David Saxon

David Saxon
The University of Sheffield | Sheffield · Department of Psychology (Faculty of Science)

Doctor of Philosophy

About

57
Publications
21,992
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1,423
Citations
Citations since 2017
27 Research Items
1124 Citations
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Introduction
David Saxon is a researcher & data analyst at the Clinical Psychology Unit at The University of Sheffield. David does research into variability in psychotherapy outcomes, with a particular interest in therapist effects in routinely collected service data using multilevel modelling.

Publications

Publications (57)
Article
Currently, no reports exist on the phenomenon of early response in humanistic-experiential therapies. This study investigated the prognostic value of early response on posttreatment outcomes in person-centered experiential therapy (PCET) for depression within the English Improving Access to Psychological Therapies program. The design of the study w...
Article
Full-text available
Objective(s): To examine the psychometric properties of the idiographic Goal-Based Outcome (GBO) tool for young people: test-retest stability, convergent validity, and sensitivity to an intervention. Methods: This measure validation study used data from a randomized controlled trial of school-based humanistic counseling. We used multilevel analy...
Article
Background The UK Government's implementation in 2008 of the Improving Access to Psychological Therapies (IAPT) initiative in England has hugely increased the availability of cognitive behavioural therapy (CBT) for the treatment of depression and anxiety in primary care. Counselling for depression—a form of person-centred experiential therapy (PCET...
Article
Full-text available
Background About one in seven adolescents have a mental health disorder in England, UK. School counselling is one of the most common means of trying to address such a problem. We aimed to determine the effectiveness and cost-effectiveness of school-based humanistic counselling (SBHC) for the treatment of psychological distress in young people in En...
Article
A pilot study of cognitive analytic therapy (CAT) plus treatment as usual (TAU), versus TAU in stressed pregnant women with anxiety and depression was undertaken as an essential preliminary to any definitive, randomised controlled trial (RCT). The trial was pragmatic, multicentre, parallel, randomised, controlled, and unblinded. Participants were p...
Article
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Psychological intervention outcomes depend in part on the therapist who provides the intervention (a therapist effect). However, recent reviews suggest that therapist effects may vary as a function of the context in which care is provided, and therefore should not be generalised beyond that context. This study statistically analysed therapist effec...
Article
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Objective: The study aimed to (a) investigate the effect of treatment location on clinical outcomes for patients receiving psychological therapy (a clinic effect, akin to the concept of a therapist effect) and (b) assess the impact of explanatory individual and aggregate demographic and process variables on the clinic and therapist effects. Metho...
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Background: A previously published article in this journal reported the service effects from 103 services within the UK Improving Access to Psychological Therapies (IAPT) initiative and the comparative effectiveness of CBT and Counselling provision. All patients received High-intensity CBT or High-intensity Counselling, but some also received Low-...
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The original version of this article unfortunately contained a mistake. In Results section, under the heading the "Application", CI difference values were incorrect in one of the sentences. The corrected sentence is given below.
Article
Background Obesity is twice as common in people with schizophrenia as in the general population. The National Institute for Health and Care Excellence guidance recommends that people with psychosis or schizophrenia, especially those taking antipsychotics, be offered a healthy eating and physical activity programme by their mental health care provid...
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Background Obesity is a major challenge for people with schizophrenia. Aims We assessed whether STEPWISE, a theory-based, group structured lifestyle education programme could support weight reduction in people with schizophrenia. Method In this randomised controlled trial (study registration: ISRCTN19447796), we recruited adults with schizophreni...
Article
Objective: To review the therapist effects literature since Baldwin and Imel's (2013) review. Method: Systematic literature review of three databases (PsycINFO, PubMed and Web of Science) replicating Baldwin and Imel (2013) search terms. Weighted averages of therapist effects (TEs) were calculated, and a critical narrative review of included stu...
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Variability is intrinsic to all human activities and psychotherapy is no exception. However, trials methodology is not suited to investigating and building our knowledge about variability. By contrast, the paradigm of practice-based evidence, which focuses on routine practice, is a better way of researching the phenomenon of variability. We outline...
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Background: Occupational burnout is common in mental health professionals, but its impact on patient outcomes is as yet uncertain. This study aimed to investigate associations between therapist-level burnout and patient-level treatment outcomes after psychological therapy. Methods: We applied multilevel modelling using depression (PHQ-9) and anxiet...
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Practice research networks (PRNs) can support the implementation of evidence based practice in routine services and generate practice based evidence. This paper describes the structure, processes and learning from a new PRN in the Improving Access to Psychological Therapies programme in England, in relation to an implementation framework and using...
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Background: The prevalence of long-term conditions (LTCs) and multiple-morbidity is increasing. Depression prevalence increases with the number of LTCs. Self-management of LTCs improves outcomes, but depression impacts on self-management. Unscheduled hospital care may be a proxy for failure of planned care to support successful self-management. M...
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This paper aims to provide researchers with practical information on sample sizes for accurate estimations of therapist effects (TEs). The investigations are based on an integrated sample of 48,648 patients treated by 1800 therapists. Multilevel modeling and resampling were used to realize varying sample size conditions to generate empirical estima...
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To consider the relationships between, therapist variability, therapy modality, therapeutic dose and therapy ending type and assess their effects on the variability of patient outcomes. Multilevel modeling was used to analyse a large sample of routinely collected data. Model residuals identified more and less effective therapists, controlling for c...
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A growing body of literature attests to the existence of therapist effects with little explanation of this phenomenon. This study therefore investigated the role of resilience and mindfulness as factors related to practitioner wellbeing and associated effective practice. Data comprised practitioners (n = 37) and their patient outcome data (n = 4980...
Conference Paper
