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Tindall L, Kerrigan P, Li J, Hayward E, Gega L. Is behavioural activation an effective treatment for depression in children and adolescents? An updated systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02429-3. [PMID: 38615316 DOI: 10.1007/s00787-024-02429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 04/15/2024]
Abstract
Behavioural Activation (BA)-a brief therapy based on the scheduling of enjoyable, purposeful and rewarding activities-is an effective and cost-effective treatment for depression in adults that shows promise for children and adolescents. We provide an update on a previous systematic review of evidence on BA-delivered in-person, telephone, or online-for depression and comorbid anxiety in children and adolescents. We conducted systematic literature searches in 6 databases up to February 2024. We included all study designs evaluating BA with participants up to 18 years old with diagnosable depression, as established by a validated screening tool or diagnostic manual. We used the Moncrieff Scale and the Cochrane Risk of Bias tool to assess study quality. We summarised the findings of all study types with a narrative synthesis and of randomised controlled trials (RCTs) with a meta-analysis. Overall, 24 studies (6 RCTs, 18 pre-post evaluations, n = 2,758) met our inclusion criteria. A meta-analysis of 4 RCTs (n = 156) showed that BA has a small effect of 0.24 (Hedge's adjusted g) in reducing depression symptoms compared to a waiting-list control, usual care and other therapies. Online and telephone-facilitated BA was shown to be feasible in 3 studies and effective in 1. Outcomes on comorbid anxiety were mixed. No economic evaluations met our inclusion criteria. BA shows sufficient promise as an intervention for reducing depression symptoms in children and adolescents to justify the need for further RCTs, providing that five conditions are met: studies are powered to detect a minimal clinically important difference; BA materials are fit-for-purpose to produce clinically meaningful change; follow-ups are longer than 6 months; primary outcomes are child-reported; and intervention costs, resource use and adverse events are reported.
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Affiliation(s)
- Lucy Tindall
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Philip Kerrigan
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Emily Hayward
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Lina Gega
- Hull York Medical School, University of York, Heslington, UK
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Mishu MP, Tindall L, Kerrigan P, Gega L. Cross-culturally adapted psychological interventions for the treatment of depression and/or anxiety among young people: A scoping review. PLoS One 2023; 18:e0290653. [PMID: 37878658 PMCID: PMC10599551 DOI: 10.1371/journal.pone.0290653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/12/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Mental health problems among young people are a major global public health challenge. Psychological interventions may improve mental health, yet most are developed in western cultures, and it is unclear whether they are applicable to other geographical settings and can be delivered successfully to diverse populations. We identified empirical studies focusing upon cross-culturally adapted psychological interventions and examined the cultural adaptation process used and the effectiveness of the interventions in the treatment of depression and/or anxiety disorders among young people (defined here as children and adolescents aged between 8-18 years). METHOD We conducted a scoping review aligning to the guidelines reported in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) Statement. Stakeholder engagement enabled us to discuss the findings of the review and obtain feedback. RESULTS We identified 17 studies of cross-culturally adapted psychological interventions that considered the appropriate language, metaphors, culturally appropriate terms, and cultural values of young people. Most studies (n = 11) adopted a randomised control trial (RCT) methodology. Six studies used the ecological validity and cultural sensitivity framework. Planned adaptation, cultural adaptation of content, and surface and deep structure level adaptations were used in other studies. Apart from one pilot study, all studies reported that culturally adapted interventions resulted in improvements in depression and/or anxiety symptoms in young people. The results suggest the potential effectiveness of cross-culturally adapted interventions within this context. Our stakeholder consultations demonstrated that engaging different community-level stakeholders in the adaptation process was highly recommended. CONCLUSIONS Whilst most included studies indicated improvements in depression and/or anxiety symptoms in young people following a cross-culturally adapted intervention, more work is needed in this area. In particular, focus should be placed upon identifying the dimensions of interventions that should be culturally adapted to make them acceptable, engaging and effective.
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Affiliation(s)
- Masuma Pervin Mishu
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Lucy Tindall
- Department of Health Sciences, Faculty of Sciences, University of York, York, United Kingdom
| | - Philip Kerrigan
- Department of Health Sciences, Faculty of Sciences, University of York, York, United Kingdom
| | - Lina Gega
- Department of Health Sciences, Faculty of Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
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Kitchen CEW, Lewis S, Ekers D, Gega L, Tiffin PA. Barriers and enablers for young people, parents and therapists undertaking behavioural activation for depression: A qualitative evaluation within a randomised controlled trial. Psychol Psychother 2023; 96:504-524. [PMID: 36808208 PMCID: PMC10952148 DOI: 10.1111/papt.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/03/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Adolescent depression is common, long-lasting and debilitating. Behavioural Activation (BA) is a brief, evidence-based therapy for depression in adults with promising outcomes for young people. OBJECTIVES We sought to understand how young people, their parents and therapists experienced manualised BA for depression within Child and Adolescent Mental Health Services. DESIGN Participants in a randomised controlled trial aged 12 to17 with depression, their parents and therapists were invited to a semi-structured interview with a researcher to explore their experiences of receiving, supporting or delivering BA. METHODS Six young people, five parents and five therapists were interviewed. Verbatim interview transcripts were coded using thematic analysis. RESULTS Factors that may optimise delivery of BA were: boosting the young person's motivation, tailoring parental input to the young person's needs/wishes and developing a positive collaboration between the young person and therapist. Engagement with treatment may be hindered by a mismatch between BA delivery and young person's preferences, concurrent mental health comorbidities that are not addressed within a wider care package, lack of parental support and therapist preconceptions against manualised therapy or BA. CONCLUSIONS Manualised BA for young people requires flexibility and adjustment to meet individual and family needs. Therapist preparation could dispel hindering preconceptions about the suitability and potential value of this brief and simple intervention for young people with complex needs and different learning styles.
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Affiliation(s)
| | - Sue Lewis
- School of Health in Social ScienceUniversity of EdinburghEdinburghUK
| | - David Ekers
- Department of Health SciencesUniversity of YorkYorkUK
- Tees, Esk and Wear Valleys NHS Foundation TrustDurhamUK
| | - Lina Gega
- Department of Health SciencesUniversity of YorkYorkUK
- Hull York Medical SchoolUniversity of YorkYorkUK
| | - Paul A. Tiffin
- Department of Health SciencesUniversity of YorkYorkUK
- Tees, Esk and Wear Valleys NHS Foundation TrustDurhamUK
- Hull York Medical SchoolUniversity of YorkYorkUK
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Saul H, Deeney B, Kwint J, Gega L. One-session treatment is as effective as multi-session therapy for young people with phobias. BMJ 2023; 381:882. [PMID: 37146996 DOI: 10.1136/bmj.p882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The studyWright B, Tindall L, Scott AJ, et al. One-session treatment compared with multisession CBT in children aged 7-16 years with specific phobias: the ASPECT non-inferiority RCT. Health Technol Assess 2022;26:1-174.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/one-session-cbt-treatment-effective-for-young-people-with-phobias/.
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Affiliation(s)
| | | | | | - Lina Gega
- University of York and Hull York Medical School, UK
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Saiger MJ, Deterding S, Gega L. Children and Young People's Involvement in Designing Applied Games: Scoping Review. JMIR Serious Games 2023; 11:e42680. [PMID: 36928258 PMCID: PMC10131627 DOI: 10.2196/42680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND User involvement is widely accepted as key for designing effective applied games for health. This especially holds true for children and young people as target audiences, whose abilities, needs, and preferences can diverge substantially from those of adult designers and players. Nevertheless, there is little shared knowledge about how concretely children and young people have been involved in the design of applied games, let alone consensus guidance on how to do so effectively. OBJECTIVE The aim of this scoping review was to describe which user involvement methods have been used in the design of applied games with children and young people, how these methods were implemented, and in what roles children and young people were involved as well as what factors affected their involvement. METHODS We conducted a systematic literature search and selection across the ACM Digital Library, IEEE Xplore, Scopus, and Web of Science databases using State of the Art through Systematic Review software for screening, selection, and data extraction. We then conducted a qualitative content analysis on the extracted data using NVivo. RESULTS We retrieved 1085 records, of which 47 (4.33%) met the eligibility criteria. The chief involvement methods were participatory design (20/47, 43%) and co-design (16/47, 37%), spanning a wide range of 45 concrete activities with paper prototyping, group discussions, and playtesting being the most frequent. In only half of the studies (24/47, 51%), children and young people participated as true design partners. Our qualitative content analysis suggested 5 factors that affect their successful involvement: comprehension, cohesion, confidence, accessibility, and time constraints. CONCLUSIONS Co-design, participatory design, and similar high-level labels that are currently used in the field gloss over very uneven degrees of participation in design and a wide variety of implementations that greatly affect actual user involvement. This field would benefit from more careful consideration and documentation of the reason of user involvement. Future research should explore concrete activities and configurations that can address the common challenges of involving children and young people, such as comprehension, cohesion, confidence, and accessibility.
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Affiliation(s)
| | - Sebastian Deterding
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Lina Gega
- Department of Health Sciences & Hull York Medical School, University of York, York, United Kingdom
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Thabrew H, Gega L. Editorial: Control alt delete - technology and children's mental health. Child Adolesc Ment Health 2023; 28:1-3. [PMID: 36642701 DOI: 10.1111/camh.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Indexed: 01/17/2023]
Abstract
With international contributions from Denmark, Peru, Italy, Turkey, Estonia, Russia, Canada, the USA, Australia and the UK, this special issue offers insights and evidence about the technology's ability to act as a force of good and a source of harm for young people's mental health. As we better understand the complex and bidirectional relationship between technology and mental health, we need to move beyond dichotomous narratives about it being good or bad; it is both, depending on how it is used. Collective responsibility across technology companies, researchers, public services and community organisations, parents and the young people themselves can make a difference in the way technology is used to protect and improve mental health.
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Affiliation(s)
- Hiran Thabrew
- Te Ara Haro, Centre for Infant, Child and Adolescent Mental Health, University of Auckland, Auckland, New Zealand
| | - Lina Gega
- Department of Health Sciences, University of York, York, UK
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Wright B, Tindall L, Scott AJ, Lee E, Cooper C, Biggs K, Bee P, Wang HI, Gega L, Hayward E, Solaiman K, Teare MD, Davis T, Wilson J, Lovell K, McMillan D, Barr A, Edwards H, Lomas J, Turtle C, Parrott S, Teige C, Chater T, Hargate R, Ali S, Parkinson S, Gilbody S, Marshall D. One session treatment (OST) is equivalent to multi-session cognitive behavioral therapy (CBT) in children with specific phobias (ASPECT): results from a national non-inferiority randomized controlled trial. J Child Psychol Psychiatry 2023; 64:39-49. [PMID: 35915056 PMCID: PMC10087411 DOI: 10.1111/jcpp.13665] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND 5%-10% children and young people (CYP) experience specific phobias that impact daily functioning. Cognitive Behaviour Therapy (CBT) is recommended but has limitations. One Session Treatment (OST), a briefer alternative incorporating CBT principles, has demonstrated efficacy. The Alleviating Specific Phobias Experienced by Children Trial (ASPECT) investigated the non-inferiority of OST compared to multi-session CBT for treating specific phobias in CYP. METHODS ASPECT was a pragmatic, multi-center, non-inferiority randomized controlled trial in 26 CAMHS sites, three voluntary agency services, and one university-based CYP well-being service. CYP aged 7-16 years with specific phobia were randomized to receive OST or CBT. Clinical non-inferiority and a nested cost-effectiveness evaluation was assessed 6-months post-randomization using the Behavioural Avoidance Task (BAT). Secondary outcome measures included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children's Anxiety Depression Scale, goal-based outcome measure, and EQ-5DY and CHU-9D, collected blind at baseline and six-months. RESULTS 268 CYPs were randomized to OST (n = 134) or CBT (n = 134). Mean BAT scores at 6 months were similar across groups in both intention-to-treat (ITT) and per-protocol (PP) populations (CBT: 7.1 (ITT, n = 76), 7.4 (PP, n = 57), OST: 7.4 (ITT, n = 73), 7.6 (PP, n = 56), on the standardized scale-adjusted mean difference for CBT compared to OST -0.123, 95% CI -0.449 to 0.202 (ITT), mean difference -0.204, 95% CI -0.579 to 0.171 (PP)). These findings were wholly below the standardized non-inferiority limit of 0.4, suggesting that OST is non-inferior to CBT. No between-group differences were found on secondary outcomes. OST marginally decreased mean service use costs and maintained similar mean Quality Adjusted Life Years compared to CBT. CONCLUSIONS One Session Treatment has similar clinical effectiveness to CBT for specific phobias in CYP and may be a cost-saving alternative.
