Assessing Psychosocial Distress in Cystic Fibrosis: Validation of the ‘Distress in Cystic Fibrosis Scale’

Experiences of anxiety and depression are common in adults with Cystic Fibrosis (AwCF) (e.g. Quittner in Thorax 69:1090-1097, 2014) and may impact on a wide range of important health-related behaviours, such as adherence to medication and timely attendance for medical review when experiencing pulmonary exacerbation. Common screening measures used in CF such as the PHQ-9 and GAD-7 may reflect an absence of anxiety or depression when clinically significant emotional difficulties are apparent on further assessment. This study preliminarily validated the previously developed Distress in Cystic Fibrosis Scale (DCFS) (Patel in Journal of Cystic Fibrosis 15:S26, 2016); a 23-item questionnaire to assess psychosocial distress in AwCF. Inpatient and outpatient participants with CF (N?=?119) completed a battery of questionnaires, including the DCFS. PCA results supported a single component model. The DCFS showed high internal consistency and correlated significantly with measures of mood and quality of life. The DCFS shows promise as a screening tool to assess clinically significant psychosocial distress in an adult CF population.

     

Brief psychological treatments for emotional disorders in Primary and Specialized Care: A randomized controlled trial

Background/Objective Brief transdiagnostic psychotherapies are a possible treatment for emotional disorders. We aimed to determine their efficacy on mild/moderate emotional disorders compared with treatment as usual (TAU) based on pharmacological interventions. Method: This study was a single-blinded randomized controlled trial with parallel design of three groups. Patients (N = 102) were assigned to brief individual psychotherapy (n = 34), brief group psychotherapy (n = 34) or TAU (n = 34). Participants were assessed before and after the interventions with the following measures: PHQ-15, PHQ-9, PHQ-PD, GAD-7, STAI, BDI-II, BSI-18, and SCID. We conducted per protocol and intention-to-treat analyses. Results: Brief psychotherapies were more effective than TAU for the reduction of emotional disorders symptoms and diagnoses with moderate/high effect sizes. TAU was only effective in reducing depressive symptoms. Conclusions: Brief transdiagnostic psychotherapies might be the treatment of choice for mild/moderate emotional disorders and they seem suitable to be implemented within health care systems.     

THE TOTALITARIAN STATE OF MIND

The paper describes the development of Dynamic Interpersonal Therapy for use with complex depression (DITCC), and a pilot study testing DITCC’s effectiveness. The pilot found large pre-post improvements in well-being and distress; moderate rates of reliable improvement and clinically significant change; and curvilinear declines in depression and anxiety. Treatment completers and near-completers (N= 19) showed a significant curvilinear decline in symptoms of depression (PHQ-9) and anxiety (GAD-7). The results provide preliminary evidence that DITCC can be used as an effective treatment approach for complex depression. However, further research is needed to test its effectiveness in different settings with a larger sample size, using appropriate comparison groups under controlled conditions to further elaborate the short-term and long-term effects.     

Psychological predictors for health-related quality of life and disability in persons with chronic obstructive pulmonary disease (COPD)

Objective: Individuals with chronic obstructive pulmonary disease (COPD) exhibit low physical and mental health-related quality of life (HRQL) and high susceptibility to disability. We investigated the influence of psychological factors on HRQL and disability in COPD individuals recruited from the general population. In line with Leventhal’s common sense model, we expected psychological factors to be associated with HRQL and disability even after controlling for medical status.

Methods: Individuals with COPD (n = 502; 59.7 years old; GOLD grades were I: 3%, II: 17%, III: 34%, IV: 46%) were assessed through an online survey administered via COPD patient organisations in Germany. Individuals filled in the Short Form Health Survey (SF-12), COPD Assessment Test, Patient Health Questionnaire (modules: GAD-2, PHQ-15, PHQ-9), Brief Illness Perception Questionnaire, a questionnaire that assesses causal illness attributions, and the internal illness-related locus of control scale of the ‘KKG questionnaire for the assessment of control beliefs about illness and health’. Multiple linear regressions were calculated.

Results: The investigated factors explained high variances (disability = 56%, physical HRQL = 28%, mental HRQL = 63%, p ≤ .001). Better mental health, more optimistic illness perceptions, attribution to psychological causes, and stronger internal locus of control were associated with lower disability and better HRQL. Comorbid somatic symptoms contributed to high disability and low quality of life.

