|
1
|
Hellberg SN, Bruening AB, Thompson KA, Hopkins TA. Applications of dialectical behavioural therapy in the perinatal period: A scoping review. Clin Psychol Psychother 2023. [PMID: 38116846 DOI: 10.1002/cpp.2937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 10/10/2023] [Accepted: 11/04/2023] [Indexed: 12/21/2023]
Abstract
Psychological distress is the most common complication of pregnancy. High-risk concerns can include severe emotion dysregulation, suicidality and self-injury, and health risk behaviours, which bear substantial consequences for caregivers and families. Yet, effective, comprehensive interventions for high-risk caregivers have received limited attention. Dialectical behaviour therapy (DBT) is a frontline treatment for such concerns. Accordingly, we conducted a scoping review on the implementation of DBT in the perinatal period. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Seven studies were identified; study designs included case studies and single-arm pilot trials. Most studies used DBT-informed protocols with significant adaptations, few included multiple components of DBT (i.e. skills group, individual therapy, phone coaching and consultation team), and none met criteria for adherent delivery of all four modes of DBT treatment. Findings suggest DBT-informed interventions may be successfully implemented to treat a range of perinatal mental health symptoms, including borderline personality disorder, depression, anxiety, and post-traumatic stress, and to promote emotion regulation and positive parenting behaviours. While results provide preliminary support for perinatal DBT, this literature is scant and empirical rigour considerably lacking. Clinical implications and future directions are outlined to aid researchers and providers in addressing the ongoing perinatal mental health crisis and developing sorely needed interventions to address the needs of high-risk caregivers.
Collapse
Affiliation(s)
- Samantha N Hellberg
- Department of Psychology and Neuroscience, UNC Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amanda B Bruening
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katherine A Thompson
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Tiffany A Hopkins
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, North Carolina, USA
| |
Collapse
|
|
2
|
Phiri P, Clarke I, Baxter L, Zeng YT, Shi JQ, Tang XY, Rathod S, Soomro MG, Delanerolle G, Naeem F. Evaluation of a culturally adapted cognitive behavior therapy-based, third-wave therapy manual. World J Psychiatry 2023; 13:15-35. [PMID: 36687373 PMCID: PMC9850872 DOI: 10.5498/wjp.v13.i1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/25/2022] [Accepted: 11/30/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Recommendations for psychotherapy have evolved over the years, with cognitive behavioral therapy (CBT) taking precedence since its inception within clinical guidelines in the United Kingdom and United States. The use of CBT for severe mental illness is now more common globally.
AIM To investigate the feasibility and acceptability of a culturally adapted, CBT-based, third-wave therapy manual using the Comprehend, Cope, and Connect approach with individuals from a diverse population presenting to primary and secondary healthcare services.
METHODS A pilot study was used to assess the feasibility and acceptability of the manualised intervention. Outcome measures were evaluated at baseline, post-intervention and 12 wk-follow up. 32 participants with mental health conditions aged 20-53 years were recruited. Assessments were completed at three time points, using Clinical Outcomes in Routine Evaluation (CORE), Hospital Anxiety and Depression Scale (HADS), Bradford Somatic Inventory and World Health Organization Disability Assessment Schedule 2.0 (WHODAS). The Patient Experience Ques-tionnaire was completed post-treatment.
RESULTS Repeated measures of analysis of variance associated with HADS depression, F (2, 36) = 12.81, P < 0.001, partial η2 = 0.42 and HADS anxiety scores, F (2, 26) = 9.93, P < 0.001, partial η2 = 0.36; CORE total score and WHODAS both showed significant effect F (1.25, 18.72) = 14.98, P < 0.001, partial η2 = 0.5. and F (1.29, 14.18) = 6.73, P < 0.001, partial η2 = 0.38 respectively.
CONCLUSION These results indicate the effectiveness and acceptability of the culturally adapted, CBT-based, third-wave therapy manual intervention among minoritized groups with moderate effect sizes. Satisfaction levels and acceptability were highly rated. The viability and cost-effectiveness of this approach should be explored further to support universal implementation across healthcare systems.
