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Headley E, Kellett S, Bee C, Lancashire J, Aadahl V, Bone C, Power N. Types and mechanisms of idiographic change during guided self-help for anxiety. Psychol Psychother 2024. [PMID: 38924285 DOI: 10.1111/papt.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/09/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To compare idiographic change during two formats of guided self-help (GSH); cognitive-behavioural therapy guided self-help (CBT-GSH) and cognitive analytic therapy guided self-help (CAT-GSH). DESIGN Qualitative inductive thematic analysis. METHODS Semi-structured interviews with N = 17 participants with a reliable change outcome on the GAD-7 after completing GSH for anxiety. Changes were categorised and themes extracted. RESULTS No differences between CAT-GSH and CBT-GSH were found regarding types of change reported. The five overarching themes found were personal qualities of success, enlightenment through understanding, specific tools and techniques, changes to relationships and tailoring support. Four themes maximally differentiated between the two different types of GSH; CAT-GSH enabled relational insight and change whilst CBT-GSH enabled better understanding of anxiety, new coping techniques and supportive relationships. CONCLUSIONS Both common and model-specific factors contribute to patient change during GSH. Whilst all forms of GSH are grounded in the psychoeducational approach, separate theoretical foundations and associated methods facilitate different types of ideographic change.
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Affiliation(s)
- Emma Headley
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Stephen Kellett
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK and Clinical and Applied Psychology Unit, University of Sheffield, Rotherham, UK
| | - Charlotte Bee
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | | | - Vikki Aadahl
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Claire Bone
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Niall Power
- Derbyshire Community Health Services NHS Foundation Trust, Derbyshire, UK
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Ghasemi SM, Feiznia Z, Karbasi T, Roostaee M, Alipour Azami Z, Hosseini Arian N, Rayyat Moeini F. Cognitive analytic therapy for the treatment of post-traumatic stress disorder: a randomized controlled trial. Nord J Psychiatry 2024:1-8. [PMID: 38832724 DOI: 10.1080/08039488.2024.2360978] [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: 12/01/2023] [Accepted: 05/22/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Post-traumatic stress disorder represents a multifaceted clinical entity with a profound impact on mental health. This study was conducted to evaluate the effects of cognitive analytic therapy on the manifestations of post-traumatic stress disorder. MATERIALS AND METHODS From May 21, 2023, to July 7, 2023, we conducted a randomized control trial in the outpatient clinic of a psychiatry Hospital. Participants were Iran-Iraq war veterans (N = 40) with a confirmed diagnosis of post-traumatic stress disorder. They were randomly allocated to cognitive analytic therapy and control groups. The primary outcome was re-experiencing, and the secondary outcomes included avoidance, hyperarousal, depression, anxiety, and numbness scores measured by appropriate questionnaires before and after the interventions. The cognitive analytic therapy group received a weekly program totaling 12 sessions of therapy adjunct to pharmacotherapy, each session lasting 90 min, and the control group received only pharmacotherapy. RESULTS Within-group analysis showed that cognitive analytic therapy (N = 19) decreased all symptom scores (all p < 0.001), while the control group (N = 20) showed a decrease in hyper-arousal, depression, and anxiety (p < 0.001) scores. Between-group analysis implied that cognitive analytic therapy was more successful than usual pharmacotherapy in decreasing all outcome scores (all p < 0.001). CONCLUSION A 12-session program of cognitive analytic therapy was effective in alleviating re-experiencing, avoidance, hyper-arousal, depression, anxiety, and numbness in post-traumatic stress disorder. It was safe and acceptable by participants reflected by a high retention rate. We recommend the incorporation of cognitive analytic therapy to the treatment of post-traumatic stress disorder.
