Routine administration of the Canadian Occupational Performance Measure: Effect on functional outcome, Australian Occupational Therapy Journal, 2009

Heather Colquhoun et al ..

Abstract:

Background/aim:  Routinely using outcome measures as an integral component of practice has been encouraged for decades yet has not been widely adopted. There are many reasons to measure outcomes yet any positive effect of measurement on our programs or clients has not been substantiated. If the time-consuming nature of outcome measurement is to be encouraged, we need to begin addressing larger questions of the value of outcome measurement on care and outcomes. This cohort study evaluated the impact of routinely administering the Canadian Occupational Performance Measure on client outcomes on a geriatric rehabilitation unit.

Methods:  Changes in Functional Independence Measure™ scores between an experimental group (n = 45) that received the routine use of the Canadian Occupational Performance Measure for evaluation/planning versus a historical comparison group (n = 58) that received ‘usual’ care were analysed using generalised linear modeling.

Results:  Both groups had significant changes in Functional Independence Measure™ scores over time. Results for differences between groups were inconclusive with a significantly underpowered analysis; however, results suggest that a medium to large effect of this intervention cannot be expected.

Conclusions:  Results are significant for the field of routine outcome measurement, suggesting that when adding the Canadian Occupational Performance Measure to routine assessment within an inpatient rehabilitation setting, substantially improved Functional Independence Measure™ score outcomes should not be expected. The value of routine outcome measurement on client outcomes remains largely unexplored. Routinely, using outcome measures requires additional research to determine the specific benefits to our programs and client outcomes.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Three preparatory studies for promoting implementation of outpatient schema therapy for borderline personality disorder in general mental health care,  Behaviour Research and Therapy, Volume 47, Issue 11, November 2009, Pages 938-945 – Dissemination and Implementation of Cognitive Behavioural Therapy

Marjon Nadort et al..

Abstract:

Objective

Three studies were conducted to prepare for the implementation of Schema Therapy (ST) for Borderline Personality Disorder (BPD) in general mental healthcare settings. Two were surveys to detect promoting and hindering factors, one was a preliminary test of a training program in ST.

Methods

In 2004, a diagnostic analysis of factors promoting and hindering implementation of a new treatment for BPD was conducted among both managers (n = 23) and therapists (n = 49) of 29 Dutch mental healthcare institutes through a written survey (Study 1). Next, a training program, including a set of DVDs displaying the major therapeutic techniques, was developed and tested among eight therapists. The training program was evaluated by the participants. After the training, three independent raters evaluated therapists’ adherence and competence, viewing videos of the therapists completing structured role-plays (Study 2). In 2008, a second written survey was conducted in 22 mental health institutes to study factors for future nationwide implementation of ST (Study 3).

Results

Both surveys indicated that the situation in most institutes was favorable for implementing a new effective treatment, as participants were not satisfied with the existing treatments, had suitable professional backgrounds, worked in settings with (B)PD-oriented care programs, and expressed a need for change. The surveys yielded clear results for promoting or hindering successful implementation of ST. Promoting factors included scientific evidence for the effectiveness of the treatment, structural changes in the patient’s personality, rapidly noticeable effects for the patient, low drop-out rates and a favorable cost-effectiveness. Possible barriers included implementation mandated unilaterally by management, choosing ST based on financial or organizational needs, extending implementation over a lengthy period of time and providing telephone support by therapists beyond office hours. The eight-day training program received very positive ratings. After the training, therapists were rated as sufficiently adherent and competent applying ST to treat BPD patients, with peer supervision and supervision recommended as a supplement to the training.

Conclusion

This study showed that the situation in 2005 was advantageous to start implementation of ST. Evaluation of the training and the achieved competence scores of trainees concluded that the training program was a good basis for training therapists in ST. Outcome of the survey in 2008 demonstrated that there was a clear interest for implementation of ST for BPD patients in the future.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Using Perceptual Control Theory and the Method of Levels to work with people who experience psychosis, The Cognitive Behaviour Therapist (2009), 2:227-242

Sara J. Tai – School of Psychological Sciences, University of Manchester, UK

Abstract:

