Board highlighted that financial savings could also be achieved. So, three years ago, in recognition of the fact that there was at that time no DBT service available to Powys residents, a bid was submitted to charitable funds to train six multi-disciplinary members of staff in order to set up a DBT service in South Powys.

Dr Kathryn Walters leads this team, which comprises Psychologists, Community Psychiatric Nurses (CPNs), an Occupational Therapist (OT) and a Psychiatrist. If, following assessment, someone is referred for a course of DBT they will join a rolling programme and be offered individual and group therapy, skills training, and phone consultations. (People in secondary mental health care with a care co-ordinator and a diagnosis of BPD can be referred. Care co-ordinators generally make referrals for DBT assessment). Feedback from people who have received DBT indicates that there is a general trend of improvement in people understanding and managing their difficulties better, and most are greatly satisfied with the programme.

Richard was in one of the first cohorts receiving DBT in Powys and spoke very favourably of his experience on the programme. Prior to joining he described his life as very difficult: “meds, meds, and more meds”, and not much support. It was rare for him to think through his thoughts – they were automatic and he would react to them. He was experiencing difficulties with his personal life to the extent that he self-harmed a lot. But this all changed once he started the 14 month DBT course. At first Richard felt that the programme went completely over his head. However, he committed himself to DBT and to the group, and he bonded quickly with fellow participants. It was reassuring to be with others who knew how he was feeling so that he didn’t have to explain all the time.

A third of the way through the DBT programme Richard had an experience which really changed his life. Everything suddenly became clear, and he felt changes within himself. He started to discuss his thoughts. By the end of the course he felt that he was a completely different person from when he had started. It is now 2 years since Richard completed the DBT programme, and he has not tried to self-harm or “do anything crazy” since. In fact, he is now into the third year of running his own business, has a good relationship with his partner, and a new baby.

Kathryn explained that people are encouraged to meet up as a “graduate group” once they have finished the course. There is also an open door for participants to get back in touch if that is what they want. The team stay in contact with annual Christmas cards. Meanwhile, demand for the South Powys DBT service has grown and there is currently a waiting list of 20 clients and three further members of staff have been trained to join the team.

So, in conclusion, it looks like the answer to the original question was definitely: “To DBT”. Which is perhaps not surprising, as much has been written online about the positive effects of DBT, such as: “DBT is not just a form of psychological therapy but a life-programme which patients use, initially to prevent serious self-harm or suicide and ultimately to build fruitful, satisfying lives”.

Do you have any experience of DBT? Whether you have or not, let us know what you think in the comments box below.

Top mental health podcasts

And now it’s 2017! Happy New Year! Traditionally we kickstart January by recommending some of our favourite blogs. In the past we’ve covered mental health, dementia and vlogging. This year we’re looking at mental health podcasts.

Podcasting is a form of audio broadcasting on the internet. You can download apps or programmes to listen to podcasts, or alternatively you can just listen on the podcast webpage. It's usually possible to subscribe to a regular podcast and receive notifications of new episodes if you find one you really like.

Personally I love listening to the radio, so finding interesting podcasts is just taking that one extra step on a highly rewarding audio journey. You can find out more about other people’s views, experiences and stories around mental health – not just in the UK but anywhere in the world. An added bonus: they’re usually free. And the real joy is that you can listen anytime and anyplace that has an internet connection (or download for later if you’re going somewhere offline).

As usual the bias in our choice is mainly (although not entirely) towards medical distress as opposed to medical illness. (You can read more about the debate around the medicalisation of mental health on this blog). However, you only have to type "mental health podcast" into your internet search engine and you will discover that the choice of listening options is endless. So, if our top picks are not yours, just start looking. But now to our list:

Shrink Rap radio

Later this month I’m starting a free online course with Future Learn - Psychology and Mental Health: Beyond Nature and Nurture with Professor of Clinical Psychology Peter Kinderman of Liverpool University. And then, as luck would have it, I found this podcast with him: Exploring the Disease Model Debate.

It’s just one of hundreds of podcasts on the Shrink Rap radio site from US clinical psychologist David Van Nuys. “All the psychology you need to know and just enough to make you dangerous”.