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Affiliation(s)
- Seyedeh Mozhgan Ghasemi
- Department of Clinical Psychology, Islamic Azad University Torbat-e-Jam Branch, Torbat-e-Jam, Iran
| | - Zahra Feiznia
- Department of Clinical Psychology, Islamic Azad University Torbat-e-Jam Branch, Torbat-e-Jam, Iran
| | - Tina Karbasi
- Department of Psychology, Islamic Azad University Neyshabur Branch, Neyshabur, Iran
| | - Morteza Roostaee
- Department of Clinical Psychology, Islamic Azad University Birjand Branch, Birjand, Iran
| | - Zhila Alipour Azami
- Department of Clinical Psychology, Islamic Azad University Birjand Branch, Birjand, Iran
| | - Navid Hosseini Arian
- Department of Clinical Psychology, Islamic Azad University Torbat-e-Jam Branch, Torbat-e-Jam, Iran
| | - Fateme Rayyat Moeini
- Department of Clinical Psychology, Aja University of Medical Sciences, Tehran, Iran
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Owen K, Laphan A, Gee B, Lince K. Evaluating cognitive analytic therapy within a primary care psychological therapy service. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023. [PMID: 37317047 DOI: 10.1111/bjc.12430] [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: 04/21/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Cognitive analytic therapy (CAT) is used within UK mental health settings as a treatment for transdiagnostic complex psychological presentations. However, it is not routinely offered by the NHS Talking Therapies, for anxiety and depression (NHS Talking Therapies) programme which provides psychological treatments for common mental health difficulties. We aimed to evaluate the outcomes of providing CAT treatment to patients presenting with depression and/or anxiety, within the context of relational difficulties, adverse childhood experience or difficulty managing emotions, returning for further psychological treatment within NHS Talking Therapies. METHODS This was a pragmatic, real-world evaluation, involving routinely collected self-report measures of depression and anxiety, to examine the treatment outcomes of NHS Talking Therapies patients offered CAT over an 18-month period. Quantitative validated measures of depression and anxiety were administered at the beginning and end of CAT treatment, and at follow up. Within-group change in depression and anxiety scores were examined statistically, and rates of reliable improvement and recovery calculated. RESULTS Statistically significant decreases in depression and anxiety scores were observed during the CAT active treatment phase. The recovery rate was 46.4%, and 71.4% of patients showed a reliable improvement post-treatment. Positive outcomes continued to be observed at follow-up, with a recovery rate of 50% and a reliable improvement rate of 79.4%. CONCLUSIONS CAT shows promise as a treatment option for NHS Talking Therapies patients re-presenting with depression and/or anxiety. More research is required to determine if CAT should be offered more widely within NHS Talking Therapies services.
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Affiliation(s)
- Kiri Owen
- Norfolk & Waveney Wellbeing Service, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Andrew Laphan
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Brioney Gee
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Karen Lince
- Norfolk & Waveney Wellbeing Service, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
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Curtiss JE, Mischoulon D, Fisher LB, Cusin C, Fedor S, Picard RW, Pedrelli P. Rising early warning signals in affect associated with future changes in depression: a dynamical systems approach. Psychol Med 2023; 53:3124-3132. [PMID: 34937601 PMCID: PMC10606954 DOI: 10.1017/s0033291721005183] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Predicting future states of psychopathology such as depressive episodes has been a hallmark initiative in mental health research. Dynamical systems theory has proposed that rises in certain 'early warning signals' (EWSs) in time-series data (e.g. auto-correlation, temporal variance, network connectivity) may precede impending changes in disorder severity. The current study investigates whether rises in these EWSs over time are associated with future changes in disorder severity among a group of patients with major depressive disorder (MDD). METHODS Thirty-one patients with MDD completed the study, which consisted of daily smartphone-delivered surveys over 8 weeks. Daily positive and negative affect were collected for the time-series analyses. A rolling window approach was used to determine whether rises in auto-correlation of total affect, temporal standard deviation of total affect, and overall network connectivity in individual affect items were predictive of increases in depression symptoms. RESULTS Results suggested that rises in auto-correlation were significantly associated with worsening in depression symptoms (r = 0.41, p = 0.02). Results indicated that neither rises in temporal standard deviation (r = -0.23, p = 0.23) nor in network connectivity (r = -0.12, p = 0.59) were associated with changes in depression symptoms. CONCLUSIONS This study more rigorously examines whether rises in EWSs were associated with future depression symptoms in a larger group of patients with MDD. Results indicated that rises in auto-correlation were the only EWS that was associated with worsening future changes in depression.