This paper provides an overview of perceptual control theory (PCT) in relation to understanding severe and enduring mental health problems. The core principles of control and conflict are reviewed in relation to understanding the experiences associated with psychotic disorders. The therapeutic application of PCT known as the Method of Levels (MOL) is described and an overview of how this might be a useful approach to use with people experiencing psychosis is provided. The benefits and difficulties of using MOL to work with people experiencing psychosis are described including case illustrations of preliminary work based on the application of MOL in clinical practice. It is concluded that PCT is a useful framework for understanding severe and enduring mental health problems and there are potential benefits in using MOL as a therapeutic intervention. Further research examining the effectiveness and feasibility of MOL as a specific treatment for psychosis is recommended.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Psychological treatment of social anxiety disorder: a meta-analysis, Psychological Medicine (2009), 39 : 241-254

C. Acarturk et al….

Vrije Universiteit University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands

Abstract:

Background Older meta-analyses of the effects of psychological treatments of social anxiety disorder have found that these treatments have moderate to large effects. However, these earlier meta-analyses also included non-randomized studies, and there are many featured studies in this area which were published after the recent meta-analysis.

Method We conducted a systematic literature search and identified 29 randomized studies examining the effects of psychological treatments, with a total of 1628 subjects. The quality of studies varied. For the analyses, we used the computer program comprehensive meta-analysis (version 2.2.021; Biostat, Englewood, NJ, USA).

Results The mean effect size on social anxiety measures (47 contrast groups) was 0.70, 0.80 on cognitive measures (26 contrast groups) and 0.70 both on depression (19 contrast groups) and general anxiety measures (16 contrast groups). We found some heterogeneity, so we conducted a series of subgroup analyses for different variables of the studies. Studies with waiting-list control groups had significantly larger effect sizes than studies with placebo and treatment-as-usual control groups. Studies aimed at subjects who met Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for social anxiety disorder had smaller effect sizes than studies in which other inclusion criteria were used.

Conclusions This study once more makes it clear that psychological treatments of social anxiety disorder are effective in adults, but that they may be less effective in more severe disorders and in studies in which care-as-usual and placebo control groups are used.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Treatment of adult post-traumatic stress disorder using a future-oriented writing therapy approach, The Cognitive Behaviour Therapist, 2009

Reginald D. V. Nixon^a1 c1 and Leonard W. Kling^a1

School of Psychology, Flinders University, Adelaide, SA, Australia

Abstract:

The aim of this pilot study was to test whether a future-oriented expressive writing intervention is able to reduce post-traumatic stress disorder (PTSD) severity and associated symptoms such as depression and unhelpful trauma-related beliefs. In an uncontrolled pre-/ post-design participants attended 8 weeks of manualized therapy. Assessment was undertaken pre- and post-treatment, and participants also completed a 3-month follow-up assessment. Of the 17 participants who began therapy, 13 were treatment completers. Results indicated a significant decrease in PTSD severity, depression and unhelpful trauma-related cognitions from pre- to post-treatment and at 3-month follow-up. Clinically meaningful change was more modest; however, three participants reported PTSD remission at 3-month follow-up. It is concluded that expressive writing with a focus on achieving future goals and personal change may have some utility in reducing post-traumatic stress but future research will need to investigate this with greater methodological rigour before firm conclusions can be made.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Show us a behaviour without a cognition and we’ll show you a rock rolling down a hill, The Cognitive Behaviour Therapist (2009), 2 : 123-133

Timothy A. Carey^a1 c1 and Warren Mansell^a2

  Abstract:

Dismantling studies are used in psychotherapy in order to understand the important components of treatment. Typically, this has occurred so that people could understand the unique contributions provided by cognitive versus behavioural techniques. Recently, mindfulness-based approaches have apparently added a third dimension to the dismantling enterprise. Dismantling is seen as an important way of understanding the change process in psychotherapy and, therefore, clarifying how we might most effectively promote change. The way in which an entity is dismantled, however, exposes assumptions about the nature of the entity and its organization. In this paper we argue that dismantling studies in psychotherapy have perhaps generated more confusion than consensus and have provided little practical benefit for clinicians. We suggest that the phenomenon of control might provide a unifying perspective from which to approach the integration of behavioural, cognitive, and mindfulness approaches. In one sense all these seemingly different approaches are doing the same thing and it is this ‘thing’ we highlight in this paper.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Cognitive behaviour therapy for a specific phobia of vomiting, The Cognitive Behaviour Therapist, 2009