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Affiliation(s)
- Barry Wright
- Leeds and York Partnership NHS Foundation Trust, York, UK
| | - Lucy Tindall
- Leeds and York Partnership NHS Foundation Trust, York, UK
| | | | - Ellen Lee
- University of Sheffield, Sheffield, UK
| | | | | | - Penny Bee
- University of Manchester, Manchester, UK
| | | | | | - Emily Hayward
- Leeds and York Partnership NHS Foundation Trust, York, UK
| | | | | | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | | | | | - Amy Barr
- University of Sheffield, Sheffield, UK
| | - Hannah Edwards
- Leeds and York Partnership NHS Foundation Trust, York, UK
| | | | | | | | - Catarina Teige
- Leeds and York Partnership NHS Foundation Trust, York, UK
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Wright B, Tindall L, Scott AJ, Lee E, Biggs K, Cooper C, Bee P, Wang HI, Gega L, Hayward E, Solaiman K, Teare MD, Davis T, Lovell K, Wilson J, McMillan D, Barr A, Edwards H, Lomas J, Turtle C, Parrott S, Teige C, Chater T, Hargate R, Ali S, Parkinson S, Gilbody S, Marshall D. One-session treatment compared with multisession CBT in children aged 7–16 years with specific phobias: the ASPECT non-inferiority RCT. Health Technol Assess 2022; 26:1-174. [DOI: 10.3310/ibct0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background
Up to 10% of children and young people have a specific phobia that can significantly affect their mental health, development and daily functioning. Cognitive–behavioural therapy-based interventions remain the dominant treatment, but limitations to their provision warrant investigation into low-intensity alternatives. One-session treatment is one such alternative that shares cognitive–behavioural therapy principles but has a shorter treatment period.
Objective
This research investigated the non-inferiority of one-session treatment to cognitive–behavioural therapy for treating specific phobias in children and young people. The acceptability and cost-effectiveness of one-session treatment were examined.
Design
A pragmatic, multicentre, non-inferiority randomised controlled trial, with embedded economic and qualitative evaluations.
Settings
There were 26 sites, including 12 NHS trusts.
Participants
Participants were aged 7–16 years and had a specific phobia defined in accordance with established international clinical criteria.
Interventions
Participants were randomised 1 : 1 to receive one-session treatment or usual-care cognitive–behavioural therapy, and were stratified according to age and phobia severity. Outcome assessors remained blind to treatment allocation.
Main outcome measures
The primary outcome measure was the Behavioural Avoidance Task at 6 months’ follow-up. Secondary outcomes included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children’s Anxiety and Depression Scale, a goal-based outcome measure, Child Health Utility 9D, EuroQol-5 Dimensions Youth version and resource usage. Treatment fidelity was assessed using the Cognitive Behaviour Therapy Scale for Children and Young People and the One-Session Treatment Rating Scale.
Results
A total of 274 participants were recruited, with 268 participants randomised to one-session treatment (n = 134) or cognitive–behavioural therapy (n = 134). A total of 197 participants contributed some data, with 149 participants in the intention-to-treat analysis and 113 in the per-protocol analysis. Mean Behavioural Avoidance Task scores at 6 months were similar across treatment groups when both intention-to-treat and per-protocol analyses were applied [cognitive–behavioural therapy: 7.1 (intention to treat), 7.4 (per protocol); one-session treatment: 7.4 (intention to treat), 7.6 (per protocol); on the standardised scale adjusted mean difference for cognitive–behavioural therapy compared with one-session treatment –0.123, 95% confidence interval –0.449 to 0.202 (intention to treat), mean difference –0.204, 95% confidence interval –0.579 to 0.171 (per protocol)]. These findings were wholly below the standardised non-inferiority limit of 0.4, which suggests that one-session treatment is non-inferior to cognitive–behavioural therapy. No between-group differences in secondary outcome measures were found. The health economics evaluation suggested that, compared with cognitive–behavioural therapy, one-session treatment marginally decreased the mean service use costs and maintained similar mean quality-adjusted life-year improvement. Nested qualitative evaluation found one-session treatment to be considered acceptable by those who received it, their parents/guardians and clinicians. No adverse events occurred as a result of phobia treatment.
Limitations
The COVID-19 pandemic meant that 48 children and young people could not complete the primary outcome measure. Service waiting times resulted in some participants not starting therapy before follow-up.
Conclusions
One-session treatment for specific phobia in UK-based child mental health treatment centres is as clinically effective as multisession cognitive–behavioural therapy and highly likely to be cost-saving. Future work could involve improving the implementation of one-session treatment through training and commissioning of improved care pathways.
Trial registration
This trial is registered as ISRCTN19883421.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 42. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Barry Wright
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - Lucy Tindall
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | | | - Ellen Lee
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katie Biggs
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Penny Bee
- School of Nursing, Midwifery and Social Care, University of Manchester, Manchester, UK
| | - Han-I Wang
- Centre for Health Economics, University of York, York, UK
| | - Lina Gega
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - Emily Hayward
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Kiera Solaiman
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Thompson Davis
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Karina Lovell
- School of Nursing, Midwifery and Social Care, University of Manchester, Manchester, UK
| | - Jon Wilson
- Central Norfolk Youth Service, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Dean McMillan
- Centre for Health Economics, University of York, York, UK
| | - Amy Barr
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Hannah Edwards
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Jennifer Lomas
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Chris Turtle
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Steve Parrott
- Centre for Health Economics, University of York, York, UK
| | - Catarina Teige
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Tim Chater
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Rebecca Hargate
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Shehzad Ali
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - Sarah Parkinson
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Simon Gilbody
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
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Wang HI, Wright B, Tindall L, Cooper C, Biggs K, Lee E, Teare MD, Gega L, Scott AJ, Hayward E, Solaiman K, Davis T, McMillan D, Gilbody S, Parrott S. Cost and effectiveness of one session treatment (OST) for children and young people with specific phobias compared to multi-session cognitive behavioural therapy (CBT): results from a randomised controlled trial. BMC Psychiatry 2022; 22:547. [PMID: 35962334 PMCID: PMC9372970 DOI: 10.1186/s12888-022-04192-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 07/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In the UK, around 93,000 (0.8%) children and young people (CYP) are experiencing specific phobias that have a substantial impact on daily life. The current gold-standard treatment-multi-session cognitive behavioural therapy (CBT) - is effective at reducing specific phobia severity; however, CBT is time consuming, requires specialist CBT therapists, and is often at great cost and limited availability. A briefer variant of CBT called one session treatment (OST) has been found to offer similar clinical effectiveness for specific phobia as multi-session CBT. The aim of this study was to assess the cost-effectiveness of OST compared to multi-session CBT for CYP with specific phobias through the Alleviating Specific Phobias Experienced by Children Trial (ASPECT), a two-arm, pragmatic, multi-centre, non-inferiority randomised controlled trial. METHODS CYP aged seven to 16 years with specific phobias were recruited nationally via Health and Social Care pathways, remotely randomised to the intervention group (OST) or the control group (CBT-based therapies) and analysed (n = 267). Resource use based on NHS and personal social services perspective and quality adjusted life years (QALYs) measured by EQ-5D-Y were collected at baseline and at six-month follow-up. Incremental cost-effectiveness ratio (ICER) was calculated, and non-parametric bootstrapping was conducted to capture the uncertainty around the ICER estimates. The results were presented on a cost-effectiveness acceptability curve (CEAC). A set of sensitivity analyses (including taking a societal perspective) were conducted to assess the robustness of the primary findings. RESULTS After adjustment and bootstrapping, on average CYP in the OST group incurred less costs (incremental cost was -£302.96 (95% CI -£598.86 to -£28.61)) and maintained similar improvement in QALYs (QALYs gained 0.002 (95% CI - 0.004 to 0.008)). The CEAC shows that the probability of OST being cost-effective was over 95% across all the WTP thresholds. Results of a set of sensitivity analyses were consistent with the primary outcomes. CONCLUSION Compared to CBT, OST produced a reduction in costs and maintained similar improvement in QALYs. Results from both primary and sensitivity analyses suggested that OST was highly likely to be cost saving. TRIAL REGISTRATION ISRCTN19883421 (30/11/2016).
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Affiliation(s)
- Han-I. Wang
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD York UK
| | - Barry Wright
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD York UK ,grid.450937.c0000 0001 1410 7560Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Lucy Tindall
- grid.450937.c0000 0001 1410 7560Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Cindy Cooper
- grid.11835.3e0000 0004 1936 9262University of Sheffield, Sheffield, UK
| | - Katie Biggs
- grid.11835.3e0000 0004 1936 9262University of Sheffield, Sheffield, UK
| | - Ellen Lee
- grid.11835.3e0000 0004 1936 9262University of Sheffield, Sheffield, UK
| | - M. Dawn Teare
- grid.1006.70000 0001 0462 7212Newcastle University, Newcastle upon Tyne, UK
| | - Lina Gega
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD York UK ,grid.413631.20000 0000 9468 0801Hull York Medical School, York, UK
| | | | - Emily Hayward
- grid.450937.c0000 0001 1410 7560Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Kiera Solaiman
- grid.11835.3e0000 0004 1936 9262University of Sheffield, Sheffield, UK
| | - Thompson Davis
- grid.64337.350000 0001 0662 7451Louisiana State University, Baton Rouge, USA ,grid.411015.00000 0001 0727 7545The University of Alabama, Tuscaloosa, USA
| | - Dean McMillan
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD York UK ,grid.413631.20000 0000 9468 0801Hull York Medical School, York, UK
| | - Simon Gilbody
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD York UK ,grid.413631.20000 0000 9468 0801Hull York Medical School, York, UK
| | - Steve Parrott
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD York UK
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Jankovic D, Saramago Goncalves P, Gega L, Marshall D, Wright K, Hafidh M, Churchill R, Bojke L. Cost Effectiveness of Digital Interventions for Generalised Anxiety Disorder: A Model-Based Analysis. Pharmacoecon Open 2022; 6:377-388. [PMID: 34961911 PMCID: PMC8711685 DOI: 10.1007/s41669-021-00318-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Digital interventions (DIs) are increasingly being used in mental health care, despite limited evidence regarding their value for money. This study aimed to evaluate the cost effectiveness of DIs for generalised anxiety disorder (GAD), in comparison with alternative care options, from the perspective of the UK health care system. METHODS An open-source decision analytic cohort model was used to extrapolate the results of a network meta-analysis over a patient's lifetime and estimate the costs and outcomes (quality-adjusted life-years) of DIs and their comparators. The net monetary benefit (NMB) and probability of cost effectiveness was estimated for each comparator, and we conducted a Value of Information analysis to evaluate the scale and drivers of uncertainty. RESULTS DIs were associated with lower NMB compared with medication and with group therapy, but greater NMB compared with non-therapeutic controls and with usual care. DIs that were supported by a clinician, an assistant or a lay person had higher delivery costs than purely patient-self-directed DIs, yielding a greater NMB when opportunity cost was above £3000/QALY. There was considerable uncertainty in the findings driven largely by uncertainty in the estimated treatment effects. The value of further research to establish the effectiveness of DIs for GAD was substantial, at least £12.9 billion. CONCLUSIONS The high uncertainty about these results does not allow for recommendations based on the cost effectiveness of DIs. However, the analysis highlights areas for future research, and demonstrates that apparent cost savings associated with DIs can be offset by reduced effectiveness.
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Affiliation(s)
- Dina Jankovic
- Centre for Health Economics, The University of York, York, YO10 5DD, UK.
| | | | - Lina Gega
- Department of Health Sciences and Hull York Medical School, University of York, York, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Meena Hafidh
- Centre for Health Economics, The University of York, York, YO10 5DD, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Laura Bojke
- Centre for Health Economics, The University of York, York, YO10 5DD, UK
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11
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Mishu MP, Faisal MR, Macnamara A, Sabbah W, Peckham E, Newbronner L, Gilbody S, Gega L. A Qualitative Study Exploring the Barriers and Facilitators for Maintaining Oral Health and Using Dental Service in People with Severe Mental Illness: Perspectives from Service Users and Service Providers. Int J Environ Res Public Health 2022; 19:ijerph19074344. [PMID: 35410025 PMCID: PMC8998854 DOI: 10.3390/ijerph19074344] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 01/07/2023]
Abstract
People with severe mental illness suffer from a high burden of oral diseases, which can negatively impact their physical and mental well-being. Despite the high burden, they are less likely to engage in oral health care including accessing dental services. We aimed to identify both the service users' and service providers' perspective on the barriers and facilitators for maintaining oral health and dental service use in people with severe mental illness. Qualitative exploration was undertaken using dyadic or one-to-one in-depth interviews with service users in the UK with a diagnosis of schizophrenia, schizoaffective disorder or bipolar disorder. Service providers, including mental health and dental health professionals, and informal carers (people identified as family or friend who are not paid carers) were also interviewed. Thematic analysis of the data revealed three main cross-cutting themes at the personal, inter-personal and systems level: amelioration of the problem, using a tailored approach and provision of comprehensive support. The main barriers identified were impact of mental ill-health, lack of patient involvement and tailored approach, and accessibility and availability of dental services including lack of integration of services. The main facilitators identified were service providers' effective communication skills and further support through the involvement of carers. The findings suggest that the integration of dental and mental health services to provide tailored support for overall health and well-being, including the oral health of the patient, can better support people with severe mental illness regarding their oral health needs.
