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Toole-Anstey C, Keevers L, Townsend ML. A Systematic Review of Child to Parent Violence Interventions. TRAUMA, VIOLENCE & ABUSE 2023; 24:1157-1171. [PMID: 34866496 DOI: 10.1177/15248380211053618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Objective: To identify, appraise and synthesize research on the interventions used in child to parent violence. Method: A systematic literature review was conducted using the electronic databases of PsycINFO, Scopus, Web of Science and CINAHL Full Text. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, three authors conducted the screening process which was implemented in two stages including screening the title and abstract, followed by screening the full text. Papers were assessed for quality using the Mixed Methods Assessment Tool. The search identified 727 studies which met the inclusion criteria, deduplication resulted in 525 number for review, with 8 articles included in the review. Results: This review identifies six themes from the six unique interventions included to address the research questions: How do practitioners effectively support families experiencing child-to-parent violence? The six themes are: Conceptualising the violence; Assessment of needs and risks; Intervention types and settings; Program techniques and components of interventions; Intervention outcomes and effectiveness; and Research design and methods. Three narratives were iteratively developed from these themes which highlight the main findings of the review: importance of the practitioner and their skills; conceptual clarity of CPV; and CPV interventions. Conclusions: The findings from this systematic review identifies the need for further research into child to parent violence including what makes interventions effective, what needs and outcomes the interventions are addressing, and the implications of classifications of this violence.
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Affiliation(s)
- Chye Toole-Anstey
- School of Health and Society, 8691University of Wollongong, Australia
| | - Lynne Keevers
- School of Health and Society, 8691University of Wollongong, Australia
| | - Michelle L Townsend
- School of Psychology, 8691University of Wollongong, Australia
- Illawarra Health and Medical Research Institute, 8691University of Wollongong, Australia
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2
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The Effectiveness of Psychological Interventions Delivered in Routine Practice: Systematic Review and Meta-analysis. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:43-57. [PMID: 36201113 PMCID: PMC9832112 DOI: 10.1007/s10488-022-01225-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
This review presents a comprehensive evaluation of the effectiveness of routinely delivered psychological therapies across inpatient, outpatient and University-based clinics. This was a pre-registered systematic-review of studies meeting pre-specified inclusion criteria (CRD42020175235). Eligible studies were searched in three databases: MEDLINE, CINAHL and PsycInfo. Pre-post treatment (uncontrolled) effect sizes were calculated and pooled using random effects meta-analysis to generate effectiveness benchmarks. Moderator analyses were used to examine sources of heterogeneity in effect sizes. Overall, 252 studies (k = 298 samples) were identified, of which 223 (k = 263 samples) provided sufficient data for inclusion in meta-analysis. Results showed large pre-post treatment effects for depression [d = 0.96, (CI 0.88-1.04), p ≤ 0.001, k = 122], anxiety [d = 0.8 (CI 0.71-0.9), p ≤ 0.001, k = 69], and other outcomes [d = 1.01 (CI 0.93-1.09), p ≤ 0.001, k = 158]. This review provides support for the effectiveness of routinely delivered psychological therapy. Effectiveness benchmarks are supplied to support service evaluations across multiple settings.
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Yoshinaga N, Tanoue H, Hayashi Y. Naturalistic outcome of nurse-led psychological therapy for mental disorders in routine outpatient care: A retrospective chart review. Arch Psychiatr Nurs 2022; 40:43-49. [PMID: 36064244 DOI: 10.1016/j.apnu.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 04/08/2022] [Accepted: 04/17/2022] [Indexed: 11/02/2022]
Abstract
This study aimed to investigate the clinical effectiveness of nurse-led cognitive/behavioral therapy (CBT) in Japanese routine outpatient care. We retrospectively collected data from 100 cases with mental disorders who had received nurse-led CBT. Results demonstrated that CBT provided by nurses led to significant improvements in quality of life and other clinical outcomes during the intervention period (all p < 0.001). Among participants who received optional follow-up, these improvements were well-maintained. This real-world evidence of nurse-led CBT bridges the research-practice gap, and will encourage frontline nurses and motivate institutional/organizational leaders, academic/professional societies, and policymakers to employ empirically-supported psychotherapeutic techniques in routine nursing care.
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Affiliation(s)
- Naoki Yoshinaga
- School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki-city, Miyazaki 889-1692, Japan.
| | - Hiroki Tanoue
- School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki-city, Miyazaki 889-1692, Japan
| | - Yuta Hayashi
- Department of Nursing, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, Hyogo 654-0142, Japan
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4
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Cnossen MC, Scholten AC, Lingsma HF, Synnot A, Tavender E, Gantner D, Lecky F, Steyerberg EW, Polinder S. Adherence to Guidelines in Adult Patients with Traumatic Brain Injury: A Living Systematic Review. J Neurotrauma 2021; 38:1072-1085. [PMID: 26431625 PMCID: PMC8054518 DOI: 10.1089/neu.2015.4121] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Guidelines aim to improve the quality of medical care and reduce treatment variation. The extent to which guidelines are adhered to in the field of traumatic brain injury (TBI) is unknown. The objectives of this systematic review were to (1) quantify adherence to guidelines in adult patients with TBI, (2) examine factors influencing adherence, and (3) study associations of adherence to clinical guidelines and outcome. We searched EMBASE, MEDLINE, Cochrane Central, PubMed, Web of Science, PsycINFO, SCOPUS, CINAHL, and grey literature in October 2014. We included studies of evidence-based (inter)national guidelines that examined the acute treatment of adult patients with TBI. Methodological quality was assessed using the Research Triangle Institute item bank and Quality in Prognostic Studies Risk of Bias Assessment Instrument. Twenty-two retrospective and prospective observational cohort studies, reported in 25 publications, were included, describing adherence to 13 guideline recommendations. Guideline adherence varied considerably between studies (range 18-100%) and was higher in guideline recommendations based on strong evidence compared with those based on lower evidence, and lower in recommendations of relatively more invasive procedures such as craniotomy. A number of patient-related factors, including age, Glasgow Coma Scale, and intracranial pathology, were associated with greater guideline adherence. Guideline adherence to Brain Trauma Foundation guidelines seemed to be associated with lower mortality. Guideline adherence in TBI is suboptimal, and wide variation exists between studies. Guideline adherence may be improved through the development of strong evidence for guidelines. Further research specifying hospital and management characteristics that explain variation in guideline adherence is warranted.