David Veale – NIHR Specialist Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and The Institute of Psychiatry, King’s College London, UK

Dr D. Veale, Centre for Anxiety Disorders and Trauma, 99 Denmark Hill, London SE5 8AZ

Abstract:

This article summarizes the current knowledge and treatment for a specific phobia of vomiting (SPOV). It is relatively uncommon compared to other specific phobias but may have been misdiagnosed in catchment-area surveys. The differential diagnosis of SPOV includes obsessive–compulsive disorder, hypochondriacal disorder and anorexia nervosa. I discuss the following: a model that is linked to past aversive experiences of vomiting; conducting a clinical assessment; making a formulation; psycho-education, engagement and therapy. The strategies employed depend on the formulation but are likely to include: exposure in vivo to cues of vomiting, exposure in imagination and role-plays of vomiting, imagery re-scripting, behavioural experiments; and dropping of safety-seeking behaviours.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Are all antidepressants equal? Evidence-Based Mental Health 2009;12:98-100

G Gartlehner^1,2, B N Gaynes³

Abstract:

Primary care physicians and psychiatrists manage the majority of patients suffering from acute phase major depressive disorder (MDD). For most patients, antidepressant treatment is the primary choice of care. Second generation antidepressants (SGAs)—developed following the first generation of tricyclic and monoamine oxidase agents—have become the preferred drug choice because of their greater tolerability, lower risk of lethality and similar efficacy compared with first generation agents.

Clinicians prescribing SGAs face a multitude of drug choices and are the target of extensive marketing campaigns by the pharmaceutical industry. In 2007, three of the 20 top selling drugs in the USA were antidepressants with annual sales ranging from $2.3 billion (venlafaxine XR (Effexor XR)) to $1.4 billion (duloxetine (Cymbalta)).¹ At the time of writing, 13 different SGAs have been approved for the treatment of major depression in the USA and Canada and two additional drugs (reboxetine, milnacipran) are available in some . .

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

St John’s wort superior to placebo and similar to antidepressants for major depression but with fewer side effects, Evidence-Based Mental Health 2009;12:78

Edzard Ernst 

Complementary Medicine Group, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK

Abstract:

Is St John’s wort (hypericum) an effective treatment for major depression?

Proportion of responders at end of treatment or at study endpoint if treatment was longer than 6 weeks (based on score improvements on Hamilton Rating Scale for Depression (HAMD), the Clinical Global Impression index (CGI), rating as at least “much improved” on global improvement subscale, Depression Scale von Zerssen (DS) or any other clinical response measure); safety (proportion of dropouts due to adverse events).

Design: Systematic review with meta-analysis.

Data sources: Clinical Trials Register of the Cochrane Collaboration Depression, Anxiety and Neurosis Group (search to July 2007), Cochrane Field for Complementary Medicine database, MEDLINE (1983–2008), EMBASE (1989–2008), PsycLIT and PsycINDEX (1987–1997), Phytodok (private database, Munich), hand search of bibliographies.

Study selection and analysis: Two reviewers assessed studies. Inclusion criteria: randomised, controlled, double blind trials of hypericum extracts versus placebo or versus standard antidepressants in people with major depression (DSM-IV . . …

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

CBT improves maternal perinatal depression in rural Pakistan, Evidence-Based Mental Health 2009;12:45

Abstract:

Does a community health worker delivered cognitive behavioural therapy (CBT) based intervention improve the health of perinatally depressed women and their newborn infants in rural Pakistan?

903 married women, aged 16–45 years, in their third trimester of pregnancy and diagnosed with DSM-IV perinatal major depression (CBT based intervention, 463; control, 440). Exclusions for mothers: serious medical condition; pregnancy related illness; disability; psychosis; and serious illness, death or moved residence during the study. Exclusions for infants: born prematurely or with congenital defect; aborted or stillborn; died within first year of birth; and given up for adoption.

40 Union Councils (administrative units) in Gujar Khan and Kallar Syedan, rural Pakistan. Recruitment: April 2005 to March 2006.

CBT based intervention or enhanced routine care (control). Both groups received visits from local female health visitors every week during the last month of pregnancy, three times in the month after birth and then once a . .

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk