A core approach to practice-based evidence: A brief history of the origins and applications of the CORE-OM and CORE System

The Current State of Evidence Regarding Audiologist-Provided Cognitive Behavioural Therapy for the Management of Tinnitus: A Scoping Review

BACKGROUND

Cognitive behavioural therapy (CBT) for tinnitus management is effective and widely recommended by national and international practice guidelines. However, all the evidence for CBT so far has come from Psychologist-led programs, and the potential role of Audiologists in providing CBT for tinnitus remains an important consideration.

OBJECTIVES

This study sets out to systematically map the body of literature relating to Audiologist-provided CBT for tinnitus, in order to summarise the current state of evidence and determine directions for future research.

ELIGIBILITY CRITERIA

Sources were eligible for inclusion if they addressed the concept of Audiologist-provided CBT. No restrictions were imposed on the date of publication. Only sources published in English were included.

SOURCES OF EVIDENCE

A wide range of primary and secondary literature sources were sought.

CHARTING METHODS

Data from included sources were charted systematically using a pre-designed data charting form.

RESULTS

Of the 267 identified sources, 30 were included in this review. This included both primary and secondary literature sources. Primary sources were compared and showed variation across Audiologist-provided CBT programs both in terms of procedural details and from a research standpoint.

CONCLUSIONS

A growing body of evidence has addressed the concept of Audiologist-provided CBT. Directions for future research include further primary research with an increased focus on face-to-face Audiologist-provided CBT, and a comparison of the outcomes of Audiologist-provided vs. Psychologist-provided CBT.

Examining therapist estimation of client working alliance and client symptom outcome using truth and bias model and response surface analysis

OBJECTIVE

The aims of this study were to investigate the congruence and discrepancy between Chinese therapist trainees' estimated client working alliance (WA) and their clients' actual WA rating, and how the congruence and discrepancy predicted client symptom outcome.

METHODS

Participants were 211 beginning therapist trainees and 1216 clients. Data from their 6888 sessions were analyzed using Truth and Bias Model and Response Surface Model.

RESULTS AND CONCLUSIONS

(i) Chinese trainees' estimation of client WA was on average significantly lower than actual client WA. (ii) At the between-person level, whether the trainee generally over- or underestimated client WA was not related to the client's initial symptom level or symptom improvement rate. (iii) At the within-person between-session level, a session where a trainee accurately perceived high client WA, compared to a session where the trainee accurately perceived low client WA, was followed by greater client symptom relief before the next session. In the case of estimation bias, a session where the trainee underestimated client WA was followed by greater client symptom reduction in the next session, rather than the other way around when the trainee overestimated client WA. Implications on therapist training were discussed.

Feasibility and Efficacy of Intensive Dialectical Behavior Therapy Skills Training in An Outpatient Setting for A Group of Patients with Extensive Care Needs - A Transdiagnostic Approach

PURPOSE

Dialectical behavior therapy (DBT) is a treatment originally developed för chronically suicidal adults. It is common to adapt it by using one specific component, the DBT skills training (DBT-ST) and apply it in a group therapy setting for a variety of mental disorders. The primary aim of the study was to explore whether patients with extended care needs would report improved mental health after participating in an intensive form of DBT-ST. The secondary aim was to explore whether the use of psychiatric inpatient care for the group would decrease.

METHODS

Thirty-seven participants completed the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), and visual analogue scale (VAS) at three time points: pre-intervention, post-intervention and at 6-month follow-up after intensive DBT-ST.

RESULTS

One-way ANOVA showed a significant effect for time on the CORE-OM: F (2,35) = 7.93, p = .001, η2 = 0.312 (large effect size). Post hoc tests indicated a significant difference between pre-intervention and post-intervention (p = .001) and between pre-intervention and follow-up (p = .01). A Friedman test indicated a statistically significant difference in the VAS scale scores across the three time points, with p-values between 0.00 and 0.05. There was no difference in psychiatric healthcare consumption.

CONCLUSION

These study results confirm to some extent the feasibility and effectiveness of the intensive DBT-ST in a transdiagnostic clinical setting. The participants had a positive outcome from the skills training program, but psychiatric healthcare consumption did not decrease.

PsyCARE study: assessing impact, cost-effectiveness, and transdiagnostic factors of the Italian ministry of health's "psychological bonus" policy

BACKGROUND

The prevalence of anxiety and depression disorders is surging worldwide, prompting a pressing demand for psychological interventions, especially in less severe cases. Responding to this need, the Italian government implemented the "Psychological Bonus" (PB) policy, allotting 25 million euros for mental health support. This policy entitles individuals to a minimum of four to twelve psychological sessions. In collaboration with the National Board of Italian Psychologists, our study assesses this policy's effectiveness. Indeed, the PsyCARE study aims to examine the utilization of the Psychological Bonus, evaluate its impact on adult and adolescent participants' psychological well-being through pre- and post-intervention assessments and six-month follow-up, and conduct a longitudinal cost-effectiveness analysis of this policy. A secondary aim is to investigate the influence of these interventions on transdiagnostic factors, including emotion regulation and epistemic trust.

METHODS

The study involves licensed psychotherapists and their patients, both adults and adolescents, benefiting from the Psychological Bonus. Data collection is underway and set to conclude in December 2023. Psychotherapists will provide diagnostic information and assess patient functioning. In addition, patients will be evaluated on mental health aspects such as clinical symptoms, emotion regulation, epistemic trust, and quality of life. We will employ linear mixed-effects models to analyze the outcomes, accounting for both fixed and random effects to capture the hierarchical structure of the data.

DISCUSSION

We anticipate the study's findings will highlight reduced psychological distress and improved quality of life for participants and demonstrate the Psychological Bonus policy's cost-effectiveness. The study will gather data on the role of specific versus nonspecific therapeutic factors in psychotherapy while adopting a patient-tailored approach to identify effective therapeutic elements and examine transdiagnostic factors. Overall, this study's findings will guide future measures within the Italian healthcare system, fostering a psychological health culture and providing valuable insights to the broader public.

STUDY REGISTRATION

https://osf.io/6zk2j.

