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Malkomsen A, Røssberg JI, Dammen T, Wilberg T, Løvgren A, Ulberg R, Evensen J. "It takes time to see the whole picture": patients' views on improvement in cognitive behavioral therapy and psychodynamic therapy after three years. Front Psychiatry 2024; 15:1342950. [PMID: 38559399 PMCID: PMC10978640 DOI: 10.3389/fpsyt.2024.1342950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction There is a lack of qualitative research that retrospectively explores how patients with major depressive disorder view their improvement in psychotherapy. Methods Fifteen patients who received short-term cognitive behavioral therapy and psychodynamic therapy were individually interviewed approximately three years after completing therapy. Results Some patients had altered their views on therapy, especially those who initially were uncertain of how helpful therapy had been. They said they did not realize the extent and importance of their improvement in therapy before some time had passed, which can be explained by the surprising cumulative effects of seemingly small changes. Discussion This should make retrospective qualitative research an important part of future psychotherapy research.
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Affiliation(s)
- Anders Malkomsen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Toril Dammen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Theresa Wilberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - André Løvgren
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Randi Ulberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Julie Evensen
- Nydalen Outpatient Clinic, Oslo University Hospital, Oslo, Norway
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Eilert N, Wogan R, Adegoke A, Earley C, Duffy D, Enrique A, Palacios J, Timulak L, Richards D. The relationship between posttherapeutic Cognitive Behavior Therapy skills usage and follow-up outcomes of internet-delivered Cognitive Behavior Therapy. J Clin Psychol 2023; 79:55-67. [PMID: 35726497 PMCID: PMC10083952 DOI: 10.1002/jclp.23403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 04/18/2022] [Accepted: 05/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clients independently applying Cognitive Behavior Therapy (CBT) skills is an important outcome of CBT-based treatments. The relationship between posttherapeutic CBT skills usage and clinical outcomes remains under-researched-especially after internet-delivered CBT (iCBT). OBJECTIVE Explore contemporaneous and lagged effects of posttherapeutic CBT skills usage frequency on iCBT follow-up outcomes. METHOD Nested within a randomized controlled trial, 241 participants received 8-week supported iCBT for anxiety and/or depression, completing measures of anxiety, depression, functional impairment, and CBT skills usage frequency at 3-, 6-, 9-, and 12-month follow-up. Cross-lagged panel models evaluated primary aims. RESULTS While analyses support a contemporaneous relationship between anxiety, depression, functional impairment, and CBT skills usage frequency, no consistent lagged effects were observed. CONCLUSION Findings align with qualitative research but the role of CBT skills usage in the maintenance of iCBT effects remains unclear. Innovative research modeling temporal and possibly circular relationships between CBT skill usage and clinical outcomes is needed to inform iCBT optimization.
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Affiliation(s)
- Nora Eilert
- E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Rebecca Wogan
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Adedeji Adegoke
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Caroline Earley
- E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Daniel Duffy
- E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Angel Enrique
- E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Jorge Palacios
- E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Ladislav Timulak
- E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Derek Richards
- E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
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Eilert N, Timulak L, Duffy D, Earley C, Enrique A, Kennedy P, McCormack C, Palacios J, Wogan R, Richards D. Following up internet-delivered cognitive behaviour therapy (CBT): A longitudinal qualitative investigation of clients' usage of CBT skills. Clin Psychol Psychother 2021; 29:200-221. [PMID: 34048613 DOI: 10.1002/cpp.2619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/01/2021] [Accepted: 05/19/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND While the acquisition and application of Cognitive Behaviour Therapy (CBT) skills is a core component and likely mechanism of effect maintenance in all CBT-based treatments, the extent of post-therapeutic CBT skills usage among internet-delivered CBT (iCBT) clients remains under-researched. METHOD Nested within a pragmatic randomized controlled trial, 241 participants received an 8-week supported iCBT intervention for anxiety and/or depression and answered open-ended questions about their use and experience of CBT skills at 3-, 6-, 9-, and 12-month follow-up. Recurrent, cross-sectional qualitative analysis following the descriptive and interpretive approach was used to create a taxonomy, through which all qualitative data was coded. RESULTS In total, 479 qualitative responses across 181 participants were analysed. Participants reported using a wide range of CBT skills and associated helpful and hindering experiences and impacts. The reasons for discontinued CBT skills usage were diverse, ranging from rare adverse effects to healthy adaptation. CONCLUSION The study shows how clients receiving iCBT in routine care learn CBT skills during treatment and utilize them in productive ways post-treatment. Findings coincide with similar research in face-to-face CBT and may inform future research to drive innovation and iCBT intervention development.