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Affiliation(s)
- Maryse C. Cnossen
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Hester F. Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Anneliese Synnot
- Center for Excellence in Traumatic Brain Injury Research, National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Emma Tavender
- Australian Satellite of Cochrane EPOC group, Melbourne, Australia
| | - Dashiell Gantner
- Center for Excellence in Traumatic Brain Injury Research, National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, Australia
| | - Fiona Lecky
- Department of Emergency Medicine, University of Sheffield, University of Manchester and Salford Royal Hospital NHS Foundation Trust, and 2012 NICE Head Injury Guideline Development Group, United Kingdom
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
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5
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Morgan TA, Dalrymple K, D'Avanzato C, Zimage S, Balling C, Ward M, Zimmerman M. Conducting Outcomes Research in a Clinical Practice Setting: The Effectiveness and Acceptability of Acceptance and Commitment Therapy (ACT) in a Partial Hospital Program. Behav Ther 2021; 52:272-285. [PMID: 33622499 DOI: 10.1016/j.beth.2020.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 12/24/2022]
Abstract
Multiple challenges exist integrating research into clinical practice, particularly in acute care settings where randomized controlled trials may be impractical or unethical. Partial or day hospitals are one such setting. As compared to outpatients and inpatients, relatively little research is conducted or reported in partial hospital program (PHP) patients, leaving providers in this setting without a solid empirical basis from which to draw. We report treatment outcomes and patient satisfaction from the first 750 patients enrolled in a clinical research PHP utilizing the acceptance and commitment therapy (ACT) treatment model. ACT is a well-established, transdiagnostic behavior therapy. However, to date no study has examined the use of ACT in acute day hospitals. We hypothesized that applying ACT with this patient group would result in significantly improved depression, anxiety, functioning, and quality of life from intake to discharge. We additionally expected that patients would report high satisfaction with ACT treatment groups. Patients (n = 750 full sample, n = 518 completed treatment) completed daily measures of symptoms, functioning, and ACT processes at intake and discharge, and postgroup satisfaction surveys. Results showed significant improvements in symptoms and impairment. ACT process variables also increased over the course of treatment. Importantly, patient satisfaction was high for all groups. Thus, ACT provides an appropriate, flexible, effective, and satisfactory model for this patient group. A comparison of our findings using ACT to the limited research using other models in PHP settings is discussed, as well as challenges in the overall process of integrating research into routine clinical care.
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6
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von Brachel R, Hirschfeld G, Berner A, Willutzki U, Teismann T, Cwik JC, Velten J, Schulte D, Margraf J. Long-Term Effectiveness of Cognitive Behavioral Therapy in Routine Outpatient Care: A 5- to 20-Year Follow-Up Study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:225-235. [PMID: 31121580 DOI: 10.1159/000500188] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/08/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Long-term follow-ups several years after receiving cognitive behavioral therapy (CBT) are scarce and most of the existing literature describes follow-up data of randomized-controlled trials. Thus, very little is known about the long-term effects of CBT in routine care. METHODS We investigated psychological functioning in a sample of 263 former outpatients who had received CBT for a variety of mental disorders such as depression, anxiety-, eating- or somatoform disorders 8.06 (SD 5.08) years after treatment termination. All participants completed a diagnostic interview as well as the Brief-Symptom Inventory (BSI) and the Beck Depression Inventory (BDI). Effect sizes and response rates according to Jacobson and Truax [J Consult Clin Psychol 1991;59:12-9] were calculated from pre- to posttreatment and from pretreatment to follow-up assessment. RESULTS Pre- to posttreatment effect sizes ranged between 0.75 (BDI) and 0.63 (BSI) and pretreatment to follow-up effect sizes were 0.92 (BDI) and 0.75 (BSI). Of all patients, 29% (BDI) and 17% (BSI) experienced clinically significant change at posttreatment and 42% (BDI) and 24% (BSI) at follow-up. CONCLUSION The results point to the long-term effectiveness of CBT under routine conditions for a wide array of problems, especially when compared to the long-term effects of medical treatment. It is noteworthy that the results at follow-up were even better than at posttreatment, indicating further improvement. However, about a quarter of the patients did not respond sufficiently to therapy, neither concerning short-term nor long-term effects.