Mental health outcomes for those who have offended and have been given a Mental Health Treatment Requirement as part of a Community Order in England and Wales

BACKGROUND

Growing evidence of mental disorders among people going through the criminal justice system suggests the potential benefit of courts adding a Mental Health Treatment Requirement (MHTR) when sentencing an offender to a Community Order (sentence) in England and Wales. Although available since 2003, MHTRs have not been widely used, and there is little evidence on outcomes.

AIM

To conduct the first large-scale evaluation of mental health outcomes of people with an MHTR as part of their community sentence across multiple sites in England and Wales.

METHODS

Data were collected from 14 sites in England and Wales about individuals who were given an MHTR as part of a community sentence. They were assessed before and after this. During the MHTR, they received a psychotherapeutic intervention by assistant psychologists in a primary care framework. Measures of psychological distress (Clinical Outcomes in Routine Evaluation-Outcome Measure), anxiety (Generalised Anxiety Disorder-7) and depression (Patient Health Questionnaire) were completed before the MHTR was implemented and after completion.

RESULTS

Where paired sample t-tests and Wilcoxon signed ranked tests were used, with samples ranging between 309 and 447 individuals, clinically significant changes were obtained for all measures. Most individuals (63%) were identified as experiencing a reliable change in at least two out of the three scales. Finally, a negative linear relationship, between measures at the start of the intervention and reliable change, was identified with higher pre-measures, indicating that more initial distress, anxiety and/or depression were associated with more sizeable changes.

CONCLUSIONS

This paper provides the first substantial evidence in support of the MHTR within a primary mental healthcare framework as an effective pathway to reduce mental health problems among individuals under probation supervision as part of a sentence after conviction for a criminal offence. This supports the expansion of the provision across England and Wales. Future research should take account of the non-completers and explore the relationship between the MHTR, mental health improvements and reoffending.

Factors Affecting Digital Tool Use in Client Interaction According to Mental Health Professionals: Interview Study

BACKGROUND

Digital tools and interventions are being increasingly developed in response to the growing mental health crisis, and mental health professionals (MHPs) considerably influence their adoption in client practice. However, how MHPs use digital tools in client interaction is yet to be sufficiently understood, which poses challenges to their design, development, and implementation.

OBJECTIVE

This study aimed to create a contextual understanding of how MHPs use different digital tools in clinical client practice and what characterizes the use across tools.

METHODS

A total of 19 Finnish MHPs participated in semistructured interviews, and the data were transcribed, coded, and inductively analyzed.

RESULTS

We found that MHP digital tool use was characterized by 3 distinct functions: communication, diagnosis and evaluation, and facilitating therapeutic change. The functions were addressed using analog tools, digitized tools that mimic their analog counterparts, and digital tools that use the possibilities native to digital. The MHP-client communication included various media alongside face-to-face meetings, the MHPs increasingly used digitized tools in client evaluation, and the MHPs actively used digitized materials to facilitate therapeutic change. MHP tool use was generally characterized by adaptability-it was negotiated in client interactions. However, there was considerable variance in the breadth of MHPs' digital toolbox. The existing clinical practices emphasized MHP-client interaction and invited incremental rather than radical developments, which challenged the achievement of the scalability benefits expected from digital tools.

CONCLUSIONS

MHPs use digitized and digital tools in client practice. Our results contribute to the user-centered research, development, and implementation of new digital solutions in mental health care by classifying them according to their function and medium and describing how MHPs use and do not use them.

Psychometric validation of the 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP)

Introduction

Reliable and valid instruments are needed to measure the impact of mental health services and programs on the journeys of recovery of service users. The aim of this study was to explore the psychometric properties of the cross-culturally adapted 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP).

Methods

One hundred and ten participants from three locations in Spain (Málaga, Barcelona and Madrid), who were users of primary and specialized mental health services, were interviewed from October 2021 to June 2022.

Results

The internal consistency obtained was excellent: ω  =.93 and α =.92. Temporal reliability using intraclass correlation coefficients was moderate (ICC=.684, p <.000). Regarding convergent validity, the QPR-15-SP had a moderate correlation with the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) (ρ =-.500, p <.000), a Visual Numeric Recovery Scale (VNRS) (ρ =.591, p <.000), and the Stages of Recovery Instrument (STORI) (r =.566, p <.000). Correlations between advanced stages of recovery and higher QPR-15-SP scores were found (Moratorium: ρ  =-.579, p <.000; Awareness: ρ =-.130, p =.189; Preparation: r =-.043, P=.665; Rebuilding: r =.460, p <.000; Growth: ρ  =.697, p <.000). In terms of divergent validity, the QPR-15-SP had low correlation with the DUKE-UNC Functional Social Support Scale (ρ =.273, p <.005). The confirmatory factor analysis of the 1-factor structure obtained reasonable goodness of fit indexes.

Discussion

The QPR-15-SP has acceptable psychometric properties, providing support for measuring recovery in Spain and allowing international comparison research.

Measuring quality of life for people with common mental health problems

BACKGROUND

It is important to identify valid and acceptable outcome measures so that interventions evaluating common mental health problems can be assessed appropriately. Some advocate the use of generic preference-based measures claimed to be applicable for all health interventions, but others argue that they are insensitive for common mental health problems. The aim of this paper is to evaluate the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), to be used in cost-effectiveness studies in people with common mental health problems.

METHOD

The CORE-OM measure was tested for completeness, acceptability and responsiveness in a pilot study. Analyses for missing data, distribution of scores, and standardised response means (SRMs) were calculated.

RESULTS

Missing data did not exceed 5% for any of the CORE-6D items both at baseline and follow-up. The overall comprehension rate was high, and only 19 participants (14%) requested clarifications to complete the questionnaire. As expected in a feasibility study, there was a small and non-significant SRM.

CONCLUSION

CORE-OM is a valid and acceptable instrument to evaluate quality of life for people with common mental health problems. More research is needed with larger sample sizes to compare CORE-6D with other condition specific quality of life instruments.

