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Clark DM, Wild J, Warnock-Parkes E, Stott R, Grey N, Thew G, Ehlers A. More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder. Psychol Med 2023; 53:5022-5032. [PMID: 35835726 PMCID: PMC10476054 DOI: 10.1017/s0033291722002008] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/01/2022] [Accepted: 06/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive therapy for social anxiety disorder (CT-SAD) is recommended by NICE (2013) as a first-line intervention. Take up in routine services is limited by the need for up to 14 ninety-min face-to-face sessions, some of which are out of the office. An internet-based version of the treatment (iCT-SAD) with remote therapist support may achieve similar outcomes with less therapist time. METHODS 102 patients with social anxiety disorder were randomised to iCT-SAD, CT-SAD, or waitlist (WAIT) control, each for 14 weeks. WAIT patients were randomised to the treatments after wait. Assessments were at pre-treatment/wait, midtreatment/wait, posttreatment/wait, and follow-ups 3 & 12 months after treatment. The pre-registered (ISRCTN 95 458 747) primary outcome was the social anxiety disorder composite, which combines 6 independent assessor and patient self-report scales of social anxiety. Secondary outcomes included disability, general anxiety, depression and a behaviour test. RESULTS CT-SAD and iCT-SAD were both superior to WAIT on all measures. iCT-SAD did not differ from CT-SAD on the primary outcome at post-treatment or follow-up. Total therapist time in iCT-SAD was 6.45 h. CT-SAD required 15.8 h for the same reduction in social anxiety. Mediation analysis indicated that change in process variables specified in cognitive models accounted for 60% of the improvements associated with either treatment. Unlike the primary outcome, there was a significant but small difference in favour of CT-SAD on the behaviour test. CONCLUSIONS When compared to conventional face-to-face therapy, iCT-SAD can more than double the amount of symptom change associated with each therapist hour.
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Affiliation(s)
- David M. Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Jennifer Wild
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Emma Warnock-Parkes
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK
| | - Richard Stott
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | - Graham Thew
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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2
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Hanevik E, Røvik FMG, Bøe T, Knapstad M, Smith ORF. Client predictors of therapy dropout in a primary care setting: a prospective cohort study. BMC Psychiatry 2023; 23:358. [PMID: 37226210 DOI: 10.1186/s12888-023-04878-7] [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: 01/27/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Therapy dropout poses a major challenge. Considerable research has been conducted on predictors of dropout, however none in the context of primary mental health services in Norway. The purpose of this study was to investigate which client characteristics can predict dropout from the service Prompt Mental Health Care (PMHC). METHODS We performed a secondary analysis of a Randomized Controlled Trial (RCT). Our sample consisted of 526 adult participants receiving PMHC-treatment in the municipalities of Sandnes and Kristiansand, between November 2015 to August 2017. Using logistic regression, we investigated the association between nine client characteristics and dropout. RESULTS The dropout rate was 25.3%. The adjusted analysis indicated that older clients had a lower odds ratio (OR) of dropping out compared to younger clients (OR = 0.43, [95% CI = 0.26, 0.71]). Moreover, clients with higher education had a lower odds ratio of dropping out compared to clients with lower levels of education (OR = 00.55, 95% CI [0.34, 0.88]), while clients who were unemployed were more likely to drop-out as compared the regularly employed (OR = 2.30, [95% CI = 1.18, 4.48]). Finally, clients experiencing poor social support had a higher odds ratio of dropping out compared to clients who reported good social support (OR = 1.81, [95% CI = 1.14, 2.87]). Sex, immigrant background, daily functioning, symptom severity and duration of problems did not predict dropout. CONCLUSION The predictors found in this prospective study might help PMHC-therapists identify clients at risk of dropout. Strategies for preventing dropout are discussed.
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Affiliation(s)
- Elin Hanevik
- Søndre Oslo DPS, Helga Vaneks Vei 6, 1281, Oslo, Norway
| | - Frida M G Røvik
- Rask Psykisk Helsehjelp, Bydel Ullern, Hoffsveien 48, 0377, Oslo, Norway
| | - Tormod Bøe
- Department of Psychosocial Science, The University of Bergen, Christies Gate 12, 5015, Bergen, Norway
- RKBU Vest, NORCE Norwegian Research Centre, Bergen, Norway
| | - Marit Knapstad
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gate 7, 5015, Bergen, Norway
| | - Otto R F Smith
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gate 7, 5015, Bergen, Norway.
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway.
- Department of Teacher Education, NLA University College, Pb 74 Sandviken, 5812, Bergen, Norway.
