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Yarwood B, Taylor R, Angelakis I. User Experiences of CBT for Anxiety and Depression: A Qualitative Systematic Review and Meta-synthesis. Community Ment Health J 2024; 60:662-671. [PMID: 37884830 DOI: 10.1007/s10597-023-01196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023]
Abstract
Cognitive behavioural therapy (CBT) is an evidence-based treatment for anxiety and depression. It is important to determine the positive and negative aspects of CBT from the perspective of service users. However, there has been a lack of qualitative exploration into service user experiences of the therapy. This review aimed to address this gap by examining participants' experiences of CBT for anxiety and depression. Databases were searched and data were synthesised thematically. CBT was well-received by participants, though barriers to engagement were identified. CBT was often perceived as too difficult or demanding, as well as interventions being short and therefore superficial. Clinician qualities of being trustworthy, non-judgemental, and understanding appear to be significant contributors to client engagement and recovery. Findings support the delivery of in-depth clinician led CBT for anxiety and depression, as well as highlighting the need to review CBT delivery to better support service users.
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Thielecke J, Buntrock C, Freund J, Braun L, Ebert DD, Berking M, Baumeister H, Titzler I. How to promote usage of telehealth interventions for farmers' mental health? A qualitative study on supporting and hindering aspects for acceptance and satisfaction with a personalized telephone coaching for depression prevention. Internet Interv 2023; 34:100671. [PMID: 37772161 PMCID: PMC10523267 DOI: 10.1016/j.invent.2023.100671] [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: 04/18/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023] Open
Abstract
Low-threshold and remotely delivered preventive interventions, like telephone coaching, are warranted for farmers who experience multiple risk factors for depression, live in underserved areas, and show low help-seeking behavior. Factors facilitating uptake and actual use of effective remote interventions are important to reduce depression disease burden. This study aimed at identifying factors that potentially can influence acceptance of and satisfaction with a telephone coaching in this occupational group.Semi-structured interviews were based on the 'Unified Theory of Acceptance and Use of Technology', the 'Evaluation', and 'Discrepancy' models for satisfaction. Interviews were conducted with 20 of 66 invited participants of a 6-months telephone coaching during an effectiveness or implementation study. Audio-recorded interviews were transcribed and analyzed (deductive-inductive qualitative content analysis). Independent coding by two persons resulted in good agreement (Κ = 0.80). Participants validated results via questionnaire.Overall, 32 supporting (SF) and 14 hindering factors (HF) for acceptance and satisfaction were identified and organized into five dimensions: Coaching result (SF = 9, HF = 3), coach (SF = 9, HF = 1), organization (SF = 5, HF = 2), the telephone as communication medium (SF = 4, HF = 5) and participant characteristics (SF = 5, HF = 3). Most named SFs were 'Flexible appointment arrangement' (n = 19/95 %) and 'low effort' (n = 17/85 %), while most reported HFs were 'lack of visual cues' (n = 12/60 %) and 'social/professional involvement restricts change process' (n = 10/50 %).The perceived changes initiated by coaching, a low effort through telephone conduct, and the indicated personalization were identified as important influencing factors on acceptance and satisfaction based on interviewees' statements. Both may be further enhanced by offering choice and advice for delivery formats (e.g., video-calls) and training of coaches in farm-related issues. Study registration German Clinical Trial Registrations: DRKS00017078 and DRKS00015655.
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Affiliation(s)
- Janika Thielecke
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Johanna Freund
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Lina Braun
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - David D. Ebert
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Exploring service users experiences of remotely delivered CBT interventions in primary care during COVID-19: An interpretative phenomenological analysis. PLoS One 2023; 18:e0279263. [PMID: 36607988 PMCID: PMC9821471 DOI: 10.1371/journal.pone.0279263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/04/2022] [Indexed: 01/07/2023] Open
Abstract
Primary Care Mental Health Services (PMHCS) aim to provide accessible and effective psychological interventions. However, there is a scarcity of qualitative research focused on patients' experiences. Service users' experience can inform development of accessible, high-quality mental health services. Nine semi-structured interviews were analysed from Primary Care Mental Health users in Northern Scotland using Interpretative Phenomenological Analysis (IPA). Four superordinate themes were generated: Orientating to treatment, Intervention features, Change enablers, and Impact. The results identified both facilitators and barriers associated with access and psychological change; and narratives around CBT acceptability, outcomes and remote delivery. The role of GPs emerged as a key determinant of access to PMHCS. The therapeutic relationship contributed to person-centred care provision, idiosyncratic change processes and self-empowerment. A personal commitment to engage with homework was described as a crucial change enabler. Findings are discussed in relation to existing literature, practical implications and suggestions for future research.