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Affiliation(s)
- Nora Eilert
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Ladislav Timulak
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Daniel Duffy
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Caroline Earley
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Angel Enrique
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Polly Kennedy
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Clare McCormack
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Jorge Palacios
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Rebecca Wogan
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Derek Richards
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
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Malkomsen A, Røssberg JI, Dammen T, Wilberg T, Løvgren A, Horgen Evensen J. The Synergistic Process of Improvement in Cognitive Behavioral Therapy for Major Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2292. [PMID: 33652563 PMCID: PMC7956317 DOI: 10.3390/ijerph18052292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a substantial lack of qualitative research concerning individual cognitive behavioral therapy (CBT) for patients with major depressive disorder (MDD). In the present study, we wanted to explore how patients suffering from MDD experience improvement in CBT. METHOD Patients with MDD (N = 10) were interviewed at therapy termination with semi-structured qualitative interviews. The transcripts were analyzed using a thematic analysis approach. RESULTS We identified three elements that were relevant to the process of improvement for all patients: the therapeutic relationship, the therapeutic interventions and increased insight. There is a dynamic interrelationship and synergy between these elements that may explain why patients considered the same elements as helpful, but often in different ways and at different stages of therapy. CONCLUSIONS Highlighting the synergies and interrelationship between the elements that patients experience as helpful, may help therapists to learn from and utilize these experiences. This is a reminder of the importance of always being attentive to the individual processes of patients.
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Affiliation(s)
- Anders Malkomsen
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway; (J.I.R.); (T.W.); (A.L.)
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway; (J.I.R.); (T.W.); (A.L.)
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Toril Dammen
- Department of Behavioral Science in Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway;
| | - Theresa Wilberg
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway; (J.I.R.); (T.W.); (A.L.)
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - André Løvgren
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway; (J.I.R.); (T.W.); (A.L.)
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McPherson S, Wicks C, Tercelli I. Patient experiences of psychological therapy for depression: a qualitative metasynthesis. BMC Psychiatry 2020; 20:313. [PMID: 32552748 PMCID: PMC7302137 DOI: 10.1186/s12888-020-02682-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/18/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Globally, national guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research concerning patient experience of treatments. A review of patient experience research can provide a comprehensive overview of this important form of evidence and thus enable the voices and subjectivities of those affected by depression to have an impact on the treatments and services they are offered. This review aims to seek a comprehensive understanding of patient experiences of psychological therapies for depression using a systematic and rigorous approach to review and synthesis of qualitative research. METHOD PsychINFO, PsychARTICLES, MEDLINE, and CINAHL were searched for published articles using a qualitative approach to examine experiences of psychological therapies for depression. All types of psychological therapy were included irrespective of model or modes of delivery (e.g. remote or in person; group or individual). Each article was assessed following guidance provided by the Critical Appraisal Skill Programme tool. Articles were entered in full into NVIVO and themes were extracted and synthesized following inductive thematic analysis. RESULTS Thirty-seven studies, representing 671 patients were included. Three main themes are described; the role of therapy features and setting; therapy processes and how they impact on outcomes; and therapy outcomes (benefits and limitations). Subthemes are described within these themes and include discussion of what works and what's unhelpful; issues integrating therapy with real life; patient preferences and individual difference; challenges of undertaking therapy; influence of the therapist; benefits of therapy; limits of therapy and what happens when therapy ends. CONCLUSIONS Findings point to the importance of common factors in psychotherapies; highlight the need to assess negative outcomes; and indicate the need for patients to be more involved in discussions and decisions about therapy, including tailoring therapy to individual needs and taking social and cultural contexts into account.
