Psychological Therapies For People Research Articles

Rewind for Posttraumatic Stress Disorder: A Randomised Controlled Trial

Background. The Rewind Technique (Rewind) is a psychological therapy for people with posttraumatic stress disorder (PTSD), which is already used regularly in the National Health Service (NHS), the third sector and private practice across the UK. This study set out to explore the potential efficacy and feasibility of remotely delivered Rewind for the treatment of PTSD. Methods. This study was a two-armed, exploratory RCT to assess the preliminary efficacy, adherence, feasibility, and factors affecting outcome of Rewind versus a waitlist control group. Results. The entire trial was delivered remotely using video calls for treatment sessions and outcome assessments. A total of 40 participants were randomised with 80% retention at the primary endpoint of 8-week postrandomisation. The difference in Clinician-Administered PTSD Scale for DSM-5 scores between the immediate and delayed Rewind arms was 12.64 (95% CI, 2.29 to 22.99, F = 6.38 , df = 1 , p = 0.02 ) at 8 weeks. The Cohen’s d was 1.05 indicating a large effect size at 8 weeks with maintenance in symptom improvement at 16 weeks. Conclusion. Rewind, delivered remotely, demonstrated a large effect size in treating symptoms of PTSD within this trial cohort. This trial demonstrates a preliminary signal of efficacy supporting the clinical use of Rewind in the treatment of people with PTSD.

Какая психотерапия эффективнее при ПТСР?

This digest offers three analytical and review materials on efficacy of various psychological therapies for people with post-traumatic stress disorders. These recently published meta-analyses are based on trials performed on adults, children and adolescents, and patients with complex trauma.

Psychological therapies for people with borderline personality disorder

Psychological therapies for people with borderline personality disorder

Attachment and therapeutic alliance in psychological therapy for people with recent onset psychosis who use cannabis.

We examine associations between client attachment style and therapeutic alliance in a 3-arm randomized controlled trial of brief motivational interviewing and cognitive-behavioural therapy compared with longer term motivational interviewing and cognitive-behavioural therapy or standard care alone. Client self-report measures of attachment style were completed at baseline, and both clients and therapists in the treatment arms of the trial completed alliance measures 1month into therapy. We found that insecure-anxious attachment was positively associated with therapist-rated alliance, whereas clients with insecure-avoidant attachment were more likely to report poorer bond with therapist. There was no evidence that client attachment significantly predicted clinical or substance misuse outcomes either directly or indirectly via alliance. Nor evidence that the length of therapy offered interacted with attachment to predict alliance.

Intellectual disabilities and ACT: feasibility of a photography-based values intervention

PurposeThere is limited evidence regarding clinical effectiveness of therapeutic interventions for people with intellectual disabilities (ID). Previous research has highlighted challenges regarding adaptation of Acceptance and Commitment Therapy (ACT) for people with ID. Central to ACT is a focus on living in congruence with individual core values. The concept of values is abstract and difficult for people with a limited verbal understanding to comprehend, and yet this approach holds much promise for people with ID. The paper aims to discuss these issues.Design/methodology/approachThe current study outlines the adaptations undertaken to facilitate making the concept of values more accessible to people with ID. It also explores the feasibility of the adapted approach to the values component.FindingsThis trial has shown that it is possible to isolate a single component of ACT and adapt it for use with people with ID. The findings highlight the potential feasibility of a value-based approach for people with ID augmented through the use of participant-produced photography to enhance conceptual understanding of the values component of ACT.Research limitations/implicationsFindings were reliant on self-report data, which may result in inaccurate reporting and may be influenced by social demands. Given the diverse and unique presentations of people with ID, the inclusion and exclusion criteria limits the extent to which the current findings may be generalised to people with ID more widely.Practical implicationsParticipant-produced photography may be directly applied to clinical practice, with implied benefits of improving access to, and meaningful engagement with psychological therapies for people with ID. Development of (and ability to articulate) a readily available and easily accessible values system, during times of adversity, represents a key implication arising from the current trial.Originality/valueThe current study shows that people with intellectual disability can be helped to appreciate abstract concepts such as personal core values. It also shows the potential to work through the medium of personal photography to explore the feasibility of the adapted approach to the values component – potentially a logical preliminary step towards an ACT-ID evidence base. To the authors’ knowledge, this novel approach is the first of its kind in the ID literature.

