Additional Individual Sessions Research Articles

Evaluation of an online pilot ‘Complex trauma stabilisation’ group intervention in an adult mental health service

BackgroundComplex-PTSD causes distressing symptoms. NICE guidelines recommend a phased treatment approach, but there are often gaps within services providing psychological treatments for CPTSD. A pilot service in East Anglia aimed to fill gaps in current service provision. An online CPTSD group intervention was developed, focusing on phase one of trauma treatment: stabilisation. AimThis project aimed to evaluate the pilot online CPTSD stabilisation group intervention by exploring if group attendance was associated with changes in CPTSD symptoms, and to explore participant experiences. MethodParticipants attended a 12-session, two-hour, weekly group programme, held online via MS Teams. Three additional individual sessions were offered before, during and after the group. Sixty-six participants completed the programme; of whom 40 completed four pre-post outcome measures (DERS, PTCI, TMQQ, ITQ), and 25 completed an anonymous feedback survey. ResultsPaired t-tests comparing pre-post measure scores showed statistically significant differences across all measures, with medium effect sizes. Lower scores were seen after group completion, indicating the group was associated with reduced CPTSD symptoms. Participant feedback indicated most participants (83 %) expressed a preference for online delivery and 68 % found the intervention beneficial. Conclusions & implicationsAttendance of the pilot online CPTSD stabilisation group intervention was associated with symptom reduction and positive feedback. This appears to be the first online, mixed-gender CPTSD stabilisation group evaluation. Ultimately results are promising, though suggest further research is warranted to establish if such groups would provide an effective treatment for CTPSD and help reduce NHS waitlists. Service recommendations are discussed.

Patients' and Therapists' Experiences of Standardized Group Cognitive Behavioral Therapy: Needs for a Personalized Approach.

Personalizing psychotherapy can be challenging within standardized group Cognitive Behavioral Therapy (CBT), in which sessions are structured according to a protocol and must accommodate the needs and preferences of multiple patients. In the current study, we aimed to examine patients' and therapists' experiences of standardized group CBT and identify their perceptions of different patient needs. Furthermore, we explored how these needs can inform possible content of add-on interventions for patients who are not improving as expected during group CBT.We conducted 21 individual in-depth interviews with patients with depression and their therapists about their experiences during group CBT with Routine Outcome Monitoring (ROM) and feedback. Interviews were analyzed by using a hermeneutic-phenomenological thematic analysis. Five themes, representing different patient needs, were identified: (1) Individual attention, (2) Psychological exploration, (3) A focus on the patient's life outside of therapy, (4) Extended assessment, and (5) Agreement on therapeutic tasks.The study supports that "one size does not fit all" when it comes to psychotherapy. Patients have varying needs when they are not making progress in therapy, and these needs, when unmet, can negatively impact the overall experience of group CBT. By acknowledging the unique needs of each patient and providing additional individual sessions as necessary, we can move towards a more personalized approach that maximizes the benefits of group psychotherapy.

Study protocol: the pragmatic, exploratory DELTA-JU trial of the group-based multimodal DELTA intervention for abstinent adolescents with substance use disorders living in youth welfare institutions.

The DELTA intervention contains 16 weekly group sessions plus additional individual sessions and educational session for parents. It aims to reduce substance use and related problems such as substance use disorders (SUD) in adolescents. Recent results indicated positive effects in psychiatric outpatients. Conducting DELTA in youth welfare settings seems feasible, however, organizational and content adjustments such as smoking cessation elements should be added in order to reduce relapse risks and to prevent negative health consequences. The pre-registered DELTA-JU study (German Clinical Trials Register, DRKS00027913) is separated into three stages: In the adjustment stage during months 1-4, we will revise the DELTA manual based on semi-structured interviews (n = 10) with personnel from youth welfare institutions specialized in serving adolescents with SUD in the study region, analyzed with content analysis. In the sampling stage during months 5-22, participants qualifying for a SUD and willing to regularly participate in the 16 weekly DELTA-JU group sessions will be enrolled to either one of two arms (cluster randomization: immediate intervention, waitlist with subsequent intervention 16 weeks later). Adolescents will be assessed at baseline and follow-up (16 weeks after first group session) with an additional pre-assessment (16 weeks before intervention starts) for the waitlist group. Assessment procedures include questionnaires and clinical interviews among others. At the same time, institutional personnel will receive a 1-day workshop on SUD-relevant topics based on the DELTA parental education group and on feedback from the qualitative interviews. Personnel will also be assessed twice with questionnaires. In the dissemination stage during months 23-24, final study evaluation results will be prepared and submitted for publication. This study will create a setting-specific manual for vulnerable adolescents suffering from SUDs, and, in many cases, from co-occurring mental disorders. If shown to be effective, DELTA-JU can be disseminated within other institutions of youth welfare.

