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ABSTRACT: The efficacy of a Computerized Cognitive Behavioural Therapy (CCBT) package, Beating the Blues, has been demonstrated in a large randomized controlled trial. The current study tests the generalizability of this finding in a naturalistic non-randomized trial.
219 patients with anxiety and/or depression were recruited to receive CCBT in routine care. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and Work and Social Adjustment scale (WSA) were administered pre-treatment, immediately on completing treatment and at 6 months post-treatment. Single-item self-report measures of anxiety and depression were also collected during each treatment session.
Completer and intention-to-treat analysis demonstrated statistically and clinically significant improvements on the CORE-OM, WSA and in self-reported anxiety and depression. Intention-to-treat analysis indicated an average 0.29-point drop on the CORE-OM, equating to an uncontrolled pre-post effect size of 0.50. Research completers achieved an average 0.61-point drop equating to an uncontrolled pre-post size of 1.00 on the same measure. Where data was available (18%), these benefits were maintained at week 32 (6 months follow-up).
CCBT can be an effective first line tool within a stepped care framework for the management of common mental health problems.
British Journal of Clinical Psychology 12/2006; 45(Pt 4):499-514. · 1.90 Impact Factor
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ABSTRACT: Computerized cognitive–behaviour therapy (CCBT) programmes have been developed to help meet the enormous need for evidence-based psychological treatment of common mental health problems in the context of a severe shortage of trained therapists to meet that need. Randomized controlled trials have confirmed the efficacy of such programmes. We present the experience of a community mental health team (CMHT) resource centre with one such programme, Beating the Blues, together with outcome data on a small sample of its clients. We conclude that experience and data, taken together, demonstrate the practical benefits of CCBT in routine practice.
Journal of Psychiatric and Mental Health Nursing 09/2004; 11(5):508 - 513. · 0.80 Impact Factor
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ABSTRACT: Poor compliance by participants consenting to be randomised to receive both physical and mental health promotion interventions represents a potentially serious threat to external and internal validity of those interventions. Quantitative and qualitative investigation of possible predictors of engagement forms an appropriate basis for efforts to enhance it.
Eight 'Preparing for Parenthood' intervention courses of a randomized controlled trial (RCT) underpinned a quantitative study. One 'Preparing for Parenthood' (PFP) intervention course, run upon completion of the RCT, formed a qualitative study. All nine courses followed identical procedures to enable clear comparisons. The three factors quantitatively explored with respect to engagement in health promoting behaviours were: locus of control (LOC), psychosocial support, and life events. The qualitative study utilised grounded theory analysis, the participants reflecting upon their experiences of the intervention and/or their reasons for not attending the course; nine interviews were completed.
Participants in the quantitative and qualitative studies were divided into three sub-groups: compliant, non-compliant, and refusers. None of the three health promoting variables predicted compliance to a statistically significant degree. However, a variable from the trial analysis was found to reach significance; those women who had had less contact with the National Health Service in the 12 months prior to the baseline assessment were more likely to refuse the invitation to PFP. The qualitative study produced nine main themes that had influenced participant engagement at both the initial recruitment stage and during the course itself.
In combination these findings may contribute to the future design of both effective and acceptable interventions to prevent postnatal depression. One such modified intervention is described and its impact on engagement outlined.
Archives of Women s Mental Health 12/2003; 6(4):275-85. · 2.06 Impact Factor
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ABSTRACT: This study examined the relationship between cognitive and interpersonal styles and outcome among 24 clients who received time-limited cognitive therapy for depression. The authors hypothesized that this relationship would be mediated by therapeutic alliance. They found that clients' interpersonal style, particularly an underinvolved style, was predictive of treatment outcome. As predicted, the impact of this style on outcome was mediated through the therapeutic alliance.
Journal of Consulting and Clinical Psychology 11/2001; 69(5):841-5. · 4.85 Impact Factor
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ABSTRACT: Social support theory and observational risk factor studies suggest that increased antenatal psychosocial support could prevent post-natal depression. We used empirical knowledge of risk and protective factors for post-natal depression not employed previously in order to develop and evaluate an antenatal preventive intervention.
We conducted a pragmatic randomized controlled trial in antenatal clinics. We screened 1300 primiparous women and 400 screened positive, 69 screen-positive women were untraceable or not eligible. Of 292 women who completed baseline assessment, 209 consented to randomization, of these 190 provided outcome data 3 months post-natally. 'Preparing for Parenthood', a structured antenatal risk factor reducing intervention designed to increase social support and problem-solving skills, was compared with routine antenatal care only. We compared the percentage depressed at 3 months after childbirth using the self-completion General Health Questionnaire Depression scale and Edinburgh Post-natal Depression Scale (EPDS), and the Schedules for Clinical Assessment in Neuropsychiatry a systematic clinical interview.