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Affiliation(s)
- Susan McPherson
- School of Health and Social Care, University of Essex, Colchester, CO4 3SQ, UK.
| | - Claire Wicks
- grid.8356.80000 0001 0942 6946School of Health and Social Care, University of Essex, Colchester, CO4 3SQ UK
| | - Ilaria Tercelli
- grid.8356.80000 0001 0942 6946School of Health and Social Care, University of Essex, Colchester, CO4 3SQ UK
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Kühne F, Lesser H, Petri F, Weck F. Do mental health patients learn what their cognitive-behaviour therapists think they do? A short report on qualitative interviews comparing perspectives. Int J Qual Stud Health Well-being 2018; 13:1527598. [PMID: 30289028 PMCID: PMC6179057 DOI: 10.1080/17482631.2018.1527598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: The acquisition of skills is essential to the conceptualization of cognitive-behavioural therapy. Yet, what experiences are encountered and what skills actually learned during therapy, and whether patients and therapists have concurrent views hereof, remains poorly understood. Method: An explorative pilot study with semi-structured, corresponding interview guides was conducted. Pilot data from our outpatient unit were transcribed and content-analyzed following current guidelines. Results: The responses of 18 participants (patients and their psychotherapists) were assigned to six main categories. Educational and cognitive aspects were mentioned most frequently and consistently by both groups. Having learned Behavioural alternatives attained the second highest agreement between perspectives. Conclusions: Patients and therapists valued CBT as an opportunity to learn new skills, which is an important prerequisite also for the maintenance of therapeutic change. We discuss limitations to generalizability but also theoretical and therapy implications.
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Affiliation(s)
- Franziska Kühne
- a Department of Psychology, Clinical Psychology and Psychotherapy , University of Potsdam , Potsdam , Germany
| | - Hannah Lesser
- a Department of Psychology, Clinical Psychology and Psychotherapy , University of Potsdam , Potsdam , Germany
| | - Franziska Petri
- a Department of Psychology, Clinical Psychology and Psychotherapy , University of Potsdam , Potsdam , Germany
| | - Florian Weck
- a Department of Psychology, Clinical Psychology and Psychotherapy , University of Potsdam , Potsdam , Germany
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Richards DA, Rhodes S, Ekers D, McMillan D, Taylor RS, Byford S, Barrett B, Finning K, Ganguli P, Warren F, Farrand P, Gilbody S, Kuyken W, O'Mahen H, Watkins E, Wright K, Reed N, Fletcher E, Hollon SD, Moore L, Backhouse A, Farrow C, Garry J, Kemp D, Plummer F, Warner F, Woodhouse R. Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive-behavioural therapy for depression. Health Technol Assess 2018; 21:1-366. [PMID: 28857042 DOI: 10.3310/hta21460] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Depression is a common, debilitating and costly disorder. The best-evidenced psychological therapy - cognitive-behavioural therapy (CBT) - is complex and costly. A simpler therapy, behavioural activation (BA), may be an effective alternative. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of BA compared with CBT for depressed adults at 12 and 18 months' follow-up, and to investigate the processes of treatments. DESIGN Randomised controlled, non-inferiority trial stratified by depression severity, antidepressant use and recruitment site, with embedded process evaluation; and randomisation by remote computer-generated allocation. SETTING Three community mental health services in England. PARTICIPANTS Adults aged ≥ 18 years with major depressive disorder (MDD) recruited from primary care and psychological therapy services. INTERVENTIONS BA delivered by NHS junior mental health workers (MHWs); CBT by NHS psychological therapists. OUTCOMES Primary: depression severity (as measured via the Patient Health Questionnaire-9; PHQ-9) at 12 months. Secondary: MDD status; number of depression-free days; anxiety (as measured via the Generalised Anxiety Disorder-7); health-related quality of life (as measured via the Short Form questionnaire-36 items) at 6, 12 and 18 months; and PHQ-9 at 6 and 18 months, all collected by assessors blinded to treatment allocation. Non-inferiority margin was 1.9 PHQ-9 points. We undertook intention-to-treat (ITT) and