The executive disruption model of tinnitus distress: Model validation in two independent datasets using factor score regression

This study presents the executive disruption model (EDM) of tinnitus distress and subsequently validates it statistically using two independent datasets (the Construction Dataset: n = 96 and the Validation Dataset: n = 200). The conceptual EDM was first operationalised as a structural causal model (construction phase). Then multiple regression was used to examine the effect of executive functioning on tinnitus-related distress (validation phase), adjusting for the additional contributions of hearing threshold and psychological distress. For both datasets, executive functioning negatively predicted tinnitus distress score by a similar amount (the Construction Dataset: β = -3.50, p = 0.13 and the Validation Dataset: β = -3.71, p = 0.02). Theoretical implications and applications of the EDM are subsequently discussed; these include the predictive nature of executive functioning in the development of distressing tinnitus, and the clinical utility of the EDM.

Referral assessment and patient waiting time decisions in specialized mental healthcare: an exploratory study of early routine collection of PROM (LOVePROM)

BACKGROUND

Norway has prioritized health services according to the principle of "severity of conditions", where waiting time reflects patients' medical urgency. We aim to investigate if the "severity-of-condition" principle performs well in the priority setting of waiting time, between and within groups of patients using community mental health services. We also aim to investigate the association between patients' diagnoses and symptom severity at the start of treatment and the corresponding waiting time.

METHODS

The study analyzed routine data from Lovisenberg electronic Patient-Reported Outcome Measurement (LOVePROM) at Lovisenberg Diaconal Hospital in Norway. We estimated patient-reported severity by using Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), together with patients' diagnoses to identify patients' needs in general. To assess the performance of current prioritization, we compared waiting times for patients with major depressive disorder and their maximum recommended waiting time. Multivariate regression models were used to assess the association between patient-reported severity, their diagnosis, and waiting times.

RESULTS

Of the 6108 mental health disorder patients, patients with moderate to severe conditions waited seven weeks, while patients with mild conditions or below clinical cutoff waited 8 weeks. Included in the sample, 1583 were diagnosed with depression. Results indicated that patients with moderate and severe depression had a slightly shorter wait-time than patients with mild depression. However, 32.4% patients with moderate depression and 83.3% patients with severe depression, waited longer than their maximum recommended waiting time. CORE-OM identified depressive patients with risk-to-self harm, who had a 0.84 weeks shorter wait-time. These results were also applied to patients with other common mental health disorders.

CONCLUSION

Overall, patients waited in accordance with the "severity of condition" principle, but the trend was not strong. Therefore, we advocate that there is substantial room for quality improvements in priority setting on waiting time. We suggest further research should investigate if routine collection of PROM and assessment of referral letters, can better inform specialists when deciding on waiting time.

GPs' identification of patients with mental distress: a coupled questionnaire and cohort study from norwegian urban general practice

BACKGROUND

Mental health problems are one of the leading causes of disease burden worldwide, and are mainly diagnosed and treated in general practice. It is unclear however, how general practitioners (GPs) identify mental health problems in their patients. The aim of this study was to explore how patients' self-reported levels of mental distress correspond with psychological diagnoses made by their GPs, and associations with sex, age, number of consultations, and somatic symptom diagnoses.

METHODS

A questionnaire study coupled with retrospective and prospective cohort data from 553 patients aged 16-65 years in six GP offices in Oslo, Norway during 21 months in 2014-2016.

RESULTS

We found that 73.3% of patients with self-reported high levels of mental distress versus only 13.3% of the patients with low levels of mental distress had received a psychological diagnosis (p < 0.01). We found an increase in number of consultations for the group with high levels of mental distress regardless of having received a psychological diagnosis (p < 0.01). There was also an increase in number of somatic symptoms (p = 0.04) and higher number of females (0.04) in this group. 35% of patients had received one or more psychological diagnosis by their GP. Mean CORE-10 score, being female and a high number of consultations was associated with having received a psychological diagnosis. In the adjusted analyses high CORE-10 score and a high number of consultations still predicted a psychological diagnosis.

CONCLUSIONS

We found a clear association between self-reported mental distress and having received a psychological diagnosis amongst the participants, and the probability for being identified increased with increasing levels of mental distress, and increasing number of visits to their doctor. This suggests that GPs can identify patients with high levels of mental distress in general practice in an adequate way, even though this can sometimes be a complex issue.

TRIAL REGISTRATION

Trial registration The main study was retrospectively registered in ClinicalTrials.gov on August 10 2019 with identification number NCT03624829.

Clinical Outcomes in Routine Evaluation Measures for Patients Discharged from Acute Psychiatric Care: Four-Arm Peer and Text Messaging Support Controlled Observational Study

Background: Peer support workers (PSW) and text messaging services (TxM) are supportive health services that are frequently examined in the field of mental health. Both interventions have positive outcomes, with TxM demonstrating clinical and economic effectiveness and PSW showing its utility within the recovery-oriented model. Objective: To evaluate the effectiveness of PSW and TxM in reducing psychological distress of recently discharged patients receiving psychiatric care. Methods: This is a prospective, rater-blinded, pilot-controlled observational study consisting of 181 patients discharged from acute psychiatric care. Patients were randomized into one of four conditions: daily supportive text messages only, peer support only, peer support plus daily text messages, or treatment as usual. Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM), a standardized measure of mental distress, was administered at four time points: baseline, six weeks, three months, and six months. MANCOVA was used to assess the impact of the interventions on participants’ scores on four CORE-OM subscales across the three follow-up time points. Recovery, clinical change, and reliable change in CORE-OM all-item analysis were examined across the four groups, and the prevalence of risk symptoms was measured. Results: A total of 63 patients completed assessments at each time point. The interaction between PSW and TxM was predictive of differences in scores on the CORE-OM functioning subscale with a medium effect size (F1,63 = 4.19; p = 0.045; ηp2 = 0.07). The PSW + TxM group consistently achieved higher rates of recovery and clinical and reliable improvement compared to the other study groups. Additionally, the text message group and the PSW + TxM group significantly reduced the prevalence of risk of self/other harm symptoms after six months of intervention, with 27.59% (χ2(1) = 4.42, p = 0.04) and 50% (χ2(1) = 9.03, p < 0.01) prevalence reduction, respectively. Conclusions: The combination of peer support and supportive text messaging is an impactful intervention with positive clinical outcomes for acute care patients. Adding the two interventions into routine psychiatric care for patients after discharge is highly recommended.