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Affiliation(s)
- Joshua E. Curtiss
- Depression Clinical and Research Program at Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David Mischoulon
- Depression Clinical and Research Program at Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lauren B. Fisher
- Depression Clinical and Research Program at Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Cristina Cusin
- Depression Clinical and Research Program at Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Szymon Fedor
- The Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Rosalind W. Picard
- The Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Paola Pedrelli
- Depression Clinical and Research Program at Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Leonidaki V, Constantinou MP. A comparison of completion and recovery rates between first-line protocol-based cognitive behavioural therapy and non-manualized relational therapies within a UK psychological service. Clin Psychol Psychother 2021; 29:754-766. [PMID: 34498349 DOI: 10.1002/cpp.2669] [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: 01/10/2021] [Revised: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 11/11/2022]
Abstract
This study compares completion and recovery rates between protocol-based cognitive behavioural therapy (CBT), offered as a first-line therapy for common mental health problems as per national guidelines, and relational therapies (RTs), scarcely provided in the English Improving Access to Psychological Therapies (IAPT) programme. This is a non-randomized, naturalistic study in a treatment-seeking community sample (n = 708). RTs consist of brief psychodynamic and relational integrative therapy. Completion rates relied on clinicians' coding and recovery rates were calculated based on the Patient Health Questionnaires-9 and the Generalized Anxiety Disorder-7. Doubly robust regression analysis was used to control both the treatment allocation and outcome variables for pretreatment differences between the intervention groups. Significantly more RT clients completed treatment compared with CBT clients. No significant differences in recovery rates between CBT and RTs were found using traditional null hypothesis significance tests; the groups were found to be equivalent using equivalence tests. Only when the analysis was repeated in treatment completers did CBT clients achieve around one-quarter higher recovery rates. Both CBT and RTs appeared to be equally effective and showed recovery and completion rates equivalent to or above the national average. These findings demonstrate the advantages of therapies other than CBT. Future research is needed to replicate the equivalence between these two treatments and to explore specific patient characteristics that make one treatment more suitable and acceptable than the other.
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Affiliation(s)
- Venetia Leonidaki
- National Problem Gambling Clinic, Central and North West London NHS Foundation Trust, London, UK
| | - Matthew P Constantinou
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Lv Z, Li J, Zhang B, Zhang N, Wang C. The Effect of Computerized Cognitive Behavioral Therapy on People's Anxiety and Depression During the 6 Months of Wuhan's Lockdown of COVID-19 Epidemic: A Pilot Study. Front Psychol 2021; 12:687165. [PMID: 34335402 PMCID: PMC8316618 DOI: 10.3389/fpsyg.2021.687165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The effectiveness of computerized cognitive behavioral therapy (CCBT) has been proven for mild and moderate anxiety and depression. In 2016, the first official Chinese CCBT system was launched by Chinese Cognitive Behavior Therapy Professional Organizations and included four items: getting out of depression, overcoming anxiety, staying away from insomnia and facing Obsessive-compulsive disorder. During the COVID-19 epidemic, Chinese CCBT system served the public for free. This study explored the effects of CCBT on anxiety and depression by comparing the use of the platform during the epidemic and during the same period in 2019. Methods: Users were divided into a depression group or an anxiety group according to their own discretion. The subjects used the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) before each training. Each training group completed the corresponding CCBT training project, which had 5-6 training sessions, an average of once every 5 days. The training content in 2019 and 2020 was identical. This study compared the demographic characteristics, depression, and anxiety levels of CCBT platform users during the lockdown period in Wuhan (LP2020), where the outbreak was concentrated in China, from January 23 to July 23, 2020 and the same period in 2019 (SP2019). Result: (1) There were significant differences in gender (χ2 = 7.215, P = 0.007), region (χ2 = 4.225, P = 0.040) and duration of illness (χ2 = 7.867, P = 0.049) between the two periods. (2) There was a positive Pearson correlation between the number of users of CCBT platform during LP2020 and number of confirmed cases of COVID-19 in each province (r = 0.9429, P < 0.001). (3) In LP2020, the SAS (t = 2.579, P = 0.011) and SDS (t = 2.894, P = 0.004) scores at T0 in Hubei were significantly higher than those in other regions. (4) The CCBT platform has an obvious effect on anxiety (F = 4.74, P = 0.009) and depression on users (F = 4.44, P = 0.009). Conclusion: This study showed women, students and people who are more seriously affected by the epidemic were more likely to accept the CCBT training. The CCBT platform made a significant contribution toward alleviating the anxiety and depression symptoms of users during the epidemic. When face-to-face psychotherapy is not available during the epidemic, CCBT can be used as an effective alternative.
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Affiliation(s)
- Zhangwei Lv
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, China
| | - Jinyang Li
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ning Zhang
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, China
| | - Chun Wang
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, China
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