The effectiveness of CBT training on service delivery systems: a benchmarking study

AbstractWales has not adopted the English IAPT system and has no centralized training plan for developing cognitive behavioural therapy (CBT) in Wales. However, Welsh Government policy expresses an ambition to improve access to evidence-based psychological therapies for people in Wales. This study focuses on one Welsh Health Board's plan to improve access to CBT. The study aims to benchmark support for effective delivery of CBT in the Health Board against NICE and Department of Health standards, and to establish whether the Health Board's plan is succeeding in developing staff capability and access to evidence-based CBT. Mental health staff funded by the Health Board to complete accredited training in CBT were asked to complete an online questionnaire asking about their training, accreditation, use of CBT, and experience of workplace support for delivering CBT. The standards were taken from the Department of Health competency framework for CBT, NICE guidelines and BABCP safety and confidentiality criteria. The Health Board performed well across seven standards of workplace support for the delivery of evidence-based CBT. Staff funded to undertake accredited CBT training continued to develop and to use CBT in their everyday clinical practice. The study indicates that the Health Board is succeeding in offering good standards of workplace support for CBT, including access to accredited CBT training. A recommendation is made that this be shared with other Welsh Health Boards and that a comparable study be undertaken within an IAPT service.

Therapeutic alliance in psychological therapy for people with schizophrenia and related psychoses: A systematic review.

Therapeutic alliance is a key predictor of therapy outcomes. Alliance may be particularly pertinent for people with schizophrenia as this group often have a history of interpersonal trauma and relationship difficulties including difficult relationships with mental health staff. This review aimed to determine (a) the quality of therapeutic alliance between people with schizophrenia and their therapists; (b) whether alliance predicts therapeutic outcomes; and (c) variables associated with alliance. Databases were searched from inception up to April 2015. The search yielded 4,586 articles, resulting in 26 eligible studies, involving 18 independent samples. Weighted average client and therapist Working Alliance Inventory-Short Form total scores were 64.51 and 61.26, respectively. There was evidence that alliance predicts overall psychotic symptomatic outcomes and preliminary evidence for alliance predicting rehospitalization, medication use, and self-esteem outcomes. There was evidence for specific client-related factors being linked to different perspectives of alliance. For example, poorer insight and previous sexual abuse were associated with worse client-rated alliance, whereas baseline negative symptoms were associated with worse therapist-rated alliance. Therapist and therapy-related factors, including therapists' genuineness, trustworthiness, and empathy were associated with better client-rated alliance, whereas suitability for therapy, homework compliance, and attendance were associated with better therapist-rated alliance. Key clinical implications include the need to consider alliance from both client and therapist perspectives during therapy and training and supervision to enhance therapist qualities that foster good alliance. Future research requires longitudinal studies with larger samples that include pan-theoretical, well-validated alliance measures to determine causal predictor variables.

Intellectual disability and computers in therapy: Views of service users and clinical psychologists

Digital media have increased the accessibility of psychological therapies for the general population, but not for people with intellectual disability (ID), despite their greater mental health needs. This study explores and compares the views of service users and clinicians on how computers can be integrated in psychological therapies for people with ID who are traditionally under-represented in mainstream services. We conducted in-depth unstructured interviews with three clinicians who had experience of working with people with ID and with three adults with ID who have experienced computerised training in cognitive behaviour therapy skills. The interviews explored the a) potential functions and benefits, b) anticipated challenges and barriers, and c) required design features of computers in therapy for people with ID. We used inductive coding to identify independent themes in the responses of clinicians and service users, and then compared the emerging themes between the two sets of participants to arrive at common themes. Six common themes emerged from service user and clinician responses: confidentiality of personal information and online applications, barriers in the communication with the therapist, value of therapist and personal contact, access to computer technologies, engagement potential of computer programmes and home practice. Three further themes were specific to clinician responses: patient suitability for computerised approaches, clinician distrust of computerised interventions, and involving a third party. Computer technologies open up possibilities for psychological therapy with people with ID by helping them overcome in-session communication difficulties and practise skills at home. On-screen pictures, interactive games, symbols, sign language and touch-screen are key design features to help engagement. The main challenges are clinician-reported difficulties in their own capacity and capability to access and use computers and in fitting computers into their own defined roles.