Rescripting Social Trauma: A Pilot Study Investigating Imagery Rescripting as an Adjunct to Cognitive Behaviour Therapy for Social Anxiety Disorder

The current pilot study aimed to investigate the benefit of imagery rescripting (IR) as an adjunct to Group Cognitive Behavioural Therapy (GCBT) for SAD, given recent research suggesting that IR is beneficial in the treatment of social anxiety disorder (SAD). Fifteen participants with SAD completed eight sessions of GCBT and two additional individual sessions of IR to address negative meanings embedded in memories of traumatic social experiences. As expected, participants reported significant reductions in fear of negative evaluation and identification of negative core beliefs as valid/accurate over the course of the two session IR intervention. Moreover, IR yielded significant improvements in negative affect and maladaptive appraisals associated with self-imagery and aversive memories, as well as depressive symptoms. However, unexpectedly, IR did not yield significant additive reductions in social anxiety symptoms over and above GCBT. Results indicate that IR appears to be a beneficial adjunct to GCBT, and lack of improvement in social anxiety symptoms across IR sessions may be due to methodological limitations. Outcomes suggest that IR may also benefit patients with comorbid depression, given high rates of comorbid unipolar depression for people with SAD, presenting an exciting area for further investigation. Taken together, findings suggest that IR may be a valuable adjunct to GCBT for SAD, especially among patients with comorbid unipolar depression. However, further research including a follow up period is indicated.

Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation.

fear of falling and reduced fall-related self-efficacy are frequent consequences of falls and associated with poorer rehabilitation outcomes. To address these psychological consequences, geriatric inpatient rehabilitation was augmented with a cognitive behavioural intervention ("Step by Step") and evaluated in a RCT. one hundred fifteen hip and pelvic fracture patients (age = 82.5years, 70% female) admitted to geriatric inpatient rehabilitation were randomly allocated to the intervention or control group. The intervention consisted of eight additional individual sessions during inpatient rehabilitation, one home visit and four telephone calls delivered over 2 months after discharge. Both groups received geriatric inpatient rehabilitation. Primary outcomes were fall-related self-efficacy (short falls efficacy scale-international) and physical activity as measured by daily walking duration (activPAL3™ sensor) after admission to rehabilitation, before discharge and 1-month post-intervention. in covariance analyses, patients in the intervention group showed a significant improvement in fall-related self-efficacy (P = 0.025, d = -0.42), but no difference in total daily walking duration (P = 0.688, d = 0.07) 1-month post-intervention compared to the control condition. Further significant effects in favour of the intervention group were found in the secondary outcomes "perceived ability to manage falls" (P = 0.031, d = 0.41), "physical performance" (short physical performance battery) (P = 0.002, d = 0.58) and a lower "number of falls" (P = 0.029, d = -0.45). the intervention improved psychological and physical performance measures but did not increase daily walking duration. For the inpatient part of the intervention further research on the required minimum intensity needed to be effective is of interest. Duration and components used to improve physical activity after discharge should be reconsidered.

A lifestyle intervention programme for the prevention of Type 2 diabetes mellitus among South Asian women with gestational diabetes mellitus [LIVING study]: protocol for a randomized trial

This study aims to determine whether a resource- and culturally appropriate lifestyle intervention programme in South Asian countries, provided to women with gestational diabetes (GDM) after childbirth, will reduce the incidence of worsening of glycaemic status in a manner that is affordable, acceptable and scalable. Women with GDM (diagnosed by oral glucose tolerance test using the International Association of the Diabetes and Pregnancy Study Groups criteria) will be recruited from 16 hospitals in India, Sri Lanka and Bangladesh. Participants will undergo a repeat oral glucose tolerance test at 6 ± 3 months postpartum and those without Type 2 diabetes, a total sample size of 1414, will be randomly allocated to the intervention or usual care. The intervention will consist of four group sessions, 84 SMS or voice messages and review phone calls over the first year. Participants requiring intensification of the intervention will receive two additional individual sessions over the latter half of the first year. Median follow-up will be 2 years. The primary outcome is the proportion of women with a change in glycaemic category, using the American Diabetes Association criteria: (i) normal glucose tolerance to impaired fasting glucose, or impaired glucose tolerance, or Type 2 diabetes; or (ii) impaired fasting glucose or impaired glucose tolerance to Type 2 diabetes. Process evaluation will explore barriers and facilitators of implementation of the intervention in each local context, while trial-based and modelled economic evaluations will assess cost-effectiveness. The study will generate important new evidence about a potential strategy to address the long-term sequelae of GDM, a major and growing problem among women in South Asia. (Clinical Trials Registry of India No: CTRI/2017/06/008744; Sri Lanka Clinical Trials Registry No: SLCTR/2017/001; and ClinicalTrials.gov Identifier No: NCT03305939).