Assignment to the intervention group did not significantly impact on post-natal depression (odds ratio for GHQ-Depression 1.22 (95% CI 0.63-2.39), P = 0.55) or on risk factors for depression. Forty-five per cent of the intervention group women attended sufficient sessions to be likely to benefit from intervention if effective. Attenders benefited no more than non-attenders.
Prevention services targeting post-natal depression should not implement antenatal support programmes on these lines until further research has demonstrated the feasibility and effectiveness of such methods. The development of novel, low cost interventions effective in reducing risk factors should be completed before further trial evaluation.
Psychological Medicine 12/2000; 30(6):1273-81. · 6.16 Impact Factor
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ABSTRACT: Risk and protective factor modification has been proposed as a rational approach to developing mental health improvement
interventions by prevention. The intervention "Preparing for Parenthood" (PFP) was developed embodying theoretical and evidence
based predictors of symptom inception and alleviation as a real world set of tasks. A manual describing and directing the
operational procedures of PFP is outlined. Course leaders trained in its application endeavoured to implement PFP with women
at risk of developing postnatal depression during pregnancy before the birth of their first child. Also described are an initial
market research survey, the outcome of three pilot courses and the final design of the PFP course. The lack of clinical efficacy
of PFP, demonstrated in a subsequent randomised evaluation, is discussed in relation to concurrent research in the field and
lessons and implications for more effective preventive intervention development and evaluation.
Archives of Women s Mental Health 11/2000; 3(3):81-90. · 2.06 Impact Factor
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ABSTRACT: This study (a) used an established comprehensive process measure to uncover a latent pattern of therapeutic focus in cognitive-behavioral and psychodynamic-interpersonal sessions; (b) used these results to develop the coding system of Therapeutic Focus on Action and Insight, which makes it possible to evaluate therapists' relative emphasis on the Constructing Meaning and Facilitating Action domains of in-session focus; and (c) evaluated its reliability and validity.
Journal of Consulting and Clinical Psychology 07/2000; 68(3):513-4. · 4.85 Impact Factor
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ABSTRACT: A total of 116 clients with a range of subsyndromal depression received 3 therapy sessions: 2 sessions 1 week apart followed by a 3rd session 3 months later (the 2 + 1 model). Clients were stratified for severity on the Beck Depression Inventory (BDI) as stressed, subclinical, or low-level clinically depressed. In a 2 x 2 design, they received either cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) therapy, either immediately or after a 4-week delay. An initial advantage for the immediate condition disappeared once the delayed-condition clients received treatment. Improvement rates at the end of treatment were 67% (stressed), 72% (subclinical), and 65% (low-level clinically depressed). There were no significant differences between CB and PI treatment methods, with the exception at 1-year follow-up, when the BDI showed a significant advantage for CB. Implications for designing very brief planned interventions are discussed.
Journal of Consulting and Clinical Psychology 05/1999; 67(2):201-11. · 4.85 Impact Factor
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ABSTRACT: Clients (n = 79) and therapists (n = 5) rated their alliance using parallel forms of the Agnew Relationship Measure (ARM) after every session of their time-limited psychodynamic-interpersonal or cognitive-behavioral treatments for depression. The ARM assesses 5 dimensions of the alliance: Bond, Partnership, Confidence, Openness, and Client Initiative. Treatment outcome was assessed as residual gain from pretreatment assessment to end of treatment, 3-month follow-up, and 1-year follow-up on 6 standard measures. Some aspects of the alliance as measured by the ARM were correlated with clients' gains in treatment. The strength of the association varied across assessment measures, occasions of outcome assessment, ARM scales, and the session number when the alliance was measured.
Journal of Consulting and Clinical Psychology 11/1998; 66(5):791-802. · 4.85 Impact Factor
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ABSTRACT: We used a new instrument, the Agnew Relationship Measure (ARM), to examine the alliance's dimensionality and to construct scales for use in future studies.
We studied the alliance as reported on the ARM by both clients and therapists in the Second Sheffield Psychotherapy Project, a randomized comparison of two contrasting time-limited psychotherapies for depression.
Clients (N = 95) and therapists (N = 5) completed parallel forms of the (ARM) after every session (N = 1120).
Five scales were constructed, based on results of simultaneous components analyses and considerations of conceptual coherence and comparability across client and therapist perspectives.
Bond, partnership, and confidence overlapped statistically (consistent with previous studies), but there are conceptual and empirical reasons for retaining the distinctions. Openness represented a relatively independent dimension. The client initiative scale had low internal consistency but the items may have value for future investigations.