Conclusion: Psychological factors, such as illness perception, attribution and internal locus of control, were associated with disability and HRQL. These factors should be considered when designing treatments for individuals with COPD, and adequate interventions should be provided to enhance illness understanding and self-management skills.     

Supervisees' perspectives on the contribution of supervision to psychotherapy outcomes

Objective

The aim of this study was to examine supervisees' perspectives about the contribution of two predefined aspects of supervision, supervisory bond (SB) and didactic input of supervisor (DI), to their ascribed outcome of therapy.

Method

Supervisees anonymously assessed the SB, supervisors' DI and their contribution to therapy outcome. Assessment was quantitative and qualitative. The supervisory aspects were assessed using a questionnaire constructed for this study. Perceived contribution was evaluated by two scaled questions, and themes generated by an open question. Supervisees (n = 111) evaluated 16 supervisors and supervision’s contribution to psychotherapy outcomes of 111 clients.

Findings

Hierarchical regression showed that supervisees' age, supervisors' status and frequency of supervision accounted for 24% of the variance ascribed to outcome. SB and DI accounted for 51% of the variance. These values, which are higher than reported in the literature, may be attributed to the assessment of predefined aspects of supervision by the same assessor. Thematic analysis of the didactic input produced more themes than for the supervisory bond.

Conclusion

Sociodemographic variables and supervisory relationship variables determine supervisees' evaluations of supervision’s contribution to outcome.

Implications for practice

Training and supervision may benefit from information obtained from quantitative and qualitative measures regarding these and other predefined variables related to supervision. The in-depth look at views and experiences shared by supervisees may advance training, practice and research.     

Enhancing recovery rates: Lessons from year one of IAPT

BackgroundThe English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines.MethodData from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7).ResultsData completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff.ConclusionsCompliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.     

Stability and change in children's skill

Summary This paper explores age-related performance variability, both within trials and between sessions, in repetitive hopping. The mean, the standard deviation (SD), and the coefficient of variation (CV) of several timing and ground-reaction-force variables of hopping were analysed by repeated-measures ANOVA for age-related effects across test sessions and foot used. Forty-five subjects in five age groups (3–4 years, 4–5 years, 6–7 years, 8–9 years, or Adult) performed self-paced, one-footed hopping on three occasions within one week. As was expected, the results showed main effects for Age in all force and time variables, with the exception of CV of medio-lateral force. No significant main effects for Feet were revealed. However, significant Feet x Session interactions were found in flight-time measures, with higher flight-time SD and lower CV for the non-preferred foot in Session 1, a reversal in Session 2, and a negligible difference in Session 3. Across sessions, decreased SD and CV for both vertical and medio-lateral force and shorter flight time indicated more efficient hopping. Overall, it was concluded that SD and CV measures were more sensitive measures of children's performance across repeated sessions than were mean scores and that the order of testing the limbs is an important consideration in experimental protocols when lateralized tasks are measured.     

Internet-based acceptance and commitment therapy for psychological distress experienced by people with hearing problems: a pilot randomized controlled trial

Psychological distress is common among people with hearing problems, but treatments that specifically target this aspect have been almost non-existent. In this pilot randomized controlled trial, an eight-week long Internet-based treatment, informed by Acceptance and Commitment Therapy, was administered to explore the feasibility and efficacy of such a treatment. Included participants were randomized to either treatment (n = 31) or wait-list control (n = 30) condition. All participants were measured prior to randomization and immediately after treatment ended using standardized self-report instruments measuring hearing-related emotional and social adjustment (Hearing Handicap Inventory for the Elderly – S, HHIE-S), quality of life (Quality of Life Inventory, QOLI), and symptoms of depression and anxiety (Patient health Questionnaire, PHQ-9 and Generalized Anxiety Disorder scale, GAD-7). Linear mixed effects regression analysis using the full intention-to-treat sample demonstrated that the treatment had superior outcomes on the main outcome measure as compared with the control group, Cohen’s d = 0.93, 95% CI [0.24, 1.63]. The benefits of treatment over control were also evident in scores of depression, Cohen’s d = 0.61, 95% CI [0.04, 1.19], and quality of life, Cohen’s d = 0.88, 95% CI [0.14, 1.61]. The results provide preliminary support for Internet-delivered acceptance and commitment therapy as a potentially effective treatment of psychological symptoms associated with hearing problems.     