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Affiliation(s)
- Ruth von Brachel
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany,
| | - Gerrit Hirschfeld
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Arleta Berner
- Faculty of Psychology and Psychotherapy, University Witten-Herdecke, Witten, Germany
| | - Ulrike Willutzki
- Faculty of Psychology and Psychotherapy, University Witten-Herdecke, Witten, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Jan Christopher Cwik
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Julia Velten
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Dietmar Schulte
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
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7
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Boswell JF. Monitoring processes and outcomes in routine clinical practice: A promising approach to plugging the holes of the practice-based evidence colander. Psychother Res 2019; 30:829-842. [DOI: 10.1080/10503307.2019.1686192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- James F. Boswell
- Department of Psychology, University at Albany, SUNY, Albany, NY, USA
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8
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Patterson CW, Williams J, Jones R. Third-wave therapies and adults with intellectual disabilities: A systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1295-1309. [PMID: 31094063 DOI: 10.1111/jar.12619] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Third-wave therapies appear to produce positive outcomes for people without intellectual disabilities. This systematic review aimed to establish which third-wave therapies have been adapted for adults with intellectual disabilities and whether they produced positive outcomes. METHOD Four databases were searched systematically (PsycINFO, Web of Science, MEDLINE and PubMed), yielding 1,395 results. Twenty studies (N = 109) met the present review's inclusion/exclusion criteria. RESULTS Included studies used mindfulness-based approaches, dialectical behaviour therapy, compassion focused therapy and acceptance and commitment therapy. Due to considerable heterogeneity in the designs and outcome measures used, a meta-analysis was not possible. CONCLUSIONS Evidence indicated that third-wave therapies improved mental health symptoms for some and improved challenging/offending behaviour, smoking and mindfulness/acceptance skills for most. These findings must be interpreted with caution due to the low methodological quality of included studies. Future research should build on the current evidence base, using scientifically rigorous designs and standardized measures.
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Affiliation(s)
| | - Jonathan Williams
- Forensic Adolescent Consultation and Therapy Service, North Wales Adolescent Service, Abergele Hospital, Abergele, UK
| | - Robert Jones
- North Wales Clinical Psychology Programme, School of Psychology, Bangor University, Bangor, UK
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9
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Titov N, Dear BF, Staples LG, Bennett-Levy J, Klein B, Rapee RM, Andersson G, Purtell C, Bezuidenhout G, Nielssen OB. The first 30 months of the MindSpot Clinic: Evaluation of a national e-mental health service against project objectives. Aust N Z J Psychiatry 2017; 51:1227-1239. [PMID: 27733709 DOI: 10.1177/0004867416671598] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The MindSpot Clinic provides online mental health services to Australian adults with anxiety and depression. This paper describes users of MindSpot between January 2013 and June 2015. Outcomes are considered against three key objectives: improving access to mental health services, improving public awareness of how to access services and providing evidence-based treatments. METHOD Website traffic data were examined to determine patterns of use. Demographic characteristics, past service utilisation and reasons for contacting MindSpot were analysed. Outcomes for patients enrolled in a MindSpot treatment course were also analysed. Primary outcomes were scores on the 9-Item Patient Health Questionnaire, Generalised Anxiety Disorder 7-Item, Yale-Brown Obsessive Compulsive Scale and Post-Traumatic Stress Disorder Checklist-Civilian Version, administered at assessment, post-treatment and 3-month follow-up. RESULTS The website was visited by almost 500,000 Australians, of which 33,990 adults started assessments, and 25,469 people completed assessment and were eligible for analysis. Mean age was 36.4 years (standard deviation = 13.3 years; range = 18-94 years), and 72% were female. The proportion living in rural or remote regions and who identified as Aboriginal and Torres Strait Islander closely matched national statistics. The majority (82%) reported that they were not currently in contact with mental health services. Most patients sought an assessment, information about treatment options, or referral to another service, and only 24% of those completing an assessment commenced a MindSpot treatment course. Of these, large clinical effects ( d: 0.7-2.4; average symptom reductions: 25.5% to 61.6%) were found from assessment to follow-up on all outcome measures. Deterioration ranged from 1.0% to 4.3%. CONCLUSION Based on the number of website visits, completed assessments and treatment outcomes, MindSpot achieved its three programme objectives. This model of service provision has considerable value as a complement to existing services, and is proving particularly important for improving access for people not using existing services.
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Affiliation(s)
- Nickolai Titov
- 1 Department of Psychology, Macquarie University, Sydney, NSW, Australia.,2 MindSpot Clinic, Sydney, NSW, Australia.,3 eCentreClinic, Macquarie University, Sydney, NSW, Australia
| | - Blake F Dear
- 1 Department of Psychology, Macquarie University, Sydney, NSW, Australia.,2 MindSpot Clinic, Sydney, NSW, Australia
| | - Lauren G Staples
- 1 Department of Psychology, Macquarie University, Sydney, NSW, Australia.,2 MindSpot Clinic, Sydney, NSW, Australia
| | - James Bennett-Levy
- 4 Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Britt Klein
- 5 Faculty of Health, Federation University Australia, Ballarat, VIC, Australia
| | - Ronald M Rapee
- 1 Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Gerhard Andersson
- 6 Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
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Hardy GE, Bishop-Edwards L, Chambers E, Connell J, Dent-Brown K, Kothari G, O'hara R, Parry GD. Risk factors for negative experiences during psychotherapy. Psychother Res 2017; 29:403-414. [PMID: 29078740 DOI: 10.1080/10503307.2017.1393575] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND It is estimated that between 3% and 15% of patients have a negative experience of psychotherapy, but little is understood about this. AIMS The aim of this study was to investigate the factors associated with patients' negative therapy experiences. METHOD The data comprised 185 patient and 304 therapist questionnaires, 20 patient and 20 therapist interviews. Patients reported on an unhelpful or harmful experience of therapy, and therapists on a therapy where they thought the patient they were working with had a poor or harmful experience. These were transcribed and analysed using thematic analysis. RESULTS There was a Lack of fit between Patient needs, Therapist skills, and Service structures. This could result in Fault Lines, a tension between Safety and containment and Power and control. This tension led to Strain and Poor Engagement, which led to Consequences following the negative therapy experience. CONCLUSIONS Patients require clear information, choice, involvement in decision-making, explicit contracting and clarity about sessions and progress. Opportunities for patient feedback should be the norm, where the therapist and service are vigilant for signs of deterioration and solutions considered. Clinical and methodological significance of this article: Estimates of "unwanted effects," including long-lasting effects, of psychotherapy have ranged from 3% to 15%. Few empirical studies have been conducted in this area. This study aimed to address this gap and provide clinicians with a model of risk factors for negative therapy effects. The findings of this study indicate the importance of providing patients with a supportive service structure that offers clear information, choice and involvement in decision-making. Explicit contracting at the beginning of therapy and clarity about sessions and progress are also important in managing patient expectations throughout. Opportunities for patient feedback should be provided.
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Affiliation(s)
- Gillian E Hardy
- a Clinical Psychology Unit, Department of Psychological Services Research Centre , University of Sheffield , Sheffield , UK
| | | | - Eleni Chambers
- c School of Nursing and Midwifery , University of Sheffield , Sheffield , UK
| | - Janice Connell
- b School of Health and Related Research , University of Sheffield , Sheffield , UK
| | - Kim Dent-Brown
- d Department of Psychology , University of Hull , Hull , UK
| | - Gemma Kothari
- b School of Health and Related Research , University of Sheffield , Sheffield , UK
| | - Rachel O'hara
- b School of Health and Related Research , University of Sheffield , Sheffield , UK
| | - Glenys D Parry
- b School of Health and Related Research , University of Sheffield , Sheffield , UK
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Waters CS, Frude N, Flaxman PE, Boyd J. Acceptance and commitment therapy (ACT) for clinically distressed health care workers: Waitlist-controlled evaluation of an ACT workshop in a routine practice setting. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 57:82-98. [PMID: 28857254 DOI: 10.1111/bjc.12155] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/30/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine the effects of a 1-day acceptance and commitment therapy (ACT) workshop on the mental health of clinically distressed health care employees, and to explore ACT's processes of change in a routine practice setting. DESIGN A quasi-controlled design, with participants block allocated to an ACT intervention or waiting list control group based on self-referral date. METHODS Participants were 35 health care workers who had self-referred for the ACT workshop via a clinical support service for staff. Measures were completed by ACT and control group participants at pre-intervention and 3 months post-intervention. Participants allocated to the waitlist condition went on to receive the ACT intervention and were also assessed 3 months later. RESULTS At 3 months post-intervention, participants in the ACT group reported a significantly lower level of psychological distress compared to the control group (d = 1.41). Across the 3-month evaluation period, clinically significant change was exhibited by 50% of ACT participants, compared to 0% in the control group. When the control group received the same ACT intervention, 69% went on to exhibit clinically significant change. The ACT intervention also resulted in significant improvements in psychological flexibility, defusion, and mindfulness skills, but did not significantly reduce the frequency of negative cognitions. Bootstrapped mediation analyses indicated that the reduction in distress in the ACT condition was primarily associated with an increase in mindfulness skills, especially observing and non-reactivity. CONCLUSIONS These findings provide preliminary support for providing brief ACT interventions as part of routine clinical support services for distressed workers. PRACTITIONER POINTS A 1-day ACT workshop delivered in the context of a routine staff support service was effective for reducing psychological distress among health care workers. The brief nature of this group intervention means it may be particularly suitable for staff support and primary care mental health service settings. The findings indicate that the beneficial effects of an ACT workshop on distressed employees' mental health were linked to improvements in specific mindfulness skills. Study limitations include non-random allocation of participants to the ACT and control groups, and measurement of mediators and outcome at the same time point (3 months post-intervention).
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Affiliation(s)
- Cerith S Waters
- School of Psychology, Cardiff University, Wales, UK.,Psychology and Counselling, Whitchurch Hospital, Cardiff University, Wales, UK
| | - Neil Frude
- School of Psychology, Cardiff University, Wales, UK.,Psychology and Counselling, Whitchurch Hospital, Cardiff University, Wales, UK
| | | | - Jane Boyd
- Psychology and Counselling, Whitchurch Hospital, Cardiff University, Wales, UK
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Jenkins SR. The Narrative Arc of TATs: Introduction to theJPASpecial Section on Thematic Apperceptive Techniques. J Pers Assess 2017; 99:225-237. [DOI: 10.1080/00223891.2016.1244066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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13
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Jones E, Chaplin E. A systematic review of the effectiveness of psychological approaches in the treatment of sex offenders with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 33:79-100. [DOI: 10.1111/jar.12345] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Emma Jones
- Department of Forensic and Neurodevelopmental Sciences Institute of Psychiatry, Psychology and Neurosciences Kings College London London UK
| | - Eddie Chaplin
- Department of Forensic and Neurodevelopmental Sciences Institute of Psychiatry, Psychology and Neurosciences Kings College London London UK
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14
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Saxon D, Barkham M, Foster A, Parry G. The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies. Clin Psychol Psychother 2016; 24:575-588. [PMID: 27424844 DOI: 10.1002/cpp.2028] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 04/06/2016] [Accepted: 05/27/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND In the psychological therapies, patient outcomes are not always positive. Some patients leave therapy prematurely (dropout), while others experience deterioration in their psychological well-being. METHODS The sample for dropout comprised patients (n = 10 521) seen by 85 therapists, who attended at least the initial session of one-to-one therapy and completed a Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment. The subsample for patient deterioration comprised patients (n = 6405) seen by the same 85 therapists but who attended two or more sessions, completed therapy and returned a CORE-OM at pre-treatment and post-treatment. Multilevel modelling was used to estimate the extent of therapist effects for both outcomes after controlling for patient characteristics. RESULTS Therapist effects accounted for 12.6% of dropout variance and 10.1% of deterioration variance. Dropout rates for therapists ranged from 1.2% to 73.2%, while rates of deterioration ranged from 0% to 15.4%. There was no significant correlation between therapist dropout rate and deterioration rate (Spearman's rho = 0.07, p = 0.52). CONCLUSIONS The methods provide a reliable means for identifying therapists who return consistently poorer rates of patient dropout and deterioration compared with their peers. The variability between therapists and the identification of patient risk factors as significant predictors has implications for the delivery of safe psychological therapy services. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE Therapists play an important role in contributing to patient dropout and deterioration, irrespective of case mix. Therapist effects on patient dropout and deterioration appear to act independently. Being unemployed as a patient was the strongest predictor of both dropout and deterioration. Patient risk to self or others was also an important predictor.
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Affiliation(s)
- David Saxon
- Centre for Psychological Services Research, University of Sheffield, Sheffield, UK
| | - Michael Barkham
- Centre for Psychological Services Research, University of Sheffield, Sheffield, UK
| | - Alexis Foster
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Glenys Parry
- Centre for Psychological Services Research, University of Sheffield, Sheffield, UK
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Training novice clinical psychologist trainees to implement effective CBT for anxiety disorders: training model and clinic outcomes. COGNITIVE BEHAVIOUR THERAPIST 2016. [DOI: 10.1017/s1754470x16000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractThe need for development of effective models of training and superivision for trainee clinical psychologists to build CBT competencies and to implement high-quality CBT is frequently highlighted. Effectiveness of trainee therapist outcomes working within different models of training, supervision and services is also important to establish. This paper reports on the development and outcome effectiveness of a model of training and supervision aimed at increasing CBT clinical skills and competence of trainee clinical psychologists offering CBT for anxiety disorders in an anxiety disorders clinic (ADC) in inner-city London. Details of the training and supervision model are provided, which was conducted over a period of 3 months, with ongoing weekly supervision throughout the intervention period. Pre- and post-intervention data were analysed from service users who attended the ADC over a 2-year period. Over the 2-year period, 10 trainees treated 57 clients. Data from completer and intention-to-treat samples indicated that scores on four outcome measures improved significantly: at post-therapy, 75% of service users who completed the intervention showed reliable and clinically significant recovery or improvement. When supported by appropriate training and supervision, as outlined in this training model, initially inexperienced trainee psychologists can achieve outcomes comparable to those obtained in other secondary-care settings with qualified therapists.
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Beaulac J, Sandre D. Impact of a CBT psychotherapy group on post-operative bariatric patients. SPRINGERPLUS 2015; 4:764. [PMID: 26682117 PMCID: PMC4674458 DOI: 10.1186/s40064-015-1558-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/24/2015] [Indexed: 01/18/2023]
Abstract
Psychological difficulties for patients seeking bariatric surgery are greater and in the post-operative phase, a significant minority go on to experience significant psychosocial difficulties, increasing their risk of poorer post-operative adjustment and associated weight regain. 17 post-operative patients participated in an eight-week cognitive behavioral therapy (CBT) based psychotherapy group at the Ottawa Hospital. A pre-post design with a 3-month follow-up investigated the impact of the group on emotional eating, general as well as obesity-specific adjustment, psychological distress, and attachment. There were significant and meaningful improvements in patients’ level of psychological distress, perceived difficulties in their lives, and weight-related adjustment that were maintained at a 3-month follow-up period. Although statistical change was not significant, there were also meaningful improvements in emotional overeating and relationship anxiety and avoidance. The intervention also appeared to be acceptable to patients in that attendance and satisfaction were good. Findings suggest that a short-term CBT psychotherapy group led to significant and meaningful benefits in psychological wellbeing for post-surgical bariatric patients.