The Psychology Podcast

Psychologist Scott Barry Kaufman brings us The Psychology Podcast.

“Each episode will feature a guest who will stimulate your mind, and give you a greater understanding of yourself, others, and the world we live in.” Recent topics have included – exercise and mental stamina, and the psychology of improvised comedy.

On Being – a social enterprise with a radio show at its heart

If you're interested in finding out how trauma can affect your mental health, then here's a podcast worth tuning in to: "Restoring the Body: Yoga, Eye Movement Desensitization and Reprocessing (EMDR), and Treating Trauma" with Bessel van der Kolk. Bessel is the Medical Director of the Trauma Center at the Justice Resource Institute in Brookline, Massachusetts in the United States.

Wellbeing podcasts from the Mental Health Foundation

The Wellbeing podcasts aim to help you relax and improve your sense of wellbeing. They feature a number of subjects including mindfulness, stress and relaxation, positive thinking, wellbeing and nutrition, and exercise and mental health.

All In The Mind - ABC Radio National

An Australian radio station has a podcast on the innovative Open Dialogue approach which was developed in Lapland and is now spreading around the world due to its high success rates in helping people experiencing severe mental distress. We hear about the way it’s working in Bradford at a Soteria House.

Wellcome Collection – Feeling Emotional

This podcast from the Wellcome Collection features psychoanalyst, psychotherapist and writer Susie Orbach in conversation with writer, campaigner, international speaker and trainer Jacqui Dillon, Chair of the Hearing Voices Network.

University of York podcasts

What’s it like being a Dialectical Behavioural Therapist or a Mental Health Nurse? Listen to interviews with mental health nurses who talk about their roles within the profession, what they get out of their jobs and why they followed these career paths.

The League of Awkward Unicorns

With a title like The League of Awkward Unicorns you just have to find out more! This is a podcast from friends and authors Alice Bradley and Deanna Zandt who talk about anxiety, depression and all the other ways your brains can play tricks on you.

Act for Change - A Night with Mental Health 

A trio of talks from 2014, including Professor of Clinical Psychology Richard Bentall on the social causes of psychosis. Hosted by YouTube but audio not video.

All in the Mind – BBC Radio 4

Another All in the Mind, this time from the British Broadcasting Corporation. These BBC Radio 4 podcasts explore  "the limits and potential of the mind, how we think and how we behave". Claudia Hammond is the regular presenter.

Medicine Unboxed

Medicine Unboxed engages the public and front-line NHS staff “with a view of medicine that is infused and elaborated by the humanities”.

Here we have Research Psychologist Eleanor Longden, Consultant Psychiatrist David Sturgeon and Professor Richard Bentall in discussion on The Heard Voice.

Royal College of Psychiatrists

Interview based podcasts from the professional medical body responsible for supporting psychiatrists throughout their careers. You can dip into a huge range of topics: everything from the Demonisation of psychiatrists in fiction to Tasers and tasering.

Chartered Institute of Personnel & Development

A podcast promoting and supporting good mental health in the workplace.

And finally...

Public Health Network Cymru will also be launching a new podcast series any minute now. It has been recorded over the past few months, with topics including LGBT health, the Knowledge Exchange, and Adverse Childhood Experiences (ACEs). The Network will also create short 5 minute podcasts with topics including the Well-being of Future Generations Act, and the Public Health Wales Wellbeing statement and plan.

Dip into some of these podcasts and let us know what you think. We always love to hear from you – you can ring, email or post a comment in the box below. And tell us about your favourite podcasts too.

All the best for 2017 from the mental health team at PAVO – Anne, Carla, Jane and Jackie.

Brain Blogger

This Blog aims to capture the multidimensional aspects of health: biological, psychological, sociological, technological and economic perspectives. It challenges the traditional biomedical model by appointing Dr Engel's influential biopsychosocial model.

http://brainblogger.com/

Dr. Shaheen Lakhan serves as editor of Brain Blogger and executive director of the Global Neuroscience Initiative Foundation (GNIF)