Problem The primary healthcare system is reported to be less able to support people living with one or more long term conditions (LTC) where they are also experiencing a mental health problem. This may be evidenced by additional use of unscheduled hospital care by people with co-morbid mental and physical health problems. We wanted to quantify the...
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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 1...
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Background: NICE guidelines state cognitive behavioural therapy (CBT) is a front-line psychological treatment for people presenting with depression in primary care. Counselling for Depression (CfD), a form of Person-Centred Experiential therapy, is also offered within Improving Access to Psychological Therapies (IAPT) services for moderate depress...
Article
Background: This was a multi-service evaluation of the clinical and organisational effectiveness of large group psychoeducational CBT delivered within a stepped care model. Method: Clinical outcomes for 4451 participants in 163 psychoeducational groups delivered across 5 services were analysed by calculating pre-post treatment anxiety (GAD-7) effec...
Article
Background: In the psychological therapies, patient outcomes are not always positive. Some patients leave therapy prematurely (dropout), while others experience deterioration in their psychological well-being. Methods: The sample for dropout comprised patients (n = 10 521) seen by 85 therapists, who attended at least the initial session of one-t...
Article
In June 2013 Therapy Today interviewed Professor Michael Barkham about embarking on a large-scale randomised control trial (RCT), funded by the BACP Research Foundation and based at the University of Sheield, that aimed to assess whether counselling for depression (CfD) was noninferior to CBT for patients with moderate to severe depression when del...
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Objective: To investigate the barriers and facilitators of an effective implementation of an outcome monitoring and feedback system in a UK National Health Service psychological therapy service. Method: An outcome monitoring system was introduced in two services. Enhanced feedback was given to therapists after session 4. Qualitative and quantita...
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The study investigated whether psychological wellbeing practitioners (PWPs) working within the UK government's Improving Access to Psychological Therapies (IAPT) initiative are differentially effective (i.e., therapist effect size) and differentially efficient (i.e., rate of clinical change), and the moderating effect of demographic and process fac...
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Background Improving Access to Psychological Therapy (IAPT) services have increased the number of people with common mental health disorders receiving psychological therapy in England, but concerns remain about how equitably these services are accessed. Method Using cohort patient data (N=363) collected as part of the independent evaluation of the...
Article
Objectives: There is a dearth of older adult evidence regarding the group treatment for co-morbid anxiety and depression. This research evaluated the effectiveness of a low-intensity group psychoeducational approach. Method: Patients attended six sessions of a manualised cognitive-behavioural group. Validated measures of anxiety, depression and...
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The purpose of the analysis was to develop a health economic model to estimate the costs and health benefits of alternative National Health Service (NHS) service configurations for people with longer-term depression. METHOD: Modelling methods were used to develop a conceptual and health economic model of the current configuration of services in She...
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Background: Effective psychological therapies have been recommended for common mental health problems, such as depression and anxiety, but provision has been poor. Improving Access to Psychological Therapies (IAPT) may provide a cost-effective solution to this problem. Aims: To determine the cost-effectiveness of IAPT at the Doncaster demonstrat...
Article
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 adult...
Article
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 an...
Article
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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 compri...
Article
The Government would like to support people to move off benefits and into work. Mental health problems such as depression and anxiety are among the commonest reasons why people cannot work. These are relatively easily treated by psychological therapy, but this is hard to find in the NHS. The NHS has funded two Demonstration Sites which will make ps...
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Aims and method Up to a third of clients referred to National Health Service (NHS) mental health services will miss their first appointment. Opt-in systems are widely used to reduce non-attendance but there has been little published research examining the effects of such methods on clients. A cohort study with non-randomised historical controls was...
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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 fi...
Article
Aims: Unplanned endings, where clients unilaterally end therapy, are of concern for psychological therapy services generally as they raise questions about the appropriateness of the treatment and it's delivery for some clients. Limited available data indicates that those who drop-out often have more severe symptoms at entry, and have poorer clinica...
Article
There is often difficulty in generalizing the results of randomized controlled trials (RCTs) to routine clinical practice given the rigid design features of such studies. The purpose of this study is to describe the effectiveness of routinely delivered, formulation-based cognitive behavioural therapy (CBT) within a publicly funded clinic for adults...
Article
Studies show that counsellors in primary care see many clients with difficulties of a severity similar to those found in secondary care services. Evidence from both RCTs and studies of routinely collected data indicates that many of these ‘clinical’ clients benefit from brief counselling intervention. However, little is known about why some benefit...
Article
Different modes of psychotherapy can be an effective form of treatment for a range of mental health problems. Psychotherapy provision in the NHS is organised in a variety of ways, with patient entry to various modes of therapy determined by a range of factors including evidence-based guidelines and patient or referrer preference. The methods by whi...
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Behavioural Activation is a contemporary contextual psychological treatment for depression. The outcome of a series of five treatment groups involving a total of 42 patients presenting to a psychotherapy department with self-reported depression is reported. Three of the treatment groups were delivered by two cognitive behavioural psychotherapists,...
Article
To determine the clinical utility and acceptability of a brief CBT psycho-educational course delivered in an NHS psychotherapy service. All patients referred, found suitable for CBT, and who had an anxiety disorder, were invited to enrol in a psycho-education course, delivered in an outpatient mental health clinic by two mental health nurses with p...
Article
In this study of routine service data and census data, the authors explore the influence of socioeconomic status on patients entering an integrated psychotherapy service. Between January 1, 2000, and September 30, 725 patients were assessed and had their Townsend Index of Material Deprivation (TIMD) scores derived from postcodes. Results showed no...

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