British Journal of Clinical Psychology 06/1998; 37 ( Pt 2):155-72. · 1.90 Impact Factor
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ABSTRACT: This paper reviews the research literature on personal therapy and makes some recommendations for how future work in this area may be improved. Despite the general acceptance of the importance of personal therapy amongst therapists, there has been relatively little research to evaluate its effectiveness. The vast majority of studies have consisted of surveys of therapists' opinions and experiences of therapy or naturalistic comparisons across therapists who have or have not had therapy. The interpretation of most findings is compromised because of small sample sizes and confounding variables, nevertheless some conclusions can be made. Whilst the majority of therapists feel that they have benefited professionally from personal therapy there is very little empirical evidence that it has any measurable effect on client outcome. However, there is some evidence that personal therapy has a positive effect on those therapist qualities often cited as constructive to client change (e.g. empathy, warmth, genuineness). What is evident is that there is a need for more methodologically sound research as well as a more theoretical understanding of how personal therapy affects clinical practice, before any firm conclusions can be drawn about its usefulness. It is suggested that it may be more useful for future research in this area to focus on therapy process rather than client outcome.
British Journal of Medical Psychology 04/1998; 71 ( Pt 1):13-25.
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ABSTRACT: It is widely suggested that many National Health Service (NHS) workers experience high levels of minor psychiatric disorder. However, inadequacies of sampling and measurement in studies to date have not allowed this suggestion to be properly evaluated.
The present study was designed to overcome these methodological weaknesses by using a sample of over 11,000 employees from 19 NHS trusts and a well-established measure of minor psychiatric disorder for which there are comparative data.
The findings show that 26.8% of the health service workers reported significant levels of minor psychiatric disorder, compared with 17.8% of people in the general population. Psychiatric morbidity was highest among managers, doctors, nurses and professions allied to medicine, with each of these groups recording higher rates than their professional counterparts outside the health service. It was lower among those in support occupations, such as administrative and ancillary staff. A feature of the findings was that female doctors and managers showed a much higher prevalence of minor psychiatric disorder than their male colleagues.
Studies are required to establish the organisational, occupational and individual determinants of minor psychiatric disorder among NHS employees.
The British Journal of Psychiatry 01/1998; 171:519-23. · 6.62 Impact Factor
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ABSTRACT: This study compared therapeutic foci in a sampling of 30 cognitive-behavioral and 27 psychodynamic-interpersonal manual-driven treatments for depression. High- and low-impact sessions were coded for each client, with the Coding System of Therapeutic Focus. Results indicated that psychodynamic-interpersonal sessions focused more on such variables as emotion, patterns, incongruities, the impact that others made on clients, clients' expected reaction of others, the tendency to avoid therapeutic progress, therapists themselves, clients' parents, and links between people and time periods in clients' lives. Cognitive-behavioral sessions placed greater emphasis on external circumstances and clients' ability to make decisions, gave more support and information and encouraged between-session experiences, and focused more on the future. Relatively few differences emerged as a function of session impact. Results are discussed in terms of the different and similar theoretical conceptions of the change process.
Journal of Consulting and Clinical Psychology 11/1997; 65(5):740-8. · 4.85 Impact Factor
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ABSTRACT: The aims of this study were: (1) to obtain a systematic estimate of the levels of fatigue in representative samples of the major occupational groups of health care workers; (2) to examine the relationship between fatigue and mental health as a function of occupational and work role factors; and (3) to test the proposition that fatigue arises from a combination of poor mental health and high job stress. Questionnaire data from 7720 NHS Trust staff was used. Higher levels of fatigue were reported among health care workers in comparison with general population figures. Highest levels of general fatigue, the subjective sensation of tiredness, were experienced by doctors (especially women doctors), professions allied to medicine and managers. Highest levels of fatigability, the onset of symptoms after exertion, were experienced by ancillary and nursing staff. Both general fatigue and fatigability were associated with high levels of psychological distress. Support was also found for the proposition that fatigue arises from a combination of poor mental health and high work demands.
Journal of Psychosomatic Research 08/1997; 43(1):83-92. · 3.30 Impact Factor
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ABSTRACT: In a replication and extension of the Second Sheffield Psychotherapy Project (SPP2), a collaborative psychotherapy project (CPP) was carried out at 3 sites within the National Health Service of the United Kingdom. Clients (N = 36) stratified at 3 levels of severity of depression were randomly assigned to one of 2 treatment approaches (psychodynamic-interpersonal or cognitive-behavioral) of 2 time-limited durations (8 or 16 sessions). Gains in both treatment approaches were approximately equivalent and were similar for CPP and SPP2 clients when measured at the end of treatment. However, CPP patients did not maintain their gains to the extent that the SPP2 clients did at 3-month and 1-year follow-up assessments. In the CPP, clients given 16 sessions showed a statistically significant advantage over clients given 8 sessions on some measures at some assessments; in the SPP2, similar effects were noted only among some subgroups of clients.
