1
|
Zheng F, Liu S, Yin Q, Zheng Y, Yang J, Huang H, Chen L, Wang Y, Chen X, Wang C. Long-term impact of self-compassion training with core stability exercise on patients with nonspecific chronic low back pain: A randomized controlled trial. J Psychosom Res 2024; 181:111678. [PMID: 38643684 DOI: 10.1016/j.jpsychores.2024.111678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE To compare the long-term effectiveness of self-compassion therapy (SCT) combined with core stability exercise (CSE) versus CSE alone in managing nonspecific chronic low back pain (NCLBP). METHODS The combined group received SCT and CSE, while the exercise group only received CSE. Treatment was administered once weekly for four weeks, followed by one year of follow-up. The primary outcomes were changes in functional limitations (measured by Roland and Morris Disability Questionnaire scores[RMDQ]) and self-reported back pain (measured by the Numeric Pain Rating Scale[NRS]) at 52 weeks, with assessments also conducted at 2, 4, and 16 weeks. RESULTS 52 (83.9%) completed the follow-up assessments and were included in the analysis (42 women [80.8%]; mean [SD] age,35.3 [10.0] years). In the combined group, the baseline mean (SD) RMDQ score was 9.3 (4.1),5.7 (5.8) at 2 weeks, 3.8 (3.4) at 4 weeks, 3.8 (3.7) at 16 weeks, and 2.4 (2.7) at 52 weeks. For the exercise group, the RMDQ scores were 8.2 (3.3) at baseline, 6.2 (4.2) at 2 weeks, 5.5 (4.7) at 4 weeks, 4.4 (4.5) at 16 weeks, and 5.2 (5.6) at 52 weeks. The estimated mean difference between the groups at 52 weeks was -3.356 points (95% CI, -5.835 to -0.878; P = 0.009), favoring the combined group. NRS scores showed similar changes. CONCLUSION The addition of self-compassion therapy enhances the long-term efficacy of core stability training for NCLBP (Preregistered at chictr.org.cn:ChiCTR2100042810).
Collapse
Affiliation(s)
- Fuming Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Shufeng Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Qunhui Yin
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Yiyi Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Jiajia Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Haoxuan Huang
- Department of psychology, Sun Yat-Sen University, Guangzhou 510006, China
| | - Lichang Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Yuyin Wang
- Department of psychology, Sun Yat-Sen University, Guangzhou 510006, China.
| | - Xi Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.
| |
Collapse
|
2
|
Tindall L, Kerrigan P, Li J, Hayward E, Gega L. Is behavioural activation an effective treatment for depression in children and adolescents? An updated systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02429-3. [PMID: 38615316 DOI: 10.1007/s00787-024-02429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 04/15/2024]
Abstract
Behavioural Activation (BA)-a brief therapy based on the scheduling of enjoyable, purposeful and rewarding activities-is an effective and cost-effective treatment for depression in adults that shows promise for children and adolescents. We provide an update on a previous systematic review of evidence on BA-delivered in-person, telephone, or online-for depression and comorbid anxiety in children and adolescents. We conducted systematic literature searches in 6 databases up to February 2024. We included all study designs evaluating BA with participants up to 18 years old with diagnosable depression, as established by a validated screening tool or diagnostic manual. We used the Moncrieff Scale and the Cochrane Risk of Bias tool to assess study quality. We summarised the findings of all study types with a narrative synthesis and of randomised controlled trials (RCTs) with a meta-analysis. Overall, 24 studies (6 RCTs, 18 pre-post evaluations, n = 2,758) met our inclusion criteria. A meta-analysis of 4 RCTs (n = 156) showed that BA has a small effect of 0.24 (Hedge's adjusted g) in reducing depression symptoms compared to a waiting-list control, usual care and other therapies. Online and telephone-facilitated BA was shown to be feasible in 3 studies and effective in 1. Outcomes on comorbid anxiety were mixed. No economic evaluations met our inclusion criteria. BA shows sufficient promise as an intervention for reducing depression symptoms in children and adolescents to justify the need for further RCTs, providing that five conditions are met: studies are powered to detect a minimal clinically important difference; BA materials are fit-for-purpose to produce clinically meaningful change; follow-ups are longer than 6 months; primary outcomes are child-reported; and intervention costs, resource use and adverse events are reported.
Collapse
Affiliation(s)
- Lucy Tindall
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Philip Kerrigan
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Emily Hayward
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Lina Gega
- Hull York Medical School, University of York, Heslington, UK
| |
Collapse
|
3
|
Adams D. Brief Report: Single-Session Interventions for Mental Health Challenges in Autistic People: An (Almost) Empty Systematic Review. J Autism Dev Disord 2024:10.1007/s10803-024-06313-6. [PMID: 38605188 DOI: 10.1007/s10803-024-06313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/13/2024]
Abstract
Single-session interventions (specific, structured programs that intentionally involve just one visit or encounter with a clinic, provider, or program) have been proven to prevent or reduce mental health challenges and reduce barriers to access. This review aimed to identify and synthesise literature on the acceptability, feasibility, effectiveness, or efficacy of (non-pharmacological) single-session interventions for autistic people. Four databases (Scopus, MEDLINE, PsycINFO, and ProQuest) were searched in 12.7.2023, with no date restrictions. Search terms were selected to identify articles reporting on single-session interventions in autistic people. Two raters screened titles/abstracts of 286 articles and full text of 17 articles, resulting in just two included articles, reporting on 46 participants. Risk of bias was assessed with the Quality Assessment with Diverse Studies (QuADS). The two included papers report on specific techniques taught within a single visit to a clinic using pre- and immediate post-intervention questionnaires. One study also reported on cortisol levels pre and post. Neither study reported on acceptability or feasibility of single-session interventions. However, there was insufficient quality evidence to evaluate the effectiveness or efficacy of single-session interventions for autistic people. Although there is substantial research on single-session interventions in the broader population, there is a lack of research into such approaches for autistic people. This is a missed opportunity to evaluate a potential means of support for those at elevated risk of mental health challenges and unmet mental health service need. Future research should co-produce and co-evaluate such approaches as a priority.
Collapse
Affiliation(s)
- Dawn Adams
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD, 4122, Australia.
- Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD, 4122, Australia.
| |
Collapse
|
4
|
Farrelly S, Peters E, Azis M, David AS, Hunter ECM. A brief CBT intervention for depersonalisation-derealisation disorder in psychosis: Results from a feasibility randomised controlled trial. J Behav Ther Exp Psychiatry 2024; 82:101911. [PMID: 37716893 DOI: 10.1016/j.jbtep.2023.101911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 08/26/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Depersonalisation/derealisation symptoms are prevalent in psychosis patients, are associated with increased impairment, and may maintain psychosis symptoms. We aimed to establish the feasibility and acceptability of a brief, six session therapy protocol adapted from a Cognitive-Behavioural model of Depersonalisation-Derealisation Disorder (DDD) in participants with psychotic symptoms. METHODS A single-blind, randomised controlled trial was conducted with a treatment-as-usual control condition. Feasibility and acceptability estimates included rates of referral, acceptance, eligibility, consent, satisfaction and improved skills/knowledge to manage depersonalisation. RESULTS Twenty-one individuals were recruited to the trial. Results suggest that the intervention was feasible and acceptable to participants and there is some signal of effect on clinical outcomes. LIMITATIONS There were some challenges in recruitment. Recruitment feasibility estimates from the research register used may not be informative for future trials recruiting directly from teams. CONCLUSIONS Overall, the results suggest that further investigations would be of interest and recommendations for this are made.
Collapse
Affiliation(s)
- Simone Farrelly
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychology, London, UK.
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychology, London, UK; South London and Maudsley NHS Foundation Trust (SLaM), PICuP (Psychological Interventions Clinic for outpatients with Psychosis), UK.
| | - Matilda Azis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychosis Studies, London, UK.
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK.
| | | |
Collapse
|
5
|
Arundell LLC, Saunders R, Buckman JEJ, Lewis G, Stott J, Singh S, Jena R, Naqvi SA, Leibowitz J, Pilling S. Differences in psychological treatment outcomes by ethnicity and gender: an analysis of individual patient data. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02610-8. [PMID: 38321296 DOI: 10.1007/s00127-024-02610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/01/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE There are discrepancies in mental health treatment outcomes between ethnic groups, which may differ between genders. NHS Talking Therapies for anxiety and depression provide evidence-based psychological therapies for common mental disorders. This study examines the intersection between ethnicity and gender as factors associated with psychological treatment outcomes. Aims were to explore by gender: (1) differences in psychological treatment outcomes for minoritized ethnic people compared to White-British people, (2) whether differences are observed when controlling for clinical and socio-demographic factors associated with outcomes, and (3) whether organization-level factors moderate differences in outcomes between ethnic groups. METHODS Patient data from eight NHS Talking Therapies for anxiety and depression services (n = 98,063) was used to explore associations between ethnicity and outcomes, using logistic regression. Stratified subsamples were used to separately explore factors associated with outcomes for males and females. RESULTS In adjusted analyses, Asian (OR = 0.82 [95% CI 0.78; 0.87], p < .001, 'Other' (OR = 0.79 [95%CI 0.72-0.87], p < .001) and White-other (0.93 [95%CI 0.89-0.97], p < .001) ethnic groups were less likely to reliably recover than White-British people. Asian (OR = 1.48 [95% CI 1.35-1.62], p < .001), Mixed (OR = 1.18 [95% CI 1.05-1.34], p = .008), 'Other' (OR = 1.60 [95% CI 1.38-1.84], p < .001) and White-other (OR = 1.18 [95% CI 1.09-1.28], p < .001) groups were more likely to experience a reliable deterioration in symptoms. Poorer outcomes for these groups were consistent across genders. There was some evidence of interactions between ethnic groups and organization-level factors impacting outcomes, but findings were limited. CONCLUSIONS Across genders, Asian, 'Other' and White-other groups experienced worse treatment outcomes across several measures in adjusted models. Reducing waiting times or offering more treatment sessions might lead to increased engagement and reduced drop-out for some patient groups.
Collapse
Affiliation(s)
- Laura-Louise C Arundell
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK.
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
| | - Rob Saunders
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
| | - Joshua E J Buckman
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
- iCope, Camden and Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Joshua Stott
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
| | - Satwant Singh
- Waltham Forest Talking Therapies, North-East London NHS Foundation Trust, London, UK
| | - Renuka Jena
- Waltham Forest Talking Therapies, North-East London NHS Foundation Trust, London, UK
| | | | - Judy Leibowitz
- iCope, Camden and Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, London, UK
| | - Stephen Pilling
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- iCope, Camden and Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, London, UK
| |
Collapse
|
6
|
Lam N, Green J, Hallas S, Forster A, Crocker TF, Andre D, Ellwood A, Clegg A, Brown L. Mapping review of pain management programmes and psychological therapies for community-dwelling older people living with pain. Eur Geriatr Med 2024; 15:33-45. [PMID: 37853269 PMCID: PMC10876761 DOI: 10.1007/s41999-023-00871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Persistent pain is common in older people and people living with frailty. Pain or the impact of pain on everyday life is potentially modifiable. We sought to map research evidence and information from randomised controlled trials (RCTs) of pain management programmes and psychological therapies targeting community-dwelling older people, and explore appropriate strategies and interventions for managing or reducing the negative impact of pain for older people, particularly those with frailty. METHOD A mapping review of pain management programmes and psychological therapies for community-dwelling older people living with chronic pain. We searched for systematic reviews of randomised controlled trials and for individual randomised controlled trials and extracted data from eligible studies. RESULTS Searches resulted in 3419 systematic review records and 746 RCT records from which there were 33 eligible interventions identified in 31 eligible RCTs (48 reports). Broad aims of the interventions were to: improve physical, psychological, or social functioning; adjust the effects or sensation of pain psychologically; enhance self-care with self-management skills or knowledge. Common mechanisms of change proposed were self-efficacy enhanced by self-management tasks and skills, using positive psychological skills or refocusing attention to improve responses to pain, and practising physical exercises to improve physiological well-being and reduce restrictions from pain. Content of interventions included: skills training and activity management, education, and physical exercise. Interventions were delivered in person or remotely to individuals or in groups, typically in 1-2 sessions weekly over 5-12 weeks. CONCLUSION All the evaluated interventions appeared to show potential to provide some benefits to older people. None of the included studies assessed frailty. However, some of the included interventions appear appropriate for community-dwelling older people living with both frailty and pain.
Collapse
Affiliation(s)
- Natalie Lam
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
- Department of Health Sciences, University of York, York, UK
| | - John Green
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Sarah Hallas
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
- University of Leeds, Leeds, UK
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK.
- University of Leeds, Leeds, UK.
| | | | - Alison Ellwood
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
- University of Leeds, Leeds, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| |
Collapse
|
7
|
Davies A, Rogers JM, Baker K, Li L, Llerena J, das Nair R, Wong D. Combined Cognitive and Psychological Interventions Improve Meaningful Outcomes after Acquired Brain Injury: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2023:10.1007/s11065-023-09625-z. [PMID: 37955821 DOI: 10.1007/s11065-023-09625-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
Interventions addressing cognitive and emotional difficulties after acquired brain injury (ABI) often focus on specific impairments in cognition or mood. These interventions can be effective at addressing their specific target, but do not routinely translate to improved activity and participation outcomes. Approaches that combine cognitive and psychological rehabilitation are increasingly popular; however, to date, there have been no systematic evaluations of their efficacy. We conducted a systematic review of five databases, searching for randomised controlled trials of adults with diagnoses of non-progressive ABI at least 1-month post injury, in receipt of interventions that combined cognitive and psychological components compared to any control. Screening and data extraction were evaluated by two independent reviewers using a standardised protocol. Effect sizes were calculated using Hedge's g and estimated using a random-effects model. Risk of bias was assessed using the PEDro-P rating system, and quality of evidence evaluated using the grading of recommendation, assessment, development and evaluation (GRADE) approach. Thirteen studies were included in the meta-analysis (n = 684). There was an overall small-to-medium effect (g = 0.42) for combined interventions compared with controls, with gains maintained at 6-month follow-up. Improvements were observed at the level of impairment, activity, participation and quality of life. GRADE ratings and analyses investigating sensitivity, heterogeneity and publication bias indicated that these effects were robust. No a priori variables moderated these effects. Overall, this review provides strong evidence that combined cognitive and psychological interventions create meaningful change in the lives of people with ABI.