UK art therapy practice-based guidelines for children and adults with learning disabilities

ABSTRACTArt therapy is a form of psychotherapy that uses art media as its primary mode of communication. Having skill and experience in art is not a pre-requirement for people to benefit from art therapy. Making art work can offer the opportunity for expression and communication within a psychological therapy for people who find it difficult to express their thoughts and feelings verbally, and it is an accessible approach for children and adults with learning disabilities. An estimated 20% of art therapists working in the UK have some involvement with children or adults who have learning disabilities. These clinical practice guidelines were devised within the UK by the British Association of Art Therapists. A guideline development group was formed by the Learning Disability Special Interest Group and a national consultation was carried out among its membership. Ten overarching guideline recommendations for clinical practice were identified, namely ‘working relationships’, ‘communication’, ‘support networks’, ‘managing risk and vulnerability’, ‘establishing therapy agreements’, ‘assessment, formulation, and therapeutic goals’, ‘working creatively and flexibly’, ‘working psychotherapeutically’, ‘monitoring progress’ and ‘professional responsibilities and self-care’. The published art therapy practice-based guidelines for children and adults with learning disabilities are an example of a clinical consensus on current best practice in the UK.

Therapeutic alliance in psychological therapy for people with recent onset psychosis who use cannabis

BackgroundThis paper examines the role of therapeutic alliance in predicting outcomes in a Randomized Controlled Trial of Motivational Interviewing and Cognitive Behavioral Therapy (MICBT) for problematic cannabis use in recent onset psychosis. MethodsAll clients were participating in a three arm pragmatic rater-blind randomized controlled trial of brief MICBT plus standard care compared with longer term MICBT plus standard care and standard care alone. Participants completed measures to assess clinical symptoms, global functioning and substance misuse at baseline, 4.5months, 9months and 18months. Clients and therapists completed the Working Alliance Inventory approximately one month into therapy. Client alliance data was available for 35 participants randomized to therapy and therapist alliance data was available for 52 participants randomized to therapy. ResultsAt baseline, poorer client-rated alliance was associated with more negative symptoms, poorer insight and greater cannabis use, whereas poorer therapist-rated alliance was only associated with amount of cannabis used per cannabis using day. Alliance ratings were also positively associated with amount of therapy: client-rated alliance was higher in the longer compared to the briefer therapy; therapist-rated alliance was associated with greater number of sessions attended (controlling for type of therapy) and therapy completion. In predicting outcome, client-rated alliance predicted total symptom scores and global functioning scores at follow-up. Neither client nor therapist alliance predicted changes in substance misuse at any time point. ConclusionsFindings demonstrate that individuals with psychosis and substance misuse who form better alliances with their therapists gain greater benefits from therapy, at least in terms of improvements in global functioning.

Motivational interviewing for improving recovery after stroke.

Psychological problems are common complications following stroke that can cause stroke survivors to lack the motivation to take part in activities of daily living. Motivational interviewing provides a specific way for enhancing intrinsic motivation, which may help to improve activities of daily living for stroke survivors. To investigate the effect of motivational interviewing for improving activities of daily living after stroke. We searched the Cochrane Stroke Group's Trials Register (November 2014), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 1), MEDLINE (1948 to March 2015), EMBASE (1980 to March 2015), CINAHL (1982 to March 2015), AMED (1985 to March 2015), PsycINFO (1806 to March 2015), PsycBITE (March 2015) and four Chinese databases. In an effort to identify further published, unpublished and ongoing trials, we searched ongoing trials registers and conference proceedings, checked reference lists, and contacted authors of relevant studies. Randomised controlled trials (RCTs) comparing motivational interviewing with no intervention, sham motivational interviewing or other psychological therapy for people with stroke were eligible. Two review authors independently selected studies for inclusion, extracted eligible data and assessed risk of bias. Outcome measures included activities of daily living, mood and death. One study involving a total of 411 participants, which compared motivational interviewing with usual care, met our inclusion criteria. The results of this review did not show significant differences between groups receiving motivational interviewing or usual stroke care for participants who were not dependent on others for activities of daily living, nor on the death rate after three-month and 12-month follow-up, but participants receiving motivational interviewing were more likely to have a normal mood than those who received usual care at three-months and 12-months follow-up. There is insufficient evidence to support the use of motivational interviewing for improving activities of daily living after stroke. Further well designed RCTs are needed.