Collapse
Affiliation(s)
- Peter Phiri
- Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Isabel Clarke
- Department of Italk, Southern Health NHS Foundation Trust, Southampton SO50 9FH, United Kingdom
| | - Lydia Baxter
- Department of Italk Step 3, Southern Health NHS Foundation Trust, Southampton SO51 9FH, United Kingdom
| | - Yu-Tian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Jian-Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
- National Center for Applied Mathematics Shenzhen, Shenzhen 518055, Guangdong Province, China
| | - Xin-Yuan Tang
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Shanaya Rathod
- Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Mustafa G Soomro
- Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Gayathri Delanerolle
- Nuffield Department of Primary Health Care Science, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Farooq Naeem
- Centre for Addition and Mental Health, University of Toronto, Toronto ON M5S, Canada
| |
Collapse
|
|
3
|
Lawlor C, Vitoratou S, Duffy J, Cooper B, De Souza T, Le Boutillier C, Carter B, Hepworth C, Jolley S. Managing emotions in psychosis: Evaluation of a brief DBT-informed skill group for individuals with psychosis in routine community services. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:735-756. [PMID: 35130354 PMCID: PMC9543194 DOI: 10.1111/bjc.12359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/19/2022] [Indexed: 12/02/2022]
Abstract
Objectives Individuals with psychosis report that emotion regulation (ER) difficulties are treatment priorities, yet little is known about how targeted ER interventions may help. We evaluated a new eight‐session Dialectical Behavioural Therapy (DBT)–informed skills group specifically adapted for individuals with psychosis: the Managing Emotions Group (MEG) in diverse, inner‐city community services. Method A mixed‐method design was utilised to assess the feasibility (acceptability and potential clinical impact) of local delivery of MEG. Uptake, completion (≥50% of sessions), post‐session satisfaction ratings, and thematic analysis of qualitative feedback from 12 completers assessed acceptability. Pre–post‐intervention changes in psychological distress, self‐reported ER difficulties, and adaptive ER skill use assessed potential clinical impact. Results Forty‐eight individuals (81% of attenders) completed the intervention (Mage = 43, 54% female) of whom 39 completed pre‐ and post‐group measures. Participants reported high satisfaction and meaningful improvements in understanding and managing emotions, with positive impact on daily life. Self‐reported psychological distress, ER difficulties, and adaptive ER skill use significantly improved, with medium‐to‐large pre‐post effects (d = 0.5–0.7) except lack of emotional clarity (d = 0.3). Conclusions MEG was feasible and acceptable, and a future feasibility randomised controlled trial is warranted. Practitioner points
Individuals with psychosis report that support with their emotions is a priority. Brief interventions for emotion regulation difficulties are acceptable to individuals with psychosis and can be feasibly delivered in a local outpatient service. Distress and emotion regulation difficulties and skills improved significantly from pre–post treatment for clients completing the managing emotions group. Further implementation and evaluation are needed to support continued refinement to meet the needs and priorities of individuals with psychosis.
Collapse
Affiliation(s)
- Caroline Lawlor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Duffy
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ben Cooper
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Clair Le Boutillier
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Ben Carter
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
|
4
|
Bullock J, Whiteley C, Moakes K, Clarke I, Riches S. Single-session Comprehend, Cope, and Connect intervention in acute and crisis psychology: A feasibility and acceptability study. Clin Psychol Psychother 2020; 28:219-225. [PMID: 32833291 DOI: 10.1002/cpp.2505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/24/2020] [Accepted: 08/14/2020] [Indexed: 01/13/2023]
Abstract
Comprehend, Cope, and Connect (CCC) is a third-wave cognitive behavioural approach developed for acute mental health services. The aim of this study was to assess feasibility and acceptability of a newly developed, manualized single-session CCC intervention delivered face-to-face with service users in acute and crisis psychology services in South London. The study adopted a within-subjects pre-post-test design. Participants (N = 23) were recruited from five acute psychiatric wards and a crisis resolution home treatment team. Service users had a range of diagnoses of complex and severe mental health conditions, in particular mood, personality, and psychotic disorders. Feasibility data were gathered for number of times the CCC formulation was accepted, duration of CCC intervention, clinician adherence to manualised protocol, and frequency of goal-based activity completion. Acceptability data on pre- and post-CCC mood and post-CCC helpfulness were self-reported by participants. Findings indicated a significant increase in positive mood (large effect) and moderate-high helpfulness rating postintervention. Most participants reported goal-based activity completion. There was high fidelity to the protocol, high percentage of acceptance of the formulation and formulation components completed, and frequent single-session completion. Single-session CCC appears feasible and acceptable in acute and crisis psychology services and yields formulation-driven goal-based activities intended to stabilize mental health crisis. High fidelity to formulation protocol suggests broader applications for single-session CCC, for example, to support clinical staff to manage crisis situations in their work environment or to train nonpsychologist clinicians to deliver the intervention for service users. A randomized controlled trial of single-session CCC would increase validity and generalisability of findings.