Collapse
Affiliation(s)
- Alexandra Davies
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Jeffrey M Rogers
- Faculty of Health Sciences, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Katharine Baker
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Lily Li
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Joshua Llerena
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Roshan das Nair
- School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- Health Research, SINTEF Digital, Dept. of Health Research, Torgaarden, P.O. Box 4760, Trondheim, NO-7465, Norway
| | - Dana Wong
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia.
| |
Collapse
|
8
|
Renner C, Jeitziner MM, Albert M, Brinkmann S, Diserens K, Dzialowski I, Heidler MD, Lück M, Nusser-Müller-Busch R, Sandor PS, Schäfer A, Scheffler B, Wallesch C, Zimmermann G, Nydahl P. Guideline on multimodal rehabilitation for patients with post-intensive care syndrome. Crit Care 2023; 27:301. [PMID: 37525219 PMCID: PMC10392009 DOI: 10.1186/s13054-023-04569-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Intensive Care Unit (ICU) survivors often experience several impairments in their physical, cognitive, and psychological health status, which are labeled as post-intensive care syndrome (PICS). The aim of this work is to develop a multidisciplinary and -professional guideline for the rehabilitative therapy of PICS. METHODS A multidisciplinary/-professional task force of 15 healthcare professionals applied a structured, evidence-based approach to address 10 scientific questions. For each PICO-question (Population, Intervention, Comparison, and Outcome), best available evidence was identified. Recommendations were rated as "strong recommendation", "recommendation" or "therapy option", based on Grading of Recommendations, Assessment, Development and Evaluation principles. In addition, evidence gaps were identified. RESULTS The evidence resulted in 12 recommendations, 4 therapy options, and one statement for the prevention or treatment of PICS. RECOMMENDATIONS early mobilization, motor training, and nutrition/dysphagia management should be performed. Delirium prophylaxis focuses on behavioral interventions. ICU diaries can prevent/treat psychological health issues like anxiety and post-traumatic stress disorders. Early rehabilitation approaches as well as long-term access to specialized rehabilitation centers are recommended. Therapy options include additional physical rehabilitation interventions. Statement: A prerequisite for the treatment of PICS are the regular and repeated assessments of the physical, cognitive and psychological health in patients at risk for or having PICS. CONCLUSIONS PICS is a variable and complex syndrome that requires an individual multidisciplinary, and multiprofessional approach. Rehabilitation of PICS should include an assessment and therapy of motor-, cognitive-, and psychological health impairments.
Collapse
Affiliation(s)
- Caroline Renner
- Department of Neurology and Neuro-Rehabilitation, Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg GmbH, Rotenburg a. F., University of Leipzig, Leipzig, Germany
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Monika Albert
- Department of Neurology, Rehabilitation ZURZACH Care, Baden, Switzerland
| | | | - Karin Diserens
- Department of Clinical Neurosciences, University Hospital, Lausanne, Switzerland
| | - Imanuel Dzialowski
- ELBLAND Neuro-Rehabilitation Center Grossenhain, Academic Teaching Hospital Technical University Dresden, Dresden, Germany
| | | | | | | | - Peter S Sandor
- Department Neurology and Psych. ZURZACH Care, Bad Zurzach, Switzerland
| | - Andreas Schäfer
- Asklepios Center for Further Education in Intensive Care - and Anaesthesia Nursing North Hesse, Frankfurt, Germany
| | - Bettina Scheffler
- Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Claus Wallesch
- BDH-Hospital Elzach - Center for Neurorehabilitation and Intensive Care, Elzach, Germany
| | - Gudrun Zimmermann
- IB University of Health and Applied Social Science Berlin, Hamburg, Cologne, Stuttgart, Munich, Germany
| | - Peter Nydahl
- Nursing Research, University Hospital of Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
- Institute of Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria.
| |
Collapse
|
9
|
Millard LA, Wan MW, Smith DM, Wittkowski A. The effectiveness of compassion focused therapy with clinical populations: A systematic review and meta-analysis. J Affect Disord 2023; 326:168-192. [PMID: 36649790 DOI: 10.1016/j.jad.2023.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Over the last 20 years, compassion focused therapy (CFT) has gained popularity as an emerging 'third wave' intervention. Although previous reviews indicated its potential benefits, a systematic review and meta-analysis of CFT in those with mental health difficulties has yet to be conducted. METHODS A systematic search of five databases was undertaken, focusing on randomised controlled trials and randomised pilot/feasibility studies of CFT only. No language restrictions were implemented. A narrative synthesis was conducted. Random effects meta-analyses were measured on levels of self-compassion, self-criticism/self-reassurance, fears of compassion and clinical symptomology. RESULTS Fifteen studies from 2013 to 2022 were included. Findings suggested that CFT was effective in improving compassion-based outcomes and clinical symptomology from baseline to post-intervention and compared to waitlist control. A range of small to large effect sizes were reported for improvements in self-compassion (0.19-0.90), self-criticism (0.15-0.72), self-reassurance (0.43-0.81), fear of self-compassion (0.18), depression (0.24-0.25) and eating disorders (0.18-0.79). Meta-analyses favoured CFT in improving levels of self-compassion and self-reassurance than control groups. LIMITATIONS The methodological quality of many of the included studies (7/15) was rated as 'unclear' due to a lack of information. There was a distinct gender gap, with 74.88% identifying as female participants. CONCLUSIONS This review was the first to examine the effectiveness of CFT in clinical populations. The results indicate that CFT has promising clinical implications, suggesting that the intervention increases compassion-based outcomes and reduces clinical symptomology in those with mental health difficulties. However, future research is required into the long-term effects of CFT.
Collapse
Affiliation(s)
- L A Millard
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, UK
| | - M W Wan
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, UK; Manchester Academic Health Science Centre, UK
| | - D M Smith
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, UK; Manchester Academic Health Science Centre, UK
| | - A Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, UK; Manchester Academic Health Science Centre, UK.
| |
Collapse
|
10
|
Taylor PJ, Duxbury P, Moorhouse J, Russell C, Pratt D, Parker S, Sutton C, Lobban F, Drake R, Eccles S, Ryder D, Patel R, Kimber E, Kerry E, Randles N, Kelly J, Palmier-Claus J. The Mental Imagery for Suicidality in Students Trial (MISST): study protocol for a feasibility randomised controlled trial of broad-minded affective coping (BMAC) plus risk assessment and signposting versus risk assessment and signposting alone. Pilot Feasibility Stud 2023; 9:43. [PMID: 36932430 PMCID: PMC10021063 DOI: 10.1186/s40814-023-01273-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/04/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Going to university is an important milestone in many people's lives. It can also be a time of significant challenge and stress. There are growing concerns about mental health amongst student populations including suicide risk. Student mental health and counselling services have the potential to prevent suicide, but evidence-based therapies are required that fit these service contexts. The Broad-Minded Affective Coping intervention (BMAC) is a brief (6 sessions), positive imagery-based intervention that aims to enhance students access to past positive experiences and associated emotions and cognitions. Pilot data provides preliminary support for the BMAC for students struggling with suicidal thoughts and behaviours, but this intervention has not yet been evaluated in the context of a randomised controlled trial (RCT). The Mental Imagery for Suicidality in Students Trial (MISST) is a feasibility RCT that aims to determine the acceptability and feasibility of evaluating the BMAC as an intervention for university students at risk of suicide within a larger efficacy trial. Key feasibility uncertainties have been identified relating to recruitment, retention, and missing data. Intervention acceptability and safety will also be evaluated. METHOD MISST is a feasibility randomised controlled trial design, with 1:1 allocation to risk assessment and signposting plus BMAC or risk assessment and signposting alone. Participants will be university students who self-report experiences of suicidal ideation or behaviour in the past 3 months. Assessments take place at baseline, 8, 16, and 24 weeks. The target sample size is 66 participants. A subset of up to 20 participants will be invited to take part in semi-structured qualitative interviews to obtain further data concerning the acceptability of the intervention. DISCUSSION The BMAC intervention may provide an effective, brief talking therapy to help university students struggling with suicidal thoughts that could be readily implemented into university student counselling services. Depending on the results of MISST, the next step would be to undertake a larger-scale efficacy trial. TRIAL REGISTRATION The trial was preregistered (17 December 2021) on ISRCTN (ISRCTN13621293) and ClinicalTrials.gov (NCT05296538).
Collapse
Affiliation(s)
- Peter James Taylor
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Paula Duxbury
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jane Moorhouse
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Chloe Russell
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Dan Pratt
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK.,Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sophie Parker
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK.,Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Chris Sutton
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK
| | - Fiona Lobban
- LA14YW, Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Richard Drake
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Steve Eccles
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - David Ryder
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK
| | - Rafeea Patel
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Eirian Kerry
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Nathan Randles
- School of Medicine, Keele University, Newcastle-Under-Lyme, UK
| | - James Kelly
- Manchester Mental Health NHS Foundation Trust, Manchester, UK.,Doctorate in Clinical Psychology, Lancaster University, Lancaster, UK
| | - Jasper Palmier-Claus
- LA14YW, Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK. .,Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK.
| |
Collapse
|
11
|
Lincoln TM. Translating affective and cognitive mechanisms of psychotic symptoms into better therapies. Psychiatry Res 2022; 317:114875. [PMID: 36244158 DOI: 10.1016/j.psychres.2022.114875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 01/05/2023]
Abstract
For a long time, psychotic symptoms were seen as too different from normal experiences to be explicable by psychological theories, let alone modifiable by psychological therapy. In the 1990s, the epidemiological research pointing to a continuum of psychotic symptoms and the clinical success in using cognitive approaches for psychosis strongly challenged this view. This inspired the field - along with my own work - to focus on a better understanding of the psychological mechanisms of psychotic symptoms in order to develop increasingly effective interventions. Together with other researchers, I have found that negative affect and aberrant arousal play a crucial role in the formation of delusions where they appear to interact with more fundamental problems in belief updating. While our understanding of the basic mechanisms that drive psychotic symptoms is gaining precision, the challenge remains to find the most suitable ways of targeting these mechanisms.
Collapse
Affiliation(s)
- Tania Marie Lincoln
- Universität Hamburg, Faculty of Psychology and Human Movement Science, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146, Hamburg, Germany.
| |
Collapse
|
12
|
Riquelme-Marín A, Rosa-Alcázar AI, Ortigosa-Quiles JM. Mindfulness-based psychotherapy in patients with obsessive-compulsive disorder: A meta-analytical Study. Int J Clin Health Psychol 2022; 22:100321. [PMID: 35892041 PMCID: PMC9287640 DOI: 10.1016/j.ijchp.2022.100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background/Objective Obsessive compulsive disorder is a disorder of special relevance in mental health, however, not all patients respond adequately to traditional intervention systems. The present work aims to study the usefulness of mindfulness-based interventions in patients with obsessive compulsive disorder. Method An exhaustive search of the literature between 1996 and 2021 allowed us to locate 11 published articles. The effect size was the pretest-posttest standardized mean change calculated for obsession-compulsion, as well as depression symptoms and conscious coping. Results he results showed mean effect sizes for mindfulness in the reduction of obsessive-compulsive symptoms (d + = 0.648) and, to a lesser extent, depression (d + = 0.417) and the improvement in Mindfull coping (d + = 0.509). There was no significant decrease in effect size when mindfulness was applied in patients with residual symptoms from previous treatments. Conclusions These results are promising regarding the usefulness of the application of intervention programs based on mindfulness in people with obsessive compulsive disorder, both as an alternative option and as a complementary treatment to more traditional intervention formats.