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González-Blanch C, Barrio-Martínez S, Priede A, Martínez-Gómez S, Pérez-García-Abad S, Miras-Aguilar M, Ruiz-Gutiérrez J, Muñoz-Navarro R, Ruiz-Rodríguez P, Medrano LA, Prieto-Vila M, Carpallo-González M, Aguilera-Martín Á, Gálvez-Lara M, Cuadrado F, Moreno E, García-Torres F, Venceslá JF, Corpas J, Jurado-González FJ, Moriana JA, Cano-Vindel A. Cost-effectiveness of transdiagnostic group cognitive behavioural therapy versus group relaxation therapy for emotional disorders in primary care (PsicAP-Costs2): Protocol for a multicentre randomised controlled trial. PLoS One 2023; 18:e0283104. [PMID: 36928238 PMCID: PMC10019745 DOI: 10.1371/journal.pone.0283104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Several randomised controlled trials (RCT) have demonstrated the superiority of transdiagnostic group cognitive-behavioural therapy (TD-CBT) to treatment as usual (TAU) for emotional disorders in primary care. To date, however, no RCTs have been conducted to compare TD-CBT to another active intervention in this setting. Our aim is to conduct a single-blind RCT to compare group TD-CBT plus TAU to progressive muscle relaxation (PMR) plus TAU in adults (age 18 to 65 years) with a suspected emotional disorder. We expect that TD-CBT + TAU will be more cost-effective than TAU + PMR, and that these gains will be maintained at the 12-month follow-up. Seven therapy sessions (1.5 hours each) will be offered over a 24-week period. The study will be carried out at four primary care centres in Cantabria, Spain. The study will take a societal perspective. Psychological assessments will be made at three time points: baseline, post-treatment, and at 12-months. The following variables will be evaluated: clinical symptoms (anxiety, depression, and/or somatic); functioning; quality of life (QoL); cognitive-emotional factors (rumination, worry, attentional and interpretative biases, emotion regulation and meta-cognitive beliefs); and satisfaction with treatment. Data on health service use, medications, and sick days will be obtained from electronic medical records. Primary outcome measures will include: incremental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICURs). Secondary outcome measures will include: clinical symptoms, QoL, functioning, and treatment satisfaction. Bootstrap sampling will be used to assess uncertainty of the results. Secondary moderation and mediation analyses will be conducted. Two questionnaires will be administered at sessions 1, 4, and 7 to assess therapeutic alliance and group satisfaction. If this trial is successful, widespread application of this cost-effective treatment could greatly improve access to psychological treatment for emotional disorders in the context of increasing demand for mental healthcare in primary care. Trial registration: ClinicalTrials.gov: Cost-effectiveness of a Transdiagnostic Psychological Treatment for Emotional Disorders in Primary Care (PsicAP). NCT05314920.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital—IDIVAL, Santander, Spain
- Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
- * E-mail:
| | - Sara Barrio-Martínez
- Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Amador Priede
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
- Mental Health Centre, Hospital de Laredo, Laredo, Spain
| | - Sandra Martínez-Gómez
- Resident of Clinical Psychology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Saioa Pérez-García-Abad
- Resident of Clinical Psychology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - María Miras-Aguilar
- Resident of Clinical Psychology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - José Ruiz-Gutiérrez
- Resident of Clinical Psychology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Roger Muñoz-Navarro
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Fuenlabrada, Madrid, Spain
| | - Leonardo A. Medrano
- Pontificia Universidad Católica Madre y Maestra, Santiago De Los Caballeros, Dominican Republic
| | | | | | - Ángel Aguilera-Martín
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Mario Gálvez-Lara
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Fátima Cuadrado
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Eliana Moreno
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Francisco García-Torres
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - José F. Venceslá
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Jorge Corpas
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Francisco J. Jurado-González
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Juan A. Moriana
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
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Smith ORF, Sæther SMM, Haug E, Knapstad M. Long-term outcomes at 24- and 36-month follow-up in the intervention arm of the randomized controlled trial of Prompt Mental Health Care. BMC Psychiatry 2022; 22:598. [PMID: 36076192 PMCID: PMC9461100 DOI: 10.1186/s12888-022-04227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Whether long-term symptom improvement is maintained after treatment in services such as the Norwegian Prompt Mental Health Care (PMHC) and the English Improving Access to Psychological Therapies is not yet known. In this prospective study, we investigate whether improvements observed at 6-month follow-up are maintained at 24- and 36-month follow-up among clients who received PMHC. METHOD Data from the treatment arm of the randomized controlled trial of PMHC were used (n = 459). The main outcomes were (reliable) recovery rate and symptoms of depression (PHQ-9) and anxiety (GAD-7). Primary outcome data at 24- and 36-months follow-up were available for 47% and 39% of participants, respectively. Secondary outcomes were work participation, functional status, health-related quality of life, and positive mental well-being. Sensitivity analyses with regard to missing data assumptions were conducted for the primary continuous outcomes. RESULTS Improvements were maintained at 24- and 36-month follow-up for symptoms of depression and anxiety, (reliable) recovery rate, and health-related quality of life. Small linear improvements since 6-month follow-up were observed for work participation, functional status, and positive mental well-being. Sensitivity analyses did not substantially alter the findings for symptoms of depression and anxiety mentioned above. CONCLUSIONS Our findings support the long-term effectiveness of PMHC, but results should be interpreted with caution due to lacking follow-up data at 24- and 36-month in the control group, and substantial attrition.
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Affiliation(s)
- Otto R. F. Smith
- grid.418193.60000 0001 1541 4204Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015 Bergen, Norway ,grid.418193.60000 0001 1541 4204Centre for Evaluation of Public Health Measure, Norwegian Institute of Public Health, Bergen, Norway ,grid.458561.b0000 0004 0611 5642Department of Teacher Education, NLA University College, Pb 74 Sandviken, 5812 Bergen, Norway
| | - Solbjørg M. M. Sæther
- grid.418193.60000 0001 1541 4204Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015 Bergen, Norway
| | - Ellen Haug
- grid.458561.b0000 0004 0611 5642Department of Teacher Education, NLA University College, Pb 74 Sandviken, 5812 Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Health Promotion and Development, University of Bergen, 5020 Bergen, Norway
| | - Marit Knapstad
- grid.418193.60000 0001 1541 4204Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015 Bergen, Norway
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Sæther SMM, Knapstad M, Grey N, Smith ORF. Moderators of treatment effect of Prompt Mental Health Care compared to treatment as usual: Results from a randomized controlled trial. Behav Res Ther 2022; 158:104198. [PMID: 36122439 DOI: 10.1016/j.brat.2022.104198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND In this exploratory study, we investigated a comprehensive set of potential moderators of response to the primary care service Prompt Mental Health Care (PMHC). METHODS Data from an RCT of PMHC (n = 463) versus treatment as usual (TAU, n = 215) were used. At baseline mean age was 34.8, 66.7% were women, and 91% scored above caseness for depression (PHQ-9) and 87% for anxiety (GAD-7). OUTCOMES change in symptoms of depression and anxiety and change in remission status from baseline to six- and 12- months follow-up. Potential moderators: sociodemographic, lifestyle, social, and cognitive variables, variables related to (mental) health problem and care. Each moderator was examined in generalized linear mixed models with robust maximum likelihood estimation. RESULTS Effect modification was only identified for anxiolytic medication for change in symptoms of depression and anxiety; clients using anxiolytic medication showed less effect of PMHC relative to TAU (all p < 0.001), although this result should be interpreted with caution due to the low number of anxiolytic users in the sample. For remission status, none of the included variables moderated the effect of treatment. CONCLUSION As a treatment for depression and/or anxiety, PMHC mostly seems to work equally well as compared to TAU across a comprehensive set of potential moderators.
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Affiliation(s)
- Solbjørg M M Sæther
- Department of Health Promotion, Norwegian Institute of Public Health, Postboks 973 Sentrum, 5808, Bergen, Norway.
| | - Marit Knapstad
- Department of Health Promotion, Norwegian Institute of Public Health, Postboks 973 Sentrum, 5808, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Postboks 7807 5020, Bergen, Norway.
