Skills (1)
Publications (9) View all
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Article: Cognitive Behavioural Treatment for Anger in Adults with Intellectual Disabilities: A Systematic Review and Meta-analysis.
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ABSTRACT: The cognitive behavioural treatment for anger in adults with intellectual disabilities has received increasing interest. The current study aims to review the current literature and provide a meta-analysis. A literature search found 12 studies eligible for the quality appraisal. The studies examined cognitive behavioural treatment for anger in adults with intellectual disabilities published since 1999. Nine studies were eligible to be included in the meta-analysis. The meta-analysis revealed large uncontrolled effect sizes for the treatment for anger in adults with intellectual disabilities, but is viewed with caution due to low sample sizes. The narrative review showed improved methodological quality of the literature. The emerging literature is encouraging. However, it is limited through concatenated data, a lack of comparative control groups and small study samples.Journal of Applied Research in Intellectual Disabilities 01/2013; 26(1):47-62. · 1.38 Impact Factor -
Article: Correction to saxon and barkham (2012).
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ABSTRACT: Reports an error in "Patterns of Therapist Variability: Therapist Effects and the Contribution of Patient Severity and Risk" by David Saxon and Michael Barkham (Journal of Consulting and Clinical Psychology, Advanced Online Publication, Jun 4, 2012, np). In the article's Appendix, the symbol β in line 1 of the model should be repeated in lines 3 and 4, rather than B. (The following abstract of the original article appeared in record 2012-14751-001.) Objective: To investigate the size of therapist effects using multilevel modeling (MLM), to compare the outcomes of therapists identified as above and below average, and to consider how key variables-in particular patient severity and risk and therapist caseload-contribute to therapist variability and outcomes. Method: We used a large practice-based data set comprising patients referred to the U.K.'s National Health Service primary care counseling and psychological therapy services between 2000 and 2008. Patients were included if they had received ≥2 sessions of 1-to-1 therapy (including an assessment), had a planned ending to treatment, and completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM; Barkham et al., 2001; Barkham, Mellor-Clark, Connell, & Cahill, 2006; Evans et al., 2002) at pre- and post-treatment. The study sample comprised 119 therapists and 10,786 patients, whose mean age was 42.1 years (71.5% were female). MLM, including Markov chain Monte Carlo procedures, was used to derive estimates to produce therapist effects and to analyze therapist variability. Results: The model yielded a therapist effect of 6.6% for average patient severity, but it ranged from 1% to 10% as patient non-risk scores increased. Recovery rates for individual therapists ranged from 23.5% to 95.6%, and greater patient severity and greater levels of aggregated patient risk in a therapist's caseload were associated with poorer outcomes. Conclusions: The size of therapist effect was similar to those found elsewhere, but the effect was greater for more severe patients. Differences in patient outcomes between those therapists identified as above or below average were large, and greater therapist risk caseload, rather than non-risk caseload, was associated with poorer patient outcomes. (PsycINFO Database Record (c) 2012 APA, all rights reserved).Journal of Consulting and Clinical Psychology 08/2012; 80(4):546. · 4.85 Impact Factor -
Article: Patterns of therapist variability: therapist effects and the contribution of patient severity and risk.
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ABSTRACT: To investigate the size of therapist effects using multilevel modeling (MLM), to compare the outcomes of therapists identified as above and below average, and to consider how key variables--in particular patient severity and risk and therapist caseload--contribute to therapist variability and outcomes. We used a large practice-based data set comprising patients referred to the U.K.'s National Health Service primary care counseling and psychological therapy services between 2000 and 2008. Patients were included if they had received ≥2 sessions of 1-to-1 therapy (including an assessment), had a planned ending to treatment, and completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM; Barkham et al., 2001; Barkham, Mellor-Clark, Connell, & Cahill, 2006; Evans et al., 2002) at pre- and post-treatment. The study sample comprised 119 therapists and 10,786 patients, whose mean age was 42.1 years (71.5% were female). MLM, including Markov chain Monte Carlo procedures, was used to derive estimates to produce therapist effects and to analyze therapist variability. The model yielded a therapist effect of 6.6% for average patient severity, but it ranged from 1% to 10% as patient non-risk scores increased. Recovery rates for individual therapists ranged from 23.5% to 95.6%, and greater patient severity and greater levels of aggregated patient risk in a therapist's caseload were associated with poorer outcomes. The size of therapist effect was similar to those found elsewhere, but the effect was greater for more severe patients. Differences in patient outcomes between those therapists identified as above or below average were large, and greater therapist risk caseload, rather than non-risk caseload, was associated with poorer patient outcomes.Journal of Consulting and Clinical Psychology 06/2012; 80(4):535-46. · 4.85 Impact Factor -
Article: Group cognitive behavioural therapy for postnatal depression: a systematic review of clinical effectiveness, cost-effectiveness and value of information analyses.