Collapse
Affiliation(s)
- Antonio Riquelme-Marín
- Corresponding autor: Dr. Antonio Riquelme-Marín. Depto. Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Murcia, Campus Universitario de Espinardo, 30100 Murcia, Spain.
| | | | | |
Collapse
|
13
|
Hurtado-Santiago S, Guzmán-Parra J, Mayoral F, Bersabé RM. Iconic Therapy for the reduction of borderline personality disorder symptoms among suicidal youth: a preliminary study. BMC Psychiatry 2022; 22:224. [PMID: 35351048 PMCID: PMC8966277 DOI: 10.1186/s12888-022-03862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iconic therapy (IT) is a new therapy that uses images to teach skills with the aim of improving the symptoms of borderline personality disorder. Preliminary results are promising, and there is indication that IT may be effective. The purpose of this preliminary study was to test the effectiveness of IT compared to a psychological supportive intervention (SI). METHODS The study was carried out at the University Regional Hospital of Malaga. Young patients (N = 40; 15-30 years) with suicidal or parasuicidal behavior and borderline personality traits were randomized into IT (N = 20) or SI (N = 20). The main outcome variable was a change in the symptoms of borderline personality disorder (BSL-23) at the end of treatment. The secondary outcome variables were suicidal ideation and behavior, self-harm, the need for medication, the number of visits to mental health professionals, maladaptive behavior, satisfaction with therapy and perceived improvement, both at the end of the intensive treatment and at the 12-month follow-up. RESULTS As expected, the two therapies produced a reduction in BPD symptoms at 10 weeks post-treatment and at the 12-month follow-up. Contrary to expectation, there were no statistically significant differences in the effectiveness of the two therapies (p > 0.05). However, at the 12-month follow-up, the effect sizes for the difference between the effectiveness of the two therapy groups on BSL-23 scores (d = 0.33) and on maladjustment to daily life (d = 0.39) was found to exceed the commonly used convention for a small effect (d = 0.20). Besides, participants in the IT group showed greater satisfaction with therapy than those who received SI. The mean difference between groups was statistically significant after the 10-week treatment period (p < .01), with a large effect size (d = 1.11). Nevertheless, this difference was not maintained at the 12-month follow-up (p > .05), although the effect size for this analysis (d = 0.34) was found to exceed a small effect. CONCLUSIONS This preliminary study did not find a statistically significant difference in the effectiveness of the two therapies, probably due to the small sample of participants, but there are some indicators (effect sizes) suggesting that perhaps IT may be superior for reducing BPD symptoms and maladjustment in daily life. Future studies with larger samples and comparisons with established treatments for borderline personality disorder are necessary to confirm that IT effects are significant and persistent in the long term. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03011190 . First posted 05/01/2017. Last update posted 15/05/2018.
Collapse
Affiliation(s)
| | - José Guzmán-Parra
- grid.452525.1University Regional Hospital of Málaga. Mental Health Unit. Biomedical Research Institute of Málaga (IBIMA, Málaga, Spain
| | - Fermín Mayoral
- grid.452525.1University Regional Hospital of Málaga. Mental Health Unit. Biomedical Research Institute of Málaga (IBIMA, Málaga, Spain
| | - Rosa M. Bersabé
- grid.10215.370000 0001 2298 7828Psychobiology and Methodology of the Behavioral Sciences Department, University of Málaga, Málaga, Spain
| |
Collapse
|
14
|
Berry K, Raphael J, Wilson H, Bucci S, Drake RJ, Edge D, Emsley R, Gilworth G, Lovell K, Odebiyi B, Price O, Sutton M, Winter R, Haddock G. A cluster randomised controlled trial of a ward-based intervention to improve access to psychologically-informed care and psychological therapy for mental health in-patients. BMC Psychiatry 2022; 22:82. [PMID: 35114980 PMCID: PMC8815159 DOI: 10.1186/s12888-022-03696-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is good evidence that psychological interventions improve patient well-being and independent living, but patients on acute mental health wards often do not have access to evidence-based psychological therapies which are strongly advised by NICE guidance for severe mental health problems. The overall aim of this programme of work is to increase patient access to psychological therapies on acute mental health inpatient wards. Stage one of the programme (which is complete) aimed to identify barriers and facilitators to delivering therapy in these settings through a large qualitative study. The key output of stage one was an intervention protocol that is designed to be delivered on acute wards to increase patient access to psychologically-informed care and therapy. Stage two of the programme aims to test the effects of the intervention on patient wellbeing and serious incidents on the ward (primary outcomes), patient social functioning and symptoms, staff burnout, ward atmosphere from staff and patient perspectives and cost effectiveness of the intervention (secondary outcomes). METHODS The study is a single blind, pragmatic, cluster randomised controlled trial and will recruit thirty-four wards across England that will be randomised to receive the new intervention plus treatment as usual, or treatment as usual only. Primary and secondary outcomes will be assessed at baseline and 6-month and 9-month follow-ups, with serious incidents on the ward collected at an additional 3-month follow-up. DISCUSSION The key output will be a potentially effective and cost-effective ward-based psychological intervention that increases patient access to psychological therapy in inpatient settings, is feasible to deliver in inpatient settings and is acceptable to patients. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT03950388. Registered 15th May 2019. https://clinicaltrials.gov/ct2/show/NCT03950388.
Collapse
Affiliation(s)
- Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK. .,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
| | - Jessica Raphael
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Helen Wilson
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard J Drake
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard Emsley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gill Gilworth
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Bolanle Odebiyi
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Owen Price
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matt Sutton
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Rachel Winter
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| |
Collapse
|
15
|
Zajkowska Z. In(s) and out(s) of adolescent depression - Trajectories of development and recovery. Brain Behav Immun Health 2021; 18:100382. [PMID: 34816138 PMCID: PMC8591391 DOI: 10.1016/j.bbih.2021.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 10/28/2022] Open
Abstract
While the role of biological markers in understanding major depressive disorder (MDD) in adults have been studied extensively, less has been done to identify the biomarkers of MDD development and recovery in adolescence. With the majority of mental health disorders starting in adolescence, identifying biomarkers of transition and recovery from MDD early in life is critical for developing effective prevention strategies. Considering most of the child and adolescent populations come from low-and-middle-income countries (LMICs), it is vital to focus on adolescent populations in these settings. With most studies coming from high-income countries (HICs), evidence suggests that elevated morning cortisol levels including cortisol awakening response (CAR), increased peripheral inflammation and brain abnormalities such as cortico-limbic dysregulation or blunted activity in reward related regions in response to positive information are associated with MDD and being at-risk for MDD development in adolescence. We also find that some of the biological mechanisms of recovery from MDD, mainly normalisation in the cortico-limbic dysregulation, are reported following psychological therapy, suggesting shared pathways leading to MDD vulnerability and recovery. Although, only a few studies include adolescent populations. Understanding molecular mechanisms through which psychological interventions are effective, as well as molecular markers of transition to depression in individuals at-risk, are important to inform effective prevention and intervention strategies.
Collapse
Affiliation(s)
- Zuzanna Zajkowska
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| |
Collapse
|
16
|
Saunders R, Buckman JE, Stott J, Leibowitz J, Aguirre E, John A, Lewis G, Cape J, Pilling S. Older adults respond better to psychological therapy than working-age adults: evidence from a large sample of mental health service attendees. J Affect Disord 2021; 294:85-93. [PMID: 34274792 PMCID: PMC8411661 DOI: 10.1016/j.jad.2021.06.084] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older adults commonly experience depression and anxiety, yet are under-represented in psychological treatment services. There is uncertainty about the outcomes from psychological therapies for older adults relative to working-age adults. This study explored: pre-treatment differences between older and working-age patients with depression or anxiety disorders; whether outcomes from psychological therapy differ between groups controlling for pre-treatment clinical severity, functioning, and socio-demographics; and whether the impact of a long-term health condition (LTC) on outcome differs by age. METHODS Data on >100,000 patients treated with psychological therapies in eight Improving Access to Psychological Therapies services were analyzed. We compared pre-treatment characteristics and therapy outcomes for older (≥65 years) and working-age (18-64 years) patients, and investigated associations between age and outcomes. RESULTS Older adults had less severe clinical presentations pre-treatment. In adjusted models older adults were more likely to reliably recover (OR=1.33(95%CI=1.24-1.43)), reliably improve (OR=1.34(95%CI =1.24-1.45)), and attrition was less likely (OR=0.48(95%CI =0.43-0.53)). Effects were more pronounced in patients with anxiety disorders compared to depression. Having an LTC was associated with a much lower likelihood of reliable recovery for working-age patients but had only a modest effect for older adults. LIMITATIONS There are potential selection biases affecting the characteristics of older people attending these services. Residual confounding cannot be ruled out due to limits on data available. CONCLUSIONS Older adults experienced better outcomes from psychological treatments than working-age adults. Given the deleterious effects if mental health conditions go untreated, increasing access to psychological therapies for older people should be an international priority.
Collapse
Affiliation(s)
- Rob Saunders
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK.
| | - Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK,iCope – Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
| | - Joshua Stott
- ADAPT lab, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
| | - Judy Leibowitz
- iCope – Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
| | | | - Amber John
- ADAPT lab, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - John Cape
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK,Camden & Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, UK
| | | |
Collapse
|
17
|
Abstract
Irritable bowel syndrome (IBS) is a common symptom-based condition of heterogeneous pathogenesis and clinical phenotype. This heterogeneity and multidimensional nature creates significant diagnostic and treatment challenges. Recent evidence has documented the benefits of diet and behavioral interventions. These nonmedical strategies are causing a shift from the traditional care model to a multidisciplinary care model. Recent evidence suggests that collaborative, team-based integrated care leads to better clinical outcomes and reduced cost per cure compared with traditional care. Although it is growing increasingly clear that integrated care offers significant benefits to IBS patients, widespread dissemination will require solutions to structural, cultural, and financial barriers.
Collapse
|
18
|
Berry C, Hodgekins J, Michelson D, Chapman L, Chelidoni O, Crowter L, Sacadura C, Fowler D. A Systematic Review and Lived-Experience Panel Analysis of Hopefulness in Youth Depression Treatment. Adolesc Res Rev 2021; 7:235-266. [PMID: 34250220 PMCID: PMC8260023 DOI: 10.1007/s40894-021-00167-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/23/2021] [Indexed: 05/03/2023]
Abstract
Hopefulness is arguably of central importance to the recovery of youth with major or complex youth depression, yet it is unclear how hopefulness can best be enhanced in treatment. A narrative synthesis of published and grey literature was combined with new insights from a youth lived-experience panel (N = 15), focusing on to what extent and how specific psychological therapies and standard mental health care scaffold hopefulness as applied to depression among 14-25-year-olds. Thirty-one studies of variable quality were included in this review; thirteen were qualitative, thirteen quantitative, and five used mixed methods. Hopefulness is an important active ingredient of psychotherapies and standard mental health care in youth depression. Evidence suggests talking and activity therapies have moderate to large effects on hopefulness and that hopefulness can be enhanced in standard mental health care. However, varying intervention effects suggest a marked degree of uncertainty. Hopefulness is best scaffolded by a positive relational environment in which there is support for identifying and pursuing personally valued goals and engaging in meaningful activity. Animated (https://www.youtube.com/watch?v=o4690PdTGec) and graphical summaries (https://doi.org/10.13140/RG.2.2.27024.84487) are available. Supplementary Information The online version contains supplementary material available at 10.1007/s40894-021-00167-0.
Collapse
Affiliation(s)
- Clio Berry
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
- Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Watson Building, Falmer, BN1 9PH UK
| | | | | | - Laura Chapman
- School of Psychology, University of Sussex, Brighton, UK
| | - Olga Chelidoni
- School of Life Sciences, University of Sussex, Brighton, UK
| | - Lucie Crowter
- School of Psychology, University of Sussex, Brighton, UK
| | - Catarina Sacadura
- Research & Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| |
Collapse
|
19
|
Lawton K, Spencer A. A Full Systematic Review on the Effects of Cognitive Behavioural Therapy for Mental Health Symptoms in Child Refugees. J Immigr Minor Health 2021; 23:624-639. [PMID: 33590440 PMCID: PMC8068688 DOI: 10.1007/s10903-021-01151-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
Global conflict in 2019 created record numbers of displaced children. These children have experienced multiple traumas and subsequently suffer high levels of mental health symptoms. Cognitive-behavioural therapy (CBT) is commonly used for post-traumatic stress disorder (PTSD), depression and anxiety, however the current evidence-base of CBT in child refugees is sparse, with mixed results. This study aimed to assess the effects of CBT on symptoms of PTSD, depression and anxiety in child refugees/AS. Ethics were reviewed and granted by the University of Manchester ethics committee. Medline, Embase, Cochrane, PsycINFO and CINAHL were systematically searched. Studies were included if CBT was delivered to refugee/AS children with pre and post-intervention measures of symptoms. Sixteen studies fulfilled criteria. In all studies, mental health symptom scores post-intervention had reduced, suggesting an improvement in mental health following CBT. This reduction was statistically significant in twelve studies (p < 0.001-0.5), clinically significant in eight studies and maintained at follow-up periods. No adverse effects of CBT were identified. This is the first systematic review to focus solely on CBT in child refugee populations, with unanimously positive results. Its use is cautiously recommended, however the need for more methodologically rigorous studies in this population is highlighted.
Collapse
Affiliation(s)
- Katie Lawton
- St Helens and Knowsley Teaching Hospitals NHS Trust, 474, Kings Road, Stretford, Manchester, M32 8QW, UK.
| | - Angela Spencer
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| |
Collapse
|
20
|
Sweetman J, Knapp P, Varley D, Woodhouse R, McMillan D, Coventry P. Barriers to attending initial psychological therapy service appointments for common mental health problems: A mixed-methods systematic review. J Affect Disord 2021; 284:44-63. [PMID: 33582432 DOI: 10.1016/j.jad.2021.01.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Non-attendance at initial appointments is a widespread problem which affects mental health services and patients. METHODS This mixed methods systematic review identified and synthesised the available literature on factors, which could be modified either by patients or by services, that can influence early attrition to services offering psychological support for common mental health problems. Searches were conducted January 2017, updated Oct 2019, in MEDLINE, CINAHL Plus, EMBASE, Cochrane Library and PsycINFO. Screening, data extraction and quality appraisal were completed independently by two reviewers. Quality appraisals used Joanna Briggs Institute tools. RESULTS Of the 31,758 references identified (21,123 unique), 34 studies were selected for inclusion. Studies used cohort (14), cross-sectional (10) and qualitative (9) designs. An additional study reported both quantitative and qualitative components. Findings from observational studies related to the presenting problem, beliefs about symptoms and treatment, contact with services, practical challenges and social support. Themes from qualitative studies centred around individual perceptions of symptoms and support, social and cultural influences, experiences with services and practical issues. Similarities and differences between quantitative and qualitative syntheses are discussed in a combined synthesis. LIMITATIONS This review did not attempt to measure the effect of factors affecting attendance, or the effectiveness of interventions to reduce non-attendance to initial treatment appointments. CONCLUSIONS Ensuring treatments offered matched patient perceptions of problems, reducing patient concerns around engagement, and offering prompt responses with flexibility to accommodate patient circumstances consistently influenced initial attendance. More work is needed to improve perceptions of mental health services in the community.