Collapse
Affiliation(s)
- Jonathan Bullock
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.,Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK
| | - Christopher Whiteley
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Kaylee Moakes
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Isabel Clarke
- Southern Health NHS Foundation Trust, Tatchbury Mount, Calmore, Southampton, UK
| | - Simon Riches
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
|
5
|
Awenat YF, Peters S, Gooding PA, Pratt D, Huggett C, Harris K, Armitage CJ, Haddock G. Qualitative analysis of ward staff experiences during research of a novel suicide-prevention psychological therapy for psychiatric inpatients: Understanding the barriers and facilitators. PLoS One 2019; 14:e0222482. [PMID: 31550251 PMCID: PMC6759174 DOI: 10.1371/journal.pone.0222482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/29/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Suicide prevention is a global priority. Psychiatric hospitalization presents an opportunity to intervene positively with, for example, psychological therapies. However, evidenced-based suicide-prevention psychological treatments are rarely available on in-patient wards. Understanding staff engagement with research investigating suicide-prevention psychological treatments is crucial for their effective, efficacious, and pragmatic implementation. A pilot randomised control trial and feasibility study of Cognitive Behavioural Suicide Prevention therapy provided the opportunity for a qualitative investigation of staff experiences and views of a psychological intervention for people with suicidal experiences on psychiatric in-patient wards. AIMS To investigate staff acceptability of Cognitive Behavioural Suicide Prevention therapy for psychiatric inpatients based on their perceptions of their experiences during the conduct of a clinical trial. METHOD Transcribed audio-recordings of qualitative interviews and a focus group (n = 19) of purposively sampled staff from eight psychiatric wards were analysed using inductive Thematic Analysis. RESULTS Facilitators and barriers were identified for: i) the conduct of the research, and, ii) the suicide-prevention intervention (Cognitive Behavioural Suicide Prevention therapy). Research-related barriers comprised communication difficulties between staff and researchers, and increased staff workload. Research-related facilitators included effective staff/researcher relationships, and alignment of the intervention with organisational goals. Suicide-prevention intervention-related barriers comprised staffs' negative beliefs about suicide which impacted on their referral of inpatients to the clinical trial, and staff perceptions of insufficient information and unfulfilled expectations for involvement in the therapy. Facilitators included staff beliefs that the therapy was beneficial for inpatients, the service and their own clinical practice. CONCLUSIONS Staff beliefs that 'suicide-talk' could precipitate suicidal behaviour resulted in covert gatekeeping and restricted referral of only inpatients judged as stable or likely to engage in therapy, which may not be those who could most benefit. Such threats to sample representativeness have implications for future therapy research design. The findings provide novel information for researchers and practitioners regarding the conduct of psychological treatment and research in psychiatric units.
Collapse
Affiliation(s)
- Yvonne F. Awenat
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Patricia A. Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Kamelia Harris
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Christopher J. Armitage
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester, University of Manchester, United Kingdom
- Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
|
6
|
Paterson C, Karatzias T, Harper S, Dougall N, Dickson A, Hutton P. A feasibility study of a cross‐diagnostic, CBT‐based psychological intervention for acute mental health inpatients: Results, challenges, and methodological implications. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 58:211-230. [DOI: 10.1111/bjc.12209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/01/2018] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Sean Harper
- Psychology Department Royal Edinburgh Hospital, NHS Lothian UK
| | - Nadine Dougall
- School of Health and Social Care Edinburgh Napier University UK
| | - Adele Dickson
- Department of Psychology and Allied Health Sciences Glasgow Caledonian University UK
| | - Paul Hutton
- School of Health and Social Care Edinburgh Napier University UK
| |
Collapse
|
|
7
|
Pudalov LR, Swogger MT, Wittink M. Towards integrated medical and mental healthcare in the inpatient setting: what is the role of psychology? Int Rev Psychiatry 2018; 30:210-223. [PMID: 30821187 DOI: 10.1080/09540261.2018.1552125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Integrated medical and psychiatric hospital units hold great promise for improving the value and quality of care for patients with severe mental illness and concomitant acute medical needs. It is important to explore the utility of providing a range of multidisciplinary inpatient services to meet patients' complex needs. Within this context, services typically provided by psychologists have received little research attention. To address this gap in the literature, this study assessed inpatient clinicians' perceptions of the need for specific behavioural services on a medical psychiatric unit, exploring their overlap with established psychological services. Results indicate the potential utility of specific psychological services, including psychological assessments, direct psychosocial interventions, and psychoeducational training. While reimbursement and billing barriers still exist for psychologists to be routinely incorporated into hospital settings, the movement towards value-based care could provide the opportunity to think about the value added. Embedding evidence-based psychological services has the potential to promote high quality, well-rounded care that aligns with the established mission of multidisciplinary teamwork on integrated medical and psychiatric inpatient units.