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Bennett SE, Almeida C, Bachmair EM, Gray SR, Lovell K, Paul L, Wearden A, Macfarlane GJ, Basu N, Dures E. Therapists' experiences of remotely delivering cognitive-behavioural or graded-exercise interventions for fatigue: a qualitative evaluation. Rheumatol Adv Pract 2022; 6:rkac083. [PMID: 36340509 PMCID: PMC9629972 DOI: 10.1093/rap/rkac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE Fatigue is a challenging feature of all inflammatory rheumatic diseases. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomized Trial) included remotely delivered personalized exercise programme (PEP) or cognitive-behavioural approach (CBA) interventions. The aim of this nested qualitative evaluation was to understand rheumatology health professionals' (therapists') perspectives of delivering the interventions in the LIFT trial. METHODS A subgroup of therapists who had delivered the personalized exercise programme (PEP) and cognitive-behavioural approach (CBA) interventions took part in semi-structured telephone interviews. RESULTS Seventeen therapists (13 women and 4 men) who delivered PEP (n = 8) or CBA (n = 9) interventions participated. Five themes were identified. In 'The benefits of informative, structured training', therapists described how they were able to practice their skills, and the convenience of having the LIFT manual for reference. When 'Getting into the swing of it', supporting patients gave therapists the confidence to tailor the content of the manual to each patient. Clinical supervision supported therapists to gain feedback and request assistance when required. In 'Delivering the intervention', therapists reported that patients valued the opportunity to talk about their fatigue and challenge their beliefs. In 'Challenges in delivering the LIFT intervention', therapists struggled to work in partnership with patients who lacked motivation or stopped engaging. Finally, in 'LIFT developing clinical skills', therapists gained confidence and professional satisfaction, seeing patients' fatigue improve over time. CONCLUSION The findings support the provision of training for rheumatology health professionals to remotely deliver fatigue-management interventions. Insights from these trials can be used to better improve clinical practice and service provision.
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Affiliation(s)
- Sarah E Bennett
- Correspondence to: Sarah E. Bennett, Translational Health Sciences, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK. E-mail:
| | - Celia Almeida
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Eva-Maria Bachmair
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Lorna Paul
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
| | - Alison Wearden
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Jetté Pomerleau V, Demoustier A, Krajden RV, Racine H, Myhr G. Cognitive-Behavioral Therapy in Intensive Case Management: A Multimethod Quantitative-Qualitative Study. J Psychiatr Pract 2022; 28:203-217. [PMID: 35511096 DOI: 10.1097/pra.0000000000000637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cognitive-behavioral therapy (CBT) has been shown to improve clinical outcomes in schizophrenia and severe and persistent mental illness, but access to it remains limited. One potential way to improve access to CBT is to provide it through intensive case management (ICM) teams. A 90-week quality improvement study was designed to assess if CBT could be implemented in ICM teams. Self-selected ICM clinicians (N=8) implemented CBT with their patients (N=40). These clinicians attended weekly seminars (36 h total) and group supervision (1.5 h/wk). Patient outcomes for this group were compared with those of other clinicians who did not attend the seminars [treatment as usual (TAU) clinicians (N=4)] and their patient population (N=49). Prescore and postscore on the Clinical Global Impressions scale and a quality-of-life scale (Montreal Life Skill Survey) were analyzed for completers in both groups (Clinical Global Impressions scores were analyzed for 25 patients in the CBT group and 29 patients in the TAU group). Weekly session reports by clinicians in the CBT group measured CBT interventions, session focus, and satisfaction with CBT. Qualitative data were obtained from clinicians in the CBT group. After 90 weeks, patients in the CBT group had fewer negative symptoms compared with patients in the TAU group. Our qualitative data describe 2 trajectories of patients: those who improved with CBT and those who did not, and they suggest factors that may impact patient trajectories in CBT. This study suggests that CBT can be used effectively in ICM teams working with patients suffering from severe and persistent mental illness.