Collapse
Affiliation(s)
| | - Peter Knapp
- Department of Health Sciences, University of York, UK; Hull York Medical School, UK
| | | | | | - Dean McMillan
- Department of Health Sciences, University of York, UK; Hull York Medical School, UK
| | | |
Collapse
|
21
|
Bennett SD, Au C, Byford S, Chorpita B, Coughtrey AE, Cross JH, Dalrymple E, Fonagy P, Ford T, Heyman I, Lewins A, Moss-Morris R, Reilly C, Xu L, Shafran R. Feasibility of telephone-delivered therapy for common mental health difficulties embedded in pediatric epilepsy clinics. Epilepsy Behav 2021; 116:107743. [PMID: 33556861 DOI: 10.1016/j.yebeh.2020.107743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mental and physical health treatment should be delivered together for children and young people with epilepsy. Training healthcare professionals (HCPs) in epilepsy services to deliver mental health interventions is an important way to facilitate integrated care. OBJECTIVE To determine the feasibility of remotely delivered assessment and psychological treatment for mental health difficulties delivered by HCPs in pediatric epilepsy clinics with limited formal training in psychological interventions. We hypothesized that it would be (i) feasible to train HCPs to deliver the psychological intervention and (ii) that participants receiving the psychological therapy would report reductions in symptoms of mental health difficulties including anxiety, depression, and behavior difficulties and improve quality of life. METHODS Thirty-four children and young people with epilepsy who had impairing symptoms of a common mental health difficulty (anxiety, depression, disruptive behavior, and/or trauma) were allocated to receive 6 months of a modular cognitive behavioral intervention delivered by a HCP with limited formal psychological therapy experience. Thirteen HCPs were trained in delivery of the intervention. Healthcare professional competence was assessed in a two-stage process. Parent-reported measures of mental health symptoms and quality of life were completed at baseline and following the intervention. Paired t-tests were used to analyze changes in symptoms over time. RESULTS All thirteen HCPs who participated in the training were considered competent in therapeutic delivery by the end of the training period. Twenty-three patients completed pre- and post-intervention measures and were included in the analysis. There were statistically significant improvements in: symptoms of mental health problems (p = 0.01; Cohen's d = 0.62), total impact of mental health problems (p = 0.03; Cohen's d = 0.52), anxiety and depression symptoms (p = 0.02; Cohen's d = 0.57) and quality of life (p = 0.01; Cohen's d = 0.57). CONCLUSION A modular cognitive behavioral treatment delivered over the telephone by HCPs with limited experience of psychological therapy was feasible and effective in treating mental health problems in children and young people with epilepsy. Health-related Quality of Life also improved over the duration of treatment. A randomized controlled trial (RCT) is needed to demonstrate efficacy of the intervention.
Collapse
Affiliation(s)
- Sophie D Bennett
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK.
| | - Christy Au
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Sarah Byford
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Bruce Chorpita
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Anna E Coughtrey
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - J Helen Cross
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Emma Dalrymple
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Peter Fonagy
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Tamsin Ford
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Isobel Heyman
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Amy Lewins
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Rona Moss-Morris
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Colin Reilly
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Laila Xu
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Roz Shafran
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| |
Collapse
|
22
|
Abstract
The early development of cognitive behavior therapy (CBT) can be characterized by the coming together of behavioral and cognitive traditions. However, the past decades have arguably seen more divergences than convergences within the field. The 9th World Congress of Behavioural and Cognitive Therapies was held in Berlin in July 2019 with the congress theme "CBT at the Crossroads." This title reflected in part the coming together of people from all over the world, but also the fact that recent developments raise important questions about the future of CBT, including whether we can in fact treat it as a unified field. In this paper, we briefly trace the history of CBT, then introduce a special issue featuring a series of articles exploring different aspects of the past, present, and future of CBT. Finally, we reflect on the possible routes ahead.
Collapse
Affiliation(s)
- Simon E. Blackwell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | | |
Collapse
|
23
|
Abstract
Perceptual control theory states that behaviour controls perception; we act against disturbances in the environment to align hierarchically organised perceived aspects of the self and the world with neurally specified reference values. The diverse symptoms of psychopathology are each examples of loss of control, which are maintained by conflicting control systems, and effective interventions shift and sustain awareness to the source of the conflict to allow trial-and-error changes (reorganisation) in the parameters of the superordinate system to the conflict, until control is restored. Experimental, phenomenological, therapeutic and computational research has examined its mechanisms, and its mode of delivery has extended it from a client-led psychotherapy (method of levels) to brief training, group interventions and computerised modalities.
Collapse
Affiliation(s)
- Warren Mansell
- CeNTrUM (Centre for New Treatments and Understanding in Mental Health), Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
| |
Collapse
|
24
|
Sonty N. Pain Psychology for Surgeons and Otolaryngologists. Otolaryngol Clin North Am 2020; 53:885-95. [PMID: 32703691 DOI: 10.1016/j.otc.2020.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pain is one of the leading reasons that brings patients into health care facilities; yet, it often is left undertreated. The biopsychosocial model of pain, which recognizes that pain is multidimensional, explains the complexities that affect the pain experience and response to treatment. Inclusion of behavioral and psychological factors in medical and surgical evaluations can facilitate an optimal outcome. When pain no longer is acute but becomes chronic, access to psychotherapeutic interventions becomes necessary to improve course and prognosis. Techniques, such as psychoeducation, deep breathing, imagery, and addressing expectations and catastrophic beliefs, can be incorporated into medical and surgical practices.
Collapse
|
25
|
Jiang Y, Chen J, Cen F, Li X, Song Z, Peng M, Liu X. Importance of respiratory airway management as well as psychological and rehabilitative treatments to COVID-19 patients. Am J Emerg Med 2020; 38:1698.e1-4. [PMID: 32601006 DOI: 10.1016/j.ajem.2020.04.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/20/2022] Open
Abstract
The clinical therapy for severe 2019 coronavirus disease (i.e., COVID-19) sufferers is relatively challenging. Herein, the processes involving salvage of a critical COVID-19 patient were retrospectively analyzed. The condition of an obese female critical COVID-19 sufferer progressively worsened in the initial period after admission. According to her symptoms and examination reports, endotracheal intubation and mechanical ventilation were timely conducted and meanwhile high-dose sedatives and analgesics were administrated. In the later therapeutic phase, however, sedative and analgesic dosages were gradually reduced, and psychological and rehabilitative therapies were conducted, concomitantly with enhancement of airway care to facilitate sputum expectoration. Eventually, the endotracheal tube was feasibly removed after intubation for 18 days and subsequently replaced with noninvasive ventilation and a high-flow nasal cannula oxygen therapy. Intensive airway care alongside psychological and rehabilitative therapies can shorten the mechanical ventilation time and improve the prognosis of COVID-19 sufferers.
Collapse
|
26
|
Thomas J, Thirlaway K, Bowes N, Meyers R. Effects of combining physical activity with psychotherapy on mental health and well-being: A systematic review. J Affect Disord 2020; 265:475-485. [PMID: 32090775 DOI: 10.1016/j.jad.2020.01.070] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Despite a vast evidence-base advocating the psychological benefits of physical activity, relatively little is understood about how combining physical activity with psychological therapies may influence these positive effects. The aim of this paper is to systematically analyse evidence from studies adopting a combined approach, and identify potential mechanisms of action on clinical outcomes. METHODS The Embase, PsycINFO and Medline (PubMed and OVID) databases were searched for applicable trials published up to December 2018. Relevant data was extracted from eligible studies, and the Effective Public Health Practice Project (EPHPP) tool was utilised to objectively assess the quality of each study. RESULTS Twenty-two studies met the inclusion criteria, seven of which were rated as methodologically `strong'. Combining physical activity with psychological therapy consistently engendered positive effects on outcomes compared with treatment as usual. Similar improvements in psychological outcomes were observed in most (7/8) groups receiving physical activity alone. Increased levels of physical activity were observed in psychologically-informed interventions, however this effect was unrelated to changes in psychological outcomes. LIMITATIONS Clinical and methodological heterogeneity precluded meta-analyses of results, while risk of bias detected in the studies may compromise overall validity of the findings. CONCLUSIONS Physical activity interventions may be a viable alternative to psychological therapies, provided psychological approaches are incorporated into the implementation design (i.e. behavioural activation). Improved psychological outcomes may be observed regardless of `dose' received, however further research is required to ascertain whether psychosocial mechanisms of change mediate positive effects.
Collapse
Affiliation(s)
- Jennifer Thomas
- School of Sport and Health Sciences, Cardiff Metropolitan University.
| | - Katie Thirlaway
- School of Sport and Health Sciences, Cardiff Metropolitan University
| | - Nicola Bowes
- School of Sport and Health Sciences, Cardiff Metropolitan University
| | - Robert Meyers
- School of Sport and Health Sciences, Cardiff Metropolitan University
| |
Collapse
|
27
|
Irvine A, Drew P, Bower P, Brooks H, Gellatly J, Armitage CJ, Barkham M, McMillan D, Bee P. Are there interactional differences between telephone and face-to-face psychological therapy? A systematic review of comparative studies. J Affect Disord 2020; 265:120-131. [PMID: 32090733 PMCID: PMC7049904 DOI: 10.1016/j.jad.2020.01.057] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite comparable clinical outcomes, therapists and patients express reservations about the delivery of psychological therapy by telephone. These concerns centre around the quality of the therapeutic relationship and the ability to exercise professional skill and judgement in the absence of visual cues. However, the empirical evidence base for such perceptions has not been clearly established. METHODS We conducted a systematic review to establish what is known empirically about interactional differences between psychotherapeutic encounters conducted face-to-face vs. by telephone. RESULTS The review identified 15 studies that used situated, comparative approaches to exploring interactional aspects of telephone and face-to-face psychological therapy. These studies revealed evidence of little difference between modes in terms of therapeutic alliance, disclosure, empathy, attentiveness or participation. However, telephone therapy sessions were significantly shorter than those conducted face-to-face. LIMITATIONS We identified only a small number of heterogeneous studies, many of which used non-randomised, opportunity samples and did not use validated measures to assess the constructs under investigation. Disparate therapeutic modalities were used across studies and samples included both clinically diagnosed and non-clinical populations. CONCLUSIONS Available evidence suggests a lack of support for the viewpoint that the telephone has a detrimental effect on interactional aspects of psychological therapy. The challenge for clinical practice is to translate this evidence into a change in practitioner and patient attitudes and behaviours. In order to do so, it is important to understand and address the breadth of factors that underpin ongoing ambivalence towards the telephone mode, which pose a barrier to wider implementation.
Collapse
Affiliation(s)
- Annie Irvine
- Department of Language and Linguistic Science, University of York, Heslington, York, UK.
| | - Paul Drew
- Department of Language and Linguistic Science, University of York, Heslington, York, UK
| | - Peter Bower
- NIHR School for Primary care Research, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and health, University of Manchester, Manchester Academic Health Science Centre Manchester, UK
| | - Helen Brooks
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, UK
| | - Judith Gellatly
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, UK
| | - Christopher J. Armitage
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, UK
| | - Penny Bee
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, UK
| |
Collapse
|
28
|
Parr JR, Brice S, Welsh P, Ingham B, Le Couteur A, Evans G, Monaco A, Freeston M, Rodgers J. Treating anxiety in autistic adults: study protocol for the Personalised Anxiety Treatment-Autism (PAT-A©) pilot randomised controlled feasibility trial. Trials 2020; 21:265. [PMID: 32171316 PMCID: PMC7071661 DOI: 10.1186/s13063-020-4161-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/11/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anxiety is common in autistic adults and significantly limits everyday opportunities and quality of life. Evidence-based psychological therapies offered by mental health services often fail to meet the needs of autistic adults. The development of appropriate treatments for mental health conditions and, in particular, anxiety has been identified as a key priority by the autism community. The Personalised Anxiety Treatment-Autism (PAT-A©) trial aims to address this need by investigating the feasibility and acceptability of delivering an individualised psychological treatment for anxiety experienced by autistic adults. METHODS/DESIGN This is a pilot randomised controlled feasibility trial. Up to 40 autistic adults with clinically diagnosed anxiety will be randomised into one of two groups (either the PAT-A© intervention or Current Clinical Services Plus two emotional literacy skills sessions). Before randomisation, participants will receive a detailed clinical assessment to inform formulation and guide anxiety treatment. As part of the baseline assessment participants will also identify two personally important 'target situations' that cause significant anxiety and impact upon their daily life. Based upon the formulation and identified target situations, participants randomised to the PAT-A© intervention will receive up to 12 individualised, one-to-one therapy sessions. Initial emotional literacy training sessions will be followed by a bespoke, modular, needs-based treatment approach utilising one or more of the following approaches: Mindfulness, Coping with Uncertainty in Everyday Situations (CUES), social anxiety and graded exposure within Virtual Reality Environments. Participants in the control arm will receive two psycho-educational sessions focussing on understanding and describing emotions and be signposted to healthcare provision as required. Data will be collected through quantitative and qualitative methods. DISCUSSION This feasibility pilot trial serves as the first stage in the development and evaluation of a manualised personalised, evidence-based psychological therapy treatment for anxiety in autistic adults. Study outcomes will be used to inform an application for a fully powered multi-site intervention trial of adults and young people. TRIAL REGISTRATION ISRCTN, ID: 15881562. Retrospectively registered on 9 August 2019.
Collapse
Affiliation(s)
- Jeremy R. Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Samuel Brice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Patrick Welsh
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Barry Ingham
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gemma Evans
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alexander Monaco
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
29
|
Rushton K, Fraser C, Gellatly J, Brooks H, Bower P, Armitage CJ, Faija C, Welsh C, Bee P. A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies Service. BMC Health Serv Res 2019; 19:997. [PMID: 31878923 PMCID: PMC6933680 DOI: 10.1186/s12913-019-4824-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Psychological treatment delivered by telephone is recommended by the National Institute for Health and Care Excellence (NICE) for mild to moderate depression and anxiety, and forms a key part of the Improving Access to Psychological Therapy (IAPT) programme in the UK. Despite evidence of clinical effectiveness, patient engagement is often not maintained and psychological wellbeing practitioners (PWPs) report lacking confidence and training to deliver treatment by telephone. This study aimed to explore the perspectives of professional decision makers (both local and national) on the barriers and facilitators to the implementation of telephone treatment in IAPT. Methods Sixteen semi-structured qualitative telephone interviews and one focus group were carried out with decision makers (n = 21) who were involved locally and nationally in policy, practice and research. The interviews and focus group were coded thematically, and then mapped onto the four core constructs of Normalisation Process Theory (NPT). Results The use of telephone for psychological treatment was universally recognised amongst participants as beneficial for improving patient choice and access to treatment. However, at service level, motives for the implementation of telephone treatments are often misaligned with national objectives. Pressure to meet performance targets has become a key driver for the use of telephone treatment, with promises of increased efficiency and cost savings. These service-focussed objectives challenge the integration of telephone treatments, and PWP acceptance of telephone treatments as non-inferior to face-to-face. Ambivalence among a workforce often lacking the confidence to deliver telephone treatments leads to reluctance among PWPs to ‘sell’ treatments to a patient population who are not generally expecting treatment in this form. Conclusions Perceptions of a need to ‘sell’ telephone treatment in IAPT persist from top-level decision makers down to frontline practitioners, despite their conflicting motives for the use of telephone. The need for advocacy to highlight the clinical benefit of telephone treatment, along with adequate workforce support and guidance on best practice for implementation is critical to the ongoing success and sustainability of telephone treatment in primary care mental health programmes.
Collapse
Affiliation(s)
- Kelly Rushton
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Claire Fraser
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Judith Gellatly
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Helen Brooks
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care and Centre for Health Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Christopher J Armitage
- School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Cintia Faija
- School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Charlotte Welsh
- School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Penny Bee
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
30
|
Abstract
BACKGROUND Adolescent social anxiety disorder (SAD) is common, impairing and persistent. There is a need to intervene early to avert its long-term consequences. Cognitive Therapy for SAD is the leading treatment for adults and shows promise for adolescents. However, given the scale of the problem of adolescent SAD and the limited availability of psychological therapists in child and adolescent mental health services, there is a substantial gap in service provision. Delivering therapy via the Internet may provide part of the solution to this problem. An Internet version of adult Cognitive Therapy for SAD has been developed, with outcomes similar to face-to-face therapy. We have recently adapted this treatment for use with adolescents with SAD. Here, we describe a randomised controlled trial designed to test the efficacy of Internet Cognitive Therapy for adolescent SAD compared to waitlist. METHODS/DESIGN Forty adolescents aged 14-18 years with a diagnosis of SAD will be recruited via schools. Participants will be randomly allocated to Internet Cognitive Therapy or to waitlist. All participants will be assessed three times during the study-at baseline (pretreatment/wait), midtreatment/wait (week 8) and posttreatment/wait (week 15). Participants in the experimental arm will also complete weekly measures as part of the online program and they will be assessed at 3 and 6 months. Postwait, participants in the waitlist arm will be offered Internet Cognitive Therapy, and weekly and posttreatment data will also be collected for them. The trial aims to test whether Internet Cognitive Therapy is superior to waitlist in reducing social anxiety symptoms and in reducing the proportion of adolescents meeting criteria for SAD. Other outcomes of interest include depression and general anxiety symptoms. Acceptability of the online treatment will also be evaluated. DISCUSSION This randomised controlled trial will provide preliminary evidence on whether this intervention, requiring relatively low levels of therapist input, is safe and clinically effective. If this is shown to be the case, Internet Cognitive Therapy for adolescents has the potential to provide a service to the large population of adolescents with untreated SAD. TRIAL REGISTRATION ISRCTN Registry, ISRCTN15079139 . Version 1 registered on 06/02/2019.
Collapse
Affiliation(s)
- Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, OxCADAT, The Old Rectory, Paradise Square, Oxford, OX1 1TW UK
| | - David M. Clark
- Department of Experimental Psychology, University of Oxford, OxCADAT, The Old Rectory, Paradise Square, Oxford, OX1 1TW UK
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW Evidence regarding the treatment of late-life depression is not necessarily generalizable to persons with a neurocognitive disorder and comorbid depression. Thus, this article reviews recent evidence that pertains to the treatment of depression in older adults with neurocognitive disorders, and synthesizes and critically analyzes this literature to identify methodological issues and gaps for the purpose of future research. RECENT FINDINGS Controlled trials and meta-analyses examining depression treatment in neurocognitive disorders, published between 2015 and 2019 (N = 16 reports), can be divided into those addressing pharmacotherapy, psychological and behavioral therapy, and somatic therapy. The evidence generally does not support benefit of antidepressant medication over placebo in treating depressive disorders in dementia. No pharmacological studies since 2015 have examined antidepressant medication in participants with mild cognitive impairment (MCI). Problem adaptation therapy demonstrates efficacy for depression in MCI and mild dementia. Other psychological and behavioral interventions for depressive symptoms in dementia demonstrate mixed findings. The only somatic treatment trials published since 2015 have assessed bright light therapy, with positive findings but methodological limitations. Psychological, behavioral, and somatic treatments represent promising treatment options for depression in neurocognitive disorders, but further studies are needed, particularly in participants with depressive disorders rather than subclinical depressive symptoms. Little is known about the treatment of depression in patients with MCI, and rigorous identification of MCI in late-life depression treatment trials will help to advance knowledge in this area. Addressing methodological issues, particularly the diagnosis and measurement of clinically significant depression in dementia, will help to move the field forward.
Collapse
|
32
|
Kalpakidou AK, Cape J, Limbachya TJ, Nazareth I, Buszewicz M. Barriers to recruitment when conducting a commissioned randomised controlled trial of medication versus psychological therapy for generalised anxiety disorder: some lessons learned. Trials 2019; 20:284. [PMID: 31126337 DOI: 10.1186/s13063-019-3385-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 04/27/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Poor recruitment is the most common reason for premature discontinuation of randomised controlled trials (RCTs). An RCT of medication versus psychological therapy for generalised anxiety disorder (GAD) was discontinued prematurely by the UK National Institute of Health Research funders because of recruitment failure. In order to inform future research studies, this article explores the reasons for poor recruitment and aspects which could have been improved. METHODS The trial recruited participants via psychological well-being practitioners (PWPs) employed within local Improving Assess to Psychological Therapies (IAPT) services at four sites in England. For this study, we initially examined the recruitment data to identify reasons why potential participants were reluctant to participate in the trial. We then investigated reasons the PWPs did not identify more potential participants. Finally, we performed retrospective analyses of a computerised clinical records system used by the IAPT services in this study. These analyses aimed to establish the number of potential participants who had not been approached about the trial as well as whether there were additional factors affecting the numbers of people who might be eligible to take part. Data were obtained for all patients assessed during the period from the date on which recruitment commenced until the closure of the trial. RESULTS Three quarters of those patients identified as possibly suitable for the trial declined to take part; the great majority did so because they did not want to be randomly assigned to receive medication. Our retrospective database analyses showed that only around 12% of potentially eligible patients for the trial were identified by the PWPs at the pilot sites. The results also indicated that only 5% of those noted at entry to the IAPT services to have a score of at least 10 on the GAD-7 questionnaire (a self-completed questionnaire with high sensitivity and specificity for GAD) would have been eligible for the trial. CONCLUSIONS Our findings suggest that poor recruitment to RCTs can be significantly affected by participants' treatment preferences and by factors influencing the recruiting clinicians. It may also be important not to include too many restrictions on inclusion criteria for pragmatic trials aiming for generalisable results. TRIAL REGISTRATION ISCRTN14845583 . Registration date: 5 February 2015.
Collapse
|
33
|
Taylor L, Waite P, Halldorsson B, Percy R, Violato M, Creswell C. Protocol for a randomised controlled feasibility study examining the efficacy of brief cognitive therapy for the Treatment of Anxiety Disorders in Adolescents (TAD-A). Trials 2019; 20:240. [PMID: 31023352 PMCID: PMC6485105 DOI: 10.1186/s13063-019-3295-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
Background Anxiety disorders affect a quarter of the population during their lifetime, and typically emerge in childhood or adolescence. Anxiety disorders disrupt young people’s social, emotional and academic development and in the absence of treatment, often follow a chronic course. Although effective treatments, such as Cognitive Behaviour Therapy (CBT), exist, only a small proportion of adolescents with anxiety disorders who need treatment receive them. Barriers to treatment provision include the fact that CBT typically requires 14–16 sessions by a highly qualified therapist and services are stretched – resulting in lengthy waiting lists and limited access to treatment. This highlights the importance of developing new ways of providing effective treatments for adolescent anxiety disorders. This study aims to assess the feasibility of a future, large-scale trial. This will give a clear indication of the likely success of running a randomised controlled trial to compare a new, brief cognitive therapy treatment to an existing CBT group therapy for adolescents with anxiety disorders. Methods/design The study will examine whether a definitive trial can be conducted on the basis of a feasibility RCT using a number of well-defined criteria. The feasibility RCT is a single-centre, randomised control trial. Forty-eight Young people (age 11–17.5 years) attending a university research clinic, who meet the diagnostic criteria for a DSM-5 anxiety disorder, will be randomly allocated to receive either (1) Adolescent Cognitive Therapy for Anxiety (ACTA), which involves six 60–90-min sessions and a booster session or (2) group CBT, which involves eight 2-h sessions and a booster session. As part of the feasibility indicators, patient outcomes, expectations and experiences, as well as health economic factors, will be assessed before, at the end of treatment and at a 3-month follow-up. Discussion The successful delivery of a future, definitive trial has the potential to bring direct benefits to young people and their families, adolescent mental health service providers, as well as benefits to adult mental health services and society more broadly by disrupting the negative trajectory commonly associated with adolescent anxiety disorders. Trial registration ISRCTN, ID: ISRCTN86123204. Retrospectively registered on 23 November 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3295-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lucy Taylor
- School of Psychology and Clinical Language Sciences, University of Reading, Harry Pitt Building, Earley Gate, Reading, RG6 6AL, UK
| | - Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Harry Pitt Building, Earley Gate, Reading, RG6 6AL, UK.
| | - Brynjar Halldorsson
- Departments of Experimental Psychology and Psychiatry, Anna, Watts Building, Oxford, OX2 6GG, UK
| | - Ray Percy
- School of Psychology and Clinical Language Sciences, University of Reading, Harry Pitt Building, Earley Gate, Reading, RG6 6AL, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, Anna, Watts Building, Oxford, OX2 6GG, UK
| |
Collapse
|
34
|
Toms G, Williams L, Rycroft-Malone J, Swales M, Feigenbaum J. The development and theoretical application of an implementation framework for dialectical behaviour therapy: a critical literature review. Borderline Personal Disord Emot Dysregul 2019; 6:2. [PMID: 30805193 PMCID: PMC6373034 DOI: 10.1186/s40479-019-0102-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dialectical behaviour therapy (DBT) is a third wave behaviour therapy combining behaviour based components with elements of mindfulness. Although DBT effectiveness has been explored, relatively little attention has been given to its implementation. Frameworks are often the basis for gathering information about implementation and can also direct how the implementation of an intervention is conducted. Using existing implementation frameworks, this critical literature review scoped the DBT implementation literature to develop and refine a bespoke DBT implementation framework. METHOD AND RESULTS The initial framework was developed by consolidating existing implementation frameworks and published guidance on DBT implementation. The critical literature review retrieved papers from Medline, CINAHL, PsycInfo, PubMed, and the reference lists of included papers. Framework elements were used as codes which were applied to the literature and guided the synthesis. Findings from the synthesis refined the framework.The critical literature review retrieved 60 papers but only 14 of these explicitly focused on implementation. The DBT implementation framework captured all the execution barriers and facilitators described in the literature. However, the evidence synthesis led to a more parsimonious framework as some elements (e.g., research and published guidance) were seldom discussed in DBT implementation. CONCLUSION To our knowledge this is the first published review exploring DBT implementation. The literature synthesis suggests some tentative recommendations which warrant further exploration. For instance, if DBT implementation is not pre-planned, having someone in the organisation who champions DBT can be advantageous. However, as the literature is limited and has methodological limitations, further prospective studies of DBT implementation are needed.