per protocol (PP) analyses. We explored cost-effectiveness by collecting direct treatment and other health- and social-care costs and calculating quality-adjusted life-years (QALYs) using the EuroQol-5 Dimensions, three-level version, at 18 months. RESULTS We recruited 440 participants (BA, n = 221; CBT, n = 219); 175 (79%) BA and 189 (86%) CBT participants provided ITT data and 135 (61%) BA and 151 (69%) CBT participants provided PP data. At 12 months we found that BA was non-inferior to CBT {ITT: CBT 8.4 PHQ-9 points [standard deviation (SD) 7.5 PHQ-9 points], BA 8.4 PHQ-9 points (SD 7.0 PHQ-9 points), mean difference 0.1 PHQ-9 points, 95% confidence interval (CI) -1.3 to 1.5 PHQ-9 points, p = 0.89; PP: CBT 7.9 PHQ-9 points (SD 7.3 PHQ-9 points), BA 7.8 PHQ-9 points (SD 6.5 PHQ-9 points), mean difference 0.0 PHQ-9 points, 95% CI -1.5 to 1.6 PHQ-9 points, p = 0.99}. We found no differences in secondary outcomes. We found a significant difference in mean intervention costs (BA, £975; CBT, £1235; p < 0.001), but no differences in non-intervention (hospital, community health, social care and medication costs) or total (non-intervention plus intervention) costs. Costs were lower and QALY outcomes better in the BA group, generating an incremental cost-effectiveness ratio of -£6865. The probability of BA being cost-effective compared with CBT was almost 80% at the National Institute for Health and Care Excellence's preferred willingness-to-pay threshold of £20,000-30,000 per QALY. There were no trial-related adverse events. LIMITATIONS In this pragmatic trial many depressed participants in both groups were also taking antidepressant medication, although most had been doing so for a considerable time before entering the trial. Around one-third of participants chose not to complete a PP dose of treatment, a finding common in both psychotherapy trials and routine practice. CONCLUSIONS We found that BA is as effective as CBT, more cost-effective and can be delivered by MHWs with no professional training in psychological therapies. FUTURE WORK Settings and countries with a paucity of professionally qualified psychological therapists, might choose to investigate the delivery of effective psychological therapy for depression without the need to develop an extensive and costly professional infrastructure. TRIAL REGISTRATION Current Controlled Trials ISRCTN27473954. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David A Richards
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Shelley Rhodes
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - David Ekers
- Psychological Therapy, Tees, Esk & Wear Valleys NHS Foundation Trust, County Durham, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - Rod S Taylor
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Barbara Barrett
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Katie Finning
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Poushali Ganguli
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Fiona Warren
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Paul Farrand
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Willem Kuyken
- Oxford Mindfulness Centre, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Heather O'Mahen
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Ed Watkins
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Kim Wright
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Nigel Reed
- Lived Experience Group, care of Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Emily Fletcher
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Lucy Moore
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Amy Backhouse
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Claire Farrow
- Psychological Therapy, Tees, Esk & Wear Valleys NHS Foundation Trust, County Durham, UK
| | - Julie Garry
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Deborah Kemp
- Psychological Therapy, Tees, Esk & Wear Valleys NHS Foundation Trust, County Durham, UK
| | - Faye Plummer
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary, Bradford, UK
| | - Faith Warner
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