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Finazzi E, MacBeth A. Service users experience of psychological interventions in primary care settings: A qualitative meta-synthesis. Clin Psychol Psychother 2021; 29:400-423. [PMID: 34260121 DOI: 10.1002/cpp.2650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/07/2022]
Abstract
Primary care mental health services play a crucial role in public mental health by providing local and accessible psychological interventions that meet individuals' needs. Despite growing research investigating service users' perspectives of psychological interventions, a qualitative systematic review in this context is not available. The present meta-synthesis collates the existing articles and gives a thematic synthesis of qualitative studies on service users' experience of psychological interventions in primary care. Multiple databases (CINAHL, EMBASE, PsychINFO, MEDLINE, and Cochrane Library) were searched for published qualitative studies of service users' experiences of psychological interventions delivered in primary care. Articles were included if they met inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme tool. All types of psychological interventions were considered across model and delivery format (e.g., face-to-face, computerised programmes, and group). NVIVO was used to code the dataset and themes were extracted following thematic synthesis. Twenty-two studies were included. Four analytical themes and 10 subthemes emerged. The identified themes were as follows: (1) 'Access and Acceptability: facilitators and barriers', (2) 'Structural aspects'; (3) 'Therapeutic process' and (4) 'Outcomes'. A model of interrelationships between themes is proposed. Findings suggest several 'essential ingredients' across psychological interventions and modalities. The crucial role of relational factors, the importance of assessing service users' perceptions of treatment features (e.g., remote delivery) and of tailoring the intervention to their needs were emphasised. Results also suggest involving service users more in discussions and decisions about psychological interventions offered might enhance access, acceptability, and engagement. Recommendations for practice and research are provided.
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Affiliation(s)
- Emilia Finazzi
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, UK.,Department of Clinical and Counselling Psychology, NHS Grampian, Aberdeen, UK
| | - Angus MacBeth
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, UK
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Rushton K, Ardern K, Hopkin E, Welsh C, Gellatly J, Faija C, Armitage CJ, Lidbetter N, Lovell K, Bower P, Bee P. 'I didn't know what to expect': Exploring patient perspectives to identify targets for change to improve telephone-delivered psychological interventions. BMC Psychiatry 2020; 20:156. [PMID: 32264865 PMCID: PMC7137505 DOI: 10.1186/s12888-020-02564-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/23/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Remote delivery of psychological interventions to meet growing demand has been increasing worldwide. Telephone-delivered psychological treatment has been shown to be equally effective and as satisfactory to patients as face-to-face treatment. Despite robust research evidence, however, obstacles remain to the acceptance of telephone-delivered treatment in practice. This study aimed to explore those issues using a phenomenological approach from a patient perspective to identify areas for change in current provision through the use of theoretically based acceptability and behaviour change frameworks. METHODS Twenty-eight semi-structured interviews with patients experiencing symptoms of common mental health problems, waiting, receiving or having recently received telephone-delivered psychological treatment via the UK National Health Service's Improving Access to Psychological Therapies (IAPT) programme. Interviews were recorded, transcribed verbatim, and analysed using the Theoretical Domains Framework (TDF) and Theoretical Framework of Acceptability (TFA). RESULTS The majority of data clustered within five key domains of the TDF (knowledge, skills, cognitive and interpersonal, environmental context and resources, beliefs about capabilities, beliefs about consequences) and mapped to all constructs of the TFA (affective attitude, ethicality, intervention coherence, self-efficacy, burden, opportunity costs, and perceived effectiveness). Themes highlighted that early stages of treatment can be affected by lack of patient knowledge and understanding, reservations about treatment efficacy, and practical obstacles such as absent non-verbal communication, which is deemed important in the development of therapeutic alliance. Yet post-treatment, patients can reflect more positively, and report gaining benefit from treatment. However, despite this, many patients say that if they were to return for future treatment, they would choose to see a practitioner face-to-face. CONCLUSIONS Using a combination of theoretically underpinned models has allowed the identification of key targets for change. Addressing knowledge deficits to shift attitudes, highlighting the merits of telephone delivered treatment and addressing skills and practical issues may increase acceptability of, and engagement with, telephone-delivered treatment.
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Affiliation(s)
- Kelly Rushton
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Kerry Ardern
- grid.11835.3e0000 0004 1936 9262Department of Psychology, University of Sheffield, Sheffield, UK
| | - Elinor Hopkin
- grid.5379.80000000121662407School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Charlotte Welsh
- grid.5379.80000000121662407School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Judith Gellatly
- grid.5379.80000000121662407School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Cintia Faija
- grid.5379.80000000121662407School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Christopher J. Armitage
- grid.5379.80000000121662407Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Karina Lovell
- grid.5379.80000000121662407School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- grid.5379.80000000121662407NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Penny Bee
- grid.5379.80000000121662407School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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