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Swandean, Arundel Road, Worthing, West Sussex, BN13 3EP, United Kingdom; School of Psychology, University of Sussex, Pevensey 1 Building, University of Sussex, Falmer, BN1 9QH, United Kingdom.
| | - Otto R F Smith
- Department of Health Promotion, Norwegian Institute of Public Health, Postboks 973 Sentrum, 5808, Bergen, Norway; Centre for Evaluation of Public Health Measure, Norwegian Institute of Public Health, Bergen, Norway.
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Wormald AD, Summerville S, McGinley M, Davoren N, Fortune DG. Enhancing primary care psychology services with assistant psychologists in Ireland: An evaluation of output, throughput and stakeholder satisfaction. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2457-e2466. [PMID: 34927299 DOI: 10.1111/hsc.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/12/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
Primary care mental health services need to expand to assist the increased number of people reporting mild to moderate mental health difficulties. In Ireland, the primary care mental health service has been recently enhanced through the employment of Assistant Psychologists (AP) in primary care psychology. This paper provides an early and brief evaluation of the impact of the AP-enhanced model through a tripartite approach to evaluation which utilises measures of throughput, output and stakeholder satisfaction. We use data from two sources; Health service key performance indicators, and a routinely gathered minimal dataset of client measures. Results indicate that the numbers of clients seen in the period rose by 16%, that AP-delivered treatments are beneficial for clients with mild to moderate mental health difficulties, and more than 80% of clients reported being 'totally satisfied' with the care received. The data provide early evidence that the AP model is beneficial in meeting clients' needs across a range of presentations within the service admission criteria, and that the AP-enhanced model may offer a satisfactory solution to primary care needs. However, further data collection is required, and additional stakeholder input is necessary for a complete evaluation of the assistant psychologist model in primary care.
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Affiliation(s)
- Andrew D Wormald
- Department of Psychology, University of Limerick, Limerick, Ireland
| | | | - Megan McGinley
- Department of Psychology, National University of Ireland, Galway, Ireland
| | - Niamh Davoren
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
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Effects and Satisfaction of Comfort Nursing plus Psychological Nursing in the Clinical Nursing of Neurology Patients: A Comparative Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8013787. [PMID: 35664947 PMCID: PMC9159892 DOI: 10.1155/2022/8013787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/24/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the effects and satisfaction of comfort nursing plus psychological nursing in the clinical nursing of neurology patients. Methods In this prospective study, 90 neurology patients admitted to our hospital from January 2019 to January 2020 were recruited and randomized into a control group and an experimental group with 45 cases in each group. The control group received routine care, and the experimental group received comfort care plus psychological care. The comfort scores and nursing satisfaction of the two groups were compared. The Hospital Anxiety and Depression Scale (HAD) was used to assess the emotional state of patients before and after the intervention. The Exercise of Self-care Agency Scale (ESCA) was used to assess the patient's self-care ability after the intervention. Results The comfort scores of the experimental group were higher than those of the control group (P < 0.05). The experimental group showed significantly higher satisfaction than the control group (P < 0.05). Patients in the experimental group had lower HAD scores after intervention than those in the control group (P < 0.05). After the intervention, the experimental group had higher ESCA scores and a higher Barthel index than the control group (P < 0.05). Conclusion Comfort nursing plus psychological care improves nursing satisfaction and self-care ability of neurology patients and relieves their negative emotions.
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Peltonen K, Kurki M, Reedtz C, Kaiser S, Rasmussen LMP, Merikukka M, Rye M, Laajasalo T, Kyrrestad H, Karjalainen P, Pettersen SD, Eng H, Breivik K, Martinussen M. Psychological tests for expectant parents and young children in the Nordic countries: A review of the evidence. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2022. [DOI: 10.1080/17405629.2022.2067141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Kirsi Peltonen
- Research Center for Child Psychiatry, University of Turku, Turku, Finland
| | - Marjo Kurki
- Department of Psychology, Itla Children’s Foundation, Helsinki, Finland
| | - Charlotte Reedtz
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sabine Kaiser
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | - Lene-Mari P. Rasmussen
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marko Merikukka
- Department of Psychology, Itla Children’s Foundation, Helsinki, Finland
| | - Marte Rye
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Henriette Kyrrestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | - Piia Karjalainen
- Department of Psychology, Itla Children’s Foundation, Helsinki, Finland
| | - Susann Dahl Pettersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | - Helene Eng
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kyrre Breivik
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Monica Martinussen
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
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Muñoz-Navarro R, Medrano LA, Limonero JT, González-Blanch C, Moriana JA, Ruiz-Rodríguez P, Cano-Vindel A. The mediating role of emotion regulation in transdiagnostic cognitive behavioural therapy for emotional disorders in primary care: Secondary analyses of the PsicAP randomized controlled trial. J Affect Disord 2022; 303:206-215. [PMID: 34998804 DOI: 10.1016/j.jad.2022.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Emotional disorders are highly prevalent in primary care. Transdiagnostic cognitive behavior therapy (TD-CBT) is a promising treatment of emotional disorders. In this study, we evaluated several emotion regulation strategies as potential mediators of treatment outcomes in a clinical sample of primary care. METHODS A total of 1061 primary care patients were included in a randomized clinical trial comparing treatment-as-usual (TAU) to TD-CBT+TAU. Of these, 631 (TAU=316; TD-CBT+TAU=315) completed the full treatment and all pre- and post-treatment scales to assess symptoms (anxiety, depression, somatization), emotion regulation strategies (worry, rumination, negative metacognition, suppression, cognitive reappraisal), overall functioning, and quality of life (QoL). RESULTS Treatment and direct effects showed that TD-CBT+TAU was superior to TAU alone. On the multivariate mediation analysis of indirect effects, three maladaptive strategies (worry, rumination and negative metacognition) had significant effects on all emotional symptoms. Suppression was also significant for depression. Rumination and negative metacognition were significant mediators of functioning, while only negative metacognition was significant for QoL. Reappraisal had no effect on any outcome. LIMITATIONS We focused mainly on maladaptive cognitive emotion regulation strategies and only studied one behavioural strategy (suppression) and one adaptive strategy (reappraisal). CONCLUSIONS Targeting certain maladaptive emotion regulation strategies (worry, rumination, suppression, negative metacognition) as mediators for treatment with TD-CBT could reduce emotional symptoms and improve well-being. Negative metacognition was the most transdiagnostic strategy, whereas an adaptive strategy such as reappraisal was not a mediator. Thus, maladaptive emotion regulation strategies are key mediators in transdiagnostic therapy for emotional disorders in primary care.