Research Watch: talking therapy for anxiety and social difficulties may improve social inclusion after diagnosis with schizophrenia

Purpose – The purpose of this paper is to summarize two 2013 papers on psychological therapies for people with a diagnosis of schizophrenia. Design/methodology/approach – The first paper is a report of a small study of cognitive behaviour therapy for anxiety in people with a diagnosis of schizophrenia attending an early intervention service. The second paper is a review of several studies looking at therapies to help people understand what others are feeling and thinking, and so cope better in social situations. Findings – Out of 11 people referred to the anxiety group, seven stayed until the end. Their self-rated anxiety and depression decreased significantly. The review of therapies for social situations suggests that there is a need for more than just training in understanding other people. It is probably necessary to offer a package of therapy that involves role-play and practising skills in actual situations, and possibly involving friends or family members. Originality/value – These papers report on therapies that have only recently begun to be considered for people with a diagnosis of schizophrenia. It seems much more attention needs to be paid to helping people with anxiety when they have this diagnosis, and also to helping people cope in social situations so that they can participate in important social activities and work.

‘Things often get worse before they get better’: participants’ responses to the cessation of recruitment and trial treatment in a trial of a psychological therapy for people with personality disorder following a safety alert. (A missed opportunity for collaboration?)

The study team were advised by the independent oversight committees to stop trial recruitment and the delivery of trial therapy due to a difference in the number of reported hospitalisations between the treatment and control group. Because of concerns over potential worry or distress for participants resulting from the trial changes, implementation was carefully monitored throughout. Discussions with participants were documented and feedback recorded whenever this was given. Feedback has been reviewed to identify learning points and enable reflection on the processes used in the trial and during implementation of the trial changes. Specific feedback was received and documented from 37 participants from all trial stages. A number of recurring themes were identified. Among the most frequently reported were the view that an initial increase in distress was expected when engaging in psychological therapies, concern over lack of alternative treatment options, alternative interpretations of the findings and insights into both the processes by which therapy was delivered in the trial and the way in which the trial changes were implemented. Feedback from participants provided useful insights and there are lessons to be learned for researchers and clinicians. Involving service users in a collaborative dialogue regarding the safety issues identified and the options for the trial may have been fruitful. There is scope for alternative understandings of safety issues in trials of psychological interventions in mental health and discussions about what constitutes safety in this context are warranted. Insights from service users should inform conceptualisations of safety in future psychotherapy trials.

The process of stopping recruitment and trial treatment in a trial of a psychological therapy for people with personality disorder following a safety alert

The study team were advised by the independent oversight committees to stop recruitment to the trial and the delivery of the trial therapy due to a difference in the number of reported hospitalisations between the treatment and control group. There was a lack of guidance on how to proceed with implementation of the changes in a trial of this type and little precedent for cessation of trial treatment in a psychotherapy trial following a safety alert. Furthermore, there were concerns over the potential for distress and disruption to participants and clinical teams as a result of the trial changes and the potential risks of discontinuing treatment prematurely. A collaborative approach to the development of the process and supporting documents was adopted, with attention given to the impact on participants and clinical teams. The changes were implemented as an urgent safety measure. The following were developed: • Written process for implementation. • Written information for participants, potential participants and clinical teams. • Guidance documents for sites. • Arrangements for local and national telephone helplines. • Media response. The following key features were intended to reduce the impact on participants and clinical teams: • Prompt, but careful action. • Staged, allowing adequate time to inform and support participants and clinical teams, and ensuring feedback received could inform further development. • Clinically appropriate, with reference to national guidelines and accepted good practice. • Honest, concise and consistent information given to all concerned and follow-up support offered as appropriate. • Regular review and reflection.

Psychological therapies for people with intellectual disabilities: comments on a Matrix of evidence for interventions in challenging behaviour

Psychological therapies with a proven efficacy in the general population are being adapted for use with people who have intellectual disabilities in community settings. A systematic review of peer-reviewed literature published between 1980 and 2010 was carried out, to identify the evidence base for effective psychological interventions in challenging behaviour. Relevant databases were searched using applied key terms. Evidence was graded, according to the quality of the research. A best-evidence Matrix was produced to improve guidance for service providers and practitioners in the range, volume and quality of psychological interventions. There is a limited amount of efficacy research that meets the most stringent standards of empirical evidence. It is important to broaden the evidence base and consider the context of psychological interventions, alongside the values underpinning care and treatment.

Psychological therapies for people with borderline personality disorder.

Psychotherapy is regarded as the first-line treatment for people with borderline personality disorder. In recent years, several disorder-specific interventions have been developed. This is an update of a review published in the Cochrane Database of Systematic Reviews in 2006. To assess the effects of psychological interventions for borderline personality disorder (BPD). We searched the following databases: CENTRAL 2010(3), MEDLINE (1950 to October 2010), EMBASE (1980 to 2010, week 39), ASSIA (1987 to November 2010), BIOSIS (1985 to October 2010), CINAHL (1982 to October 2010), Dissertation Abstracts International (31 January 2011), National Criminal Justice Reference Service Abstracts (15 October 2010), PsycINFO (1872 to October Week 1 2010), Science Citation Index (1970 to 10 October 2010), Social Science Citation Index (1970 to 10 October 2010), Sociological Abstracts (1963 to October 2010), ZETOC (15 October 2010) and the metaRegister of Controlled Trials (15 October 2010). In addition, we searched Dissertation Abstracts International in January 2011 and ICTRP in August 2011. Randomised studies with samples of patients with BPD comparing a specific psychotherapeutic intervention against a control intervention without any specific mode of action or against a comparative specific psychotherapeutic intervention. Outcomes included overall BPD severity, BPD symptoms (DSM-IV criteria), psychopathology associated with but not specific to BPD, attrition and adverse effects. Two review authors independently selected studies, assessed the risk of bias in the studies and extracted data. Twenty-eight studies involving a total of 1804 participants with BPD were included. Interventions were classified as comprehensive psychotherapies if they included individual psychotherapy as a substantial part of the treatment programme, or as non-comprehensive if they did not.Among comprehensive psychotherapies, dialectical behaviour therapy (DBT), mentalisation-based treatment in a partial hospitalisation setting (MBT-PH), outpatient MBT (MBT-out), transference-focused therapy (TFP), cognitive behavioural therapy (CBT), dynamic deconstructive psychotherapy (DDP), interpersonal psychotherapy (IPT) and interpersonal therapy for BPD (IPT-BPD) were tested against a control condition. Direct comparisons of comprehensive psychotherapies included DBT versus client-centered therapy (CCT); schema-focused therapy (SFT) versus TFP; SFT versus SFT plus telephone availability of therapist in case of crisis (SFT+TA); cognitive therapy (CT) versus CCT, and CT versus IPT.Non-comprehensive psychotherapeutic interventions comprised DBT-group skills training only (DBT-ST), emotion regulation group therapy (ERG), schema-focused group therapy (SFT-G), systems training for emotional predictability and problem solving for borderline personality disorder (STEPPS), STEPPS plus individual therapy (STEPPS+IT), manual-assisted cognitive treatment (MACT) and psychoeducation (PE). The only direct comparison of an non-comprehensive psychotherapeutic intervention against another was MACT versus MACT plus therapeutic assessment (MACT+). Inpatient treatment was examined in one study where DBT for PTSD (DBT-PTSD) was compared with a waiting list control. No trials were identified for cognitive analytical therapy (CAT).Data were sparse for individual interventions, and allowed for meta-analytic pooling only for DBT compared with treatment as usual (TAU) for four outcomes. There were moderate to large statistically significant effects indicating a beneficial effect of DBT over TAU for anger (n = 46, two RCTs; standardised mean difference (SMD) -0.83, 95% confidence interval (CI) -1.43 to -0.22; I(2) = 0%), parasuicidality (n = 110, three RCTs; SMD -0.54, 95% CI -0.92 to -0.16; I(2) = 0%) and mental health (n = 74, two RCTs; SMD 0.65, 95% CI 0.07 to 1.24 I(2) = 30%). There was no indication of statistical superiority of DBT over TAU in terms of keeping participants in treatment (n = 252, five RCTs; risk ratio 1.25, 95% CI 0.54 to 2.92).All remaining findings were based on single study estimates of effect. Statistically significant between-group differences for comparisons of psychotherapies against controls were observed for BPD core pathology and associated psychopathology for the following interventions: DBT, DBT-PTSD, MBT-PH, MBT-out, TFP and IPT-BPD. IPT was only indicated as being effective in the treatment of associated depression. No statistically significant effects were found for CBT and DDP interventions on either outcome, with the effect sizes moderate for DDP and small for CBT. For comparisons between different comprehensive psychotherapies, statistically significant superiority was demonstrated for DBT over CCT (core and associated pathology) and SFT over TFP (BPD severity and treatment retention). There were also encouraging results for each of the non-comprehensive psychotherapeutic interventions investigated in terms of both core and associated pathology.No data were available for adverse effects of any psychotherapy. There are indications of beneficial effects for both comprehensive psychotherapies as well as non-comprehensive psychotherapeutic interventions for BPD core pathology and associated general psychopathology. DBT has been studied most intensely, followed by MBT, TFP, SFT and STEPPS. However, none of the treatments has a very robust evidence base, and there are some concerns regarding the quality of individual studies. Overall, the findings support a substantial role for psychotherapy in the treatment of people with BPD but clearly indicate a need for replicatory studies.

Effectiveness of the Cognitive Differentiation Program of the Integrated Psychological Therapy

The aim of the current pilot study was to compare two strategies in the application of the cognitive differentiation program of Integrated Psychological Therapy for people with schizophrenia. Twenty-six outpatients were randomly assigned to the application of the program in group sessions (CDg), or to its application in individualized sessions (CDi). The program provides cognitive exercises to promote better performance in cognition, and both groups of participants completed the same number of exercises following the same number of sessions per week. Outcomes were assessed on neuropsychological measures of attention, executive functioning and everyday memory, and everyday functioning. Effect sizes showed the absence of effects in everyday memory and social functioning, higher improvements in the CDi group in attention, and a higher improvement in the CDg condition in executive functioning. The results suggest that the program application model could be individualized, depending on patient-specific cognitive deficits.

Dilemmas in providing psychological therapy as an integral component of mental health care

Our notions of what constitutes a good therapeutic relationship come from models developed for people with high levels of personal resources who actively choose therapy in preference to other ways of addressing their problems. The context is quite different for those with more severe and enduring mental health problems, when therapy can be one of many interventions being provided. Some of the dilemmas that arise within the therapeutic relationship in such cases can be understood in terms of the therapeutic relationship being conceived of within the dynamics of a dyad, when the actual situation is more akin to a triadic relationship comprising the client, the therapist and others involved in the client's care. Examples of threats to the therapeutic alliance, which I encounter quite frequently in my work, are explored from the perspective of the therapeutic couple within three-person space, as well as from the perspective of the differing, and sometimes conflicting, functions of mental health care. The implications of this for the provision of psychological therapy for people with severe mental health problems within the NHS are then considered.

Efficacy of psychological therapies for people with HIV disease

Efficacy of psychological therapies for people with HIV disease

The PI 500: Long-Term Follow-up of Borderline Inpatients Meeting DSM-III Criteria I. Global Outcome

The PI 500: Long-Term Follow-up of Borderline Inpatients Meeting DSM-III Criteria I. Global Outcome