Enhancing the effect of psychotherapy through systematic client feedback in outpatient mental healthcare: A cluster randomized trial

Objective: Systematic client feedback (SCF), the regular monitoring and informing of patients' progress during therapy to patient and therapist, has been found to have effects on treatment outcomes varying from very positive to slightly negative. Several prior studies have been biased by researcher allegiance or lack of an independent outcome measure. The current study has taken this into account and aims to clarify the effects of SCF in outpatient psychological treatment.

Method: Outpatients (n = 1733) of four centers offering brief psychological treatments were cluster randomized to either treatment as usual (TAU) or TAU with SCF based on the Partners for Change Outcome Management System (PCOMS). Primary outcome measure was the Outcome Questionnaire (OQ-45). Effects of the two treatment conditions on treatment outcome, patient satisfaction, dropout rate, costs, and treatment duration were assessed using a three-level multilevel analysis. DSM-classification, sex, and age of each patient were included as covariates.

Results: In both analyses, SCF significantly improved treatment outcome, particularly in the first three months. No significant effects were found on the other outcome variables.

Conclusions: Addition of systematic client feedback to treatment as usual, is likely to have a beneficial impact in outpatient psychological treatment. Implementation requires a careful plan of action.

Clinical or methodological significance of this article: This study, with large sample size and several independent outcome measures, provides strong evidence that addition of systematic client feedback to outpatient psychological treatment can have a beneficial effect on treatment outcome (symptoms and wellbeing), particularly in the first three months. However, implementation requires a careful plan of action.

Mental health consequences of detaining children and families who seek asylum: a scoping review

Almost 80 million people globally are forcibly displaced. A small number reach wealthy western countries and seek asylum. Over half are children. Wealthy reception countries have increasingly adopted restrictive reception practices including immigration detention. There is an expanding literature on the mental health impacts of immigration detention for adults, but less about children. This scoping review identified 22 studies of children detained by 6 countries (Australia, Canada, Hong Kong, Netherlands, the UK and the US) through searches of Medline, PsychINFO, Emcare, CINAHL and Scopus data bases for the period January 1992-May 2019. The results are presented thematically. There is quantitative data about the mental health of children and parents who are detained and qualitative evidence includes the words and drawings of detained children. The papers are predominantly small cross-sectional studies using mixed methodologies with convenience samples. Despite weaknesses in individual studies the review provides a rich and consistent picture of the experience and impact of immigration detention on children's wellbeing, parental mental health and parenting. Displaced children are exposed to peri-migration trauma and loss compounded by further adversity while held detained. There are high rates of distress, mental disorder, physical health and developmental problems in children aged from infancy to adolescence which persist after resettlement. Restrictive detention is a particularly adverse reception experience and children and parents should not be detained or separated for immigration purposes. The findings have implications for policy and practice. Clinicians and researchers have a role in advocacy for reception polices that support the wellbeing of accompanied and unaccompanied children who seek asylum.

Opioid dependence disorder and comorbid chronic pain: comparison of groups based on patient-attributed direction of the causal relationship between the two conditions

Background:

Chronic pain is highly prevalent in treatment-seeking opioid-dependent patients; therefore, this comorbid presentation is an important clinical consideration for both addiction and pain specialists. The objectives of the present study were to examine whether the direction of causal attribution of opioid dependence disorder and chronic pain resulted in two distinct clinical populations, and, if so, to compare treatment received during the 5-year follow-up period.

Methods:

Participants comprised opioid-dependent patients with chronic pain who reported a perceived causal relationship, in either direction, between the development of these two conditions (n = 252). A range of health- and addiction-related instruments were used at study inception. Treatment characteristics were obtained for the follow-up period from national health registers.

Results:

Those reporting that pain caused opioid dependence disorder (n = 174; 69%) were characterised by poorer pain-related health, more illicit cannabinoid use (p = 0.031), more frequent illicit use of opioid analgesics (p = 0.025) and they were in receipt of higher doses of prescribed opioid analgesics. Those reporting that opioid dependence disorder caused pain (n = 78; 31%) were characterised by poorer overall physical health (p = 0.002), more severe psychiatric symptoms and more overall drug use (p = 0.001).

Conclusion:

Two distinct clinical populations were identified, determined by how participants perceive the causal relationship between opioid dependence disorder and chronic pain. These two populations have differing clinical profiles and treatment requirements: those reporting that pain caused opioid dependence disorder were characterised by poorer pain-related health and more illicit use of drugs with analgesic properties; and those reporting that opioid dependence disorder caused pain were characterised by more overall use of substances, multiple substance use and more intravenous substance use and poorer general health. Identifying the causal direction, where such a relationship exists, could help addiction and pain services to develop more effective, individualised treatment strategies.

Mental health of forced migrants recently granted leave to remain in the United Kingdom

BACKGROUND

Asylum seekers who are granted leave to remain in the United Kingdom are required to make a rapid transition to housing and welfare benefits. The challenges facing new refugees during this 'transition period' can affect their mental health, but this has not been quantified.

AIMS

To assess the impact of the transition period on new refugees' mental health in the 12 months after being granted leave to remain in the United Kingdom.

METHOD

A longitudinal survey design was used to measure the mental health of 30 newly recognised refugees at monthly intervals in the first 6 months and again at 1 year after receiving leave to remain in the United Kingdom. There were five outcome measures for symptoms of anxiety, depression, distress, post-traumatic stress disorder (PTSD), post-migration living difficulties (PMLD) and a life events calendar to record key changes in housing and welfare.

RESULTS

The results showed that the trajectory of scores across all measures fluctuates, but overall they all improve from baseline to Month 12. Scores for depression and PMLD showed significant improvement at Month 5, and scores for anxiety, depression, distress and PMLD showed significant improvement at Month 12. PTSD scores did not show significant improvement at any month. In months with a high number of stressful life events, participants had worse PMLD and PTSD scores.

CONCLUSION

Overall improvement in mental health could partly be explained by the stability of being granted leave to remain in the United Kingdom, but may also be due to the high level of practical support these participants received. Recommendations are made for those working with clients during the transition period.