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Affiliation(s)
- Julie Beaulac
- Department of Psychology, The Ottawa Hospital, Ottawa, ON Canada ; Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Daniella Sandre
- Department of Psychology, The Ottawa Hospital, Ottawa, ON Canada
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Kazdin AE. Treatment as usual and routine care in research and clinical practice. Clin Psychol Rev 2015; 42:168-78. [DOI: 10.1016/j.cpr.2015.08.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/27/2015] [Accepted: 08/29/2015] [Indexed: 10/23/2022]
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Halje K, Timpka T, Tylestedt P, Adler AK, Fröberg L, Schyman T, Johansson K, Dahl K. Self-referral psychological treatment centre for young adults: a 2-year observational evaluation of routine practice before and after treatment. BMJ Open 2015; 5:e008030. [PMID: 26283666 PMCID: PMC4550710 DOI: 10.1136/bmjopen-2015-008030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To examine a self-referral psychological service provided to young adults with regard to effects on anxiety, depression and psychological distress and to explore client factors predicting non-adherence and non-response. DESIGN Observational study over a 2-year period. SETTING Young Adults Centre providing psychological services by self-referral (preprimary care) to Linköping, Åtvidaberg, and Kinda municipalities (combined population 145,000) in Östergötland county, Sweden. PARTICIPANTS 607 young adults (16-25 years of age); 71% females (n=429). INTERVENTION Individually scheduled cognitive behavioural therapy delivered in up to six 45 min sessions structured according to an assessment of the client's mental health problems: anxiety, depression, anxiety and depression combined, or decreased distress without specific anxiety or depression. PRIMARY OUTCOME MEASURES Pre-post intervention changes in psychological distress (General Health Questionnaire-12, GHQ-12), Hospital Anxiety and Depression Scale Anxiety/Depression (HADS-A/D). RESULTS 192 clients (32.5%) discontinued the intervention on their own initiative and 39 clients (6.6%) were referred to a psychiatric clinic during the course of the intervention. Intention-to-treat analyses including all clients showed a medium treatment effect size (d=0.64) with regard to psychological distress, and small effect sizes were observed with regard to anxiety (d=0.58) and depression (d=0.57). Restricting the analyses to clients who adhered to the agreed programme, a large effect size (d=1.26) was observed with regard to psychological distress, and medium effect sizes were observed with regard to anxiety (d=1.18) and depression (d=1.19). Lower age and a high initial HADS-A score were the strongest risk factors for non-adherence, and inability to concentrate and thinking of oneself as a worthless person increased the risk for discontinuation. CONCLUSIONS We conclude that provision of psychological services to young people through a self-referral centre has potential to improve long-term mental health in communities, but management of non-adherence remains a central challenge.
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Affiliation(s)
- Karin Halje
- Young Adults Centre, Region Östergötland, Linköping, Sweden
| | - Toomas Timpka
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Unit for Health Analysis, Centre for Healthcare Development, Region Östergötland, Linköping, Sweden
| | | | | | - Lena Fröberg
- Young Adults Centre, Region Östergötland, Linköping, Sweden
| | - Tommy Schyman
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Kristoffer Johansson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Katarina Dahl
- Young Adults Centre, Region Östergötland, Linköping, Sweden
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Calvert R, Kellett S, Hagan T. Group cognitive analytic therapy for female survivors of childhood sexual abuse. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2015; 54:391-413. [DOI: 10.1111/bjc.12085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 04/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Stephen Kellett
- Centre for Psychological Therapies Research; University of Sheffield; UK
- Sheffield Health & Social Care NHS Foundation Trust; Sheffield UK
| | - Theresa Hagan
- Sheffield Health & Social Care NHS Foundation Trust; Sheffield UK
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A Logic Model for Evaluating the Academic Health Department. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 22:182-9. [PMID: 25723875 DOI: 10.1097/phh.0000000000000236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Academic Health Departments (AHDs) are collaborative partnerships between academic programs and practice settings. While case studies have informed our understanding of the development and activities of AHDs, there has been no formal published evaluation of AHDs, either singularly or collectively. Developing a framework for evaluating AHDs has potential to further aid our understanding of how these relationships may matter. In this article, we present a general theory of change, in the form of a logic model, for how AHDs impact public health at the community level. We then present a specific example of how the logic model has been customized for a specific AHD. Finally, we end with potential research questions on the AHD based on these concepts. We conclude that logic models are valuable tools, which can be used to assess the value and ultimate impact of the AHD.
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Kazdin AE. Evidence-based psychotherapies I: qualifiers and limitations in what we know. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2014. [DOI: 10.1177/0081246314533750] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychosocial interventions have advanced remarkably for the treatment of a broad range of psychiatric disorders and related sources of impairment among children, adolescents, and adults. By one count, over 320 interventions have been identified as evidence-based in light of rigorously controlled studies and replication of treatment effects. Yet, how evidence-based psychotherapies have been evaluated and reported raises questions about their impact. This article evaluates both methodological and substantive issues that limit what can be stated about evidence-based psychotherapies and their effects. Among the methodological topics are the control conditions to which evidence-based psychotherapies are compared, selective reporting of measures, and the limited evidence that evidence-based psychotherapies have clinically significant impact. Among the substantive issues are the paucity of research on moderators that would help us better direct patients to treatments from which they are likely to profit and our limited understanding of the mechanisms responsible for therapeutic change. The issues discussed are fundamental to what can be stated about the impact of evidence-based psychotherapies and impact and the bases for their effects. It is not clear at present whether concerted efforts are in place to alter research in ways that would redress the issues. There are, however, novel new directions for research that build on the evidence-based psychotherapies, and these are addressed in a companion article.
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Do evidence-based interventions work when tested in the "real world?" A systematic review and meta-analysis of parent management training for the treatment of child disruptive behavior. Clin Child Fam Psychol Rev 2014; 16:18-34. [PMID: 23420407 DOI: 10.1007/s10567-013-0128-0] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Evidence-based interventions are often unavailable in everyday clinical settings. This may partly reflect practitioners' assumptions that research evidence does not reflect "real-world" conditions. To examine this further, we systematically assessed the clinical effectiveness of parent management training (PMT) for the treatment of child disruptive behavior across different real-world practice contexts. We identified 28 relevant randomized controlled trials from a systematic search of electronic bibliographic databases and conducted a meta-analysis of child outcomes across trials. Planned subgroup analyses involved comparisons between studies grouped according to individual real-world practice criteria and total real-world practice criteria scores, reflecting the extent to which PMT was delivered by non-specialist therapists, to a clinic-referred population, in a routine setting, and as part of a routine service. Meta-analysis revealed a significant overall advantage for PMT compared with waitlist control conditions. Subgroup analyses did not demonstrate significant differences in effect size estimates according to the total number of real-world practice criteria met by studies. Moreover, no consistent relationships were found between specific practice criteria and effect size estimates. In conclusion, PMT appears to be an effective treatment for children with disruptive behavior problems. There was no clear evidence that conducting PMT in real-world practice contexts is a deterrent to achieving effective child behavior outcomes, although relative advantage to "usual care" was not directly examined and the power of the analysis was limited as a result of significant heterogeneity. More research is needed to investigate whether this finding is generalizable to other psychological interventions. Suggestions are also made for developing more differentiated criteria to assist with evaluating the specific applicability of research evidence to different care providers.
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Abstract
Attempts to regulate service delivery in line with results from randomized trials have been vigorously debated. In this paper, results from practice-based studies using the CORE System illustrate the potential to enrich knowledge about the actual outcome of psychological therapy in routine care. These studies also provide data for important questions in psychotherapy research, like orientation differences, the importance of the therapist factor, number of sessions needed for clinical effect, and the alliance-outcome question. Obstacles and challenges in making such studies are illustrated. In conclusion, arguments are put forward for introducing a common measurement system that strikes a balance between clinicians' questions and the need for comparable data, and that encompasses the complexities of patients' reasons for seeking psychological help.
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Affiliation(s)
- Rolf Holmqvist
- a Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
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Bertrand K, Richer I, Brunelle N, Beaudoin I, Lemieux A, Ménard JM. Substance abuse treatment for adolescents: how are family factors related to substance use change? J Psychoactive Drugs 2013; 45:28-38. [PMID: 23662329 DOI: 10.1080/02791072.2013.763560] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Parental involvement in adolescents' substance abuse treatment is highly recommended, even though the mechanisms explaining how this favors youths' recovery are not well understood. The present study examines the association between (1) changes in adolescents' substance use and parenting practices, as measured by adolescent self-disclosure and parental warmth; (2) changes in mothers' mental health and their parenting practices, and (3) parental use of services offered by substance abuse treatment centres, parenting practices and adolescent substance use. In total, 147 adolescents and 69 mothers participated in this study. Participants were assessed upon adolescent admission into treatment, as well as at three- and six-month follow-up. Results show an association between improved maternal mental health and greater parental warmth, as perceived by adolescents. In addition, greater parental use of treatment services was found to be associated with greater adolescent self-disclosure and greater reduction of adolescent substance use. Finally, greater adolescent self-disclosure and parental warmth were both associated with lower adolescent substance use. These findings underscore the need to facilitate parents' access to and involvement in treatment of adolescents. The parent-adolescent relationship and the mental health of parents are essential aspects to consider for interventions.
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Affiliation(s)
- Karine Bertrand
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Quebec, Canada.
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Bertrand K, Brunelle N, Richer I, Beaudoin I, Lemieux A, Ménard JM. Assessing covariates of drug use trajectories among adolescents admitted to a drug addiction center: mental health problems, therapeutic alliance, and treatment persistence. Subst Use Misuse 2013; 48:117-28. [PMID: 23127200 DOI: 10.3109/10826084.2012.733903] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aimed to assess covariates of drug use trajectories among 102 adolescents admitted to a drug user treatment program between November 2005 and November 2006 in Québec, Canada. The influences of mental health, therapeutic alliance, and treatment persistence were examined. The Addiction Severity Index was used to measure drug use severity and mental health problems; the California Psychotherapy Alliance Scales was used for therapeutic alliance. latent growth curve analysis showed associations between (1) mental health and initial drug use severity; (2) therapeutic alliance and initial drug use severity; and (3) number of post-treatment sessions attended and drug use severity over time.
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Affiliation(s)
- Karine Bertrand
- Département des Sciences de la Santé Communautaire (Toxicomanie), Université de Sherbrooke, Longueuil, Quebec, Canada.
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Nicoll M, Beail N, Saxon D. Cognitive Behavioural Treatment for Anger in Adults with Intellectual Disabilities: A Systematic Review and Meta-analysis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2012; 26:47-62. [PMID: 23255378 DOI: 10.1111/jar.12013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew Nicoll
- Men's Personality Disorder Service; Rampton Hospital; Nottinghamshire Healthcare Trust; Retford UK
| | - Nigel Beail
- South West Yorkshire Partnership NHS Foundation Trust; Department of Psychology; University of Sheffield; Sheffield UK
| | - David Saxon
- Centre for Psychological Services Research; ScHARR; University of Sheffield; Sheffield UK
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Cahill J. Clinically representative research in the psychological therapies: an emerging paradigm. J Res Nurs 2012. [DOI: 10.1177/1744987112465079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This paper considers the tension between the ‘biology’ and the ‘therapeutic relationship’ camps within mental health nursing, which is focussed on differing conceptualisations of what it is that constitutes evidence and appropriate lines of inquiry. I argue that the struggle that mental health nurses have experienced in delivering evidence-based practice also resides in the thorny issue of methodological inquiry and how it is written into nursing practice. I would suggest that what is alienating to practitioners is the way in which evidence and evidence-based enquiry is generated. This paper offers a line of methodological inquiry that is based in clinical representativeness, a way of conducting and evaluating research to produce an evidence base that is informed from the ‘bottom up’ by ‘practice’. This paper not only contributes to the knowledge base of clinically representative research (CRR) but examines the ways in which this knowledge base has been produced and is currently perpetuated. The following themes are addressed: Processes and outcomes in CRR: I identify key treatment outcomes and processes operating in practice settings and consider with what confidence we can make conclusions on observed outcomes in these settings. I also examine key moderating and mediating processes influencing such outcomes. Practice of CRR: I reflect on the paradigm of CRR giving particular attention to how the paradigm has developed and is maintained. I look at how the relationship of CRR to effifficacy research has influenced paradigm development. Future directions of CRR: I summarise the conclusions of CRR to date and identify points of consensus, disagreement and clarity suggesting in what areas the field has moved forward and whether there are instances where points of conflict have contributed to growth.