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Differential Effects of an Evolutionary-Based EMDR Therapy on Depression and Anxiety Symptoms: A Case Series Study. JOURNAL OF EMDR PRACTICE AND RESEARCH 2018. [DOI: 10.1891/1933-3196.12.2.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A novel evolutionary-based therapy, treating depression downhill (TDD), was designed as a specific therapy for depression as a syndrome (Krupnik, 2014) and later integrated with eye movement desensitization and reprocessing (EMDR) therapy into a combined TDD-EMDR treatment. The combined therapy integrates modified EMDR procedures into the theoretical context of TDD. These procedures are applied during the second (acceptance) stage of TDD-EMDR’s three-stage proltocol with the focus on acceptance of defeat/failure/loss rather than on distressing memories. Here, we report a case series of 21 military personnel diagnosed with depressive disorders, who received a course of TDD-EMDR. Eighty percent of completers (n= 15) did not meet the criteria of depressive disorder by the treatment’s end. After 12 sessions, they showed a significant reduction on the Beck’s Depression Inventory-II (BDI-II) with a large effect size (d= 2.8) and an increase in accepting disposition (d= 1.8) on the Acceptance and Action Questionnaire. Noncompleters showed similar to completers decrease of BDI-II scores at mid-treatment. We observed no statistically significant decrease of the anxiety symptoms on the Beck’s Anxiety Inventory. These results suggest that TDD-EMDR may be an effective treatment for depressive disorders. They also indicate that it may preferentially target depressive over anxiety symptoms, as was previously observed for TDD. Suggestions are made for future research.
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Finning K, Richards DA, Moore L, Ekers D, McMillan D, Farrand PA, O'Mahen HA, Watkins ER, Wright KA, Fletcher E, Rhodes S, Woodhouse R, Wray F. Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation. BMJ Open 2017; 7:e014161. [PMID: 28408544 PMCID: PMC5541446 DOI: 10.1136/bmjopen-2016-014161] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 02/21/2017] [Accepted: 03/08/2017] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To explore participant views on acceptability, mechanisms of change and impact of behavioural activation (BA) delivered by junior mental health workers (MHWs) versus cognitive behavioural therapy (CBT) delivered by professional psychotherapists. DESIGN Semistructured qualitative interviews analysed using a framework approach. PARTICIPANTS 36 participants with major depressive disorder purposively sampled from a randomised controlled trial of BA versus CBT (the COBRA trial). SETTING Primary care psychological therapies services in Devon, Durham and Leeds, UK. RESULTS Elements of therapy considered to be beneficial included its length and regularity, the opportunity to learn and not dwelling on the past. Homework was an important, although challenging aspect of treatment. Therapists were perceived as experts who played an important role in treatment. For some participants the most important element of therapy was having someone to talk to, but for others the specific factors associated with BA and CBT were crucial, with behavioural change considered important for participants in both treatments, and cognitive change unsurprisingly discussed more by those receiving CBT. Both therapies were considered to have a positive impact on symptoms of depression and other areas of life including feelings about themselves, self-care, work and relationships. Barriers to therapy included work, family life and emotional challenges. A subset (n=2) of BA participants commented that therapy felt too simple, and MHWs could be perceived as inexperienced. Many participants saw therapy as a learning experience, providing them with tools to take away, with work on relapse prevention essential. CONCLUSIONS Despite barriers for some participants, BA and CBT were perceived to have many benefits, to have brought about cognitive and behavioural change and to produce improvements in many domains of participants' lives. To optimise the delivery of BA, inexperienced junior MHWs should be supported through good quality training and ongoing supervision. TRIAL REGISTRATION NUMBER ISRCTN27473954, 09/12/2011.
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Affiliation(s)
| | | | - Lucy Moore
- University of Exeter Medical School, Exeter, UK
| | - David Ekers
- Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - Paul A Farrand
- School of Psychology, University of Exeter, Exeter, UK
- Clinical Education Development and Research (CEDAR), University of Exeter, Exeter, UK
| | | | | | - Kim A Wright
- School of Psychology, University of Exeter, Exeter, UK
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