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Affiliation(s)
- Roger Muñoz-Navarro
- Department of Personality, Assessment and Psychological Treatments Faculty of Psychology. University of Valencia, Av. Blasco Ibáñez, 10. 46010. Valencia, Spain.
| | - Leonardo Adrián Medrano
- Department of Psychology, Pontificia Universidad Católica Madre y Maestra, Autopista Duarte Km 1 1/2, Santiago De Los Caballeros 51000, Dominican Republic.
| | - Joaquín T Limonero
- Department of Basic Psychology, University Autonoma of Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
| | - César González-Blanch
- Mental Health Centre, University Hospital "Marqués de Valdecilla"- IDIVAL. Av. Valdecilla, 25, 39008 Santander, Cantabria, Spain.
| | - Juan A Moriana
- Department of Psychology, University of Córdoba/ Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC/Reina Sofía University Hospital. Av. Menéndez Pidal, s/n, 14004 Córdoba, Spain.
| | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid. Calle Teruel, 4, 28941 Fuenlabrada, Madrid, Spain.
| | - Antonio Cano-Vindel
- Department of Experimental Psychology. Faculty of Psychology, Complutense University of Madrid, Campus de Somosaguas, s/n, 28223 Madrid, Spain.
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Cost-effectiveness and cost-utility evaluation of individual vs. group transdiagnostic psychological treatment for emotional disorders in primary care (PsicAP-Costs): a multicentre randomized controlled trial protocol. BMC Psychiatry 2022; 22:99. [PMID: 35139809 PMCID: PMC8826705 DOI: 10.1186/s12888-022-03726-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/22/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Emotional disorders are common, and they have become more prevalent since the COVID-19 pandemic. Due to a high attendance burden at the specialized level, most emotional disorders in Spain are treated in primary care, where they are usually misdiagnosed and treated using psychotropic drugs. This contributes to perpetuate their illness and increase health care costs. Following the IAPT programme and the transdiagnostic approach, the PsicAP project developed a brief group transdiagnostic cognitive-behavioural therapy (tCBT) as a cost-effective alternative. However, it is not suitable for everyone; in some cases, one-on-one sessions may be more effective. The objective of the present study is to compare, in cost-benefit terms, group and individual tCBT with the treatment usually administered in Spanish primary care (TAU). METHODS A randomized, controlled, multicentre, and single-blinded trial will be performed. Adults with mild to moderate emotional disorders will be recruited and placed in one of three arms: group tCBT, individual tCBT, or TAU. Medical data and outcomes regarding emotional symptoms, disability, quality of life, and emotion regulation biases will be collected at baseline, immediately after treatment, and 6 and 12 months later. The data will be used to calculate incremental cost-effectiveness and cost-utility ratios. DISCUSSION This trial aims to contribute to clinical practice research. The involvement of psychologists in primary care and the implementation of a stepped-care model for mental disorders are recommended. Group therapy and a transdiagnostic approach may help optimize health system resources and unblock waiting lists so that people can spend less time experiencing mental health problems. TRIAL REGISTRATION ClinicalTrials.gov: NCT04847310; Protocols.io: bx2npqde. (April 19, 2021).
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11
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Sandin K, Gjengedal RGH, Osnes K, Hannisdal M, Berge T, Leversen JSR, Røv LG, Reme SE, Lagerveld S, Blonk R, Nordahl HM, Shields G, Wells A, Hjemdal O. Metacognitive therapy and work-focused interventions for patients on sick leave due to anxiety and depression: study protocol for a randomised controlled wait-list trial. Trials 2021; 22:854. [PMID: 34838125 PMCID: PMC8626756 DOI: 10.1186/s13063-021-05822-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background Common mental disorders such as depression and anxiety are major contributors to the global burden of disease. Affected individuals suffer reduced quality of life, impaired functioning and reduced capacity to work. Maintaining employment is an important determinant for health and wellbeing, and the economic impact of depression and anxiety is a significant societal expense. Treatments providing effective symptom reduction and helping patients return to work (RTW) would thus have substantial public health benefits. The present study will explore the effectiveness of metacognitive therapy (MCT) and work-focused interventions on reducing symptoms and increasing RTW rates for patients on sick leave due to depression and anxiety. Methods The study is a randomised controlled wait-list trial (RCT; N = 240). The intervention group will receive protocol-based MCT and work-focused interventions immediately after inclusion. The control condition is a wait-list control group. All patients will receive up to 12 weekly sessions. The study context is a Norwegian outpatient clinic part of a national programme aimed at reducing sick leave. The co-primary outcomes are change in RTW and symptoms of depression and anxiety at the end of treatment. In addition to self-report, sick leave will also be collected from national registries from 2 years prior to intervention to 4 years after intervention. Symptoms of depression and anxiety will be collected by self-report at pre- and post-treatment and at 6 and 12 months follow-up after treatment. A cost-effectiveness analysis will use total cost and quality-adjusted life-years as the secondary outcomes. Discussion There is broad consensus on the importance of identifying treatment that effectively reduces depression and anxiety symptoms and aids RTW. This study is an important contribution to the field as it is the first RCT on MCT and work-focused interventions for patients on sick leave due to anxiety and depression. Trial registration ClinicalTrials.gov NCT03301922. Registered on October 4, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05822-4.