Collapse
Affiliation(s)
- Gill Toms
- Gill Toms, School of Healthcare Sciences, Bangor University, Fron Heulog, Bangor, Gwynedd LL57 2EF UK
| | - Lynne Williams
- Gill Toms, School of Healthcare Sciences, Bangor University, Fron Heulog, Bangor, Gwynedd LL57 2EF UK
| | - Jo Rycroft-Malone
- Gill Toms, School of Healthcare Sciences, Bangor University, Fron Heulog, Bangor, Gwynedd LL57 2EF UK
| | - Michaela Swales
- North Wales Clinical Psychology Programme, School of Psychology, Brigantia Building, Bangor University, Bangor, Gwynedd LL57 2DG UK
| | - Janet Feigenbaum
- Research Department of Clinical, Education and Health Psychology, University College London, Gower Street, London, WC1E 6BT UK
| |
Collapse
|
35
|
Abstract
Tinnitus is a common symptom of unclear origin that can be multifactorially caused and maintained. It is frequently, but not inevitably, associated with hearing loss. Emotional distress and maladaptive coping strategies - that are associated with or amplified by the tinnitus percept - pose key targets for psychological interventions. Once somatic contributors are identified and treated as applicable, psychological approaches comprise normalizing psychoeducational and psychotherapeutic interventions. Measures to improve hearing perception (e. g., hearing aids or cochlear implants) can also contribute to tinnitus habituation through direct (improvement of hearing perception) or indirect (improvement of emotional wellbeing or quality of life) effects.
Collapse
Affiliation(s)
- B Boecking
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Karlplatz 7, 10117, Berlin, Deutschland.
| | - P Brueggemann
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Karlplatz 7, 10117, Berlin, Deutschland
| | - B Mazurek
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Karlplatz 7, 10117, Berlin, Deutschland
| |
Collapse
|
36
|
Turner H, Bryant-Waugh R, Marshall E, Wood F. Patient expectations, eating disorder severity and personality features: Impact on eating pathology in psychological therapy for eating disorders. Eat Behav 2019; 32:85-89. [PMID: 30665178 DOI: 10.1016/j.eatbeh.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 12/07/2018] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Abstract
Many factors have been shown to impact treatment outcome in eating disorders, including illness related variables (e.g. symptom severity), and broader clinical features (e.g. personality pathology). Less is known about the potential impact of patient related variables, such as patients' views regarding treatment suitability and success. This study explored the impact of eating disorder severity, personality features and patient expectations regarding treatment suitability and success, on eating pathology at treatment end. Participants were 128 adults with diagnosed eating disorders who completed a course of evidence-based psychological therapy in a community eating disorders service in the UK. Patients completed measures of eating disorder psychopathology and personality features at treatment commencement, and a measure of patient expectations regarding change after session six. They repeated the measure of eating disorder psychopathology at treatment end. All patients had some level of positive expectations regarding the suitability and potential success of treatment after session six. Eating disorder severity significantly predicted eating pathology at treatment end. However, strength of positive expectations regarding treatment success significantly predicted eating pathology over and above baseline level of eating disorder severity. Personality features at baseline were not significantly related to treatment outcome. Findings suggest that patients' expectations regarding the likely success of therapy have a significant impact on treatment outcome. Patients who develop a strong belief that treatment will work may be more likely to actively engage in the process of therapy to achieve their recovery goals. These findings have important implications for the early phase of therapy and how patients are oriented towards treatment.
Collapse
Affiliation(s)
- Hannah Turner
- Eating Disorders Service, Southern Health NHS Foundation Trust, April House, 9 Bath Road, Bitterne, Southampton SO19 5ES, UK.
| | - Rachel Bryant-Waugh
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Emily Marshall
- Eating Disorders Service, Southern Health NHS Foundation Trust, April House, 9 Bath Road, Bitterne, Southampton SO19 5ES, UK
| | - Francesca Wood
- Eating Disorders Service, Southern Health NHS Foundation Trust, April House, 9 Bath Road, Bitterne, Southampton SO19 5ES, UK
| |
Collapse
|
37
|
Cella M, Wykes T. The nuts and bolts of Cognitive Remediation: Exploring how different training components relate to cognitive and functional gains. Schizophr Res 2019; 203:12-16. [PMID: 28919130 DOI: 10.1016/j.schres.2017.09.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/06/2017] [Accepted: 09/10/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cognitive Remediation (CR) is an evidence based treatment targeting cognitive and functional difficulties in people with psychosis. Despite the large number of effectiveness studies, only limited evidence exists for the active ingredients of this therapy. This study begins to fill this gap by exploring the relationship between CR ingredients, including alliance with a therapist, and therapy outcomes. METHOD This is a secondary analysis based on data from a published randomised controlled trial comparing CR+treatment-as-usual (TAU) to TAU alone. We considered the association between CR active ingredients including errorless learning, massed practice, strategy use and therapeutic alliance on the cognitive, functioning and symptom outcomes that significantly improved following therapy. RESULTS Forty-six of the 96 participants were randomised to CR. After therapy the CR group showed significant improvement in non-verbal memory, functioning and approaching significance, improvements in executive functions. All therapy ingredients were inter-related but strategy use alone was associated therapeutic alliance. Cognitive improvements were associated with massed practice, number of useful strategies and therapeutic alliance, but improvements in functioning were associated only with therapeutic alliance. CONCLUSIONS These findings build the evidence base for the usefulness of specific therapy components. As for other psychological therapies it appears that therapeutic alliance may be an important factor in driving change for key CR outcomes, particularly functioning, in people with psychosis.
Collapse
Affiliation(s)
- Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
38
|
Mercer L, Evans LJ, Turton R, Beck A. Psychological Therapy in Secondary Mental Health Care: Access and Outcomes by Ethnic Group. J Racial Ethn Health Disparities 2018; 6:419-426. [PMID: 30430460 DOI: 10.1007/s40615-018-00539-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/05/2018] [Accepted: 10/29/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To explore the differences in access to, and outcomes of, psychological therapy for different ethnic groups across a South London Mental Health Trust. METHOD This study used Trust data to explore the proportions of ethnic groups accessing psychological therapy as a proportion of all patients supported by the Trust, as well as their outcomes within broad diagnostic clusters. RESULTS Compared to proportions in the local population, there were significantly more White/White British patients and significantly fewer patients from 'other ethnic groups' in the Trust (p < .05). There was also significantly greater proportion of Black/Black British patients with schizophrenia diagnoses compared to the proportion of Black/Black British people in the local population (p < .001). Of those accessing psychological therapy, there were significantly more White/White British and 'other ethnic group' patients and significantly fewer Black/Black British patients (p < .05). For schizophrenia diagnoses, significantly fewer Black/Black British and 'other ethnic group' patients were accessing psychological therapy (p < .05); however for behavioural and emotional disorders, there were significantly higher proportions of 'other ethnic group' and White/White British patients. Outcomes varied by diagnosis; Black/Black British patients experienced significantly higher distress scores at the beginning of therapy for depression and neurotic diagnoses (p < .05), with the latter persisting at the end of treatment. CONCLUSIONS Across the Trust, there were significant differences in the proportion of ethnic groups in accessing psychological therapy, as well as in outcomes. More research is needed to understand the factors that may underlie these disparities.
Collapse
Affiliation(s)
- Louise Mercer
- South London and Maudsley NHS Foundation Trust, London, England, UK
- Department of Psychology and Psychotherapy, Maudsley Hospital, Denmark Hill, London, UK
| | - Lauren Jayne Evans
- South London and Maudsley NHS Foundation Trust, London, England, UK
- Department of Psychology and Psychotherapy, Maudsley Hospital, Denmark Hill, London, UK
| | - Robert Turton
- South London and Maudsley NHS Foundation Trust, London, England, UK.
- Department of Psychology and Psychotherapy, Maudsley Hospital, Denmark Hill, London, UK.
| | - Alison Beck
- South London and Maudsley NHS Foundation Trust, London, England, UK
- Department of Psychology and Psychotherapy, Maudsley Hospital, Denmark Hill, London, UK
| |
Collapse
|
39
|
Awenat YF, Peters S, Gooding PA, Pratt D, Shaw-Núñez E, Harris K, Haddock G. A qualitative analysis of suicidal psychiatric inpatients views and expectations of psychological therapy to counter suicidal thoughts, acts and deaths. BMC Psychiatry 2018; 18:334. [PMID: 30326878 PMCID: PMC6192165 DOI: 10.1186/s12888-018-1921-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/02/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Suicide is a global problem and suicidal behavior is common in acute psychiatric wards. Inpatient suicides regularly occur with 10.4/100,000 such deaths recorded in the UK in 2016. Inpatient suicides are potentially the most avoidable of all suicides as inpatients have 24-h staff contact. Current inpatient treatment prioritizes maintenance of physical safety by observation, medication and general supportive measures, however efficacious and effective specific treatments are lacking. Psychological treatments have a growing evidence base for suicide prevention yet provision of inpatient therapy is uncommon. The present qualitative study aimed to understand the patient acceptability issues by investigating suicidal inpatients views and expectations of a novel suicide-focussed cognitive behavioural psychological therapy which was nested alongside a pilot clinical trial of the intervention. METHODS Thematic analysis of semi-structured individual qualitative interviews with twenty suicidal psychiatric inpatients to investigate their views and expectations about ward-based suicide-focused psychological treatment. RESULTS Two main themes were identified. The first, 'A therapy that works', revealed inpatients' views of the necessary components for effective ward-based suicide-focused psychological therapy. The second, 'Concerns about in-patient suicide-focused therapy', depicted their fears about engaging in this treatment. Results suggested that suicide-focused psychological therapy was cautiously welcomed by inpatients' whose narratives expressed their needs, priorities and concerns. Further data analysis enabled formation of a user-informed model of suicide-focussed psychological therapy which offers guidance for researchers and clinicians. CONCLUSIONS We conclude that hospitalization of suicidal individuals offers a critical opportunity to intervene with effective treatment to preserve life and that suicide-focussed psychological therapy is likely to be well received by suicidal inpatients warranting further testing with a sufficiently powered definitive trial. It is important that provision of ward-based psychological therapy for suicidal inpatients addresses the considerable context-specific challenges inherent in this setting. TRIAL REGISTRATION NUMBER ISRCTN 17890126 , Registry: UK Clinical Trials Gateway, Date of registration: 22/04/15, Date of enrolment of first participant to the trial: 20/05/14 (retrospectively registered).
Collapse
Affiliation(s)
- Yvonne F Awenat
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL, UK. .,Manchester Academic Health Science Centre, MAHSC, Manchester, UK. .,Greater Manchester Mental Health NHS Trust, Manchester, UK.
| | - Sarah Peters
- 0000000121662407grid.5379.8Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL UK ,0000 0004 0417 0074grid.462482.eManchester Academic Health Science Centre, MAHSC, Manchester, UK ,0000000121662407grid.5379.8Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Patricia A Gooding
- 0000000121662407grid.5379.8Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL UK ,0000 0004 0417 0074grid.462482.eManchester Academic Health Science Centre, MAHSC, Manchester, UK ,0000000121662407grid.5379.8Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Daniel Pratt
- 0000000121662407grid.5379.8Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL UK ,0000 0004 0417 0074grid.462482.eManchester Academic Health Science Centre, MAHSC, Manchester, UK ,Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Emma Shaw-Núñez
- 0000000121662407grid.5379.8Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL UK ,Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Kamelia Harris
- 0000000121662407grid.5379.8Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL UK
| | - Gillian Haddock
- 0000000121662407grid.5379.8Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL UK ,0000 0004 0417 0074grid.462482.eManchester Academic Health Science Centre, MAHSC, Manchester, UK ,Greater Manchester Mental Health NHS Trust, Manchester, UK
| |
Collapse
|
40
|
Wright K, Dodd A, Warren FC, Medina-Lara A, Taylor R, Jones S, Owens C, Javaid M, Dunn B, Harvey JE, Newbold A, Lynch T. The clinical and cost effectiveness of adapted dialectical behaviour therapy (DBT) for bipolar mood instability in primary care (ThrIVe-B programme): a feasibility study. Trials 2018; 19:560. [PMID: 30326960 PMCID: PMC6192204 DOI: 10.1186/s13063-018-2926-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/19/2018] [Indexed: 01/03/2023] Open
Abstract
Background In bipolar spectrum disorder, some individuals experience ongoing, frequent fluctuations in mood outside of affective episodes. There are currently no evidence-based psychological interventions designed to address this. This feasibility study is a phase II evaluation of a dialectical behavioural therapy-informed approach (Therapy for Inter-episode mood Variability in Bipolar [ThrIVe-B]). It seeks to examine the feasibility and acceptability of a future definitive trial evaluating the clinical and cost effectiveness of the ThrIVe-B programme. Methods/design Patients will be randomised 1:1 to either treatment as usual only (control arm) or the ThrIVe-B intervention plus treatment as usual (intervention arm). Follow-up points will be at 3, 6, 9 and 15 months after baseline, with 9 months as the primary end point for the candidate primary outcome measures. We aim to recruit 48 individuals meeting diagnostic criteria for a bipolar spectrum disorder and reporting frequent mood swings outside of acute episodes, through primary and secondary care services and self-referral. To evaluate feasibility and acceptability, we will examine recruitment and retention rates, completion rates for study measures and feedback from participants on their experience of study participation and therapy. Discussion Proceeding to a definitive trial will be indicated if the following criteria are met: (1) trial participation does not lead to serious negative consequences for our participants; (2) any serious concerns about the acceptability and feasibility of the trial procedures can be rectified prior to a definitive trial; (3) follow-up data at 9 months are available for at least 60% of participants; (4) at least 60% of patients in the ThrIVe-B arm complete treatment. Trial registration ISRCTN, ISRCTN54234300. Registered on 20 July 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2926-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kim Wright
- Department of Psychology, University of Exeter, Exeter, UK.
| | - Alyson Dodd
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | | | | | - Rod Taylor
- University of Exeter Medical School, Exeter, UK
| | - Steven Jones
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Mahmood Javaid
- Biomedical Informatics Hub, University of Exeter, Exeter, UK
| | - Barney Dunn
- Department of Psychology, University of Exeter, Exeter, UK
| | - Julie E Harvey
- Department of Psychology, University of Exeter, Exeter, UK
| | | | - Tom Lynch
- Department of Psychology, University of Southampton, Southampton, UK
| |
Collapse
|
41
|
Hurtado-Santiago S, Guzmán-Parra J, Bersabé RM, Mayoral F. Effectiveness of iconic therapy for the reduction of borderline personality disorder symptoms among suicidal youth: study protocol for a randomised controlled trial. BMC Psychiatry 2018; 18:277. [PMID: 30176878 PMCID: PMC6122595 DOI: 10.1186/s12888-018-1857-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/22/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is associated with an intensive use of mental health services, even in the absence of a full diagnosis. Early symptom detection and intervention may help alleviate adverse long-term outcomes. Iconic Therapy is an innovative manual-driven psychotherapy that treats BPD symptoms in a specific and intensive manner. Preliminary results are promising and the indication is that Iconic Therapy may be effective in reducing BPD symptoms. The aim of this study is to assess how effective Iconic Therapy is compared to Structured Support Therapy in a real clinical setting. METHODS/DESIGN Our study will be a controlled 12-month pragmatic, two-armed RCT. A total of 72 young people (15 to 25 years old) with suicidal ideation/self-injuring behaviour and BPD traits and symptoms will participate in the study. The subjects will be randomised into two groups: Iconic Therapy or Structured Support Therapy. The participants will be assigned to either group on a 1:1 basis. Both the Iconic Therapy and the Structured Support Therapy programmes consist of 11 weekly sessions delivered by two trained psychologists in a group format of between 8 to 12 outpatients. The primary outcome will be measured by the change in symptom severity. Secondary outcomes include changes in suicidal ideation/ behaviour, non-suicidal self-injury, maladjustment to daily life and cost-effective analysis. The primary outcome will be a decrease in the severity of BPD symptoms as assessed by the Borderline Symptom List (BSL-23). For the clinical evaluation, three study assessments will take place: at baseline, after treatment and at 12-month follow-up. We hypothesise that patients attending the Iconic Therapy group will show a significantly higher reduction in symptoms than those in the Structured Support Therapy group. Data will be analysed using generalised estimating equation (GEE) models. DISCUSSION By responding to the need for briefer and more comprehensive therapies for BPD, we foresee that Iconic Therapy may provide an alternative treatment whose specific therapeutic principles, visually represented on icons, will overcome classical Structured Support Therapy at reducing BPD symptoms. TRIAL REGISTRATION NCT03011190.
Collapse
Affiliation(s)
- Silvia Hurtado-Santiago
- Saint John of God Psychiatric Centre, Hospitaller Order of Saint John of God, Málaga, Spain.
| | - José Guzmán-Parra
- Mental Health Department, Medical Research Institute (IBIMA) of Málaga, Regional University Hospital of Málaga, Málaga, Spain
| | - Rosa M Bersabé
- Department of Psychobiology and Methodology of the Behavioural Sciences Department, University of Málaga, Málaga, Spain
| | - Fermín Mayoral
- Mental Health Department, Medical Research Institute (IBIMA) of Málaga, Regional University Hospital of Málaga, Málaga, Spain
| |
Collapse
|
42
|
Leigh E, Clark DM. Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995). Clin Child Fam Psychol Rev 2018; 21:388-414. [PMID: 29654442 PMCID: PMC6447508 DOI: 10.1007/s10567-018-0258-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Social anxiety disorder is a condition characterised by a marked and persistent fear of being humiliated or scrutinised by others. Age-of-onset data point to adolescence as a developmentally sensitive period for the emergence of the condition, at a time when the peer group becomes increasingly important. Social anxiety in adolescence is associated with considerable impairment that persists through to adulthood. There are clear potential benefits to delivering effective interventions during adolescence. However, there is limited evidence on the specific efficacy of available therapies. This is in contrast to adults, for whom we have interventions with very specific treatment effects. One such treatment is individual cognitive therapy. Cognitive therapy is based on the cognitive model of social anxiety proposed by Clark and Wells (in: Heimberg, Leibowitz, Hope, Scheiber (eds) Social phobia: diagnosis, assessment and treatment, The Guilford Press, New York, 1995). The present review examines the potential application of this adult cognitive model to the understanding of adolescent social anxiety and considers additional adolescent-specific factors that need to be accommodated. It is suggested that a developmentally sensitive adoption of the cognitive model of social anxiety disorder (Clark and Wells 1995) for adolescents may lead to better treatment outcomes.
Collapse
Affiliation(s)
- Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
- Oxford Centre for Anxiety Disorders and Trauma, The Old Rectory, Paradise Square, Oxford, OX1 1TW, UK.
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| |
Collapse
|
43
|
Pile V, Smith P, Leamy M, Blackwell SE, Meiser-Stedman R, Stringer D, Ryan EG, Dunn BD, Holmes EA, Lau JYF. A brief early intervention for adolescent depression that targets emotional mental images and memories: protocol for a feasibility randomised controlled trial (IMAGINE trial). Pilot Feasibility Stud 2018; 4:97. [PMID: 29997904 PMCID: PMC6030737 DOI: 10.1186/s40814-018-0287-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/02/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adolescent depression is common and impairing. There is an urgent need to develop early interventions to prevent depression becoming entrenched. However, current psychological interventions are difficult to access and show limited evidence of effectiveness. Schools offer a promising setting to enhance access to interventions, including reducing common barriers such as time away from education. Distressing negative mental images and a deficit in positive future images, alongside overgeneral autobiographical memories, have been implicated in depression across the lifespan, and interventions targeting them in adults have shown promise. Here, we combine techniques targeting these cognitive processes into a novel, brief psychological intervention for adolescent depression. This feasibility randomised controlled trial will test the feasibility and acceptability of delivering this imagery-based cognitive behavioural intervention in schools. METHODS/DESIGN Fifty-six adolescents (aged 16-18) with high symptoms of depression will be recruited from schools. Participants will be randomly allocated to the imagery-based cognitive behavioural intervention (ICBI) or the control intervention, non-directive supportive therapy (NDST). Data on feasibility and acceptability will be recorded throughout, including data on recruitment, retention and adherence rates as well as adverse events. In addition, symptom assessment will take place pre-intervention, post-intervention and at 3-month follow-up. Primarily, the trial aims to establish whether it is feasible and acceptable to carry out this project in a school setting. Secondary objectives include collecting data on clinical measures, including depression and anxiety, and measures of the mechanisms proposed to be targeted by the intervention. The acceptability of using technology in assessment and treatment will also be evaluated. DISCUSSION Feasibility, acceptability and symptom data for this brief intervention will inform whether an efficacy randomised controlled trial is warranted and aid planning of this trial. If this intervention is shown in a subsequent definitive trial to be safe, clinically effective and cost-effective, it has potential to be rolled out as an intervention and so would significantly extend the range of therapies available for adolescent depression. This psychological intervention draws on cognitive mechanism research suggesting a powerful relationship between emotion and memory and uses imagery as a cognitive target in an attempt to improve interventions for adolescent depression. TRIAL REGISTRATION ISRCTN85369879.
Collapse
Affiliation(s)
- Victoria Pile
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Patrick Smith
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Mary Leamy
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Simon E. Blackwell
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | | | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Elizabeth G. Ryan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Emily A. Holmes
- Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Y. F. Lau
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| |
Collapse
|
44
|
Casey MB, Smart K, Segurado R, Hearty C, Gopal H, Lowry D, Flanagan D, McCracken L, Doody C. Exercise combined with Acceptance and Commitment Therapy (ExACT) compared to a supervised exercise programme for adults with chronic pain: study protocol for a randomised controlled trial. Trials 2018; 19:194. [PMID: 29566744 PMCID: PMC5865382 DOI: 10.1186/s13063-018-2543-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/13/2018] [Indexed: 01/03/2023] Open
Abstract
Background Acceptance and Commitment Therapy (ACT) is a form of cognitive behavioural therapy, which may be beneficial for people with chronic pain. The approach aims to enhance daily functioning through increased psychological flexibility. Whilst the therapeutic model behind ACT appears well suited to chronic pain, there is a need for further research to test its effectiveness in clinical practice, particularly with regards to combining ACT with physical exercise. Methods/design This prospective, two-armed, parallel-group, single-centre randomised controlled trial (RCT) will assess the effectiveness of a combined Exercise and ACT programme, in comparison to supervised exercise for chronic pain. One hundred and sixty patients, aged 18 years and over, who have been diagnosed with a chronic pain condition by a physician will be recruited to the trial. Participants will be individually randomised to one of two 8-week, group interventions. The combined group will take part in weekly psychology sessions based on the ACT approach, in addition to supervised exercise classes led by a physiotherapist. The control group will attend weekly supervised exercise classes but will not take part in an ACT programme. The primary outcome will be pain interference at 12-week follow-up, measured using the Brief Pain Inventory-Interference Scale. Secondary outcomes will include self-reported pain severity, self-perception of change, patient satisfaction, quality of life, depression, anxiety and healthcare utilisation. Treatment process measures will include self-efficacy, pain catastrophising, fear avoidance, pain acceptance and committed action. Physical activity will be measured using Fitbit ZipTM activity trackers. Both groups will be followed up post intervention and again after 12 weeks. Estimates of treatment effects at follow-up will be based on an intention-to-treat framework, implemented using a linear mixed-effects model. Individual and focus group qualitative interviews will be undertaken with a purposeful sample of participants to explore patient experiences of both treatments. Discussion To our knowledge, this will be the first RCT to examine whether combining exercise with ACT produces greater benefit for patients with chronic pain, compared to a standalone supervised exercise programme. Trial registration www.ClinicalTrials.gov, ID: NCT03050528. Registered on 13 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2543-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Máire-Bríd Casey
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Keith Smart
- Physiotherapy Department, St Vincents University Hospital, Elm Park, Dublin 4, Ireland
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland
| | - Conor Hearty
- Department of Pain Medicine, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Hari Gopal
- Department of Pain Medicine, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Damien Lowry
- Psychology Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Dearbhail Flanagan
- Physiotherapy Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Lance McCracken
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 5th Floor Bermondsey Wing, Guy's Campus, London, SE1 9RT, United Kingdom
| | - Catherine Doody
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland
| |
Collapse
|
45
|
Wykes T, Joyce E, Velikonja T, Watson A, Aarons G, Birchwood M, Cella M, Dopson S, Fowler D, Greenwood K, Johnson S, McCrone P, Perez J, Pickles A, Reeder C, Rose D, Singh S, Stringer D, Taylor M, Taylor R, Upthegrove R. The CIRCuiTS study (Implementation of cognitive remediation in early intervention services): protocol for a randomised controlled trial. Trials 2018; 19:183. [PMID: 29544551 PMCID: PMC5856221 DOI: 10.1186/s13063-018-2553-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cognitive problems in people with schizophrenia predict poor functional recovery even with the best possible rehabilitation opportunities and optimal medication. A psychological treatment known as cognitive remediation therapy (CRT) aims to improve cognition in neuropsychiatric disorders, with the ultimate goal of improving functional recovery. Studies suggest that intervening early in the course of the disorder will have the most benefit, so this study will be based in early intervention services, which treat individuals in the first few years following the onset of the disorder. The overall aim is to investigate different methods of CRT. Methods This is a multicentre, randomised, single-blinded, controlled trial based in early intervention services in National Health Service Mental Health Trusts in six English research sites. Three different methods of providing CRT (intensive, group, and independent) will be compared with treatment as usual. We will recruit 720 service users aged between 16 and 45 over 3 years who have a research diagnosis of non-affective psychosis and will be at least 3 months from the onset of the first episode of psychosis. The primary outcome measure will be the degree to which participants have achieved their stated goals using the Goal Attainment Scale. Secondary outcome measures will include improvements in cognitive function, social function, self-esteem, and clinical symptoms. Discussion It has already been established that cognitive remediation improves cognitive function in people with schizophrenia. Successful implementation in mental health services has the potential to change the recovery trajectory of individuals with schizophrenia-spectrum disorders. However, the best mode of implementation, in terms of efficacy, service user and team preference, and cost-effectiveness is still unclear. The CIRCuiTS trial will provide guidance for a large-scale roll-out of CRT to mental health services where cognitive difficulties impact recovery and resilience. Trial registration ISRCTN, ISRCTN14678860, Registered on 6 June 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2553-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK. .,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK.
| | - Eileen Joyce
- UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Tjasa Velikonja
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Andrew Watson
- UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Gregory Aarons
- University of California, San Diego, 9500 Gilman Dr. (0812), La Jolla, CA, 92093-0812, USA
| | - Max Birchwood
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Sue Dopson
- Saïd Business School, University of Oxford, Park End Street, Oxford, OX1 1HP, UK
| | - David Fowler
- Psychology Department, University of Sussex, Brighton, Sussex, BN1 9RH, UK
| | - Kathy Greenwood
- Sussex Partnership NHS Foundation Trust and University of Sussex, Sussex House, Falmer, Brighton, BN1 9RH, UK
| | - Sonia Johnson
- Division of Psychiatry, UCL, Mental Health Sciences Unit, 2nd Floor Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Jesus Perez
- Cambridge & Peterborough NHS Foundation Trust, CAMEO, Block 7 Ida Darwin, Fulbourn Hospital, Cambridge, CB2 5EE, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Clare Reeder
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Diana Rose
- Health Services and Population Research Department, Institute of Psychology, Psychiatry and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Swaran Singh
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Matthew Taylor
- South London & Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Rumina Taylor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Rachel Upthegrove
- College of Medical and Dental Sciences, University of Birmingham, 25 Vincent Drive, Birmingham, B15 2F, UK
| |
Collapse
|
46
|
Abstract
OBJECTIVE To determine whether participants with severe head injury (SHI) allocated to a brief compassion focused imagery (CFI) intervention show greater change in compassion than those exposed to relaxation imagery (RI). METHOD Participants were exposed to a preparatory video to promote engagement and then randomly allocated to intervention. Pre- and post-preparatory measures were Motivation for Intervention and Fears of Compassion Scales, State-Trait Anxiety Inventory (STAI) and PANAS. Pre- and post-intervention self-report measures were the Empathy Quotient, Self-Compassion Scale, STAI and Relaxation Scale. Heart rate variability (HRV) was monitored throughout. RESULTS Motivation for therapy increased after the preparatory video (z = 3.44, p = 0.001). Across the intervention, group differences were not found on self-report measures or HRV changes. When CFI and RI groups were pooled, improvement in relaxation (r = .41, p < 0.01) and state anxiety (r = .29, p < 0.05) were found across the intervention; these outcomes were not associated with changes in self-compassion or HRV. CONCLUSION Brief CFI, a central aspect of compassion focused therapy, did not produce a reliable change in people with SHI. Enhanced motivation for psychological therapy after a brief preparatory video is relevant and underlines the need to understand mechanisms of action rather than the pursuing whole protocol approaches to therapy.