Collapse
Affiliation(s)
- Lauren R Pudalov
- a Chronic Pain Rehabilitation Program and Bariatric & Metabolic Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Marc T Swogger
- b Department of Psychiatry, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Marsha Wittink
- c Departments of Family Medicine and Psychiatry, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| |
Collapse
|
|
8
|
Awenat YF, Peters S, Gooding PA, Pratt D, Shaw-Núñez E, Harris K, Haddock G. A qualitative analysis of suicidal psychiatric inpatients views and expectations of psychological therapy to counter suicidal thoughts, acts and deaths. BMC Psychiatry 2018; 18:334. [PMID: 30326878 PMCID: PMC6192165 DOI: 10.1186/s12888-018-1921-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/02/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Suicide is a global problem and suicidal behavior is common in acute psychiatric wards. Inpatient suicides regularly occur with 10.4/100,000 such deaths recorded in the UK in 2016. Inpatient suicides are potentially the most avoidable of all suicides as inpatients have 24-h staff contact. Current inpatient treatment prioritizes maintenance of physical safety by observation, medication and general supportive measures, however efficacious and effective specific treatments are lacking. Psychological treatments have a growing evidence base for suicide prevention yet provision of inpatient therapy is uncommon. The present qualitative study aimed to understand the patient acceptability issues by investigating suicidal inpatients views and expectations of a novel suicide-focussed cognitive behavioural psychological therapy which was nested alongside a pilot clinical trial of the intervention. METHODS Thematic analysis of semi-structured individual qualitative interviews with twenty suicidal psychiatric inpatients to investigate their views and expectations about ward-based suicide-focused psychological treatment. RESULTS Two main themes were identified. The first, 'A therapy that works', revealed inpatients' views of the necessary components for effective ward-based suicide-focused psychological therapy. The second, 'Concerns about in-patient suicide-focused therapy', depicted their fears about engaging in this treatment. Results suggested that suicide-focused psychological therapy was cautiously welcomed by inpatients' whose narratives expressed their needs, priorities and concerns. Further data analysis enabled formation of a user-informed model of suicide-focussed psychological therapy which offers guidance for researchers and clinicians. CONCLUSIONS We conclude that hospitalization of suicidal individuals offers a critical opportunity to intervene with effective treatment to preserve life and that suicide-focussed psychological therapy is likely to be well received by suicidal inpatients warranting further testing with a sufficiently powered definitive trial. It is important that provision of ward-based psychological therapy for suicidal inpatients addresses the considerable context-specific challenges inherent in this setting. TRIAL REGISTRATION NUMBER ISRCTN 17890126 , Registry: UK Clinical Trials Gateway, Date of registration: 22/04/15, Date of enrolment of first participant to the trial: 20/05/14 (retrospectively registered).