Making a difference to children’s reasoning skills before school-entry: The contribution of the home learning environment

Children’s cognitive development is facilitated by interactions with more knowledgeable others. Such interactions occur in children’s families in the context of the home learning environment (HLE). Consequently, quality enhancements of the HLE may also improve children’s cognitive abilities. A non-intensive intervention was developed to improve both the HLE and children’s cognitive abilities in a sample of 116 four-year-old Australian children and their parents. The intervention consisted of parents or caregivers attending a parents’ evening at which the importance of the HLE was discussed, and an additional individual session that introduced the principles of counting and dialogic reading. The HLE and children’s fluid reasoning were assessed before and twice after the intervention. Families and their children in the intervention group showed significantly greater gains in both the quality of the HLE and children’s fluid reasoning than members of the control group and these differences were sustained over time. Consequently, non-intensive family interventions may positively impact on the HLE and children’s cognitive abilities and thus influence children’s learning trajectories.

Supporting caregivers in developing responsive communication partnerships with their children: Extending a caregiver-led interactive language program

This study investigates whether extension of a caregiver-led interactive language program may enhance its effectiveness in supporting communication. Caregiver-led language programs, which focus on establishing responsive interaction patterns to support opportunities for communication between caregivers and young children within natural settings, are frequently used in early childhood intervention services. One example is the Hanen Program It Takes Two to Talk® (ITTT), which involves working in groups with caregivers, with some concurrent individualized support for families. Given the importance of communication, potential strategies to enhance the effectiveness of such programs warrant investigation. Based on a transactional theory of interaction, it can be hypothesized that by directly supporting communication partners to continuously adapt to each others’ behaviours, individualized interventions may further enhance the outcomes of ITTT and, potentially, similar programs. In phase one of this study, 10 caregivers of young children with a range of disability labels completed the ITTT program. Participants were then randomly assigned to a control or experimental group for phase two. In the experimental group, the caregivers were provided with additional individual sessions with a Speech Language Therapist over the subsequent four months. Assessments of caregiver–child interactions were conducted prior to commencing the ITTT program, following the completion of phase one, and again at the completion of phase two. Significant positive changes were found at the completion of phase one for all participants. These findings support the effectiveness of the ITTT program. At the completion of phase two further significant positive changes were found for the experimental group. For the control group there was no further notable change. Although this is a small study, the findings have implications for practice in demonstrating that extending the individualized support provided within such programs may facilitate increased communication, with benefits for caregiver–child interactions and relationships and for child participation more broadly.

Improving Preschoolers’ Numerical Abilities by Enhancing the Home Numeracy Environment

ABSTRACTResearch Findings: Young children develop numeracy competencies during interactions with more knowledgeable others. Such interactions typically occur in the home numeracy environment (HNE). In this study a nonintensive intervention procedure was developed to improve both the HNE and numerical competencies. All parents of 113 Australian children (age 4 years, 5 months, on average at the beginning of the study) were invited to participate in a 2-part intervention that included attending 1 group meeting at which information regarding the HNE was provided and participating in an additional individual session that introduced them to the principles of counting. The HNE and children’s numerical competencies were assessed before and after the intervention. Participating and nonparticipating families did not differ on any of the study variables at the beginning of the study, yet not only did the intervention group significantly improve their HNE, but children in this group also showed significantly greater numerical competency development compared with the nonparticipating group. Practice or Policy: Results indicate that less intensive interventions can have effects on the HNE and children’s numerical competencies. Consequently, even on small budgets interventions should be undertaken.

Home Learning Environment and Concept Formation: A Family Intervention Study with Kindergarten Children

Children’s cognitive development has a neural basis, yet children’s learning is facilitated by interactions with more knowledgeable others. Young children experience such interactions in the context of the home learning environment (HLE), when parents support children’s thinking and learning during everyday activities. Consequently, one way to improve children’s cognitive abilities may be to enhance the quality of the HLE. In this study a non-intensive intervention was developed to improve both, HLE and children’s cognitive abilities. The sample consisted of 113 Australian 4-year-old children and their parents. All parents were invited to participate in a two-part intervention that included firstly attending a group meeting at which information regarding the HLE was provided, and secondly participating in an additional individual session that introduced the principles of counting and dialogic reading. HLE and children’s concept formation, as an indicator of fluid reasoning, were assessed before and after the intervention. Families and children in the intervention group showed significantly greater gains than the control group, both in the quality of HLD and the children's concept formation than members of the control group. Results indicate that non-intensive family interventions may positively impact on HLE and children’s fluid reasoning.

OP0286 Effects of an Educational Program on the Safety Knowledge and Skills of Patients with Rheumatoid Arthritis Treated by Biologics

BackgroundBiologics are very efficient drugs used in rheumatoid arthritis (RA) but they are also known for entailing specific risks. Therefore, it is necessary to translate the patients’ skills of safety...

Group therapy in community mental health centres

<b>Background:</b> Developing accessible community mental health centres (CMHCs) with high quality of care, has been a major health strategy in Norway. There is, however, scarce knowledge about the kinds of therapy which are practiced at the CMHCs. <b>Aims:</b> We wanted to study the extent of use of group therapy in CMHCs, types of group therapy, and characteristics of patients who receive such therapy. We also wanted to explore if the use of group therapy seemed to be according to trends suggested by the research literature. <b>Material and Methods:</b> A cross-sectional study of all patients (N=3041) receiving consultations at eight selected CMHCs during 4 weeks in 2005. The catchment areas of these CMHCs represented about 10% of the national population. Demographic, clinical, and treatment information was recorded. <b>Results:</b> 15.1% received group therapy, and of these, 40.2% received analytic group therapy, 14.6% cognitive therapy, and 45.2% received ‘other types’ of group therapy. Group patients were older, had less psychopathology, and were more often treated in day-care or in-patient units. One half also received additional individual sessions (combined therapy). Patients in combined therapy had more severe psychiatric problems than those receiving group sessions alone, and patients in analytic groups had less psychopathology than patients receiving ‘other types’ of group therapy. Analytic groups were most common in day-care services. <b>Conclusion:</b> Analytic group therapies have a more central position in everyday clinical work than cognitive group therapy. There are few evidence based guidelines for selecting group therapy methods and more research is needed to decide both what kind of group therapy should be offered to different patient categories, and what kind of group therapy approaches the community mental health centres should be able to offer, within and across the different units.

Is Cognitive-Behavioural Therapy More Effective Than Psychoeducation in Bipolar Disorder?

Psychosocial research in bipolar disorder (BD) has not yet assessed the relative benefits of a short course of psychoeducation (PE), compared with a longer course of cognitive-behavioural therapy (CBT) containing psychoeducational principles. This pilot study evaluated the efficacy and added benefit of adding a course of CBT to a standard course of brief PE, as maintenance therapy for BD. Seventy-nine consenting adult men and women with BD on stable medication regimens, who were in full or partial remission from an index episode (BD I = 52; BD II = 27), were randomized to receive either 7 sessions of individual PE, or 7 sessions of PE followed by 13 additional individual sessions of CBT. Weekly mood and medication adherence was rated using the National Institute of Mental Health's Life Chart Method, while psychosocial functioning and mental health use were assessed monthly. Forty-six participants completed the entire study. Participants who received CBT in addition to PE experienced 50% fewer days of depressed mood over the course of one year. Participants who received PE alone had more antidepressant increases compared with those who received CBT. There were no group differences in hospitalization rates, medication adherence, psychosocial functioning, or mental health use. Pilot data from this real-world study suggest that even after medication treatment has been optimized, a longer course of adjunctive CBT may offer some additional benefits over a shorter course of PE alone for the maintenance treatment of BD. Larger randomized controlled trials with equal treatment lengths are indicated.

Cognitive Therapy With the Core Beliefs of a Distressed, Lonely Caregiver

The purpose of this case study is to describe, in detail, a systematic approach that was used to modify a long-standing dysfunctional schema in a depressed female outpatient over the age of 60. In our opinion, this paper addresses a gap in the current cognitive therapy literature which contains very little description of methods for schema change. The client, Mrs. A., was depressed as a result of caring for her elderly mother who was suffering from advanced Alzheimer’s disease. She first received a 20-session course of treatment for her depression which focused on goals such as reducing guilt, setting limits, and making some time for her personal needs. After attaining these goals, she was given the opportunity to participate in an intense program of 18 additional individual sessions to evaluate and revise a key core belief, using an adaptation of Young’s (1990) method of the Historical Test of Schemas. This core belief was stated as follows: “In order to alleviate my feelings of inferiority, I must be all things to everyone.” Mrs. A was able to discuss the origin and the maintenance of this schema throughout her life, and she also was able to revise it in a way that allowed her to be more accepting of herself and her abilities.

Individual Psychotherapy as an Adjunct to Group Psychotherapy

This paper describes a form of combined psychotherapy in which the individual sessions are used as an adjunct to group therapy. Each group member is seen regularly in individual sessions to focus primarily on the member's ongoing group work. The individual sessions are scheduled on a rotating basis. Typically, each group member is seen in an individual session once every four weeks. Additional individual sessions are available only when immediate attention is appropriate and necessary. The group is viewed as the primary therapeutic component. A cost-effective therapeutic approach that uses both individual and group methods, this modality lends itself well to a clinic and to a private practice setting.