A Psychosocial Genomics Pilot Study in Oncology for Verifying Clinical, Inflammatory and Psychological Effects of Mind-Body Transformations-Therapy (MBT-T) in Breast Cancer Patients: Preliminary Results

Several studies have highlighted the key role of chronic inflammation in breast cancer development, progression, metastasis, and therapeutic outcome. These processes are mediated through a variety of cytokines and hormones that exert their biological actions either locally or distantly via systemic circulation. Recent findings suggest that positive psychosocial experiences, including psychotherapeutic interventions and therapeutic mind-body protocols, can modulate the inflammatory response by reducing the expression of genes/proteins associated with inflammation and stress-related pathways. Our preliminary results indicate that a specific mind-body therapy (MBT-T) could induce a significant reduction of the release of different cytokines and chemokines, such as SCGFβ, SDF-1α, MCP3, GROα, LIF, and IL-18, in the sera of breast cancer patients compared to a control group, suggesting that MBT-T could represent a promising approach to improve the wellness and outcome of breast cancer patients.

CORE-OM as a routine outcome measure for adolescents with emotional disorders: factor structure and psychometric properties

Background

Instruments for monitoring the clinical status of adolescents with emotional problems are needed. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) according to theory measures problems/symptoms, well-being, functioning and risk. Documentation of whether the theoretical factor structure for CORE-OM is applicable for adolescents is lacking.

Methods

This study examined the factor structure and psychometric properties of the CORE-OM based on two samples of adolescents (age 14–18): youths seeking treatment for emotional problems (N = 140) and high school students (N = 531). A split half approach was chosen. An exploratory factor analysis (EFA) was performed on the first half of the stratified samples to establish the suitability of the model. A Confirmatory Factor Analysis (CFA) with the chosen model from the EFA was performed on the second half. Internal consistency and clinical cut-off scores of the CORE-OM were investigated.

Results

The best fitting model only partially confirmed the theoretical model for the CORE-OM. The model consisted of five factors: 1) General problems, 2) risk to self, 3) positive resources 4) risk to others and 5) problems with others. The clinical cut-off score based on the all-item total was higher than in an adult sample. Both the all-item total and general problems cut-off scores showed gender differences.

Conclusion

The factor analysis on CORE-OM for adolescents resulted in a five-factor solution, and opens up for new subscales concerning positive resources and problems with others. A 17-item solution for the general problems/symptoms scale is suggested. We advise developers of self-report instruments not to reverse items, if they do not intend to measure a separate factor, since these seem to affect the dimensionality of the scales. Comparing means for gender in non-clinical samples should not be done without modification of the general emotional problem and the positive resources scales. Slightly elevated CORE-OM scores (up to 1.3) in adolescents may be normal fluctuations.

Acceptance and Commitment Therapy for perinatal mood and anxiety disorders: A feasibility and proof of concept study

OBJECTIVES

The aim of the current study was to assess the feasibility, safety, and effectiveness of a newly developed Acceptance and Commitment Therapy (ACT) intervention developed specifically to address the unique context of pregnancy and parenthood. The intervention was delivered to women accessing a specialist Perinatal Community Mental Health Service (PCMHS).

DESIGN

An open-label pilot study was conducted of an 8-week, group-delivered ACT intervention targeting women with moderate-to-severe mood and/or anxiety disorders during pregnancy and/or postpartum.

METHODS

Outcomes included session attendance rates, dropout rates, crisis/inpatient service use, and standardized symptom scales. Participant's responses to open-ended questions contained in an end of therapy questionnaire were analysed using thematic analysis.

RESULTS

Seventy-four women were referred to the intervention with 65 (88%) completing treatment. The median number of sessions attended was 7. No women required input from crisis/inpatient services. All reported finding the intervention helpful. The implementation of ACT in daily life, therapist support, and group processes were cited as helpful aspects of the intervention. At post-treatment, there was a significant reduction in global distress (d = 0.99) and depressive symptoms (d = 1.05), and an increase in psychological flexibility (d = 0.93). On the secondary outcome of global distress, 38% of women were classified as recovered, 31% had reliably improved, 27% remained the same, and 4% had reliably deteriorated.

CONCLUSIONS

The delivery of ACT in a routine practice setting is feasible, safe, and effective. A randomized control trial (RCT) is needed to establish the efficacy and cost-effectiveness of this group-delivered ACT intervention.

PRACTITIONER POINTS

Group-delivered Acceptance and Commitment Therapy (ACT) is acceptable for women with moderate-to-severe perinatal mood and/or anxiety disorders and can be feasibly delivered in a routine practice setting. The trans-diagnostic nature of ACT enables the concurrent treatment of depressive and anxiety symptoms within the same intervention which is particularly helpful in the perinatal context given the comorbidity of mood and anxiety disorders. With training and supervision, mental health practitioners without extensive education in the delivery of psychological therapies can facilitate the ACT group programme. As this was a feasibility study, there was no control group, adherence to the manual was not assessed, and the absence of a follow-up period limits our knowledge of the longer-term benefits of the ACT group programme.

The TinMan study: feasibility trial of a psychologically informed, audiologist-delivered, manualised intervention for tinnitus

OBJECTIVE

To develop a manualised psychological treatment for tinnitus that could enhance audiologist usual care, and to test feasibility of evaluating it in a randomised controlled trial.

DESIGN

Feasibility trial, random allocation of patients to manualised treatment or treatment as usual, and mixed-methods evaluation. Study sample: Senior audiologists, and adults with chronic tinnitus.

RESULTS

Recruitment reached 63% after 6 months (feasibility pre-defined as 65%). Only nine patients (47%) were retained for the duration of the trial. Patients reported that the treatment was acceptable and helped reassure them about their tinnitus. Audiologists reported mixed feelings about the kinds of techniques that are presented to them as 'psychologically informed'. Audiologists also reported lacking confidence because the training they had was brief, and stated that more formal supervision would have been helpful to check adherence to the treatment manual.

CONCLUSIONS

The study indicate potential barriers to audiologist use of the manual, and that a clinical trial of the intervention is not yet feasible. However, positive indications from outcome measures suggest that further development work would be worthwhile. Refinements to the manual are indicated, and training and supervision arrangements to better support audiologists to use the intervention in the clinic are required. Trial Registration: ISRCTN13059163.

Comparison of psychiatric comorbidity in treatment-seeking, opioid-dependent patients with versus without chronic pain

AIM

To compare psychiatric morbidity in treatment-seeking, opioid-dependent patients with versus without chronic pain.

DESIGN

A retrospective comparative cohort design was used involving record linkage from routinely collected, nationally held data sets. Data were managed within a Scottish Government-certified Safe Haven.

SETTING AND PARTICIPANTS

Participants comprised all patients of an NHS Substance Misuse Service in the East of Scotland (n = 467) who were in treatment during 2005 and had been in treatment for varying lengths of time. Their mean age at study inception was 35.0 years in the chronic pain group and 32.1 years; 68% of the chronic pain group and 74% of the no pain group were male.

MEASUREMENTS

The outcomes were (a) psychiatric comorbidity assessed at study inception using the 28-item General Health Questionnaire and the Clinical Outcomes in Routine Evaluation-Outcome Measure and (b) receipt of at least one prescription for a psychiatric condition during a 5-year period following study inception. The independent variable was chronic pain measured at study inception using the Brief Pain Inventory-Short Form.

FINDINGS

A total of 246 (52.7%) reported chronic pain and 221 (47.3%) did not. A higher proportion of patients with chronic pain had at least one psychiatric morbidity (62.4 versus 46.3%, P < 0.001). At the study inception, a higher proportion of patients with chronic pain were prescribed anxiolytics (49.0 versus 39.1%, P = 0.015) and antimanic drugs (9.9 compared with 4.9%, P = 0.015).

CONCLUSIONS

Patients of opioid treatment services in Scotland who report chronic pain may have a higher prevalence of psychiatric comorbidity than those who do not.

Service evaluation of a Human Givens Therapy service for veterans

BACKGROUND

PTSD Resolution is a charitable provider of mental health support and treatment via Human Givens Therapy to members of the Armed Forces Community. This study utilized data from their client database to evaluate outcomes of their services.

AIMS

To determine whether treatment by the service resulted in improvements in mental health; to the extent possible, compare these outcomes with those of NHS IAPT (National Health Service - Improving Access to Psychological Therapies) services; and to evaluate how other factors, notable reported stress levels and prior treatment, impacted outcomes.

METHODS

Administratively collected data from the service provider collected between 2014 and 2016 were utilized. Clients still undergoing services were excluded. The CORE-10 (10-item Clinical Outcomes in Routine Evaluation) measure was used as the outcome measure. Demographic factors examined included age, sex, employment, accommodation, relationship status, distress at the time of presentation and prior treatment history. The effect of the factors was analysed using χ2 test as well as linear regression and Poisson regression analyses according to the nature of the variable.

RESULTS

PTSD Resolution clients appeared to show a similar degree of improvement as IAPT patients. Job-seekers and those who are living alone benefited less from the treatment. Despite high levels of distress and prior treatment among this client group, these factors did not seem to affect treatment outcomes.

CONCLUSIONS

The services of this provider appear to be an acceptable alternative for IAPT treatment, to the degree such a comparison can be made given differences in measures and client groups.

Measurement-Based Care in the Veteran's Health Administration: A Critique and Recommendations for Future Use in Mental Health Practice

Measurement-based care (MBC), a mechanism through which feedback is given to providers and patients, is increasingly being used in mental health care and has a number of benefits. These include providing information about treatment progress, encouraging a discussion around these topics, providing a method for shared decision-making and personalized treatment, and improving treatment outcomes. Although there are many benefits to using MBC, it is still not being used regularly. Barriers include time to administer measures and uncertainty regarding which measures to administer. This paper will briefly describe MBC and its use in mental health care and then will focus on the use and implementation of MBC within the Veteran's Health Administration (VHA). The VHA is a large healthcare system in which there have been ongoing efforts to implement MBC. Suggestions for successful implementation will be discussed.

Comparing outcomes: The Clinical Outcome in Routine Evaluation from an international point of view

OBJECTIVES

The Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM) is a freely accessible self-assessment questionnaire with a total of 34 items measuring the progress of psychological or psychotherapeutic treatments according to four scales (well-being, problems, functioning, and risk). The CORE-OM originated in the United Kingdom and has been translated into 54 languages and dialects. The aim of this study is to systematically compare the translated versions.

METHOD

A total of 21 translations were compared using methods of systematic review and meta-analysis.

RESULTS

The results show a certain heterogeneity between the studies; however, the 21 translations can be declared as equivalent.

CONCLUSION

The factorial structure could not be replicated in any of translations. Therefore, further analysis of the CORE-OM domains is recommended. In addition, some supplementary restrictions on the translation process, data collection, and reporting of results are necessary to ensure comparability and quality of CORE-OM translations.

Psychological advocacy towards healing (PATH): A randomized controlled trial of a psychological intervention in a domestic violence service setting

BACKGROUND

Experience of domestic violence and abuse (DVA) is associated with mental illness. Advocacy has little effect on mental health outcomes of female DVA survivors and there is uncertainty about the effectiveness of psychological interventions for this population.

OBJECTIVE

To test effectiveness of a psychological intervention delivered by advocates to DVA survivors.

DESIGN, MASKING, SETTING, PARTICIPANTS

Pragmatic parallel group individually randomized controlled trial of normal DVA advocacy vs. advocacy + psychological intervention. Statistician and researchers blinded to group assignment. Setting: specialist DVA agencies; two UK cities. Participants: Women aged 16 years and older accessing DVA services.

INTERVENTION

Eight specialist psychological advocacy (SPA) sessions with two follow up sessions.

MEASUREMENTS

Primary outcomes at 12 months: depression symptoms (PHQ-9) and psychological distress (CORE-OM). Primary analysis: intention to treat linear (logistic) regression model for continuous (binary) outcomes.

RESULTS

263 women recruited (78 in shelter/refuge, 185 in community), 2 withdrew (1 community, control group; 1 intervention, refuge group), 1 was excluded from the study for protocol violation (community, control group), 130 in intervention and 130 in control groups. Recruitment ended June 2013. 12-month follow up: 64%. At 12-month follow up greater improvement in mental health of women in the intervention group. Difference in average CORE-OM score between intervention and control groups: -3.3 points (95% CI -5.5 to -1.2). Difference in average PHQ-9 score between intervention and control group: -2.2 (95% CI -4.1 to -0.3). At 12 months, 35% of the intervention group and 55% of the control group were above the CORE-OM -2clinical threshold (OR 0.32, 95% CI 0.16 to 0.64); 29% of the intervention group and 46% of the control group were above the PHQ-9 clinical threshold (OR 0.41, 95% CI 0.21 to 0.81).

LIMITATIONS

64% retention at 12 months.

CONCLUSIONS

An eight-session psychological intervention delivered by DVA advocates produced clinically relevant improvement in mental health outcomes compared with normal advocacy care.

TRIAL REGISTRATION

ISRCTN registry ISRCTN58561170 Original Research 3675/3750.

Factor analysis of the Clinical Outcomes in Routine Evaluation - Outcome Measures (CORE-OM) in a Kenyan sample

BACKGROUND

There is no generic psychotherapy outcome measure validated for Kenyan populations. The objective of this study was to test the acceptability and factor structure of the Clinical Outcomes in Routine Evaluation - Outcome Measure in patients attending psychiatric clinics at two state-owned hospitals in Nairobi.

METHODS

Three hundred and forty-five patients filled out the CORE-OM after their initial therapy session. Confirmatory and Exploratory Factor Analysis (CFA/EFA) were used to study the factor structure of the CORE-OM.

RESULTS

The English version of the CORE-OM seemed acceptable and understandable to psychiatric patients seeking treatment at the state-owned hospitals in Nairobi. Factor analyses showed that a model with a general distress factor, a risk factor, and a method factor for positively framed items fit the data best according to both CFA and EFA analysis. Coefficient Omega Hierarchical showed that the general distress factor was reliably measured even if differential responding to positively framed items was regarded as error variance.

CONCLUSIONS

The English language version of the CORE-OM can be used with psychiatric patients attending psychiatric treatment in Nairobi. The factor structure was more or less the same as has been shown in previous studies. The most important limitation is the relatively small sample size.

Predicting health-related quality of life (EQ-5D-5 L) and capability wellbeing (ICECAP-A) in the context of opiate dependence using routine clinical outcome measures: CORE-OM, LDQ and TOP

Background

Economic evaluation normally requires information to be collected on outcome improvement using utility values. This is often not collected during the treatment of substance use disorders making cost-effectiveness evaluations of therapy difficult. One potential solution is the use of mapping to generate utility values from clinical measures. This study develops and evaluates mapping algorithms that could be used to predict the EuroQol-5D (EQ-5D-5 L) and the ICEpop CAPability measure for Adults (ICECAP-A) from the three commonly used clinical measures; the CORE-OM, the LDQ and the TOP measures.

Methods

Models were estimated using pilot trial data of heroin users in opiate substitution treatment. In the trial the EQ-5D-5 L, ICECAP-A, CORE-OM, LDQ and TOP were administered at baseline, three and twelve month time intervals. Mapping was conducted using estimation and validation datasets. The normal estimation dataset, which comprised of baseline sample data, used ordinary least squares (OLS) and tobit regression methods. Data from the baseline and three month time periods were combined to create a pooled estimation dataset. Cluster and mixed regression methods were used to map from this dataset. Predictive accuracy of the models was assessed using the root mean square error (RMSE) and the mean absolute error (MAE). Algorithms were validated using sample data from the follow-up time periods.

Results

Mapping algorithms can be used to predict the ICECAP-A and the EQ-5D-5 L in the context of opiate dependence. Although both measures can be predicted, the ICECAP-A was better predicted by the clinical measures. There were no advantages of pooling the data. There were 6 chosen mapping algorithms, which had MAE scores ranging from 0.100 to 0.138 and RMSE scores ranging from 0.134 to 0.178.

Conclusion

It is possible to predict the scores of the ICECAP-A and the EQ-5D-5 L with the use of mapping. In the context of opiate dependence, these algorithms provide the possibility of generating utility values from clinical measures and thus enabling economic evaluation of alternative therapy options.

Trial registration

ISRCTN22608399. Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-0926-7) contains supplementary material, which is available to authorized users.

An Exploration Into Effectiveness of Existential–Phenomenological Therapy as a U.K. NHS Psychological Treatment Intervention

Counselling and psychotherapy are rooted in humanistic and phenomenological approaches that place emphasis on a choice of therapies being available to individuals. Practice-based evidence makes an important contribution to the field of evidence-based practice on which National Health Service (NHS) clinicians and patients base decisions about psychological treatment interventions that are most likely to be effective. This research aimed to explore the effectiveness of Existential–Phenomenological Therapy (EPT) as routinely used to treat NHS patients in a U.K. secondary care setting. Quantitative data were analyzed from all available NHS routine patients’ ( N = 143) Clinical Outcomes in Routine Evaluation Outcome Measures for all those who were treated with EPT ( n = 34) and Cognitive Behavioral Therapy ( n = 109) from January 2008 to September 2010. Differences were found between waiting list and posttherapy ( p = .016) and between pretherapy and posttherapy ( p = .03) for EPT research participants and mean results produced reliable and clinically significant change for some. A quarter of these participants moved from a clinical to nonclinical population from pretherapy to posttherapy. A similar pattern was found for the EPT and cognitive behavioral therapy NHS routine practice patients.

A psychologically informed, audiologist-delivered, manualised intervention for tinnitus: protocol for a randomised controlled feasibility trial (Tin Man study)

BACKGROUND

Chronic tinnitus is a common incurable condition often associated with depression, anxiety, insomnia and reduced quality of life. Within National Health Service (NHS) audiology in the United Kingdom (UK), no standard protocol currently exists for the treatment of tinnitus. Counselling is only available in less than half of audiology departments, and there is no agreed standard for what constitutes tinnitus counselling. There is substantial evidence from systematic reviews for the clinical benefit of cognitive behaviour therapy (CBT) for tinnitus delivered by clinical psychologists or psychiatrists, but no studies have sufficiently evidenced the NHS model of tinnitus care where management is increasingly being delivered by audiology professionals. In a pilot randomised controlled trial (RCT), this study aims to evaluate the feasibility of comparing a psychologically informed guidance manual developed to support audiologist management of tinnitus with usual treatment.