Collapse
Affiliation(s)
- Yvonne F Awenat
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL UK
- Manchester Academic Health Science Centre, MAHSC, Manchester, UK
- Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL UK
- Manchester Academic Health Science Centre, MAHSC, Manchester, UK
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Patricia A Gooding
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL UK
- Manchester Academic Health Science Centre, MAHSC, Manchester, UK
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL UK
- Manchester Academic Health Science Centre, MAHSC, Manchester, UK
- Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Emma Shaw-Núñez
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL UK
- Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Kamelia Harris
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, M13 9PL UK
- Manchester Academic Health Science Centre, MAHSC, Manchester, UK
- Greater Manchester Mental Health NHS Trust, Manchester, UK
| |
Collapse
|
|
9
|
Lamster F, Kiener J, Wagner K, Rief W, Görge SC, Iwaniuk S, Leube D, Falkenberg I, Kluge I, Kircher T, Mehl S. Ist Wahn indirekt veränderbar? Ein stimmungsverbesserndes Konzept der kognitive Verhaltenstherapie für die stationäre Standardversorgung von Patienten mit schizophrenen Störungen. VERHALTENSTHERAPIE 2018. [DOI: 10.1159/000486966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
|
10
|
Jacobsen P, Peters E, Chadwick P. Mindfulness-Based Crisis Interventions for patients with psychotic symptoms on acute psychiatric wards (amBITION study): Protocol for a feasibility randomised controlled trial. Pilot Feasibility Stud 2016; 2:43. [PMID: 27516897 PMCID: PMC4977064 DOI: 10.1186/s40814-016-0082-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 06/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inpatient psychiatric care is a scarce and expensive resource in the National Health Service (NHS), with chronic bed shortages being partly driven by high re-admission rates. People often need to go into hospital when they have a mental health crisis due to overwhelming distressing psychotic symptoms, such as hearing voices (hallucinations) or experiencing unusual beliefs (delusions). Brief talking therapies may be helpful for people during an acute inpatient admission as an adjunct to medication in reducing re-admission rates, and despite promising findings from trials in the USA, there have not yet been any clinical trials on this kind of intervention within NHS settings. METHODS/DESIGN The amBITION study is a feasibility randomised controlled trial (RCT) of a manualised brief talking therapy (Mindfulness-Based Crisis Intervention; MBCI). Inpatients on acute psychiatric wards are eligible for the study if they report at least one positive psychotic symptom, and are willing and able to engage in a talking therapy. In addition to treatment as usual (TAU), participants will be randomly allocated to receive either MBCI or a control intervention (Social Activity Therapy; SAT) which will be based on doing activities on the ward with the therapist. The primary objective of the study is to find out whether it is possible to carry out this kind of trial successfully within UK inpatient settings and to find out whether patients and staff find it an acceptable intervention. The secondary objective is to collect pilot data on primary and secondary outcome measures, including re-admission rates at 6 month follow-up. This will provide information on the appropriateness of re-admission as the primary outcome measure for future efficacy trials, as well as data on the acceptability and utility of the clinical self-report measures. DISCUSSION The results of the feasibility trial will indicate whether a subsequent efficacy pilot trial is warranted, and if so, will provide vital information for the planning of such a trial (e.g. pilot data on expected effect sizes). If future research finds that MBCI is an effective and safe intervention, then patients will benefit from access to better treatment within inpatient care which would reduce re-admission rates. This trial therefore addresses an area of urgent concern for service users, clinicians and the wider NHS. TRIAL REGISTRATION ISRCTN37625384.
Collapse
Affiliation(s)
- Pamela Jacobsen
- Department of Psychology (PO 78), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, SE5 8AF London, UK
| | - Emmanuelle Peters
- Department of Psychology (PO 78), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, SE5 8AF London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paul Chadwick
- Department of Psychology (PO 78), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, SE5 8AF London, UK
| |
Collapse
|
|
11
|
Nikolitch K, Laliberté V, Yu C, Strychowsky N, Segal M, Looper KJ, Rej S. Tolerability and suitability of brief group mindfulness-oriented interventions in psychiatric inpatients: a pilot study. Int J Psychiatry Clin Pract 2016; 20:170-4. [PMID: 27334931 DOI: 10.1080/13651501.2016.1197276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Mindfulness-oriented therapies have a positive impact on patients' overall well-being and alleviate many psychiatric conditions. However, little is known about their use in people with severe mental illness. We aimed to identify which clinical and sociodemographic factors are associated with suitability/tolerability of a brief group mindfulness-oriented therapy. METHODS This retrospective study examines pre-/post-data from 40 psychiatric inpatients who underwent one session of a 10-min mindfulness-oriented group intervention between January and March 2014. The main outcome was 'suitability for and tolerating the brief mindfulness-oriented group intervention'. We assessed potential correlates of the main outcome, including female gender, shorter hospitalisation, the absence of psychosis and good pre-morbid functioning. RESULTS The intervention was well tolerated (92.5%) and 50% of patients met both of our relatively stringent suitability and tolerability criteria. Sociodemographic and clinical variables were not associated with suitability/tolerability. Tai chi was the most suitable/tolerable compared to body scan and mindful eating (76.5% vs. 35.7% vs. 22.2%, Fisher's exact p = 0.01, Bonferroni p < 0.05). CONCLUSIONS Brief group mindfulness therapy interventions are very well tolerated and often suitable for acutely hospitalised psychiatric inpatients, including those with acute psychosis. Mindfulness-oriented intervention with an active component (e.g., tai chi, mindful walking) may potentially be best suited for this population.
Collapse
Affiliation(s)
- Katerina Nikolitch
- a Geri-PARTy Research Group, Department of Psychiatry , Jewish General Hospital, McGill University , Montreal , Canada
| | - Vincent Laliberté
- a Geri-PARTy Research Group, Department of Psychiatry , Jewish General Hospital, McGill University , Montreal , Canada
| | - Ching Yu
- a Geri-PARTy Research Group, Department of Psychiatry , Jewish General Hospital, McGill University , Montreal , Canada
| | - Natalie Strychowsky
- a Geri-PARTy Research Group, Department of Psychiatry , Jewish General Hospital, McGill University , Montreal , Canada
| | - Marilyn Segal
- a Geri-PARTy Research Group, Department of Psychiatry , Jewish General Hospital, McGill University , Montreal , Canada
| | - Karl J Looper
- a Geri-PARTy Research Group, Department of Psychiatry , Jewish General Hospital, McGill University , Montreal , Canada
| | - Soham Rej
- a Geri-PARTy Research Group, Department of Psychiatry , Jewish General Hospital, McGill University , Montreal , Canada ;,b Division of Geriatric Psychiatry, Department of Psychiatry , University of Toronto , Toronto , Canada
| |
Collapse
|
|
12
|
Araci D, Clarke I. Investigating the efficacy of a whole team, psychologically informed, acute mental health service approach. J Ment Health 2016; 26:307-311. [PMID: 26855262 DOI: 10.3109/09638237.2016.1139065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Service user demand and service changes, from hospital based, to community and hospital mix, within acute adult mental health services, focus the need for psychologically informed, holistic, approaches. AIMS (1) Describe and report feasibility of a psychologically led Intensive Support Programme (ISP) to meet this need. (2) Present results of a pilot evaluation of this programme. METHOD ISP was implemented in four acute mental health services of the Southern Health NHS Trust, available to both inpatient and outpatient acute services. Evaluation of the service one month after data collection, illustrates operation and level of uptake across different professional roles. The programme was evaluated by assessing psychological distress (CORE-10) and confidence in self-management (Mental Health Confidence Scale) of participating service users before and after intervention. RESULTS The service evaluation demonstrated extensive roll out of this programme across acute services of an extensive NHS Trust. Repeated measure t-tests demonstrated significant decrease in distress (p < 0.0005) and significant increase in confidence in self-management of mental health (p < 0.0005). CONCLUSION Evaluation shows that ISP can be delivered in routine care in an acute mental health service and results in improvement in self management skills and facilitation of recovery.
Collapse
Affiliation(s)
- David Araci
- a Dorset Healthcare NHS Foundation Trust, St. Ann's Hospital, St. Ann's Hospital , Dorset Forensic Team , Poole , United Kingdom of Great Britain and Northern Ireland and
| | - Isabel Clarke
- b Southern Health NHS Foundation Trust , Southampton , United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
|
13
|
[Guideline-conform psychiatric psychotherapeutic treatment for patients with schizophrenia : A normative evaluation of necessary personnel requirements]. DER NERVENARZT 2016; 87:286-94. [PMID: 26820457 DOI: 10.1007/s00115-015-0056-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although national treatment guidelines and current publications of the German Federal Joint Committee (Gemeinsamer Bundesausschuss) recommend cognitive behavior therapy for all patients with schizophrenia, the implementation of these recommendations in current inpatient and outpatient treatment is only rudimentary. OBJECTIVES The aim of this study was to systematically search randomized controlled studies (RCTs), meta-analyses and the guidelines of the German Association for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) and the British National Institute for Health and Clinical Excellence (NICE) in order to assess the number of personnel necessary for psychiatric and therapeutic inpatient treatment in line with present guidelines. Moreover, the number of staff required was compared with the personnel resources designated by the German psychiatry personnel regulations (Psych-PV). METHODS The German and NICE guidelines, RCTs and meta-analyses were analyzed and an adequate weekly treatment plan for an inpatient unit was developed. Moreover, the number of personnel necessary to realize the treatment plan was calculated. RESULTS In order to realize adequate inpatient treatment approximately 107 min extra for medical psychotherapeutic personnel per patient and week (of which 72 min for psychotherapy) and another 60 min for nursing staff per patient and week are required in addition to the current Psych-PV regulations. Thus, implementation in an open ward with 20 inpatients would require 3.62 positions for physicians, 0.7 positions in psychology and 12.85 positions for nursing staff (including management positions and night shifts). DISCUSSION These evidence-based recommendations for precise specifications of inpatient treatment should lead to improved inpatient treatment in line with present guidelines. Moreover, outpatients and day patients could be included in this treatment model. The results should be considered in the construction of the future prospective payment system for inpatient psychiatric healthcare in Germany.