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Affiliation(s)
- Kenneth Sandin
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Postboks 23 Vinderen, 0319, Oslo, Norway. .,Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway.
| | - Ragne G H Gjengedal
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Postboks 23 Vinderen, 0319, Oslo, Norway.,Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Kåre Osnes
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Postboks 23 Vinderen, 0319, Oslo, Norway
| | - Marit Hannisdal
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Postboks 23 Vinderen, 0319, Oslo, Norway
| | - Torkil Berge
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Postboks 23 Vinderen, 0319, Oslo, Norway
| | - Jonas S R Leversen
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Postboks 23 Vinderen, 0319, Oslo, Norway
| | - Lars G Røv
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Postboks 23 Vinderen, 0319, Oslo, Norway
| | - Silje Endresen Reme
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Suzanne Lagerveld
- Dutch Institute for Employee Benefit Schemes (UWV), Amsterdam, The Netherlands
| | | | - Hans M Nordahl
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gemma Shields
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK
| | - Adrian Wells
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK.,Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Odin Hjemdal
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Postboks 23 Vinderen, 0319, Oslo, Norway.,Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
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12
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Lervik LV, Hoffart A, Knapstad M, Smith ORF. Exploring the temporal associations between avoidance behavior and cognitions during the course of cognitive behavioral therapy for clients with symptoms of social anxiety disorder. Psychother Res 2021; 32:195-208. [PMID: 34142636 DOI: 10.1080/10503307.2021.1930243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES In cognitive behavioral therapy (CBT) for social anxiety disorder (SAD), avoidance behavior (AB) and cognitions (COG) are two important targets of intervention, but so far no studies have directly examined their relative importance. By means of cross-lagged panel models (CLPM), we examined their temporal associations and impacts on outcome in clients with symptoms of SAD while addressing typical methodological challenges. METHOD We used data from the first six therapy sessions in a sample of 428 primary care clients (mean [SD] age = 34.6 [12.2], 34.3% men), participating in the Prompt Mental Health Care trial. Session-by-session data was collected on AB, COG, depression and general anxiety. Competing multiple indicator CLPMs were tested. RESULTS The Random Intercept-CLPM provided best fit, and indicated that AB predicted COG at subsequent time points (.39 ≤ β ≤ .42 for T2-T5, p < .05), but not vice versa. In addition, AB, but not COG, predicted clients' general anxiety score at subsequent time points. Results were both robust to the inclusion of depressive symptoms as a within-level covariate, and sensitivity tests for stationarity and missing data assumptions. CONCLUSION Targeting avoidance behavior for primary care clients with symptoms of SAD may be more vital for the optimal effect of CBT than targeting cognitions. Methodological considerations and limitations of the study are discussed.Trial registration: ClinicalTrials.gov identifier: NCT03238872.
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Affiliation(s)
- Linn Vathne Lervik
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Asle Hoffart
- Modum Bad Psychiatric Center, Vikersund, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Marit Knapstad
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Otto R F Smith
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
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Venning A, Oswald TK, Barnes M, Glover F, Lawn S, Azadi L, Tepper N, Redpath P. It's what's under the hood that counts: comparing therapeutic outcomes when using Australian versus UK-produced clinical materials in an Australian mental health program. AUST HEALTH REV 2021; 45:606-612. [PMID: 34161753 DOI: 10.1071/ah20307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/01/2021] [Indexed: 11/23/2022]
Abstract
Objective MindStep™ is an Australian low-intensity cognitive behaviour therapy (LICBT) program for individuals with mild-to-moderate symptoms of anxiety and depression. UK-produced LICBT guided self-help (GSH) materials were originally used in the MindStep™ program. In 2017, Australian LICBT GSH materials were developed to better suit Australian users. This study explored whether the Australian-produced materials continued to achieve the benchmark recovery rates established in the UK and maintained in recent Australian studies. Methods Binomial logistic regression was conducted using retrospective client data, including the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder 7-item scale, between 2016 and 2019. Results During time periods in which the Australian-produced materials were used, equivalent rates of reliable recovery and improvement were achieved compared with time periods in which the UK-produced materials were used. Australian-trained LICBT coaches, using Australian-produced LICBT GSH materials, achieve client recovery rates of up to 60%, reliable improvement rates of 58% and reliable recovery rates of 46% (with the probability of recovery increasing with client age). Conclusions These findings are particularly pertinent with COVID-19 changing the landscape of mental health service delivery, requiring greater flexibility in the use of teleservices to ensure access to effective mental health care for populations that may already experience problems with isolation, access and service engagement. What is known about the topic? LICBT is an acceptable, feasible and effective treatment approach for people experiencing mild-to-moderate anxiety and depression in Australia. LICBT GSH materials used with clients in Australia originated from the UK. However, according to guidelines, LICBT GSH materials should be contextualised to suit the audience they are being used with. What does this paper add? This paper demonstrates that LICBT GSH materials tailored to an Australian context can be used in place of UK-produced materials because they yield equivalent and consistent therapeutic outcomes. Although contextualising the LICBT GSH materials for health services users was important, it is likely that the evidence-based cognitive behaviour therapy techniques sitting 'under the hood' of these materials are most important to ensure successful therapeutic outcomes. What are the implications for practitioners? As we face unprecedented challenges following 2020, the physical, social, psychological and economic impacts of life-changing events must not inhibit access to treatments for common mental health conditions. It is anticipated that more non-traditional, alternative providers of mental health services will be needed to scale-up and respond to increasing demand. This paper shows that the provision of telephone-based LICBT in Australia, by trained coaches using Australian-produced GSH materials, is an evidenced-based support pathway that can reduce the access gap to treatments.
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Affiliation(s)
- Anthony Venning
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tassia K Oswald
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Mary Barnes
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Fiona Glover
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Sharon Lawn
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Leva Azadi
- Remedy HealthCare Group, 11 Little Lonsdale Street, Melbourne, Vic., Australia
| | - Nicci Tepper
- Remedy HealthCare Group, 11 Little Lonsdale Street, Melbourne, Vic., Australia
| | - Paula Redpath
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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A systematic review and meta-analysis of psychological interventions to improve mental wellbeing. Nat Hum Behav 2021; 5:631-652. [PMID: 33875837 DOI: 10.1038/s41562-021-01093-w] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/05/2021] [Indexed: 12/20/2022]
Abstract
Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.