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Affiliation(s)
- Jane Cahill
- Senior Research Fellow, School of Healthcare, University of Leeds, UK
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Grafanaki S. ‘Learning from research’: Therapist perspectives on the benefits and challenges of participating in a longitudinal, systematic case-study. COUNSELLING & PSYCHOTHERAPY RESEARCH 2012. [DOI: 10.1080/14733145.2012.689310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ruwaard J, Lange A, Schrieken B, Dolan CV, Emmelkamp P. The effectiveness of online cognitive behavioral treatment in routine clinical practice. PLoS One 2012; 7:e40089. [PMID: 22792217 PMCID: PMC3390320 DOI: 10.1371/journal.pone.0040089] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 05/31/2012] [Indexed: 11/23/2022] Open
Abstract
CONTEXT Randomized controlled trails have identified online cognitive behavioral therapy as an efficacious intervention in the management of common mental health disorders. OBJECTIVE To assess the effectiveness of online CBT for different mental disorders in routine clinical practice. DESIGN An uncontrolled before-after study, with measurements at baseline, posttest, 6-week follow-up, and 1-year follow-up. PARTICIPANTS & SETTING 1500 adult patients (female: 67%; mean age: 40 years) with a GP referral for psychotherapy were treated at a Dutch online mental health clinic for symptoms of depression (n = 413), panic disorder (n = 139), posttraumatic stress (n = 478), or burnout (n = 470). INTERVENTIONS Manualized, web-based, therapist-assisted CBT, of which the efficacy was previously demonstrated in a series of controlled trials. Standardized duration of treatment varied from 5 weeks (online CBT for Posttraumatic stress) to 16 weeks (online CBT for Depression). MAIN OUTCOME MEASURES Validated self-report questionnaires of specific and general psychopathology, including the Beck Depression Inventory, the Impact of Event Scale, the Panic Disorder Severity Scale-Self Report, the Oldenburg Burnout Inventory, and the Depression Anxiety Stress Scales. RESULTS Treatment adherence was 71% (n = 1071). Study attrition was 21% at posttest, 33% at 6-week FU and 65% at 1-year FU. Mixed-model repeated measures regression identified large short-term reductions in all measures of primary symptoms (d = 1.9±0.2 to d = 1.2±0.2; P<.001), which sustained up to one year after treatment. At posttest, rates of reliable improvement and recovery were 71% and 52% in the completer sample (full sample: 55%/40%). Patient satisfaction was high. CONCLUSIONS Results suggest that online therapist-assisted CBT may be as effective in routine practice as it is in clinical trials. Although pre-treatment withdrawal and long-term outcomes require further study, results warrant continued implementation of online CBT.
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Affiliation(s)
- Jeroen Ruwaard
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
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Barkham M, Stiles WB, Connell J, Mellor-Clark J. Psychological treatment outcomes in routine NHS services: what do we mean by treatment effectiveness? Psychol Psychother 2012; 85:1-16. [PMID: 22903890 DOI: 10.1111/j.2044-8341.2011.02019.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The question of how effective therapies are in routine practice is crucial. The answer depends on how we define effectiveness. Both the definition of who was treated and the index chosen to represent outcome can affect estimates dramatically. DESIGN We used data from the Clinical Outcomes in Routine Evaluation (CORE) Primary Care National Practice-Based Evidence database-2005 on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) from 33,587 patients and examined rates of improvement in psychological therapies in UK National Health Service (NHS) primary care services using various definitions of effectiveness. METHODS We constructed successively more restrictive sub-samples of patients, including practice-based analogues of several types of intent-to-treat (ITT) groups and completer groups. We focussed on patients scoring above clinical cut-off at intake, but we also considered samples that included sub-clinical patients. We assessed two types of recovery rates, improvement rates, mean pre-post change, and pre-post effect sizes for each sub-sample. RESULTS There was wide variation in the overall effectiveness of treatments as a function of which subset of data was considered and which specific criterion of recovery rate was adopted. Recovery rates and pre-post effect sizes ranged from 19% to 65% and 0.60 to 1.95, respectively. CONCLUSIONS Because estimates of effectiveness could have significant policy implications, clarity on the meanings of the differing constructions is essential.
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Affiliation(s)
- Michael Barkham
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, UK.
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Affiliation(s)
- Anthony F. Jorm
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
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Lucock M, Kirby R, Wainwright N. A pragmatic randomized controlled trial of a guided self-help intervention versus a waiting list control in a routine primary care mental health service. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 50:298-309. [DOI: 10.1348/014466510x520231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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