Collapse
|
|
14
|
Folke F, Hursti T, Tungström S, Söderberg P, Ekselius L, Kanter JW. Behavioral Activation Between Acute Inpatient and Outpatient Psychiatry: Description of a Protocol and a Pilot Feasibility Study. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2014.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
|
15
|
Owen M, Sellwood W, Kan S, Murray J, Sarsam M. Group CBT for psychosis: A longitudinal, controlled trial with inpatients. Behav Res Ther 2015; 65:76-85. [DOI: 10.1016/j.brat.2014.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/07/2014] [Accepted: 12/12/2014] [Indexed: 11/29/2022]
|
|
16
|
Mitchison D, Jakes S, Kelly S, Rhodes J. Are Young People Hospitalised with Psychosis Interested in Psychological Therapy? Clin Psychol Psychother 2013; 22:22-31. [PMID: 23983175 DOI: 10.1002/cpp.1864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/25/2013] [Accepted: 07/29/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Deborah Mitchison
- Birunji Youth Mental Health Unit; Campbelltown Hospital; Sydney Australia
| | - Simon Jakes
- Birunji Youth Mental Health Unit; Campbelltown Hospital; Sydney Australia
| | - Siobhan Kelly
- Birunji Youth Mental Health Unit; Campbelltown Hospital; Sydney Australia
| | - John Rhodes
- Department of Psychology; Central and North West London National Health Service Foundation Trust; London UK
| |
Collapse
|
|
17
|
Borschmann R, Henderson C, Hogg J, Phillips R, Moran P. Crisis interventions for people with borderline personality disorder. Cochrane Database Syst Rev 2012:CD009353. [PMID: 22696385 DOI: 10.1002/14651858.cd009353.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND People with borderline personality disorder (BPD) frequently present to health services in crisis, often involving suicidal thoughts or actions. Despite this, little is known about what constitutes effective management of acute crises in this population. OBJECTIVES To review the evidence for the effectiveness of crisis interventions for adults with BPD in any setting. For the purposes of the review, we defined crisis intervention as 'an immediate response by one or more individuals to the acute distress experienced by another individual, which is designed to ensure safety and recovery and lasts no longer than one month.' SEARCH METHODS We searched the following databases in September 2011: CENTRAL (The Cochrane Library 2011, Issue 3), MEDLINE (1948 to August Week 5 2011), MEDLINE In Process & Other Non-indexed Citations (8 September 2011), EMBASE (1980 to Week 36 2011), PsycINFO (1806 to September Week 1 2011), CINAHL (1937 to current), Social Services Abstracts (1979 to current), Social Care Online (12 September 2011), Science Citation Index (1970 to current), Social Science Citation Index (1970 to current), Conference Proceedings Citation Index - Science (1990 to current), Conference Proceedings Citation Index - Social Science and Humanities (1990 to current) and ZETOC Conference proceedings (12 September 2011). We searched for dissertations in WorldCat (12 September 2011), Australasian Digital Theses Program (ADTP; 12 September 2011), Networked Digital Library of Theses and Dissertations (NDLTD), 12 September 2011 and Theses Canada Portal (12 September 2011). We searched for trials in the International Clinical Trials Registry Platform (ICTRP) and searched reference lists from relevant literature. We contacted the 10 most published researchers in the field of BPD (as indexed by BioMed Experts), in addition to contacting topic experts, Marsha Linehan, Arnoud Arntz and Paul Links, about ongoing trials and unpublished data. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing crisis interventions with usual care or no intervention or a waiting list control for adults of any age with BPD. DATA COLLECTION AND ANALYSIS Two authors independently screened titles, abstracts and full-text articles and assessed these against the inclusion criteria. MAIN RESULTS The search identified 15 studies, 13 of which we excluded. Reasons for exclusion were: lack of randomisation (N = 8); retrospective design (N = 2); or the intervention was a complex psychological therapy lasting longer than one month (N = 3). We identified two ongoing RCTs that met the inclusion criteria, with a combined predicted sample size of 688. These trials are ongoing and the results are therefore not included in the review, although they will be incorporated into future updates. AUTHORS' CONCLUSIONS A comprehensive search of the literature showed that currently there is no RCT-based evidence for the management of acute crises in people with BPD and therefore we could not reach any conclusions about the effectiveness of any single crisis intervention. High-quality, large-scale, adequately powered RCTs in this area are urgently needed.
Collapse
Affiliation(s)
- Rohan Borschmann
- Health Service and Population Research Department, Institute of Psychiatry, King’s College London, London, UK.
| | | | | | | | | |
Collapse
|
|
18
|
Post-Admission Cognitive Therapy: A Brief Intervention for Psychiatric Inpatients Admitted After a Suicide Attempt. COGNITIVE AND BEHAVIORAL PRACTICE 2012. [DOI: 10.1016/j.cbpra.2010.11.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
|
19
|
Pilot Study of Group Cognitive Behaviour Therapy for Heterogeneous Acute Psychiatric Inpatients: Treatment in a Sole-Standalone Session Allowing Patients to Choose the Therapeutic Target. Behav Cogn Psychother 2011; 39:359-65. [DOI: 10.1017/s1352465810000834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Group CBT (G-CBT) for heterogeneous acute psychiatric inpatients (HAPIs), which allows patients to choose the group therapeutic target, might have clinical utility but is empirically untested. Aims: To test the feasibility, acceptability and patient-rated effectiveness of G-CBT for HAPIs in which patients' themselves choose the group therapeutic targets, within a previously rarely used sole-standalone session format. Method: Weekly G-CBT was run for two HAPI wards. The G-CBT was evaluated in terms of attendances/re-attendances, and patient feedback on 5-point scales of how strongly patients agreed/disagreed that the group was useful, enjoyable, worth re-attending, and had led to them learning something they could use to reduce their distress. Results: One hundred and thirty-seven separate patients attended a total of 291 times across 31 groups. Being female or having a diagnosis of bipolar disorder significantly predicted re-attendance. Sixty-three percent of patient feedback questionnaires were obtained from groups 10–31 and over 75% of respondents agreed positively with each of the evaluation dimensions. Conclusions: Practise-based evidence from this pilot study suggests that G-CBT for HAPIs, allowing patients to choose therapeutic targets in a sole-session format, is feasible, acceptable and patients find it effective. This supports more widespread deployment of this CBT treatment format. Future research might now test the format's clinical effectiveness with standardized and objective clinical outcome measures.
Collapse
|
|
20
|
Gökhan N, Meehan EF, Peters K. The Value of Mindfulness-Based Methods in Teaching at a Clinical Field Placement. Psychol Rep 2010; 106:455-66. [DOI: 10.2466/pr0.106.2.455-466] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The value of mindfulness-based methods in an undergraduate field placement was investigated in relation to the acquisition of self-care and other basic clinical competencies. The participants were 22 students in an applied behavioral analysis course, which included a mindfulness-based training module, and 20 students enrolled in an experimental psychology course without mindfulness training. The Mindfulness Attention and Awareness Scale, the Freiberg Mindfulness Inventory, and the Kentucky Inventory of Mindfulness Skills were used as measurements before and after intervention. Mindfulness-trained participants kept records and were asked to share their personal experiences during supervision and an exit interview. Results demonstrated that training significantly increased mindfulness. Qualitative data indicated enhanced self-care, attention to well-being, self-awareness, active involvement acquiring skills, and empathy and compassion. The need to expand the utility of mindfulness to the realm of education and the importance of including comparison groups with other self-care modules for future studies were discussed.
Collapse
Affiliation(s)
- Nurper Gökhan
- LaGuardia Community College of the City University of New York
| | - Edward F. Meehan
- The College of Staten Island of the City University of New York, CSI/IBR Center for Developmental Neuroscience and Developmental Disabilities
| | - Kevin Peters
- The College of Staten Island of the City University of New York
| |
Collapse
|