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Knapstad M, Smith ORF. Social anxiety and agoraphobia symptoms effectively treated by Prompt Mental Health Care versus TAU at 6- and 12-month follow-up: Secondary analysis from a randomized controlled trial. Depress Anxiety 2021; 38:351-360. [PMID: 33393688 PMCID: PMC7986705 DOI: 10.1002/da.23132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/17/2020] [Accepted: 12/18/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Prompt Mental Health Care (PMHC, Norwegian adaption of Improving Access to Psychological Therapies) has shown effects on symptoms of anxiety and depression compared to treatment as usual (TAU). In this secondary analysis, we examine the effectiveness of PMHC among clients presenting with symptoms of social anxiety disorder (SAD) and/or agoraphobia on core symptoms at 6- and 12-month follow-up. METHODS Randomized controlled trial in two PMHC sites (70:30 ratio PMHC:TAU). Of participants, 61.3% (n = 472) scored at caseness for SAD and 47.7% (n = 367) for agoraphobia (40% both). Effects on SAD avoidance and physiological discomfort (SPIN-9), SAD cognitions (ATQ-SA), agoraphobic avoidance (MIA-8), and agoraphobic cognitions (ATQ-AP) were examined in piecewise growth models. RESULTS The PMHC group showed substantially greater symptom reduction than the TAU group for all outcomes: At 6-month follow-up, the between-group effect sizes were d -0.60 (95% CI: -0.94 to -0.26) for SPIN-9, -0.45 (95% CI: -0.70 to -0.20) for ATQ-SA, -0.50 (95% CI: -0.87 to -0.13) for MIA-8, and -0.61 (95% CI: -0.92 to -0.31) for ATQ-AP. All effects were sustained at similar level at a 12-month follow-up. CONCLUSION PMHC effectively alleviated SAD and agoraphobia symptoms, and individuals struggling with such symptoms constituted a large proportion of clients. Although results should be interpreted with caution due to risk of attrition bias, they lend further support for a scale-up of PMHC and similar initiatives. Individuals struggling with SAD and/or agoraphobia stood out as relatively high burdened, whereas only one of five had sought help the last 12 months, underscoring the need for the PMHC service.
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Affiliation(s)
- Marit Knapstad
- Department of Health PromotionNorwegian Institute of Public HealthBergenNorway,Department of Clinical PsychologyUniversity of BergenBergenNorway
| | - Otto R. F. Smith
- Department of Health PromotionNorwegian Institute of Public HealthBergenNorway
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Lervik LV, Knapstad M, Hoffart A, Smith ORF. Psychometric Properties of the Norwegian Version of the Cognitive Therapy Adherence and Competence Scale (CTACS) and Its Associations With Outcomes Following Treatment in IAPT Norway. Front Psychol 2021; 12:639225. [PMID: 33664702 PMCID: PMC7921157 DOI: 10.3389/fpsyg.2021.639225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background: No studies have examined the underlying structure or predictive validity of the Cognitive Therapy Adherence and Competence Scale (CTACS). Examining the structure of the CTACS is of great relevance because it could provide information on what constitutes competence in CBT, and whether some underlying factors are more important for predicting treatment outcomes than others. This study investigates the psychometric properties of the Norwegian version of CTACS and its associations with treatment outcomes in a sample of primary care clients who received CBT for anxiety and/or depression. Method: Independent assessors rated audiotaped therapy sessions (early, mid and late in treatment) in a sample of 132 primary care clients (mean [SD] age = 34.8 [11.8], 63.6% women), participating in the Prompt Mental Health Care trial. Outcomes were symptoms of anxiety and depression assessed by patient self-report questionnaires. Structural validity was examined by means of confirmatory and exploratory factor analyses (CFA/EFA), whereas longitudinal associations with treatment outcome were explored by adopting multilevel modeling. Results: No evidence was found for the divergent validity of the constructs competence and adherence as indicated by a very high correlation between these two subscales in CTACS (0.97). Regarding reliability, ICCs for the mean score of the full competence scale and its associated subscales were generally good to excellent (0.70–0.80), although the subscale measuring the quality of the therapeutic relationship was relatively low (0.44). Internal consistency was overall acceptable, but our CFA models did not provide an acceptable fit for the pre-specified one-factor and four-factor solutions. EFA results were difficult to interpret, with a sub-optimal three-factor solution providing best model fit and only two meaningful factors [CBT specific skills (α = 0.82) and session structure (α = 0.59)]. Overall, the results indicated no evidence for the scales' predictive validity. Conclusion: Our findings point to several psychometric problems of the CTACS that may limit both its research and clinical utility. The importance of providing empirical evidence for both reliability and validity aspects of scales are discussed and suggestions for future research are provided.
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Affiliation(s)
- Linn Vathne Lervik
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Marit Knapstad
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Asle Hoffart
- Department of Psychology, University of Oslo, Oslo, Norway.,Modum Bad Psychiatric Center, Vikersund, Norway
| | - Otto R F Smith
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
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Cano-Vindel A, Muñoz-Navarro R, Moriana JA, Ruiz-Rodríguez P, Medrano LA, González-Blanch C. Transdiagnostic group cognitive behavioural therapy for emotional disorders in primary care: the results of the PsicAP randomized controlled trial. Psychol Med 2021; 52:1-13. [PMID: 33550995 PMCID: PMC9772911 DOI: 10.1017/s0033291720005498] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/28/2020] [Accepted: 12/30/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Emotional disorders are highly prevalent in primary care. We aimed to determine whether a transdiagnostic psychological therapy plus treatment-as-usual (TAU) is more efficacious than TAU alone in primary care adult patients. METHODS A randomized, two-arm, single-blind clinical trial was conducted in 22 primary care centres in Spain. A total of 1061 adult patients with emotional disorders were enrolled. The transdiagnostic protocol (n = 527) consisted of seven 90-min sessions (8-10 patients) delivered over a 12-14-week period. TAU (n = 534) consisted of regular consultations with a general practitioner. Primary outcome measures were self-reported symptoms of anxiety, depression, and somatizations. Secondary outcome measures were functioning and quality of life. Patients were assessed at baseline, post-treatment, and at 3, 6, and 12 months. Intention-to-treat and per-protocol analyses were performed. RESULTS Post-treatment primary outcomes were significantly better in the transdiagnostic group compared to TAU (anxiety: p < 0.001; Morris's d = -0.65; depression: p < 0.001; d = -0.58, and somatic symptoms: p < 0.001; d = -0.40). These effects were sustained at the 12-month follow-up (anxiety: p < 0.001; d = -0.44; depression: p < 0.001; d = -0.36 and somatic symptoms: p < 0.001; d = -0.32). The transdiagnostic group also had significantly better outcomes on functioning (d = 0.16-0.33) and quality of life domains (d = 0.24-0.42), with sustained improvement at the 12-month follow-up in functioning (d = 0.25-0.39) and quality of life (d = 0.58-0.72). Reliable recovery rates showed large between-group effect sizes (d > 0.80) in favour of the transdiagnostic group after treatment and at the 12-month follow-up. CONCLUSIONS Adding a brief transdiagnostic psychological intervention to TAU may significantly improve outcomes in emotional disorders treated in primary care. TRIAL REGISTRATION isrctn.org identifier: ISRCTN58437086.