Journal of Consulting and Clinical Psychology 11/1996; 64(5):1079-85. · 4.85 Impact Factor
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ABSTRACT: Criteria for reliable and clinically significant improvement were applied to standard and individually tailored outcome measures data from 212 depressed clients who had been randomly assigned to receive either 8 or 16 sessions of time-limiting psychotherapy. The data were used to address 2 questions: (a) Is the dose-effect curve for psychological symptoms negatively accelerated? and (b) is there a differential rate of response for acute, chronic, and characterological/interpersonal components of depression? The results supported the differential rate of response of different components of depression and suggested qualifications to the acute, chronic, and characterological/interpersonal components and evidence that both supported and qualified previous suggestions that the dose-effect curve is negatively accelerated.
Journal of Consulting and Clinical Psychology 11/1996; 64(5):927-35. · 4.85 Impact Factor
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ABSTRACT: Following the suggestion that therapeutic change is accelerated in time-limited psychotherapy, this study investigated the across-session patterns of session impact in the treatments of 117 depressed clients who were randomly allocated to 8 or 16 sessions of cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) therapy. After each session, all clients completed the Session Evaluation Questionnaire and 75 of the clients completed the Session Impacts Scale. Session ratings indicated that sessions were perceived increasingly positively on most impact dimensions (e.g., session depth and smoothness, relationship with the therapist, feelings of understanding and problem solving, postsession positive mood) as treatment progressed. Early in treatment, PI therapy sessions were less smooth (i.e., more tense and uncomfortable) and less focused on problem solving, but PI sessions changed more rapidly than CB sessions on these dimensions, so that later in treatment, sessions of both treatments were equivalently positive. In both treatments, the trend toward more positive sessions was more rapid (i.e., the across-session slope was steeper) in 8-session treatments than in 16-session treatments. Such accelerated changes in session impact may reflect the suggested acceleration of therapeutic change associated with shorter time limits.
Journal of Consulting and Clinical Psychology 07/1996; 64(3):577-86. · 4.85 Impact Factor
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ABSTRACT: Twenty-seven of 114 depressed clients, stratified for severity of depression, obtained a Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III; American Psychiatric Association, 1980) diagnosis of Cluster C personality disorder--that is, avoidant, obsessive-compulsive or dependent personality disorder (PD clients)--whereas the remaining 87 did not (non-personality-disorder [NPD] clients). All clients completed either 8 or 16 sessions of cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) psychotherapy. On most measures, PD clients began with more severe symptomatology than NPD clients. Among those who received PI therapy, PD clients maintained this difference posttreatment and at 1-year follow-up. Among those who received CB therapy, posttreatment differences between PD and NPD groups were not significant. Treatment length did not influence outcome for PD clients. PD clients whose depression was also relatively severe showed significantly less improvement after treatment than either PD clients with less severe depression or NPD clients.
Journal of Consulting and Clinical Psychology 01/1996; 63(6):997-1004. · 4.85 Impact Factor
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ABSTRACT: Depressed psychotherapy clients (N = 117) rated the treatment principle credibility of cognitive-behavioural (CB) and psychodynamic-interpersonal (PI) before they were randomly assigned to receive either eight or 16 sessions of one of these treatments, and they rated their expectations of the treatment to which they were assigned immediately before (initial credibility) and immediately after their first session (emergent credibility). Results indicated that before they were assigned to a treatment, clients rated CB treatment principle credibility higher than PI treatment principle credibility. After assignment, however, clients rated initial credibility similar regardless of whether they were assigned to CB or PI therapy, and their ratings of emergent credibility increased to a similar degree from immediately before to immediately after the first session in both treatments. Clients' endorsement of CB and PI treatment principle credibility predicted improvement in PI therapy but not improvement in CB therapy. Initial and emergent credibility of clients' assigned treatment predicted improvement for clients who received eight sessions of therapy, but not for clients who received 16 sessions of therapy. The implications of these findings are discussed.
British Journal of Clinical Psychology 12/1995; 34 ( Pt 4):555-69. · 1.90 Impact Factor
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ABSTRACT: One hundred four clients completed a mailed follow-up 1 year after completing 8 of 16 sessions of treatment, either cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) psychotherapy. Although mean scores on outcome measures at 1 year suggested that gains were, in general, well maintained, only 29% of clients were asymptomatic on all 3 occasions of testing (end of treatment, 3 months and 1 year later) without recourse to further treatment. However, only 11% of those asymptomatic at end of treatment experienced relapse or recurrence of depression, albeit on the limited evidence of just two follow-up assessments. The results of comparisons among treatment conditions at 1 year differed substantially from those obtained earlier: Eight-session PI treatment now appeared less efficacious than the other 3 treatment conditions, and there was now no measurable benefit of 16-session over 8-session CB, irrespective of initial severity of depression. These findings confirm the importance of follow-up in evaluation of psychotherapies for depression.
Journal of Consulting and Clinical Psychology 07/1995; 63(3):378-87. · 4.85 Impact Factor