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Affiliation(s)
- Masuma Pervin Mishu
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, York YO10 5DD, UK; (M.R.F.); (E.P.); (L.N.); (L.G.); (S.G.)
- Correspondence:
| | - Mehreen Riaz Faisal
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, York YO10 5DD, UK; (M.R.F.); (E.P.); (L.N.); (L.G.); (S.G.)
| | - Alexandra Macnamara
- Hull York Medical School, University of York, Heslington, York YO10 5DD, UK;
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, Denmark Hill Campus, Caldecot Road, London SE5 9RW, UK;
| | - Emily Peckham
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, York YO10 5DD, UK; (M.R.F.); (E.P.); (L.N.); (L.G.); (S.G.)
| | - Liz Newbronner
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, York YO10 5DD, UK; (M.R.F.); (E.P.); (L.N.); (L.G.); (S.G.)
| | - Simon Gilbody
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, York YO10 5DD, UK; (M.R.F.); (E.P.); (L.N.); (L.G.); (S.G.)
- Hull York Medical School, University of York, Heslington, York YO10 5DD, UK;
| | - Lina Gega
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, York YO10 5DD, UK; (M.R.F.); (E.P.); (L.N.); (L.G.); (S.G.)
- Hull York Medical School, University of York, Heslington, York YO10 5DD, UK;
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12
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Gega L, Jankovic D, Saramago P, Marshall D, Dawson S, Brabyn S, Nikolaidis GF, Melton H, Churchill R, Bojke L. Digital interventions in mental health: evidence syntheses and economic modelling. Health Technol Assess 2022; 26:1-182. [PMID: 35048909 DOI: 10.3310/rcti6942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Economic evaluations provide evidence on whether or not digital interventions offer value for money, based on their costs and outcomes relative to the costs and outcomes of alternatives. OBJECTIVES (1) Evaluate and summarise published economic studies about digital interventions across different technologies, therapies, comparators and mental health conditions; (2) synthesise clinical evidence about digital interventions for an exemplar mental health condition; (3) construct an economic model for the same exemplar mental health condition using the previously synthesised clinical evidence; and (4) consult with stakeholders about how they understand and assess the value of digital interventions. METHODS We completed four work packages: (1) a systematic review and quality assessment of economic studies about digital interventions; (2) a systematic review and network meta-analysis of randomised controlled trials on digital interventions for generalised anxiety disorder; (3) an economic model and value-of-information analysis on digital interventions for generalised anxiety disorder; and (4) a series of knowledge exchange face-to-face and digital seminars with stakeholders. RESULTS In work package 1, we reviewed 76 economic evaluations: 11 economic models and 65 within-trial analyses. Although the results of the studies are not directly comparable because they used different methods, the overall picture suggests that digital interventions are likely to be cost-effective, compared with no intervention and non-therapeutic controls, whereas the value of digital interventions compared with face-to-face therapy or printed manuals is unclear. In work package 2, we carried out two network meta-analyses of 20 randomised controlled trials of digital interventions for generalised anxiety disorder with a total of 2350 participants. The results were used to inform our economic model, but when considered on their own they were inconclusive because of the very wide confidence intervals. In work package 3, our decision-analytic model found that digital interventions for generalised anxiety disorder were associated with lower net monetary benefit than medication and face-to-face therapy, but greater net monetary benefit than non-therapeutic controls and no intervention. Value for money was driven by clinical outcomes rather than by intervention costs, and a value-of-information analysis suggested that uncertainty in the treatment effect had the greatest value (£12.9B). In work package 4, stakeholders identified several areas of benefits and costs of digital interventions that are important to them, including safety, sustainability and reducing waiting times. Four factors may influence their decisions to use digital interventions, other than costs and outcomes: increasing patient choice, reaching underserved populations, enabling continuous care and accepting the 'inevitability of going digital'. LIMITATIONS There was substantial uncertainty around effect estimates of digital interventions compared with alternatives. This uncertainty was driven by the small number of studies informing most comparisons, the small samples in some of these studies and the studies' high risk of bias. CONCLUSIONS Digital interventions may offer good value for money as an alternative to 'doing nothing' or 'doing something non-therapeutic' (e.g. monitoring or having a general discussion), but their added value compared with medication, face-to-face therapy and printed manuals is uncertain. Clinical outcomes rather than intervention costs drive 'value for money'. FUTURE WORK There is a need to develop digital interventions that are more effective, rather than just cheaper, than their alternatives. STUDY REGISTRATION This study is registered as PROSPERO CRD42018105837. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Lina Gega
- Department of Health and Social Care Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK.,Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Dina Jankovic
- Centre for Health Economics, University of York, York, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - David Marshall
- Centre for Reviews & Dissemination, University of York, York, UK
| | - Sarah Dawson
- Common Mental Disorders Group, Cochrane Collaboration, University of York, York, UK.,Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Sally Brabyn
- Department of Health and Social Care Sciences, University of York, York, UK
| | | | - Hollie Melton
- Centre for Reviews & Dissemination, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews & Dissemination, University of York, York, UK.,Common Mental Disorders Group, Cochrane Collaboration, University of York, York, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
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13
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Mishu MP, Faisal MR, Macnamara A, Sabbah W, Peckham E, Newbronner L, Gilbody S, Gega L. Exploring the contextual factors, behaviour change techniques, barriers and facilitators of interventions to improve oral health in people with severe mental illness: A qualitative study. Front Psychiatry 2022; 13:971328. [PMID: 36304558 PMCID: PMC9592713 DOI: 10.3389/fpsyt.2022.971328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
People with severe mental illness (SMI) have significantly poorer oral health compared to people without SMI and interventions targetted to improve oral health in this population failed to show any long-term improvement. Interventions are influenced by many contextual factors ranging from individual to systems level. This study aimed to understand the contextual factors, behaviour change techniques of the available oral health interventions and explore the barriers to and facilitators for engagement with these interventions from the perspectives of people with SMI (service users) and related service providers. Intervention details were extracted from 12 intervention studies identified from a previous systematic review using the template for intervention description and replication checklist (TIDieR) and behaviour change techniques (BCTs) were coded using the behaviour change technique taxonomy v1. Sixteen individual BCTs were identified and out of which "4.1 instructions on how to perform the behaviour" (n = 9) and "6.1 demonstration of behaviour" (n = 6) were most frequently used BCTs. Video vignettes prepared from the different intervention components identified from existing studies were shown to service users and service providers in dyadic or one-to-one interview format to elicit their views on barriers and facilitators for engagement with the intervention components. Interviews were analysed using Framework analysis and were guided by theoretical domains framework (TDF); and capability, opportunity and motivation (COM-B) model of behaviour change. Main facilitators identified to increase capability, opportunity and motivation of service users were the involvement of carers/care coordinators and integration of dental and mental health care, provision of oral health/hygiene information/products at an appropriate level and provision of tailored support according to individual needs and preferences. Barriers identified were related to lack of communication skills of the service providers, provision of coordinated care, lack of support in visiting a dentist and navigating the payment system and long follow up times. Appropriate training was considered as a facilitator, and staff turnovers and workload were considered as main barriers by the service providers. The findings suggest that comprehensive interventions that target barriers and enhance facilitators from individual to systems level are needed to improve oral health outcomes of people with SMI.
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Affiliation(s)
- Masuma Pervin Mishu
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Mehreen Riaz Faisal
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
| | | | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
| | - Emily Peckham
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
| | - Liz Newbronner
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
| | - Simon Gilbody
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom.,Hull York Medical School, University of York, Heslington, United Kingdom
| | - Lina Gega
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom.,Hull York Medical School, University of York, Heslington, United Kingdom
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14
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Saramago P, Gega L, Marshall D, Nikolaidis GF, Jankovic D, Melton H, Dawson S, Churchill R, Bojke L. Digital Interventions for Generalized Anxiety Disorder (GAD): Systematic Review and Network Meta-Analysis. Front Psychiatry 2021; 12:726222. [PMID: 34938209 PMCID: PMC8685377 DOI: 10.3389/fpsyt.2021.726222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Generalized anxiety disorder is the most common mental health condition based on weekly prevalence. Digital interventions have been used as alternatives or as supplements to conventional therapies to improve access, patient choice, and clinical outcomes. Little is known about their comparative effectiveness for generalized anxiety disorder. Methods: We conducted a systematic review and network meta-analysis of randomized controlled trials comparing digital interventions with medication, non-digital interventions, non-therapeutic controls, and no intervention. Results: We included 21 randomized controlled trials with a total of 2,350 participants from generalized anxiety disorder populations. Pooled outcomes using analysis of Covariance and rankograms based on the surface under the cumulative ranking curves indicated that antidepressant medication and group therapy had a higher probability than digital interventions of being the "best" intervention. Supported digital interventions were not necessarily "better" than unsupported (pure self-help) ones. Conclusions: Due to very wide confidence intervals, network meta-analysis results were inconclusive as to whether digital interventions are better than no intervention and non-therapeutic active controls, or whether they confer an additional benefit to standard therapy. Future research needs to compare digital interventions with one-to-one therapy and with manualized non-digital self-help and to include antidepressant medication as a treatment comparator and effect modifier.
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Affiliation(s)
- Pedro Saramago
- Centre for Health Economics, University of York, York, United Kingdom
| | - Lina Gega
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, Heslington, United Kingdom
- Tees, Esk and Wear Valleys NHS Trust, Darlington, United Kingdom
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Georgios F. Nikolaidis
- Centre for Health Economics, University of York, York, United Kingdom
- IQVIA, London, United Kingdom
| | - Dina Jankovic
- Centre for Health Economics, University of York, York, United Kingdom
| | - Hollie Melton
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Sarah Dawson
- Common Mental Disorders Group, Cochrane Collaboration, York, United Kingdom
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
- Common Mental Disorders Group, Cochrane Collaboration, York, United Kingdom
| | - Laura Bojke
- Centre for Health Economics, University of York, York, United Kingdom
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15
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Aboujaoude E, Gega L. Editorial Perspective: Missing the forest for the trees - how the focus on digital addiction and gaming diverted attention away from wider online risks. Child Adolesc Ment Health 2021; 26:369-371. [PMID: 34448531 DOI: 10.1111/camh.12503] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 12/24/2022]
Abstract
Despite the many ways in which Internet-related technologies can affect psychology, research into the Internet's mental health consequences has disproportionately focussed on the narrow topics of online addiction and the closely related Internet gaming disorder. Over two decades into the online revolution, the Internet is being blamed for dramatic transformations, including a rise in extremism, social polarization and weakened democracies. In trying to understand how these shifts could have happened, or how they might be contained, society looks to mental health experts - after all, it is the interaction between technology and human psychology that is encouraging certain behaviours online and discouraging others. The field, however, has precious little to offer by way of explanations. To no small degree, this is due to the tendency to approach online psychological problems primarily through the addiction framework. The result has been to blind us to other important traits and phenomena that are playing out online and on social media, including impulsivity, aggression, inattention, narcissism and the psychological meaning of living in a postprivacy world. The article covers historical aspects of how the addiction model came to dominate the field; some insufficiently heeded early warning signals about other online ills and the big price society is paying today for this approach. We end with a call for a significant broadening of the focus of research when it comes to online psychopathology.