Collapse
Affiliation(s)
- Iain N Campbell
- a Institute of Health and Wellbeing , College of Veterinary, Medical and Life Sciences, University of Glasgow, Gartnavel Royal Hospital , Glasgow , UK
| | - Melanie Gallagher
- a Institute of Health and Wellbeing , College of Veterinary, Medical and Life Sciences, University of Glasgow, Gartnavel Royal Hospital , Glasgow , UK
| | - Hamish J McLeod
- a Institute of Health and Wellbeing , College of Veterinary, Medical and Life Sciences, University of Glasgow, Gartnavel Royal Hospital , Glasgow , UK
| | - Brian O'Neill
- a Institute of Health and Wellbeing , College of Veterinary, Medical and Life Sciences, University of Glasgow, Gartnavel Royal Hospital , Glasgow , UK
| | - Tom M McMillan
- a Institute of Health and Wellbeing , College of Veterinary, Medical and Life Sciences, University of Glasgow, Gartnavel Royal Hospital , Glasgow , UK
| |
Collapse
|
47
|
Pybis J, Saxon D, Hill A, Barkham M. The comparative effectiveness and efficiency of cognitive behaviour therapy and generic counselling in the treatment of depression: evidence from the 2 nd UK National Audit of psychological therapies. BMC Psychiatry 2017; 17:215. [PMID: 28599621 PMCID: PMC5466727 DOI: 10.1186/s12888-017-1370-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 05/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive Behaviour Therapy (CBT) is the front-line psychological intervention for step 3 within UK psychological therapy services. Counselling is recommended only when other interventions have failed and its effectiveness has been questioned. METHOD A secondary data analysis was conducted of data collected from 33,243 patients across 103 Improving Access to Psychological Therapies (IAPT) services as part of the second round of the National Audit of Psychological Therapies (NAPT). Initial analysis considered levels of pre-post therapy effect sizes (ESs) and reliable improvement (RI) and reliable and clinically significant improvement (RCSI). Multilevel modelling was used to model predictors of outcome, namely patient pre-post change on PHQ-9 scores at last therapy session. RESULTS Counselling received more referrals from patients experiencing moderate to severe depression than CBT. For patients scoring above the clinical cut-off on the PHQ-9 at intake, the pre-post ES (95% CI) for CBT was 1.59 (1.58, 1.62) with 46.6% making RCSI criteria and for counselling the pre-post ES was 1.55 (1.52, 1.59) with 44.3% of patients meeting RCSI criteria. Multilevel modelling revealed a significant site effect of 1.8%, while therapy type was not a predictor of outcome. A significant interaction was found between the number of sessions attended and therapy type, with patients attending fewer sessions on average for counselling [M = 7.5 (5.54) sessions and a median (IQR) of 6 (3-10)] than CBT [M = 8.9 (6.34) sessions and a median (IQR) of 7 (4-12)]. Only where patients had 18 or 20 sessions was CBT significantly more effective than counselling, with recovery rates (95% CIs) of 62.2% (57.1, 66.9) and 62.4% (56.5, 68.0) respectively, compared with 44.4% (32.7, 56.6) and 42.6% (30.0, 55.9) for counselling. Counselling was significantly more effective at two sessions with a recovery rate of 34.9% (31.9, 37.9) compared with 22.2% (20.5, 24.0) for CBT. CONCLUSIONS Outcomes for counselling and CBT in the treatment of depression were comparable. Research efforts should focus on factors other than therapy type that may influence outcomes, namely the inherent variability between services, and adopt multilevel modelling as the given analytic approach in order to capture the naturally nested nature of the implementation and delivery of psychological therapies. It is of concern that half of all patients, regardless of type of intervention, did not show reliable improvement.
Collapse
Affiliation(s)
- Jo Pybis
- Research Office, British Association for Counselling and Psychotherapy, BACP House, 15 St John’s Business Park, Lutterworth, Leicestershire, LE174HB UK
| | - David Saxon
- Centre for Psychological Services Research, ScHARR, University of Sheffield, Sheffield, UK
| | - Andy Hill
- Research Office, British Association for Counselling and Psychotherapy, BACP House, 15 St John’s Business Park, Lutterworth, Leicestershire, LE174HB UK
| | - Michael Barkham
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, UK
| |
Collapse
|
48
|
Rachman SJ. Invited essay: Cognitive influences on the psychological immune system. J Behav Ther Exp Psychiatry 2016; 53:2-8. [PMID: 27664815 DOI: 10.1016/j.jbtep.2016.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 02/18/2016] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
Abstract
The construct of the psychological immune system is described and analysed. The direct and indirect cognitive influences on the system are discussed, and the implications of adding a cognitive construal to the influential model of a behavioural immune system are considered. The psychological immune system has two main properties: defensive and healing. It encompasses a good amount of health-related phenomena that is outside the scope of the behavioural model or the biological immune system. Evidence pertaining to the psychological immune system includes meta-analyses of the associations between psychological variables such as positive affect/wellbeing and diseases and mortality, and associations between wellbeing and positive health. The results of long-term prospective studies are consistent with the conclusions drawn from the meta-analyses. Laboratory investigations of the effects of psychological variables on the biological immune system show that negative affect can slow wound-healing, and positive affect can enhance resistance to infections, for example in experiments involving the introduction of the rhinovirus and the influenza A virus. A number of problems concerning the assessment of the functioning of the psychological immune system are considered, and the need to develop techniques for determining when the system is active or not, is emphasized. This problem is particularly challenging when trying to assess the effects of the psychological immune system during a prolonged psychological intervention, such as a course of resilience training.
Collapse
Affiliation(s)
- S J Rachman
- Department of Psychology, University of British Columbia, Canada.
| |
Collapse
|
49
|
Pillny M, Lincoln TM. Predictors of improved functioning in patients with psychosis: The role of amotivation and defeatist performance beliefs. Psychiatry Res 2016; 244:117-22. [PMID: 27479101 DOI: 10.1016/j.psychres.2016.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/28/2016] [Accepted: 07/09/2016] [Indexed: 11/29/2022]
Abstract
Defeatist performance beliefs (DPBs) are associated with the severe impairments in functioning of patients with negative symptoms of schizophrenia. This association has been found to be mediated by amotivation, a core aspect of negative symptoms. Although causality is assumed, longitudinal evidence for this is lacking. The current study aimed to extend previous findings by investigating both cross-sectional and longitudinal associations between DPBs, motivational impairments and functioning in a sample of patients with psychotic disorders (N=58). We hypothesized, that DPBs would be related to functioning in cross-sectional and longitudinal analyses and that this link would be mediated by motivational impairments. Data was assessed at baseline and post-treatment in a trial on the effects of cognitive behavior therapy for psychosis. At baseline, amotivation mediated the association between DPBs and functioning. From baseline to post-treatment, reduction of amotivation was associated with improvement of functioning significantly, whereas reduction of DPBs was unrelated to improvements in functioning or amotivation. The findings suggest that improvement in amotivation accounts for favorable treatment outcomes in regard to functioning but question the causal role of DPBs in negative symptoms and functioning.
Collapse
Affiliation(s)
- Matthias Pillny
- Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany.
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| |
Collapse
|
50
|
Edge D, Degnan A, Cotterill S, Berry K, Drake R, Baker J, Barrowclough C, Hughes-Morley A, Grey P, Bhugra D, Cahoon P, Tarrier N, Lewis S, Abel K. Culturally-adapted Family Intervention (CaFI) for African-Caribbeans diagnosed with schizophrenia and their families: a feasibility study protocol of implementation and acceptability. Pilot Feasibility Stud 2016; 2:39. [PMID: 27965857 PMCID: PMC5154101 DOI: 10.1186/s40814-016-0070-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 06/24/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND African-Caribbeans in the UK have the highest schizophrenia incidence and greatest inequity in access to mental health services of all ethnic groups. The National Institute for Health and Care Excellence (NICE) highlights this crisis in care and urgent need to improve evidence-based mental healthcare, experiences of services and outcomes for this group. Family intervention (FI) is clinically and cost-effective for the management of schizophrenia but it is rarely offered. Evidence for FI with minority ethnic groups generally, and African-Caribbeans in particular, is lacking. This study aims to test the feasibility and acceptability of delivering Culturally-adapted Family Intervention (CaFI) to African-Caribbean service users diagnosed with schizophrenia. METHODS/DESIGN This is a feasibility cohort design study. Over a 12-month intervention period, 30 service users and their families, recruited from hospital and community settings, will receive ten one-hourly sessions of CaFI. Where biological families are absent, access to the intervention will be optimised through 'family support members'; trusted individuals nominated by service users or study volunteers. We shall collect data on eligibility, uptake, retention and attrition and assess the utility and feasibility of collecting various outcome measures including readmission, service engagement, working alliance, clinical symptoms and functioning, perceived criticism, psychosis knowledge, familial stress and economic costs. Measures will be collected at baseline, post-intervention and at 3-month follow-up using validated questionnaires and standardised interviews. Admission rates and change in care management will be rated by independent case note examination. Variability in the measures will inform sample size estimates for a future trial. Independent raters will assess fidelity to the intervention in 10 % of sessions. Feedback at the end of each session along with thematically-analysed qualitative interviews will examine CaFI's acceptability to service users, families and healthcare professionals. DISCUSSION This innovative response to inequalities in mental healthcare experienced by African-Caribbeans diagnosed with schizophrenia might improve engagement in services, access to evidence-based interventions and clinical outcomes. Successful implementation of CaFI in this group could pave the way for better engagement and provision across marginalised groups and therefore has potentially important implications for commissioning and service delivery in ethnically diverse populations. This study will demonstrate whether the approach is feasible and acceptable and can be implemented with fidelity in different settings.
Collapse
Affiliation(s)
- Dawn Edge
- Centre for Women’s Mental Health, Institute of Brain, Behaviour and Mental Health and School of Psychological Sciences, University of Manchester, G6 Coupland Building, Manchester, M13 9PL UK
| | - Amy Degnan
- Centre for Women’s Mental Health, Institute of Brain, Behaviour and Mental Health and School of Psychological Sciences, University of Manchester, Third Floor Jean McFarlane Building, Manchester, UK
| | - Sarah Cotterill
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Katherine Berry
- School of Psychological Sciences, University of Manchester, Second Floor Zochonis Building, Manchester, UK
| | - Richard Drake
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Third Floor Jean McFarlane Building, Manchester, UK
- Manchester Mental Health & Social Care Trust, 70 Manchester Rd, Manchester, M21 9UN UK
| | - John Baker
- Faculty of Medicine and Health, University of Leeds, Baines Wing, Leeds, LS2 9JT UK
| | - Christine Barrowclough
- School of Psychological Sciences, University of Manchester, Second Floor Zochonis Building, Manchester, UK
| | - Adwoa Hughes-Morley
- MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Manchester, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Paul Grey
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Third Floor Jean McFarlane Building, Manchester, UK
| | - Dinesh Bhugra
- Institute of Psychiatry, Kings College London, London, WC2R 2LS UK
| | - Patrick Cahoon
- Manchester Mental Health and Social Care NHS Trust, Chorlton House, Chorlton, Manchester, UK
| | - Nicholas Tarrier
- Institute of Psychiatry, Kings College London, London, WC2R 2LS UK
| | - Shôn Lewis
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Third Floor Jean McFarlane Building, Manchester, UK
| | - Kathryn Abel
- Centre for Women’s Mental Health, Institute of Brain, Behaviour and Mental Health, University of Manchester, Third Floor Jean McFarlane Building, Manchester, UK
- Manchester Mental Health & Social Care Trust, 70 Manchester Rd, Manchester, M21 9UN UK
| |
Collapse
|