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Affiliation(s)
- Antonio Cano-Vindel
- Faculty of Psychology, Complutense University of Madrid, Campus de Somosaguas, s/n, 28223 Madrid, Spain
| | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Social and Human Sciences, University of Zaragoza, C/Cdad. Escolar, S/N, 44003, Teruel, Spain
| | - Juan A. Moriana
- Department of Psychology, University of Córdoba/ Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC/Reina Sofía University Hospital, Av. Menéndez Pidal, s/n, 14004 Córdoba, Spain
| | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Calle Teruel, 4, 28941 Fuenlabrada, Madrid, Spain
| | | | - César González-Blanch
- Mental Health Centre, University Hospital “Marqués de Valdecilla”- IDIVAL, Av. Valdecilla, 25, 39008 Santander, Cantabria, Spain
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Myrtveit Sæther SM, Knapstad M, Grey N, Rognerud MA, Smith ORF. Long-term outcomes of Prompt Mental Health Care: A randomized controlled trial. Behav Res Ther 2020; 135:103758. [PMID: 33129157 DOI: 10.1016/j.brat.2020.103758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/24/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022]
Abstract
Prompt Mental Health Care (PMHC, Norwegian adaptation of Improving Access to Psychological Therapies) is found successful in alleviating symptoms of anxiety and depression. Here, we investigate whether improvement is maintained over time. A randomized controlled trial was conducted in two PMHC sites from November 2015 to August 2017, randomly assigning 681 adults with anxiety and/or mild to moderate depression (70:30 ratio: PMHC n = 463, TAU n = 218). Main outcomes were recovery rates and changes in symptoms of depression and anxiety from baseline to 12 months. Secondary outcomes were functional status, health-related quality of life, mental wellbeing and work participation. At 12 months after baseline the reliable recovery rate was 59.4% in PMHC and 36.6% in TAU, giving a between-group effect size of 0.51 (95%CI: 0.26, 0.77, p < 0.001). Differences in symptom change gave between-group effect sizes of -0.67 (95%CI: -0.99, -0.36, p < 0.001) for depression and -0.58 (95%CI: -0.91, -0.26, p < 0.001) for anxiety. PMHC was also at 12 months found more effective in improving functional status, health-related quality of life and mental wellbeing, but not work participation. In sum, substantial treatment effects of PMHC remain at 12 months follow-up, although results should be interpreted with caution due to risk of attrition bias.
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Affiliation(s)
| | - Marit Knapstad
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gate 7, 5015, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Bergen, Norway.
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, United Kingdom; School of Psychology, University of Sussex, United Kingdom.
| | | | - Otto R F Smith
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gate 7, 5015, Bergen, Norway.
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Nieuwenhuijsen K, Verbeek JH, Neumeyer-Gromen A, Verhoeven AC, Bültmann U, Faber B. Interventions to improve return to work in depressed people. Cochrane Database Syst Rev 2020; 10:CD006237. [PMID: 33052607 PMCID: PMC8094165 DOI: 10.1002/14651858.cd006237.pub4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Work disability such as sickness absence is common in people with depression. OBJECTIVES To evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders. SEARCH METHODS We searched CENTRAL (The Cochrane Library), MEDLINE, Embase, CINAHL, and PsycINFO until April 4th 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs of work-directed and clinical interventions for depressed people that included days of sickness absence or being off work as an outcome. We also analysed the effects on depression and work functioning. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data and rated the certainty of the evidence using GRADE. We used standardised mean differences (SMDs) or risk ratios (RR) with 95% confidence intervals (CI) to pool study results in studies we judged to be sufficiently similar. MAIN RESULTS: In this update, we added 23 new studies. In total, we included 45 studies with 88 study arms, involving 12,109 participants with either a major depressive disorder or a high level of depressive symptoms. Risk of bias The most common types of bias risk were detection bias (27 studies) and attrition bias (22 studies), both for the outcome of sickness absence. Work-directed interventions Work-directed interventions combined with clinical interventions A combination of a work-directed intervention and a clinical intervention probably reduces days of sickness absence within the first year of follow-up (SMD -0.25, 95% CI -0.38 to -0.12; 9 studies; moderate-certainty evidence). This translates back to 0.5 fewer (95% CI -0.7 to -0.2) sick leave days in the past two weeks or 25 fewer days during one year (95% CI -37.5 to -11.8). The intervention does not lead to fewer persons being off work beyond one year follow-up (RR 0.96, 95% CI 0.85 to 1.09; 2 studies, high-certainty evidence). The intervention may reduce depressive symptoms (SMD -0.25, 95% CI -0.49 to -0.01; 8 studies, low-certainty evidence) and probably has a small effect on work functioning (SMD -0.19, 95% CI -0.42 to 0.06; 5 studies, moderate-certainty evidence) within the first year of follow-up. Stand alone work-directed interventions A specific work-directed intervention alone may increase the number of sickness absence days compared with work-directed care as usual (SMD 0.39, 95% CI 0.04 to 0.74; 2 studies, low-certainty evidence) but probably does not lead to more people being off work within the first year of follow-up (RR 0.93, 95% CI 0.77 to 1.11; 1 study, moderate-certainty evidence) or beyond (RR 1.00, 95% CI 0.82 to 1.22; 2 studies, moderate-certainty evidence). There is probably no effect on depressive symptoms (SMD -0.10, 95% -0.30 CI to 0.10; 4 studies, moderate-certainty evidence) within the first year of follow-up and there may be no effect on depressive symptoms beyond that time (SMD 0.18, 95% CI -0.13 to 0.49; 1 study, low-certainty evidence). The intervention may also not lead to better work functioning (SMD -0.32, 95% CI -0.90 to 0.26; 1 study, low-certainty evidence) within the first year of follow-up. Psychological interventions A psychological intervention, either face-to-face, or an E-mental health intervention, with or without professional guidance, may reduce the number of sickness absence days, compared with care as usual (SMD -0.15, 95% CI -0.28 to -0.03; 9 studies, low-certainty evidence). It may also reduce depressive symptoms (SMD -0.30, 95% CI -0.45 to -0.15, 8 studies, low-certainty evidence). We are uncertain whether these psychological interventions improve work ability (SMD -0.15 95% CI -0.46 to 0.57; 1 study; very low-certainty evidence). Psychological intervention combined with antidepressant medication Two studies compared the effect of a psychological intervention combined with antidepressants to antidepressants alone. One study combined psychodynamic therapy with tricyclic antidepressant (TCA) medication and another combined telephone-administered cognitive behavioural therapy (CBT) with a selective serotonin reuptake inhibitor (SSRI). We are uncertain if this intervention reduces the number of sickness absence days (SMD -0.38, 95% CI -0.99 to 0.24; 2 studies, very low-certainty evidence) but found that there may be no effect on depressive symptoms (SMD -0.19, 95% CI -0.50 to 0.12; 2 studies, low-certainty evidence). Antidepressant medication only Three studies compared the effectiveness of SSRI to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results. Improved care Overall, interventions to improve care did not lead to fewer days of sickness absence, compared to care as usual (SMD -0.05, 