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Affiliation(s)
- Elias Aboujaoude
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Lina Gega
- Department of Health Sciences and Hull York Medical School, University of York, York, UK
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16
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Achtyes ED, Gega L, Linnaranta O. Editorial: mHealth: Self-Management and Complementary Psychiatric Treatment. Front Psychiatry 2021; 12:777090. [PMID: 34744848 PMCID: PMC8569125 DOI: 10.3389/fpsyt.2021.777090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eric D. Achtyes
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, United States
- Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, United States
| | - Lina Gega
- Department of Health Sciences and Hull York Medical School, University of York, York, United Kingdom
| | - Outi Linnaranta
- Mental Health Team, Finnish Institute for Health and Welfare, Helsinki, Finland
- Faculty of Medicine, Department of Psychiatry, McGill University, Quebec City, QC, Canada
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17
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Gega L, Aboujaoude E. How Digital Technology Mediated the Effects of the COVID-19 Pandemic on Mental Health: The Good, the Bad, and the Indifferent. Front Digit Health 2021; 3:733151. [PMID: 34713202 PMCID: PMC8521901 DOI: 10.3389/fdgth.2021.733151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Lina Gega
- Department of Health Sciences & Hull York Medical School, University of York, York, United Kingdom
| | - Elias Aboujaoude
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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18
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Kitchen CEW, Tiffin PA, Lewis S, Gega L, Ekers D. Innovations in Practice: A randomised controlled feasibility trial of Behavioural Activation as a treatment for young people with depression. Child Adolesc Ment Health 2021; 26:290-295. [PMID: 32725758 DOI: 10.1111/camh.12415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Behavioural Activation (BA) treatment effectively reduces symptoms of depression in adults and is more cost-effective than more complex therapies. Two recent systematic reviews of BA for depression in young people highlighted the need for more studies in this area. METHODS In order to evaluate the acceptability of BA treatment for adolescents with depression and the feasibility of conducting a trial of this intervention in Child and Adolescent Mental Health Services (CAMHS), 22 patients from across three sites were randomised to BA or usual CAMHS care. Existing CAMHS staff were trained to deliver the manualised intervention via a brief course. Following treatment, young people and their parents/carers were asked to complete a feedback survey. Symptoms and functioning were assessed at 3- and 6-month follow-up. The trial was registered with the ISRCTN Registry (ref: ISRCTN52147450; https://www.isrctn.com/). RESULTS Recruitment targets were achieved through screening large numbers of CAMHS service users. Intervention adherence by the participating adolescents was high (median number of completed BA sessions was seven out of a total of eight). There were tentative suggestions of improvements following treatment; a large change in a positive direction for the BA group, but not for usual care, was observed by visual comparisons of mean scores on measures of depression, self-esteem and functioning. No adverse events were reported. CONCLUSIONS The findings suggest that BA in this setting is acceptable and warrants evaluation via a fully powered randomised controlled trial.
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Affiliation(s)
| | - Paul A Tiffin
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK.,Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | - Sue Lewis
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Lina Gega
- Department of Health Sciences, University of York, York, UK
| | - David Ekers
- Department of Health Sciences, University of York, York, UK.,Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
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19
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Affiliation(s)
- Elias Aboujaoude
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Lina Gega
- Department of Health Sciences and Hull York Medical School, University of York, York, UK
| | - Andy J Saltarelli
- Office of Learning Technologies & Spaces, Stanford University, Stanford, CA, USA
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20
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Jankovic D, Bojke L, Marshall D, Saramago Goncalves P, Churchill R, Melton H, Brabyn S, Gega L. Systematic Review and Critique of Methods for Economic Evaluation of Digital Mental Health Interventions. Appl Health Econ Health Policy 2021; 19:17-27. [PMID: 32803521 DOI: 10.1007/s40258-020-00607-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Investment in digital interventions for mental health conditions is growing rapidly, offering the potential to elevate systems that are currently overstretched. Despite a growing literature on economic evaluation of digital mental health interventions (DMHIs), including several systematic reviews, there is no conclusive evidence regarding their cost-effectiveness. This paper reviews the methodology used to determine their cost-effectiveness and assesses whether this meets the requirements for decision-making. In doing so we consider the challenges specific to the economic evaluation of DMHIs, and identify where consensus and possible further research is warranted. METHODS A systematic review was conducted to identify all economic evaluations of DMHIs published between 1997 and December 2018. The searches included databases of published and unpublished research, reference lists and citations of all included studies, forward citations on all identified protocols and conference abstracts, and contacting authors researchers in the field. The identified studies were critiqued against a published set of requirements for decision-making in healthcare, identifying methodological challenges and areas where consensus is required. RESULTS The review identified 67 papers evaluating DMHIs. The majority of the evaluations were conducted alongside trials, failing to capture all relevant available evidence and comparators, and long-term impact of mental health disorders. The identified interventions are complex and heterogeneous. As a result, there are a number of challenges specific to their evaluation, including estimation of all costs and outcomes, conditional on analysis viewpoint, and identification of relevant comparators. A taxonomy for DMHIs may be required to inform what interventions can reasonably be pooled and compared. CONCLUSIONS This study represents the first attempt to understand the appropriateness of the methodologies used to evaluate the value for money of DMHIs, helping work towards consensus and methods' harmonisation on these complex interventions.
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Affiliation(s)
- Dina Jankovic
- Centre for Health Economics, The University of York, Alcuin College, A Block, York, YO10 5DD, UK.
| | - Laura Bojke
- Centre for Health Economics, The University of York, Alcuin College, A Block, York, YO10 5DD, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Pedro Saramago Goncalves
- Centre for Health Economics, The University of York, Alcuin College, A Block, York, YO10 5DD, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Hollie Melton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sally Brabyn
- Department of Health Sciences, University of York, York, UK
| | - Lina Gega
- Department of Health Sciences and Hull York Medical School, University of York, York, UK
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21
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Abel KM, Bee P, Gega L, Gellatly J, Kolade A, Hunter D, Callender C, Carter LA, Meacock R, Bower P, Stanley N, Calam R, Wolpert M, Stewart P, Emsley R, Holt K, Linklater H, Douglas S, Stokes-Crossley B, Green J. An intervention to improve the quality of life in children of parents with serious mental illness: the Young SMILES feasibility RCT. Health Technol Assess 2020; 24:1-136. [PMID: 33196410 DOI: 10.3310/hta24590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Quality of life for children and adolescents living with serious parental mental illness can be impaired, but evidence-based interventions to improve it are scarce. OBJECTIVE Co-production of a child-centred intervention [called Young Simplifying Mental Illness plus Life Enhancement Skills (SMILES)] to improve the health-related quality of life of children and adolescents living with serious parental mental illness, and evaluating its acceptability and feasibility for delivery in NHS and community settings. DESIGN Qualitative and co-production methods informed the development of the intervention (Phase I). A feasibility randomised controlled trial was designed to compare Young SMILES with treatment as usual (Phase II). Semistructured qualitative interviews were used to explore acceptability among children and adolescents living with their parents, who had serious mental illness, and their parents. A mixture of semistructured qualitative interviews and focus group research was used to examine feasibility among Young SMILES facilitators and referrers/non-referrers. SETTING Randomisation was conducted after baseline measures were collected by the study co-ordinator, ensuring that the blinding of the statistician and research team was maintained to reduce detection bias. PARTICIPANTS Phase I: 14 children and adolescents living with serious parental mental illness, seven parents and 31 practitioners from social, educational and health-related sectors. Phase II: 40 children and adolescents living with serious parental mental illness, 33 parents, five referrers/non-referrers and 16 Young SMILES facilitators. INTERVENTION Young SMILES was delivered at two sites: (1) Warrington, supported by the National Society for the Prevention of Cruelty to Children (NSPCC), and (2) Newcastle, supported by the NHS and Barnardo's. An eight-session weekly group programme was delivered, with four to six children and adolescents living with serious parental mental illness per age-appropriate group (6-11 and 12-16 years). At week 4, a five-session parallel weekly programme was offered to the parents/carers. Sessions lasted 2 hours each and focused on improving mental health literacy, child-parent communication and children's problem-solving skills. MAIN OUTCOME MEASURES Phase ll children and parents completed questionnaires at randomisation and then again at 4 and 6 months post randomisation. Quality of life was self-reported by children and proxy-reported by parents using the Paediatric Quality of Life questionnaire and KIDSCREEN. Semistructured interviews with parents (n = 14) and children (n = 17) who participated in the Young SMILES groups gathered information about their motivation to sign up to the study, their experiences of participating in the group sessions, and their perceived changes in themselves and their family members following intervention. Further interviews with individual referrers (n = 5) gathered information about challenges to recruitment and randomisation. Two focus groups (n = 16) with practitioners who facilitated the intervention explored their views of the format and content of the Young SMILES manual and their suggestions for changes. RESULTS A total of 35 families were recruited: 20 were randomly allocated to Young SMILES group and 15 to treatment as usual. Of those, 28 families [15/20 (75%) in the intervention group and 13/15 (87%) in the control group] gave follow-up data at the primary end point (4 months post baseline). Participating children had high adherence to the intervention and high completion rates of the questionnaires. Children and adolescents living with their parents, who had serious mental illness, and their parents were mainly very positive and enthusiastic about Young SMILES, both of whom invoked the benefits of peer support and insight into parental difficulties. Although facilitators regarded Young SMILES as a meaningful and distinctive intervention having great potential, referrers identified several barriers to referring families to the study. One harm was reported by a parent, which was dealt with by the research team and the NSPCC in accordance with the standard operating procedures. LIMITATIONS The findings from our feasibility study are not sufficient to recommend a fully powered trial of Young SMILES in the near future. Although it was feasible to randomise children and adolescents living with serious parental mental illness of different ages to standardised, time-limited groups in both NHS and non-NHS settings, an intervention like Young SMILES is unlikely to address underlying core components of the vulnerability that children and adolescents living with serious parental mental illness express as a population over time. CONCLUSIONS Young SMILES was widely valued as unique in filling a recognised gap in need. Outcome measures in future studies of interventions for children and adolescents living with serious parental mental illness are more likely to capture change in individual risk factors for reduced quality of life by considering their unmet need, rather than on an aggregate construct of health-related quality of life overall, which may not reflect these young people's needs. FUTURE WORK A public health approach to intervention might be best. Most children and adolescents living with serious parental mental illness remain well most of the time, so, although their absolute risks are low across outcomes (and most will remain resilient most of the time), consistent population estimates find their relative risk to be high compared with unexposed children. A public health approach to intervention needs to be both tailored to the particular needs of children and adolescents living with serious parental mental illness and agile to these needs so that it can respond to fluctuations over time. TRIAL REGISTRATION Current Controlled Trials ISRCTN36865046. FUNDING This project was funded by the National Institute of Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Penny Bee
- Division of Nursing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Lina Gega
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Judith Gellatly
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Division of Nursing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Adekeye Kolade
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Diane Hunter
- National Society for the Prevention of Cruelty to Children, London, UK
| | - Craig Callender
- Northumberland Tyne and Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle upon Tyne, UK
| | - Lesley-Anne Carter
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Rachel Meacock
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Peter Bower
- National Primary Care Research and Development Centre, University of Manchester, Manchester, UK
| | - Nicky Stanley
- School of Social Work, University of Central Lancashire, Preston, UK
| | - Rachel Calam
- Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Miranda Wolpert
- Evidence Based Practice Unit, University College London, London, UK.,Anna Freud Centre, London, UK
| | - Paul Stewart
- National Society for the Prevention of Cruelty to Children, London, UK
| | - Richard Emsley
- Department for Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kim Holt
- Department of Social Work, Education and Community Wellbeing, University of Northumbria, Newcastle upon Tyne, UK
| | - Holly Linklater
- Department of Education and Inclusive Pedagogy, University of Edinburgh, Edinburgh, UK
| | - Simon Douglas
- Northumberland Tyne and Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle upon Tyne, UK
| | - Bryony Stokes-Crossley
- Northumberland Tyne and Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle upon Tyne, UK
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
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22
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Heslin M, Gellatly J, Pedley R, Knopp-Hoffer J, Hardy G, Arundel C, Bee P, McMillan D, Peckham E, Gega L, Barkham M, Bower P, Gilbody S, Lovell K, Byford S. Out of pocket expenses in obsessive compulsive disorder. J Ment Health 2020; 31:607-612. [PMID: 32357807 DOI: 10.1080/09638237.2020.1755028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Despite anecdotal evidence that the out of pocket costs of OCD can be substantial in some cases, there is no evidence on how many people they affect, or the magnitude of these costs.Aims: This paper explores the type and quantity of out of pocket expenses reported by a large sample of adults with OCD.Methods: Data on out of pocket expenses were collected from participants taking part in the OCTET multi-centre randomised controlled trial. Participants were aged 18+, meeting DSM-IV criteria for OCD, and scoring 16+ on the Yale Brown Obsessive Compulsive Scale. Individual-level resource use data including a description and estimated cost of out of pocket expenses were measured using an adapted version of the Adult Service Use Schedule (AD-SUS): a questionnaire used to collect data on resource use.Results: Forty-five percent (208/465) reported out of pocket expenses due to their OCD. The mean cost of out of pocket expenses was £19.19 per week (SD £27.56 SD), range £0.06-£224.00.Conclusions: Future economic evaluations involving participants with OCD should include out of pocket expenses, but careful consideration of alternative approaches to the collection and costing of this data is needed.
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Affiliation(s)
- Margaret Heslin
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Judith Gellatly
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jasmin Knopp-Hoffer
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Gillian Hardy
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, UK
| | | | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Dean McMillan
- Hull York Medical School & Department of Health Sciences, University of York, York, UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | - Lina Gega
- Hull York Medical School & Department of Health Sciences, University of York, York, UK
| | - Michael Barkham
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Peter Bower
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Simon Gilbody
- Hull York Medical School & Department of Health Sciences, University of York, York, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
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23
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Aboujaoude E, Gega L, Parish MB, Hilty DM. Editorial: Digital Interventions in Mental Health: Current Status and Future Directions. Front Psychiatry 2020; 11:111. [PMID: 32174858 PMCID: PMC7056878 DOI: 10.3389/fpsyt.2020.00111] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/10/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elias Aboujaoude
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Lina Gega
- Department of Health Sciences & Hull York Medicine School, University of York, York, United Kingdom
| | - Michelle B. Parish
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA, United States
| | - Donald M. Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA, United States
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24
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Cerga-Pashoja A, Doukani A, Gega L, Walke J, Araya R. Added value or added burden? A qualitative investigation of blending internet self-help with face-to-face cognitive behaviour therapy for depression. Psychother Res 2020; 30:998-1010. [PMID: 32024447 DOI: 10.1080/10503307.2020.1720932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objectives: Numerous studies and reviews have explored the value of adding therapist support to internet self-help for improving client adherence and outcomes. This study is different as it explores the value of adding internet self-help to face-to-face therapy, from the perspective of practitioners who used both. This study explores practitioners' experiences of whether-and how-internet self-help blended with face-to-face therapy may confer an added value or become an added burden to their routine practice. Methods: Using a structured topic guide, we collected narrative data via 3 focus groups and 1 telephone interview from 11 practitioners across two sites in England. We carried out a thematic analysis within two domains, "value vs. burden". Results: Practitioners reported that internet self-help can confer added value to face-to-face therapy by: fostering client engagement with face-to-face sessions; making therapy ubiquitous beyond sessions; and preventing therapeutic drift between sessions. Conversely, internet self-help can add burden to face-to-face therapy when it is experienced as disruptive, overwhelming and time-consuming. Conclusions: Recognizing and mitigating factors that can turn internet self-help from an added value to an added burden will help practitioners adopt and make the most out of blended therapy.
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Affiliation(s)
- Arlinda Cerga-Pashoja
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Asmae Doukani
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lina Gega
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Jennifer Walke
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ricardo Araya
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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25
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Arnott B, Kitchen CEW, Ekers D, Gega L, Tiffin PA. Behavioural activation for overweight and obese adolescents with low mood delivered in a community setting: feasibility study. BMJ Paediatr Open 2020; 4:e000624. [PMID: 32399504 PMCID: PMC7204816 DOI: 10.1136/bmjpo-2019-000624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Mood and weight problems are common in young people, yet few treatments address both conditions concurrently. Behavioural activation (BA) has shown promise as a treatment for adults with comorbid obesity and depression. This study aimed to examine the feasibility and acceptability of a manualised BA treatment targeting weight and mood problems in young people. METHODS Young people with low mood and weight difficulties were identified via a school-based screening process. Following a diagnostic interview, young people with clinically significant mood problems and concurrent overweight/obesity were invited to participate. A total of 8-12 sessions of BA were delivered by a graduate therapist to eight adolescents (four male) aged 12-15 years. Weight, mood and functioning were assessed before, during and after treatment, and a semistructured qualitative interview was conducted, along with selected outcome measures at 4 months' follow-up. RESULTS Low attrition and positive qualitative feedback suggested the intervention was acceptable. Trends towards a reduction in reported depression symptoms and improved functioning scores were observed at follow-up, with more mixed results for change in body mass index. Of those attending the 4-month follow-up, 57% (4/7) no longer met the screening threshold for major depressive disorder. However, low screening and baseline recruitment rates would pose challenges to executing a larger trial. CONCLUSIONS BA delivered by a graduate therapist in a British community setting is an acceptable, feasible treatment for comorbid mood and weight problems in adolescence, and its effectiveness should be evaluated in an adequately powered randomised controlled trial.
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Affiliation(s)
- Bronia Arnott
- Population Health Sciences Institute Newcastle University, Newcastle upon Tyne, UK
| | | | - David Ekers
- Department of Health Sciences, University of York, York, North Yorkshire, UK.,Tees Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | - Lina Gega
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Paul Alexander Tiffin
- Department of Health Sciences & the Hull York Medical School, University of York, York, North Yorkshire, UK.,Tees Esk and Wear Valleys NHS Foundation Trust, Teesside, UK
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26
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Gellatly J, Bee P, Kolade A, Hunter D, Gega L, Callender C, Hope H, Abel KM. Developing an Intervention to Improve the Health Related Quality of Life in Children and Young People With Serious Parental Mental Illness. Front Psychiatry 2019; 10:155. [PMID: 31024349 PMCID: PMC6465622 DOI: 10.3389/fpsyt.2019.00155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/04/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: Children and adolescents living with parental mental illness (CAPRI) are at increased risk of behavioral, social and educational difficulties, mental and physical health problems and have poorer quality of life (QoL). Adverse outcomes can extend into adulthood but are not inevitable. Recent policy and stakeholder consultation recognize the urgent need for interventions that extend beyond objective, service-led measures of health. Systematic evidence synthesis has demonstrated a lack of evidence-based interventions for enhancing holistic, child-centered outcomes. We aimed to co-develop a manualised, community-based intervention to improve QoL in CAPRI. Precedence was given to the QoL domains that were prioritized by stakeholders and deemed feasible to modify within a health and social care context. We describe here the modeling phase of developing the intervention emphasizing co-production activities with CAPRI, their families and professionals who support them. Methods: Semi-structured interviews and focus groups with CAPRI (n = 14), parents (n = 7), and professionals from health, social and educational sectors (n = 31) in the UK. Topic guides qualitatively explored participants prior experiences, unmet needs, perceived barriers and facilitators to receiving/delivering support, and their ideals for a new intervention. Findings were synthesized with existing research evidence and presented to a mixed panel of clinical academics and health and social care professionals. A consensus exercise was used to identify the preferred structure, format and content of the manualised intervention. Results: An 8-week group intervention for 6-16 year olds and their parents, called Young SMILES, has been co-developed along with associated training materials for facilitators. Each session addresses an identified need, but is underpinned by cross-cutting themes pertaining to mental health literacy, parent-child communication, and problem solving skills. Sessions are delivered by two trained facilitators and held in accessible and acceptable community locations weekly for 2 h. Conclusion: Young SMILES captures a broad age range and level of need for CAPRI and can be evaluated with quantifiable child-centered outcomes. In line with current policy directives, this is the first UK-based, multi-context intervention to improve QoL in this population. Implementation and referral mechanisms are currently being evaluated in a multi-site feasibility trial.
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Affiliation(s)
- Judith Gellatly
- Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Division of Nursing, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Penny Bee
- Division of Nursing, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Adekeye Kolade
- Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | | | - Lina Gega
- Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| | - Craig Callender
- St. Nicholas Hospital, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Holly Hope
- Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Kathryn M. Abel
- Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Aboujaoude E, Gega L. From Digital Mental Health Interventions to Digital "Addiction": Where the Two Fields Converge. Front Psychiatry 2019; 10:1017. [PMID: 32038336 PMCID: PMC6986463 DOI: 10.3389/fpsyt.2019.01017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/23/2019] [Indexed: 12/03/2022] Open
Abstract
Scientific literature from the last two decades indicates that, when it comes to mental health, technology is presented either as panacea or anathema. This is partly because researchers, too frequently, have planted themselves either in the field of digital mental health interventions (variably called "telepsychiatry", "digital therapeutics", "computerized therapy", etc.), or in that of the problems arising from technology, with little cross-fertilization between the two. Yet, a closer look at the two fields reveals unifying themes that underpin both the advantages and dangers of technology in mental health. This article discusses five such themes. First, the breakneck pace of technology evolution keeps digital mental health interventions updated and creates more potentially problematic activities, leaving researchers perennially behind, so new technologies become outdated by the time they are studied. Second, the freedom of creating and using technologies in a regulatory vacuum has led to proliferation and choice, but also to a Wild-West online environment. Third, technology is an open window to access information, but also to compromise privacy, with serious implications for online psychology and digital mental health interventions. Fourth, weak bonds characterize online interactions, including those between therapists and patients, contributing to high attrition from digital interventions. Finally, economic analyses of technology-enabled care may show good value for money, but often fail to capture the true costs of technology, a fact that is mirrored in other online activities. The article ends with a call for collaborations between two interrelated fields that have been-till now-mutually insular.
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Affiliation(s)
- Elias Aboujaoude
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Lina Gega
- Mental Health and Addiction Research Group, Department of Health Sciences & Hull York Medical School, University of York, York, United Kingdom
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28
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Turkington D, Gega L, Lebert L, Douglas-Bailey M, Rustom N, Alberti M, Deighton S, Naeem F. A training model for relatives and friends in cognitive behaviour therapy (CBT) informed care for psychosis. Cogent Psychology 2018. [DOI: 10.1080/23311908.2018.1497749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Douglas Turkington
- Northumberland, Tyne & Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle-upon-Tyne, UK
| | - Lina Gega
- Department of Health Sciences & Hull York Medical School, University of York, Alcuin Research Resource Centre, York, Heslington, UK
| | - Latoyah Lebert
- Northumberland, Tyne & Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle-upon-Tyne, UK
| | - Maggie Douglas-Bailey
- Northumberland, Tyne & Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle-upon-Tyne, UK
| | | | - Mary Alberti
- Schizophrenia Society of Ontario, Toronto, Canada
| | | | - Farooq Naeem
- Department of Psychiatry, Queen’s University, Kingston, Canada
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29
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Gellatly J, Bee P, Gega L, Bower P, Hunter D, Stewart P, Stanley N, Calam R, Holt K, Wolpert M, Douglas S, Green J, Kolade A, Callender C, Abel KM. A community-based intervention (Young SMILES) to improve the health-related quality of life of children and young people of parents with serious mental illness: randomised feasibility protocol. Trials 2018; 19:550. [PMID: 30314509 PMCID: PMC6186077 DOI: 10.1186/s13063-018-2935-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/24/2018] [Indexed: 11/22/2022] Open
Abstract
Background Children and young people of parents with mental illness (COPMI) are at risk of poor mental, physical and emotional health, which can persist into adulthood. They also experience poorer social outcomes and wellbeing as well as poorer quality of life than their peers with ‘healthy’ parents. The needs of COPMI are likely to be significant; however, their prevalence is unknown, although estimates suggest over 60% of adults with a serious mental illness have children. Many receive little or no support and remain ‘hidden’, stigmatised or do not regard themselves as ‘in need’. Recent UK policies have identified supporting COPMI as a key priority, but this alone is insufficient and health-related quality of life has been neglected as an outcome. Methods/design An age-appropriate standardised intervention for COPMI, called Young SMILES, was developed in collaboration with service users, National Health Service (NHS) and non-NHS stakeholders in our previous work. This protocol describes a randomised feasibility trial comparing Young SMILES with usual care, involving 60 families that will be identified through third sector organisations and NHS services, and recruited and randomised on a 1:1 basis to receive Young SMILES or usual care. Outcomes of the feasibility trial are rates of recruitment, follow-up and withdrawals, intervention uptake, and engagement. The optimal child-reported outcomes will also be determined alongside the assessment of resource use. A qualitative evaluation conducted at 3-months will explore the experiences and views of children and young people as well as parents accessing the intervention and the facilitators delivering the intervention. Discussion This paper details the rationale, design, training and recruitment methods for a feasibility study to inform the design and effective implementation of a larger scale randomised controlled trial of Young SMILES. Trial Registration ISRCTN36865046, registered 18 December 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2935-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Judith Gellatly
- Centre for Mental Health and Safety and Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. .,Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Lina Gega
- Department of Health Sciences, University of York, York, UK
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | | | | | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Rachel Calam
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Kim Holt
- Department of Social Work, Education & Community Wellbeing, Northumbria University, Newcastle, UK
| | | | - Simon Douglas
- Research and Development, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Newcastle upon Tyne, UK
| | - Jonathan Green
- School of Biological Sciences, Division of Neuroscience & Experimental Psychology, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Adekeye Kolade
- Centre for Mental Health and Safety and Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Craig Callender
- Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Newcastle upon Tyne, UK
| | - Kathryn M Abel
- Centre for Mental Health and Safety and Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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30
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Wright BD, Cooper C, Scott AJ, Tindall L, Ali S, Bee P, Biggs K, Breckman T, Davis Iii TE, Gega L, Hargate RJ, Lee E, Lovell K, Marshall D, McMillan D, Teare MD, Wilson J. Clinical and cost-effectiveness of one-session treatment (OST) versus multisession cognitive-behavioural therapy (CBT) for specific phobias in children: protocol for a non-inferiority randomised controlled trial. BMJ Open 2018; 8:e025031. [PMID: 30121618 PMCID: PMC6104754 DOI: 10.1136/bmjopen-2018-025031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Specific phobias (intense, enduring fears of an object or situation that lead to avoidance and severe distress) are highly prevalent among children and young people. Cognitive-behavioural therapy (CBT) is a well-established, effective intervention, but it can be time consuming and costly because it is routinely delivered over multiple sessions during several months. Alternative methods of treating severe and debilitating phobias in children are needed, like one-session treatment (OST), to reduce time and cost, and to prevent therapeutic drift and help children recover quickly. Our study explores whether (1) outcomes with OST are 'no worse' than outcomes with multisession CBT, (2) OST is acceptable to children, their parents and the practitioners who use it and (3) OST offers good value for money to the National Health Service (NHS) and to society. METHOD A pragmatic, non-inferiority, randomised controlled trial will compare OST with multisession CBT-based therapy on their clinical and cost-effectiveness. The primary clinical outcome is a standardised behavioural task of approaching the feared stimulus at 6 months postrandomisation. The outcomes for the within-trial cost-effectiveness analysis are quality-adjusted life years based on EQ-5D-Y, and individual-level costs based of the intervention and use of health and social service care. A nested qualitative evaluation will explore children's, parents' and practitioners' perceptions and experiences of OST. A total of 286 children, 7-16 years old, with DSM-IV diagnoses of specific phobia will be recruited via gatekeepers in the NHS, schools and voluntary youth services, and via public adverts. ETHICS AND DISSEMINATION The trial received ethical approval from North East and York Research Ethics Committee (Reference: 17/NE/0012). Dissemination plans include publications in peer-reviewed journals, presentations in relevant research conferences, local research symposia and seminars for children and their families, and for professionals and service managers. TRIAL REGISTRATION NUMBER ISRCTN19883421;Pre-results.
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Affiliation(s)
- Barry D Wright
- Child Oriented Mental Health Intervention Centre, IT Centre, Innovation Way, York, UK
| | - Cindy Cooper
- ScHARR, The University of Sheffield, Sheffield, UK
| | | | - Lucy Tindall
- Child Oriented Mental Health Intervention Centre, IT Centre, Innovation Way, York, UK
| | - Shehzad Ali
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Katie Biggs
- ScHARR, The University of Sheffield, Sheffield, UK
| | | | - Thompson E Davis Iii
- Psychological Services Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Lina Gega
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Rebecca Julie Hargate
- Child Oriented Mental Health Intervention Centre, IT Centre, Innovation Way, York, UK
| | - Ellen Lee
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Dean McMillan
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - M Dawn Teare
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Jonathan Wilson
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
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Lovell K, Bower P, Gellatly J, Byford S, Bee P, McMillan D, Arundel C, Gilbody S, Gega L, Hardy G, Reynolds S, Barkham M, Mottram P, Lidbetter N, Pedley R, Molle J, Peckham E, Knopp-Hoffer J, Price O, Connell J, Heslin M, Foley C, Plummer F, Roberts C. Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive-compulsive disorder: the Obsessive-Compulsive Treatment Efficacy randomised controlled Trial (OCTET). Health Technol Assess 2018; 21:1-132. [PMID: 28681717 DOI: 10.3310/hta21370] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Obsessive-Compulsive Treatment Efficacy randomised controlled Trial emerged from a research recommendation in National Institute for Health and Care Excellence obsessive-compulsive disorder (OCD) guidelines, which specified the need to evaluate cognitive-behavioural therapy (CBT) treatment intensity formats. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of two low-intensity CBT interventions [supported computerised cognitive-behavioural therapy (cCBT) and guided self-help]: (1) compared with waiting list for high-intensity CBT in adults with OCD at 3 months; and (2) plus high-intensity CBT compared with waiting list plus high-intensity CBT in adults with OCD at 12 months. To determine patient and professional acceptability of low-intensity CBT interventions. DESIGN A three-arm, multicentre, randomised controlled trial. SETTING Improving Access to Psychological Therapies services and primary/secondary care mental health services in 15 NHS trusts. PARTICIPANTS Patients aged ≥ 18 years meeting Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for OCD, on a waiting list for high-intensity CBT and scoring ≥ 16 on the Yale-Brown Obsessive Compulsive Scale (indicative of at least moderate severity OCD) and able to read English. INTERVENTIONS Participants were randomised to (1) supported cCBT, (2) guided self-help or (3) a waiting list for high-intensity CBT. MAIN OUTCOME MEASURES The primary outcome was OCD symptoms using the Yale-Brown Obsessive Compulsive Scale - Observer Rated. RESULTS Patients were recruited from 14 NHS trusts between February 2011 and May 2014. Follow-up data collection was complete by May 2015. There were 475 patients randomised: supported cCBT (n = 158); guided self-help (n = 158) and waiting list for high-intensity CBT (n = 159). Two patients were excluded post randomisation (one supported cCBT and one waiting list for high-intensity CBT); therefore, data were analysed for 473 patients. In the short term, prior to accessing high-intensity CBT, guided self-help demonstrated statistically significant benefits over waiting list, but these benefits did not meet the prespecified criterion for clinical significance [adjusted mean difference -1.91, 95% confidence interval (CI) -3.27 to -0.55; p = 0.006]. Supported cCBT did not demonstrate any significant benefit (adjusted mean difference -0.71, 95% CI -2.12 to 0.70). In the longer term, access to guided self-help and supported cCBT, prior to high-intensity CBT, did not lead to differences in outcomes compared with access to high-intensity CBT alone. Access to guided self-help and supported cCBT led to significant reductions in the uptake of high-intensity CBT; this did not seem to compromise patient outcomes at 12 months. Taking a decision-making approach, which focuses on which decision has a higher probability of being cost-effective, rather than the statistical significance of the results, there was little evidence that supported cCBT and guided self-help are cost-effective at the 3-month follow-up compared with a waiting list. However, by the 12-month follow-up, data suggested a greater probability of guided self-help being cost-effective than a waiting list from the health- and social-care perspective (60%) and the societal perspective (80%), and of supported cCBT being cost-effective compared with a waiting list from both perspectives (70%). Qualitative interviews found that guided self-help was more acceptable to patients than supported cCBT. Professionals acknowledged the advantages of low intensity interventions at a population level. No adverse events occurred during the trial that were deemed to be suspected or unexpected serious events. LIMITATIONS A significant issue in the interpretation of the results concerns the high level of access to high-intensity CBT during the waiting list period. CONCLUSIONS Although low-intensity interventions are not associated with clinically significant improvements in OCD symptoms, economic analysis over 12 months suggests that low-intensity interventions are cost-effective and may have an important role in OCD care pathways. Further research to enhance the clinical effectiveness of these interventions may be warranted, alongside research on how best to incorporate them into care pathways. TRIAL REGISTRATION Current Controlled Trials ISRCTN73535163. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Peter Bower
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Judith Gellatly
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
| | | | - Simon Gilbody
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
| | - Lina Gega
- Social Work and Communities, Northumbria University, Newcastle, UK
| | - Gillian Hardy
- Department of Psychology, University of Sheffield, Sheffield, UK
| | | | - Michael Barkham
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Patricia Mottram
- Cheshire & Wirral Partnership, NHS Foundation Trust, Wallasey, UK
| | | | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Jo Molle
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | | | - Owen Price
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Janice Connell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Margaret Heslin
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christopher Foley
- Centre for Biostatistics in the Institute of Population Health, University of Manchester, Manchester, UK
| | - Faye Plummer
- Department of Health Sciences, University of York, York, UK
| | - Christopher Roberts
- Centre for Biostatistics in the Institute of Population Health, University of Manchester, Manchester, UK
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Rathod S, Gega L, Degnan A, Pikard J, Khan T, Husain N, Munshi T, Naeem F. The current status of culturally adapted mental health interventions: a practice-focused review of meta-analyses. Neuropsychiatr Dis Treat 2018; 14:165-178. [PMID: 29379289 PMCID: PMC5757988 DOI: 10.2147/ndt.s138430] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In recent years, there has been a steadily increasing recognition of the need to improve the cultural competence of services and cultural adaptation of interventions so that every individual can benefit from evidence-based care. There have been attempts at culturally adapting evidence-based interventions for mental health problems, and a few meta-analyses have been published in this area. This is, however, a much debated subject. Furthermore, there is a lack of a comprehensive review of meta-analyses and literature reviews that provide guidance to policy makers and clinicians. This review summarizes the current meta-analysis literature on culturally adapted interventions for mental health disorders to provide a succinct account of the current state of knowledge in this area, limitations, and guidance for the future research.
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Affiliation(s)
| | - Lina Gega
- Department of Health Sciences, University of York, York, UK
| | - Amy Degnan
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Jennifer Pikard
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Tasneem Khan
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Tariq Munshi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Farooq Naeem
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
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Lovell K, Bower P, Gellatly J, Byford S, Bee P, McMillan D, Arundel C, Gilbody S, Gega L, Hardy G, Reynolds S, Barkham M, Mottram P, Lidbetter N, Pedley R, Molle J, Peckham E, Knopp-Hoffer J, Price O, Connell J, Heslin M, Foley C, Plummer F, Roberts C. Low-intensity cognitive-behaviour therapy interventions for obsessive-compulsive disorder compared to waiting list for therapist-led cognitive-behaviour therapy: 3-arm randomised controlled trial of clinical effectiveness. PLoS Med 2017; 14:e1002337. [PMID: 28654682 PMCID: PMC5486961 DOI: 10.1371/journal.pmed.1002337] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/26/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is prevalent and without adequate treatment usually follows a chronic course. "High-intensity" cognitive-behaviour therapy (CBT) from a specialist therapist is current "best practice." However, access is difficult because of limited numbers of therapists and because of the disabling effects of OCD symptoms. There is a potential role for "low-intensity" interventions as part of a stepped care model. Low-intensity interventions (written or web-based materials with limited therapist support) can be provided remotely, which has the potential to increase access. However, current evidence concerning low-intensity interventions is insufficient. We aimed to determine the clinical effectiveness of 2 forms of low-intensity CBT prior to high-intensity CBT, in adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for OCD. METHODS AND FINDINGS This study was approved by the National Research Ethics Service Committee North West-Lancaster (reference number 11/NW/0276). All participants provided informed consent to take part in the trial. We conducted a 3-arm, multicentre randomised controlled trial in primary- and secondary-care United Kingdom mental health services. All patients were on a waiting list for therapist-led CBT (treatment as usual). Four hundred and seventy-three eligible patients were recruited and randomised. Patients had a median age of 33 years, and 60% were female. The majority were experiencing severe OCD. Patients received 1 of 2 low-intensity interventions: computerised CBT (cCBT; web-based CBT materials and limited telephone support) through "OCFighter" or guided self-help (written CBT materials with limited telephone or face-to-face support). Primary comparisons concerned OCD symptoms, measured using the Yale-Brown Obsessive Compulsive Scale-Observer-Rated (Y-BOCS-OR) at 3, 6, and 12 months. Secondary outcomes included health-related quality of life, depression, anxiety, and functioning. At 3 months, guided self-help demonstrated modest benefits over the waiting list in reducing OCD symptoms (adjusted mean difference = -1.91, 95% CI -3.27 to -0.55). These effects did not reach a prespecified level of "clinically significant benefit." cCBT did not demonstrate significant benefit (adjusted mean difference = -0.71, 95% CI -2.12 to 0.70). At 12 months, neither guided self-help nor cCBT led to differences in OCD symptoms. Early access to low-intensity interventions led to significant reductions in uptake of high-intensity CBT over 12 months; 86% of the patients allocated to the waiting list for high-intensity CBT started treatment by the end of the trial, compared to 62% in supported cCBT and 57% in guided self-help. These reductions did not compromise longer-term patient outcomes. Data suggested small differences in satisfaction at 3 months, with patients more satisfied with guided self-help than supported cCBT. A significant issue in the interpretation of the results concerns the level of access to high-intensity CBT before the primary outcome assessment. CONCLUSIONS We have demonstrated that providing low-intensity interventions does not lead to clinically significant benefits but may reduce uptake of therapist-led CBT. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN) Registry ISRCTN73535163.
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Affiliation(s)
- Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- * E-mail:
| | - Peter Bower
- NIHR School for Primary Care Research, University of Manchester, Manchester, United Kingdom
| | - Judith Gellatly
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Dean McMillan
- Hull York Medical School & Department of Health Sciences, University of York, York, United Kingdom
| | - Catherine Arundel
- Department of Health Sciences, University of York, York, United Kingdom
| | - Simon Gilbody
- Hull York Medical School & Department of Health Sciences, University of York, York, United Kingdom
| | - Lina Gega
- Hull York Medical School & Department of Health Sciences, University of York, York, United Kingdom
| | - Gillian Hardy
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Shirley Reynolds
- School of Psychology, University of Reading, Reading, United Kingdom
| | - Michael Barkham
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Patricia Mottram
- Cheshire & Wirral Partnership, NHS Foundation Trust, Wallasey, United Kingdom
| | | | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jo Molle
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Emily Peckham
- Department of Health Sciences, University of York, York, United Kingdom
| | - Jasmin Knopp-Hoffer
- NIHR School for Primary Care Research, University of Manchester, Manchester, United Kingdom
| | - Owen Price
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Janice Connell
- ScHARR, University of Sheffield, Sheffield, United Kingdom
| | - Margaret Heslin
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Christopher Foley
- Department of Public Health & Primary Care, Cambridge University, Cambridge, United Kingdom
| | - Faye Plummer
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Christopher Roberts
- Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
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Abstract
Virtual reality can be more effective and less burdensome than real-life exposure. Optimal virtual reality delivery should incorporate in situ direct dialogues with a therapist, discourage safety behaviours, allow for a mismatch between virtual and real exposure tasks, and encourage self-directed real-life practice between and beyond virtual reality sessions.
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Affiliation(s)
- Lina Gega
- Lina Gega, PhD, RMN, EMB650, Reader in Mental Health, Mental Health and Addiction Research Group (MHARG), Department of Health Sciences & Hull York Medical School, University of York, Alcuin Research Resource Centre, Heslington, York YO10 5DD, UK.
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Rathod S, Pinninti N, Irfan M, Gorczynski P, Rathod P, Gega L, Naeem F. Mental Health Service Provision in Low- and Middle-Income Countries. Health Serv Insights 2017; 10:1178632917694350. [PMID: 28469456 PMCID: PMC5398308 DOI: 10.1177/1178632917694350] [Citation(s) in RCA: 253] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/27/2017] [Indexed: 11/16/2022] Open
Abstract
This article discusses the provision of mental health services in low- and middle-income countries (LMICs) with a view to understanding the cultural dynamics-how the challenges they pose can be addressed and the opportunities harnessed in specific cultural contexts. The article highlights the need for prioritisation of mental health services by incorporating local population and cultural needs. This can be achieved only through political will and strengthened legislation, improved resource allocation and strategic organisation, integrated packages of care underpinned by professional communication and training, and involvement of patients, informal carers, and the wider community in a therapeutic capacity.
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Affiliation(s)
- Shanaya Rathod
- Clinical Trials Facility, Southern Health NHS Foundation Trust, Southampton, UK
| | - Narsimha Pinninti
- School of Osteopathic Medicine, Rowan University and Oaks Integrated Care, Stratford, NJ, USA
| | - Muhammed Irfan
- Department of Mental Health, Psychiatry & Behavioral Sciences, Peshawar Medical College, Peshawar, Pakistan
| | - Paul Gorczynski
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Pranay Rathod
- Department of Economics, The London School of Economics and Political Science, London, UK
| | - Lina Gega
- Department of Health Sciences and Hull York Medical School, University of York, York, UK
| | - Farooq Naeem
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
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Vereenooghe L, Reynolds S, Gega L, Langdon PE. Can a computerised training paradigm assist people with intellectual disabilities to learn cognitive mediation skills? A randomised experiment. Behav Res Ther 2015; 71:10-9. [PMID: 26004217 DOI: 10.1016/j.brat.2015.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 11/28/2022]
Abstract
AIMS The aim was to examine whether specific skills required for cognitive behavioural therapy (CBT) could be taught using a computerised training paradigm with people who have intellectual disabilities (IDs). Training aimed to improve: a) ability to link pairs of situations and mediating beliefs to emotions, and b) ability to link pairs of situations and emotions to mediating beliefs. METHOD Using a single-blind mixed experimental design, sixty-five participants with IDs were randomised to receive either computerised training or an attention-control condition. Cognitive mediation skills were assessed before and after training. RESULTS Participants who received training were significantly better at selecting appropriate emotions within situation-beliefs pairs, controlling for baseline scores and IQ. Despite significant improvements in the ability of those who received training to correctly select intermediating beliefs for situation-feelings pairings, no between-group differences were observed at post-test. CONCLUSIONS The findings indicated that computerised training led to a significant improvement in some aspects of cognitive mediation for people with IDs, but whether this has a positive effect upon outcome from therapy is yet to be established.
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Affiliation(s)
- Leen Vereenooghe
- Department of Psychological Sciences, Norwich Medical School, University of East Anglia, UK
| | | | | | - Peter E Langdon
- Tizard Centre, University of Kent, UK; Broadland Clinic, Hertfordshire Partnership University NHS Foundation Trust, Norfolk, UK
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Gellatly J, Bower P, McMillan D, Roberts C, Byford S, Bee P, Gilbody S, Arundel C, Hardy G, Barkham M, Reynolds S, Gega L, Mottram P, Lidbetter N, Pedley R, Peckham E, Connell J, Molle J, O’Leary N, Lovell K. Obsessive Compulsive Treatment Efficacy Trial (OCTET) comparing the clinical and cost effectiveness of self-managed therapies: study protocol for a randomised controlled trial. Trials 2014; 15:278. [PMID: 25011730 PMCID: PMC4226946 DOI: 10.1186/1745-6215-15-278] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/01/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND UK National Institute of Health and Clinical Excellence guidelines for obsessive compulsive disorder (OCD) specify recommendations for the treatment and management of OCD using a stepped care approach. Steps three to six of this model recommend treatment options for people with OCD that range from low-intensity guided self-help (GSH) to more intensive psychological and pharmacological interventions. Cognitive behavioural therapy (CBT), including exposure and response prevention, is the recommended psychological treatment. However, whilst there is some preliminary evidence that self-managed therapy packages for OCD can be effective, a more robust evidence base of their clinical and cost effectiveness and acceptability is required. METHODS/DESIGN Our proposed study will test two different self-help treatments for OCD: 1) computerised CBT (cCBT) using OCFighter, an internet-delivered OCD treatment package; and 2) GSH using a book. Both treatments will be accompanied by email or telephone support from a mental health professional. We will evaluate the effectiveness, cost and patient and health professional acceptability of the treatments. DISCUSSION This study will provide more robust evidence of efficacy, cost effectiveness and acceptability of self-help treatments for OCD. If cCBT and/or GSH prove effective, it will provide additional, more accessible treatment options for people with OCD. TRIAL REGISTRATION Current Controlled Trials: ISRCTN73535163. Date of registration: 5 April 2011.
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Affiliation(s)
- Judith Gellatly
- School of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, UK
| | - Peter Bower
- Centre for Primary Care, The University of Manchester, Manchester, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - Christopher Roberts
- School of Epidemiology and Health Sciences, The University of Manchester, Manchester, UK
| | - Sarah Byford
- Department of Health Sciences, University of York, York, UK
| | - Penny Bee
- School of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | | | - Gillian Hardy
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Michael Barkham
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Lina Gega
- Insight Healthcare, Newcastle Upon Tyne, UK
| | - Patricia Mottram
- Cheshire and Wirral Partnership NHS Foundation Trust, Wallasey, UK
| | | | - Rebecca Pedley
- School of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | | | - Jo Molle
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Neil O’Leary
- School of Epidemiology and Health Sciences, The University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, UK
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Mobini S, Mackintosh B, Illingworth J, Gega L, Langdon P, Hoppitt L. Effects of standard and explicit cognitive bias modification and computer-administered cognitive-behaviour therapy on cognitive biases and social anxiety. J Behav Ther Exp Psychiatry 2014; 45:272-9. [PMID: 24412966 PMCID: PMC3989036 DOI: 10.1016/j.jbtep.2013.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 12/15/2013] [Accepted: 12/18/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES This study examines the effects of a single session of Cognitive Bias Modification to induce positive Interpretative bias (CBM-I) using standard or explicit instructions and an analogue of computer-administered CBT (c-CBT) program on modifying cognitive biases and social anxiety. METHODS A sample of 76 volunteers with social anxiety attended a research site. At both pre- and post-test, participants completed two computer-administered tests of interpretative and attentional biases and a self-report measure of social anxiety. Participants in the training conditions completed a single session of either standard or explicit CBM-I positive training and a c-CBT program. Participants in the Control (no training) condition completed a CBM-I neutral task matched the active CBM-I intervention in format and duration but did not encourage positive disambiguation of socially ambiguous or threatening scenarios. RESULTS Participants in both CBM-I programs (either standard or explicit instructions) and the c-CBT condition exhibited more positive interpretations of ambiguous social scenarios at post-test and one-week follow-up as compared to the Control condition. Moreover, the results showed that CBM-I and c-CBT, to some extent, changed negative attention biases in a positive direction. Furthermore, the results showed that both CBM-I training conditions and c-CBT reduced social anxiety symptoms at one-week follow-up. LIMITATIONS This study used a single session of CBM-I training, however multi-sessions intervention might result in more endurable positive CBM-I changes. CONCLUSIONS A computerised single session of CBM-I and an analogue of c-CBT program reduced negative interpretative biases and social anxiety.
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Affiliation(s)
- Sirous Mobini
- School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Bundy Mackintosh
- Department of Psychological Sciences, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Jo Illingworth
- School of Social Work and Psychology, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Lina Gega
- Department of Psychological Sciences, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Peter Langdon
- Department of Psychological Sciences, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Laura Hoppitt
- School of Social Work and Psychology, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
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Gega L, White R, Clarke T, Turner R, Fowler D. Virtual environments using video capture for social phobia with psychosis. Cyberpsychol Behav Soc Netw 2013; 16:473-9. [PMID: 23659722 DOI: 10.1089/cyber.2013.1510] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A novel virtual environment (VE) system was developed and used as an adjunct to cognitive behavior therapy (CBT) with six socially anxious patients recovering from psychosis. The novel aspect of the VE system is that it uses video capture so the patients can see a life-size projection of themselves interacting with a specially scripted and digitally edited filmed environment played in real time on a screen in front of them. Within-session process outcomes (subjective units of distress and belief ratings on individual behavioral experiments), as well as patient feedback, generated the hypothesis that this type of virtual environment can potentially add value to CBT by helping patients understand the role of avoidance and safety behaviors in the maintenance of social anxiety and paranoia and by boosting their confidence to carry out "real-life" behavioral experiments.
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Affiliation(s)
- Lina Gega
- MHCO Northumberland Talking Therapies (IAPT), Newcastle-Upon-Tyne, United Kingdom.
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Gega L, Smith J, Reynolds S. Cognitive behaviour therapy (CBT) for depression by computer vs. therapist: patient experiences and therapeutic processes. Psychother Res 2013; 23:218-31. [PMID: 23390994 DOI: 10.1080/10503307.2013.766941] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Abstract This case series compares patient experiences and therapeutic processes between two modalities of cognitive behaviour therapy (CBT) for depression: computerized CBT (cCBT) and therapist-delivered CBT (tCBT). In a mixed-methods repeated-measures case series, six participants were offered cCBT and tCBT in sequence, with the order of delivery randomized across participants. Questionnaires about patient experiences were administered after each session and a semi-structured interview was completed with each participant at the end of each therapy modality. Therapy expectations, patient experiences and session impact ratings in this study generally favoured tCBT. Participants typically experienced cCBT sessions as less meaningful, less positive and less helpful compared to tCBT sessions in terms of developing understanding, facilitating problem-solving and building a therapeutic relationship.
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Affiliation(s)
- Lina Gega
- Norwich Medical School, University of East Anglia, Norwich, UK.
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Gega L, Swift L, Barton G, Todd G, Reeve N, Bird K, Holland R, Howe A, Wilson J, Molle J. Computerised therapy for depression with clinician vs. assistant and brief vs. extended phone support: study protocol for a randomised controlled trial. Trials 2012; 13:151. [PMID: 22925596 PMCID: PMC3495903 DOI: 10.1186/1745-6215-13-151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/31/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Computerised cognitive behaviour therapy (cCBT) involves standardised, automated, interactive self-help programmes delivered via a computer. Randomised controlled trials (RCTs) and observational studies have shown than cCBT reduces depressive symptoms as much as face-to-face therapy and more than waiting lists or treatment as usual. cCBT's efficacy and acceptability may be influenced by the "human" support offered as an adjunct to it, which can vary in duration and can be offered by people with different levels of training and expertise. METHODS/DESIGN This is a two-by-two factorial RCT investigating the effectiveness, cost-effectiveness and acceptability of cCBT supplemented with 12 weekly phone support sessions are either brief (5-10 min) or extended (20-30 min) and are offered by either an expert clinician or an assistant with no clinical training. Adults with non-suicidal depression in primary care can self-refer into the study by completing and posting to the research team a standardised questionnaire. Following an assessment interview, eligible referrals have access to an 8-session cCBT programme called Beating the Blues and are randomised to one of four types of support: brief-assistant, extended-assistant, brief-clinician or extended-clinician.A sample size of 35 per group (total 140) is sufficient to detect a moderate effect size with 90% power on our primary outcome measure (Work and Social Adjustment Scale); assuming a 30% attrition rate, 200 patients will be randomised. Secondary outcome measures include the Beck Depression and Anxiety Inventories and the PHQ-9 and GAD-7. Data on clinical outcomes, treatment usage and patient experiences are collected in three ways: by post via self-report questionnaires at week 0 (randomisation) and at weeks 12 and 24 post-randomisation; electronically by the cCBT system every time patients log-in; by phone during assessments, support sessions and exit interviews. DISCUSSION The study's factorial design increases its efficiency by allowing the concurrent investigation of two types of adjunct support for cCBT with a single sample of participants. Difficulties in recruitment, uptake and retention of participants are anticipated because of the nature of the targeted clinical problem (depression impairs motivation) and of the studied interventions (lack of face-to-face contact because referrals, assessments, interventions and data collection are completed by phone, computer or post). TRIAL REGISTRATION Current Controlled Trials ISRCTN98677176.
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Affiliation(s)
- Lina Gega
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Louise Swift
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Gillian Todd
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Norfolk & Suffolk NHS Foundation Trust (NSFT), Hellesdon Hospital, Norwich NR6 5BE, UK
| | - Nesta Reeve
- Norfolk & Suffolk NHS Foundation Trust (NSFT), Hellesdon Hospital, Norwich NR6 5BE, UK
| | - Kelly Bird
- Norfolk & Suffolk NHS Foundation Trust (NSFT), Hellesdon Hospital, Norwich NR6 5BE, UK
| | - Richard Holland
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Amanda Howe
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- NHS Norfolk, Lakeside 400, Old Chapel Way, Broadland Business Park, Norwich NR7 OWG, UK
| | - Jon Wilson
- Norfolk & Suffolk NHS Foundation Trust (NSFT), Hellesdon Hospital, Norwich NR6 5BE, UK
| | - Jo Molle
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Norfolk & Suffolk NHS Foundation Trust (NSFT), Hellesdon Hospital, Norwich NR6 5BE, UK
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Giora A, Gega L, Landau S, Marks I. Adult Recall of Having Been Bullied in Attenders of an Anxiety Disorder Unit and Attenders of a Dental Clinic: A Pilot Controlled Study. Behav change 2012. [DOI: 10.1375/bech.22.1.44.66785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractLittle is known about the prevalence of having been bullied in adults with versus adults without an anxiety disorder, so a pilot comparison was undertaken. A questionnaire on recall of having been bullied was completed by 81 attenders of a behavioural psychotherapy unit for anxiety disorders and by 81 attenders of a dental clinic who had no psychiatric problems but who were similar to the anxiety disorder group in gender, marital and employment characteristics. Recall of being bullied was significantly more common in the anxiety disorder referrals than in the dental patients. Results warrant testing of whether being bullied as a child increases the likelihood of developing an anxiety disorder in later life, controlling for demographic, personality and ethnic variables.
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Marks IM, Gega L. Review by Jeroen Ruwaard and Alfred Lange (Cognitive Behaviour Therapy, 2009, 38(2), p. 132) of Hands-on-Help: Computer-Aided Psychotherapy (Maudsley Monograph 49) by I. M. Marks, K. Cavanagh, and L. Gega. New York: Psychology Press 2007. Letter to the editors. Cogn Behav Ther 2010; 38:192. [PMID: 20183693 DOI: 10.1080/16506070903162889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cuijpers P, Marks IM, van Straten A, Cavanagh K, Gega L, Andersson G. Computer-aided psychotherapy for anxiety disorders: a meta-analytic review. Cogn Behav Ther 2010; 38:66-82. [PMID: 20183688 DOI: 10.1080/16506070802694776] [Citation(s) in RCA: 285] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Computer-aided psychotherapy (CP) is said to (1) be as effective as face-to-face psychotherapy, while requiring less therapist time, for anxiety disorder sufferers, (2) speed access to care, and (3) save traveling time. CP may be delivered on stand-alone or Internet-linked computers, palmtop computers, phone-interactive voice response, DVDs, and cell phones. The authors performed a meta-analysis of 23 randomised controlled studies (RCTs) that compared CP with non-CP in anxiety disorders: phobias, n = 10; panic disorder/agoraphobia, n = 9; PTSD, n = 3; obsessive-compulsive disorder, n = 1. Overall mean effect size of CP compared with non-CP was 1.08 (95% confidence interval: 0.84-1.32). CP and face-to-face psychotherapy did not differ significantly from each other (13 comparisons, d = -0.06). Much caution is needed when interpreting the findings indicating that outcome was unrelated to type of disorder, type of comparison group, mode of CP delivery (Internet, stand-alone PC, palmtop), and recency of the CP system and that effect size decreased when more therapist time was replaced by the computer. Because CP as a whole was as effective as face-to-face psychotherapy, certain forms of CP deserve to be integrated into routine practice.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, Amsterdam, The Netherlands.
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Marks IM, Cuijpers P, Cavanagh K, van Straten A, Gega L, Andersson G. Meta-analysis of computer-aided psychotherapy: problems and partial solutions. Cogn Behav Ther 2010; 38:83-90. [PMID: 20183689 DOI: 10.1080/16506070802675239] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Meta-analysis can be valuable if it heeds its originators' caution that intimate communing with the data is essential. A critique of the authors' own meta-analysis shows that the danger of overly broad conclusions could be reduced by attention to specificities and awareness of potentially hidden sources of variance. Conclusions from even good meta-analyses are best placed in perspective, along with naturalistic reviews, open studies, and even anecdotes to yield a fair picture of what computer-aided psychotherapy or any other treatment can achieve under varying conditions. The most realistic picture comes from zooming in and out and melding meta-analyses with further types of evidence.
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Affiliation(s)
- Isaac M Marks
- Institute of Psychiatry, King's College London, 43 Dulwich Common, London, UK.
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Abstract
Research into computer-aided psychotherapy is thriving around the world. Most of it concerns computer-aided cognitive-behavioural therapy (CCBT). A recent narrative review found 97 computer-aided psychotherapy systems from nine countries reported in 175 studies, of which 103 were randomised controlled trials. The rapid spread of the mass delivery of psychotherapy through CCBT, catalysed in the UK by the National Institute for Health and Clinical Excellence's recommendation of two CCBT programmes and the Department of Health's CCBT implementation guidance, seems unprecedented. This editorial is a synopsis of the current status of CCBT and its future directions.
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Mataix-Cols D, Cameron R, Gega L, Kenwright M, Marks IM. Effect of referral source on outcome with cognitive-behavior therapy self-help. Compr Psychiatry 2006; 47:241-5. [PMID: 16769296 DOI: 10.1016/j.comppsych.2005.11.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Revised: 08/09/2005] [Accepted: 11/17/2005] [Indexed: 11/20/2022] Open
Abstract
Little is known about how psychiatric patients' source of referral relates to treatment outcome. This study examines the effect of referral source on clinical outcome with computer-aided cognitive-behavior therapy (CCBT) for anxiety and depressive disorders. Three hundred fifty-five referrals to a clinic that offered CCBT with brief backup from a clinician were classified into general practitioner (GP) referrals (34%), mental health (MH) professional referrals (42%), and self-referrals (SR, 24%), and compared on sociodemographic and clinical features and treatment outcome. At intake, referrals from all 3 sources had similar sociodemographic features and problem duration, but GP referrals had less comorbidity, whereas MH professional referrals were being treated for their problem more often and were less motivated to change than were SR. Among treatment completers, SRs had the least and MH professional referrals had the most impaired work/social adjustment. Each referral group improved on generic and syndrome-specific measures; however, GP referrals improved the most and MH professional referrals the least. The 3 groups received similar therapist support and were equally satisfied after treatment. We conclude that GP referrals had the best outcome with CCBT for anxiety/depressive disorders. Referral source can be important in psychotherapy research because it may affect the type of patient seen and may predict treatment outcome.
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Affiliation(s)
- David Mataix-Cols
- Department of Psychological Medicine, Imperial College London, W6 8RP London, UK.
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Gega L, Norman IJ, Marks IM. Computer-aided vs. tutor-delivered teaching of exposure therapy for phobia/panic: randomized controlled trial with pre-registration nursing students. Int J Nurs Stud 2006; 44:397-405. [PMID: 16631177 DOI: 10.1016/j.ijnurstu.2006.02.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 02/21/2006] [Accepted: 02/22/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Exposure therapy is effective for phobic anxiety disorders (specific phobias, agoraphobia, social phobia) and panic disorder. Despite their high prevalence in the community, sufferers often get no treatment or if they do, it is usually after a long delay. This is largely due to the scarcity of healthcare professionals trained in exposure therapy, which is due, in part, to the high cost of training. Traditional teaching methods employed are labour intensive, being based mainly on role-play in small groups with feedback and coaching from experienced trainers. In an attempt to increase knowledge and skills in exposure therapy, there is now some interest in providing relevant teaching as part of pre-registration nurse education. Computers have been developed to teach terminology and simulate clinical scenarios for health professionals, and offer a potentially cost effective alternative to traditional teaching methods. OBJECTIVE To test whether student nurses would learn about exposure therapy for phobia/panic as well by computer-aided self-instruction as by face-to-face teaching, and to compare the individual and combined effects of two educational methods, traditional face-to-face teaching comprising a presentation with discussion and questions/answers by a specialist cognitive behaviour nurse therapist, and a computer-aided self-instructional programme based on a self-help programme for patients with phobia/panic called FearFighter, on students' knowledge, skills and satisfaction. DESIGN Randomised controlled trial, with a crossover, completed in 2 consecutive days over a period of 4h per day. PARTICIPANTS Ninety-two mental health pre-registration nursing students, of mixed gender, age and ethnic origin, with no previous training in cognitive behaviour therapy studying at one UK university. RESULTS The two teaching methods led to similar improvements in knowledge and skills, and to similar satisfaction, when used alone. Using them in tandem conferred no added benefit. Computer-aided self-instruction was more efficient as it saved teacher preparation and delivery time, and needed no specialist tutor. CONCLUSION Computer-aided self-instruction saved almost all preparation time and delivery effort for the expert teacher. When added to past results in medical students, the present results in nurses justify the use of computer-aided self-instruction for learning about exposure therapy and phobia/panic and of research into its value for other areas of health education.
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Affiliation(s)
- L Gega
- King's College London, Florence Nightingale School of Nursing & Midwifery, London, UK
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Abstract
The aim of this study was to test a questionnaire for screening people with anxiety/ depression for their suitability for certain forms of computer-guided self-help. A total of 196 referrals completed the screening questionnaire. Three clinicians each independently judged the referrals' broad problem type and suitability. Referrals were randomized to 1 of 3 clinicians for a screening interview. The results show that inter-clinician agreement was good for questionnaire-based problem type and suitability, and excellent for screening interview-based problem type and suitability. Agreement between the questionnaire and interview was good on problem type but poor on suitability. Compared with the screening interview, the questionnaire detected suitable patients well but unsuitable patients less well. In conclusion, by quickly scanning the completed questionnaire, clinicians were able sensitively to detect patients' problem types that were suitable for certain forms of self-help. Some unsuitability items need refining.
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Affiliation(s)
- Lina Gega
- School of Nursing and Midwifery, King's College, London, UK.
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Mataix-Cols D, Cowley AJ, Hankins M, Schneider A, Bachofen M, Kenwright M, Gega L, Cameron R, Marks IM. Reliability and validity of the work and social adjustment scale in phobic disorders. Compr Psychiatry 2005; 46:223-8. [PMID: 16021593 DOI: 10.1016/j.comppsych.2004.08.007] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The Work and Social Adjustment Scale (WSAS) is a simple widely used 5-item measure of disability whose psychometric properties need more analysis in phobic disorders. The reliability, factor structure, validity, and sensitivity to change of the WSAS were studied in 205 phobic patients (73 agoraphobia, 62 social phobia, and 70 specific phobia) who participated in various open and randomized trials of self-exposure therapy. Internal consistency of the WSAS was excellent in all phobics pooled and in agoraphobics and social phobics separately. Principal components analysis extracted a single general factor of disability. Specific phobics gave less consistent ratings across WSAS items, suggesting that some items were less relevant to their problem. Internal consistency was marginally higher for self-ratings than clinician ratings of the WSAS. Self-ratings and clinician ratings correlated highly though patients tended to rate themselves as more disabled than clinicians did. WSAS total scores reflected differences in phobic severity and improvement with treatment. The WSAS is a valid, reliable, and change-sensitive measure of work/social and other adjustment in phobic disorders, especially in agoraphobia and social phobia.
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