METHODS/DESIGN

Phase 1 consisted of three development stages: (1) a scoping review to generate a comprehensive set of tinnitus counselling components, (2) a Delphi survey involving expert patients (n = 18) and clinicians (n = 21) to establish consensus on the essential core attributes of tinnitus counselling, and (3) incorporation of these elements into a manualised care protocol. In phase 2, following training in a dedicated workshop, the manualised intervention will be delivered by three experienced audiologists across three different sites. Patients (n = 30) will be randomly allocated to receive either (1) psychologically informed management from an audiologist trained to deliver the manualised intervention or (2) treatment as usual (TAU) from an audiologist who has not received this training. Quantitative outcome measures will be administered at baseline, discharge and 6-month follow-up. Qualitative interviews with participating patients and clinicians will be conducted to gather perspectives on the feasibility and acceptability of the manualised intervention.

DISCUSSION

The feasibility of proceeding to a definitive RCT will be assessed via compliance with the manual, willingness to be randomised, number of eligible participants, rate of recruitment, retention and collection of quantitative outcome measures. This research offers an important first step to an evidence-based, standardised and accessible approach to tinnitus care.

TRIAL REGISTRATION

ISRCTN13059163. Date of registration: 6 May 2016.

Assessing Patient Progress in Psychological Therapy Through Feedback in Supervision: the MeMOS* Randomized Controlled Trial (*Measuring and Monitoring clinical Outcomes in Supervision: MeMOS)

BACKGROUND

Psychological therapy services are often required to demonstrate their effectiveness and are implementing systematic monitoring of patient progress. A system for measuring patient progress might usefully 'inform supervision' and help patients who are not progressing in therapy.

AIMS

To examine if continuous monitoring of patient progress through the supervision process was more effective in improving patient outcomes compared with giving feedback to therapists alone in routine NHS psychological therapy.

METHOD

Using a stepped wedge randomized controlled design, continuous feedback on patient progress during therapy was given either to the therapist and supervisor to be discussed in clinical supervison (MeMOS condition) or only given to the therapist (S-Sup condition). If a patient failed to progress in the MeMOS condition, an alert was triggered and sent to both the therapist and supervisor. Outcome measures were completed at beginning of therapy, end of therapy and at 6-month follow-up and session-by-session ratings.

RESULTS

No differences in clinical outcomes of patients were found between MeMOS and S-Sup conditions. Patients in the MeMOS condition were rated as improving less, and more ill. They received fewer therapy sessions.

CONCLUSIONS

Most patients failed to improve in therapy at some point. Patients' recovery was not affected by feeding back outcomes into the supervision process. Therapists rated patients in the S-Sup condition as improving more and being less ill than patients in MeMOS. Those patients in MeMOS had more complex problems.

Performance of the CORE-10 and YP-CORE measures in a sample of youth engaging with a community mental health service

This article assesses the performance and psychometric properties of two versions of the Clinical Outcomes in Routine Evaluation (CORE) measures that assess psychological distress: the Young Person's CORE (YP-CORE) for 11-16 year olds and the CORE-10 for those 17 or older. The sample comprised 1592 young people aged 12-25 who completed the YP-CORE and CORE-10 during their initial engagement with an early intervention service. Total and average scores were examined for both measures. Gender and age differences were evaluated using t-tests and analysis of variance. The factor structures were assessed with principal axis and confirmatory factor analyses. Multigroup confirmatory factor analyses were then employed to evaluate measurement invariance across age and gender. Analyses were supportive of the CORE measures as reliable instruments to assess distress in 12-25 year olds. Based upon eigenvalues in combination with the comparative fit index, the Tucker-Lewis Index, and the root-mean-square error of approximation, both measures were unidimensional. Analysis indicated the factor structure, loadings, item thresholds, and residuals were invariant across age and gender, although partial support for strict invariance was found for gender among 12-16 year olds. Results are compared to previous studies and discussed in the context of program planning, service delivery, and evaluation. Copyright © 2016 John Wiley & Sons, Ltd.

Initial Validation of a Comprehensive Assessment Instrument for Bereavement-Related Grief Symptoms and Risk of Complications: The Indicator of Bereavement Adaptation-Cruse Scotland (IBACS)

Objective

This study assessed the validity of the Indicator of Bereavement Adaptation Cruse Scotland (IBACS). Designed for use in clinical and non-clinical settings, the IBACS measures severity of grief symptoms and risk of developing complications.

Method

N = 196 (44 male, 152 female) help-seeking, bereaved Scottish adults participated at two timepoints: T1 (baseline) and T2 (after 18 months). Four validated assessment instruments were administered: CORE-R, ICG-R, IES-R, SCL-90-R. Discriminative ability was assessed using ROC curve analysis. Concurrent validity was tested through correlation analysis at T1. Predictive validity was assessed using correlation analyses and ROC curve analysis. Optimal IBACS cutoff values were obtained by calculating a maximal Youden index J in ROC curve analysis. Clinical implications were compared across instruments.

Results

ROC curve analysis results (AUC = .84, p < .01, 95% CI between .77 and .90) indicated the IBACS is a good diagnostic instrument for assessing complicated grief. Positive correlations (p < .01, 2-tailed) with all four instruments at T1 demonstrated the IBACS' concurrent validity, strongest with complicated grief measures (r = .82). Predictive validity was shown to be fair in T2 ROC curve analysis results (n = 67, AUC = .78, 95% CI between .65 and .92; p < .01). Predictive validity was also supported by stable positive correlations between IBACS and other instruments at T2. Clinical indications were found not to differ across instruments.

Conclusions

The IBACS offers effective grief symptom and risk assessment for use by non-clinicians. Indications are sufficient to support intake assessment for a stepped model of bereavement intervention.