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ABSTRACT: Postnatal depression (PND) describes a wide range of distressing symptoms that can occur in women following childbirth. There is substantial evidence to support the use of cognitive behaviour therapy (CBT) in the treatment of depression, and psychological therapies are recommended by the National Institute for Health and Clinical Excellence as a first-line treatment for PND. However, access is limited owing to expense, waiting lists and availability of therapists. Group CBT may, therefore, offer a solution to these problems by reducing therapist time and increasing the number of available places for treatment. To evaluate the clinical effectiveness and cost-effectiveness of group CBT compared with currently used packages of care for women with PND. Seventeen electronic bibliographic databases were searched (for example MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, PsycINFO, etc.), covering biomedical, health-related, science, social science and grey literature (including current research). Databases were searched from 1950 to January 2008. In addition, the reference lists of relevant articles were checked and various health services' related resources were consulted via the internet. The study population included women in the postpartum period (up to 1 year), meeting the criteria of a standardised PND diagnosis using the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, or scoring above cut-off on the Edinburgh Postnatal Depression Scale (EPDS). No exclusion was made on the basis of the standardised depression screening/case finding instrument of standardised clinical assessment tool used to define PND. All full papers were read by two reviewers (AS and DS) who made independent decisions regarding inclusion or exclusion, and consensus, where possible, was obtained by meeting to compare decisions. In the event of disagreement, a third reviewer (EK) read the paper and made the decision. All data from included quantitative studies were extracted by one reviewer (AS) using a standardised data extraction form. All data from included qualitative studies were extracted by two reviewers (AS and AB) using a standardised data extraction form with disagreements resolved by discussion. Two different data extraction forms were used, one for the quantitative papers and a second for the qualitative papers. Six studies met the inclusion criteria for the quantitative review. Three were randomised controlled trials (RCTs) and three were non-randomised trials. Two studies met the inclusion criteria for the qualitative review. These were both treatment evaluations incorporating qualitative methods. Only one study was deemed appropriate for the decision problem; therefore a meta-analysis was not performed. This study indicated that the reduction in the EPDS score through group CBT compared with routine primary care (RPC) was 3.48 [95% confidence interval (CI) 0.23 to 6.73] at the end of the treatment period. At 6-month follow-up the relative reduction in EPDS score was 4.48 (95% CI 1.01 to 7.95). Three studies showed the treatment to be effective in reducing depression when compared to RPC, usual care or waiting list groups. There was no adequate evidence on which to assess group CBT compared with other treatments for PND. Two studies of group CBT for PND were included in the qualitative review. Both studies demonstrated patient acceptability of group CBT for PND, although negative feelings towards group CBT were also identified. A de novo economic model was constructed to assess the cost-effectiveness of group CBT. The base-case results indicated a cost per quality-adjusted life-year (QALY) of 46,462 pounds for group CBT compared with RPC. The 95% CI for this ratio ranged from 37,008 to 60,728 pounds. There was considerable uncertainty in the cost per woman of running a CBT course, of the appropriateness of efficacy data to the decision problem, and the residual length of benefit associated with group CBT. These were tested using univariate sensitivity analyses. Supplementary analyses that fitted distributions to the cost of treatment and the duration of comparative advantage reported a cost per QALY of 36,062 pounds (95% CI 20,464 to 59,262 pounds). The cost per QALY ratio for group CBT in PND was uncertain because of gaps in the evidence base. There was little quantitative or qualitative RCT evidence to assess the effectiveness of group CBT for PND. The evidence that was available was of low quality in the main because of poor reporting of the results. Furthermore, little information was reported on concurrent treatment used in the studies, which was controlled for in only two of the studies. Evidence from the clinical effectiveness review provided inconsistent and low quality information on which to base any interpretations for service provision. Although three of the included studies provided some indication that group psycho-education incorporating CBT is effective compared with RPC, there is enough doubt in the quality of the study, the level of CBT implemented in the group programmes, and the applicability to a PND population to limit any interpretations significantly. It is also considered that the place of group CBT in a stepped care programme needs to be identified, as well as there being a need for a clearer referral process for group CBT.Health technology assessment (Winchester, England). 09/2010; 14(44):1-107, iii-iv. -
Article: Who drops-out? Do measures of risk to self and to others predict unplanned endings in primary care counselling?
Counselling and Psychotherapy Research 03/2010; 10(1):13-21.