95% CI -0.16 to 0.06; 7 studies, moderate-certainty evidence). However, in studies with a low risk of bias, the intervention probably leads to fewer days of sickness absence in the first year of follow-up (SMD -0.20, 95% CI -0.35 to -0.05; 2 studies; moderate-certainty evidence). Improved care probably leads to fewer depressive symptoms (SMD -0.21, 95% CI -0.35 to -0.07; 7 studies, moderate-certainty evidence) but may possibly lead to a decrease in work-functioning (SMD 0.5, 95% CI 0.34 to 0.66; 1 study; moderate-certainty evidence). Exercise Supervised strength exercise may reduce sickness absence, compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54; one study, low-certainty evidence). However, aerobic exercise probably is not more effective than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24; 2 studies, moderate-certainty evidence). Both studies found no differences between the two conditions in depressive symptoms. AUTHORS' CONCLUSIONS A combination of a work-directed intervention and a clinical intervention probably reduces the number of sickness absence days, but at the end of one year or longer follow-up, this does not lead to more people in the intervention group being at work. The intervention may also reduce depressive symptoms and probably increases work functioning more than care as usual. Specific work-directed interventions may not be more effective than usual work-directed care alone. Psychological interventions may reduce the number of sickness absence days, compared with care as usual. Interventions to improve clinical care probably lead to lower sickness absence and lower levels of depression, compared with care as usual. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. Further research is needed to assess which combination of work-directed and clinical interventions works best.
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Affiliation(s)
- Karen Nieuwenhuijsen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Academic Medical Center, Amsterdam, Netherlands
| | - Jos H Verbeek
- Cochrane Work Review Group, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Academic Medical Center, Amsterdam, Netherlands
| | | | | | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Babs Faber
- Coronel Institute of Occupational Health/Dutch Research Center for Insurance Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Harris E, Barker C, Burton K, Lucock M, Astin F. Self-management support activities in primary care: A qualitative study to compare provision across common health problems. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30354-2. [PMID: 32682579 DOI: 10.1016/j.pec.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore the views of primary care teams about the provision of self-management support to patients with common health problems. METHODS Semi-structured interviews were conducted with twenty-one members of the primary care team from thirteen general practices. Interviews were transcribed verbatim, and analysed using the 'Framework' approach. RESULTS Three categories and six sub-categories illustrating different self-management support activities across common health problems were identified from the analysis of interviews, and contributed to one major theme and one cross-cutting theme. Referral and signposting were frequently used to facilitate patient engagement with external services and resources. Practitioners faced some challenges in balancing medical management and psychosocial support and motivating patients to engage with self-management. CONCLUSIONS Primary care teams described providing a wide range of self-management support activities, but the pattern of use varied for different types of health problem. These patterns may have been influenced, in part, by general practices focusing upon achieving financially incentivised quality improvement goals. PRACTICE IMPLICATIONS To improve self-management support, practitioners need a digital repository of services/resources, motivational interviewing skills, an understanding of the optimum duration and pattern of consultations, and incentivised targets that match a biopsychosocial model of care.
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Affiliation(s)
- Emma Harris
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.
| | - Caroline Barker
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Kim Burton
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Mike Lucock
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Felicity Astin
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; Research and Development, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
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Lervik LV, Knapstad M, Smith ORF. Process evaluation of Prompt Mental Health Care (PMHC): the Norwegian version of Improving Access to Psychological Therapies. BMC Health Serv Res 2020; 20:437. [PMID: 32430000 PMCID: PMC7236093 DOI: 10.1186/s12913-020-05311-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 05/08/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Prompt Mental Health Care (PMHC) is the Norwegian adaptation of Improving Access to Psychological Therapies (IAPT). Thus far, evaluations of PMHC have mostly focused on the effectiveness, rather than on contextual and implementation processes. Therefore, the objective of this study was to do a process evaluation and examine: 1) To what extent do the services follow guidelines provided by the Norwegian Directorate of Health (NDH), 2) what the therapists experienced as important barriers and facilitators in implementing the service, and 3) client treatment satisfaction and its associations with baseline variables. METHOD The present study uses data from 526 clients who received PMHC treatment in the municipalities of Sandnes and Kristiansand. The therapists completed questionnaires about each client's course of treatment. We conducted semi-structured interviews with the therapists and analysed them using thematic analysis. Data from client questionnaires were used to report descriptive sample statistics including symptom severity and treatment satisfaction. Linear regression was adopted to examine the associations between client treatment satisfaction and baseline characteristics. RESULTS Several aspects of PMHC were implemented in line with the guidelines provided by NDH. Importantly, both services reached out to the intended target group, and could further be characterized as low-threshold with relatively short waiting times (median waiting time between initial contact and treatment start was 27 days, IQR 18-39), no waiting lists, and frequent use of self-referral (33.3%). From the client perspective, results indicated a high degree of treatment satisfaction (Mean = 3.93 (SD = .71, range 1-5)), and this was true across demographic characteristics and symptom severity at baseline (all p > .05). Most notable challenges that came forward were; the low provision of guided self-help (received by only 1.0% of clients), the lack of focus on work participation (low to some degree of focus in 70.8% among sick-listed clients), the collaboration with other services (no collaboration in 85.3% of the clients), and some aspects regarding future development of the service. CONCLUSION Both sites managed to implement key aspects of PMHC in line with the guidelines, but further development of the program is warranted. Discussion of challenges and future recommendations are presented.
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Affiliation(s)
- Linn Vathne Lervik
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015, Bergen, Norway.
| | - Marit Knapstad
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015, Bergen, Norway.,Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Otto Robert Frans Smith
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015, Bergen, Norway
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