The association of antidepressant and statin use with death and incident cardiovascular disease varies by depression severity

Depression has been reported to be associated with a greater risk of death and cardiovascular disease (CVD); however, the impact of antidepressants (ADM) on CVD risk remains controversial. Statin use is known to decrease CVD risk. Whether the use of these medications together affects CVD risk has not been studied. Patients (N = 26,828) completing the patient health questionnaire (PHQ-9), ≥40 years of age, without prior CVD, and no prior ADM use were studied. Depressive severity was categorized as none-mild (PHQ-9 score ≤14, n = 21,517) and moderate-severe (PHQ-9 score ≥15, n = 5311). Cox hazard regression was used to evaluate the association of no ADM/no statin use (n = 23,104 [86.1%]), ADM/no statin use (n = 877 [3.3%]), no ADM/statin use (n = 2627 [9.8%]), and ADM/statin use (n = 220 [.8%]) with major adverse cardiovascular events (MACE: death, CAD, stroke). Patients averaged 56 ± 12 years; 61% female. There were 1182 (4.4%) 3 year MACE events. The association of ADM and statin use with MACE varied by depressive symptom severity, with statin therapy associated with a decreased risk in the none-mild group (HR = .78, p = .007) and ADM in the moderate-high group (HR = 0.58, p = 0.02). Concomitant use of ADMs and statins did not appear to provide additive benefit.     

“Sharing in people's pain is not an easy thing to do”: Cognitive Behavioural Therapists' understandings of compassion in the workplace

Objectives

Compassion is central to the aim of improving patient care and staff well-being within healthcare systems. To inform service development, explorations of experiences and meanings of compassion are needed. This study explored cognitive behavioural therapists ' understandings of compassion within their work environment.

Design

A qualitative study was conducted using semistructured interviews and interpretative phenomenological analysis (IPA).

Methods

Data were obtained from five practicing cognitive behavioural therapists.

Results

Two superordinate themes were developed, each with two subordinate themes. CBT therapists reported entering the profession with intrinsic motivation to care for others. They further developed an interest in compassion with exposure to clients and ongoing professional development in compassion-focused therapy (CFT). Compassionate work environments helped to facilitate compassionate practice; however, for many, workplaces were perceived to lack compassion. Challenges were encountered when negative workplace interactions left therapists feeling fatigued, distressed and demoralised. There was a desire for recognition and to be seen as more than a “work machine,” the experience of which was a threat to retaining therapists within the profession.

Conclusions

Current recruitment and training processes are producing staff with skills and motivation to deliver compassionate care. However, lack of compassion within workplaces can be a barrier to actioning these skills and motivations. Research needs to focus on how to effectively implement and run systems that are compassionate for both staff and clients. To provide compassionate care, staff need work environments that show compassion to them. These findings provide some insights into and practical suggestions regarding how this can be achieved.     

Psychiatric Distress and Suicidal Tendencies in Adult Cancer Survivors: Verifying the Validity of the Brief Symptom Inventory-18 for Identifying Suicidal Ideation in the Hospitalized Population of Mainland China

The Brief Symptom Inventory-18 (BSI-18) is widely used to assess psychiatric distress but has not been verified in the Chinese population. From March to April 2019, 293 hospitalized cancer patients, aged 20–87, completed the cross-sectional survey with demographics questionnaire, BSI-18, and PHQ-9. We analyzed the single suicide-related item of PHQ-9 with the full score clinical outpoint for BSI-18 and PHQ-9 using SPSS 22.0 and R 2.15, including Pearson's χ² test and ROC curve analyses. A Pearson's χ² test was carried out to compare the three different methods with the gold screening criteria. The p-value was correspondingly to .006, .066, .838. When the PHQ-9?≥?10 criteria for the BSI-18, receiver operating characteristic analysis revealed that AUC values were 0.839, optimal cut-off points for both BSI-18?≥?50, the sensitivity of 85.8%, and 62.5%, respectively. The BSI-18 is suitable for a screening tool for psychological distress and could also be used in clinical settings for preliminary screening of hospitalized cancer patients.

     

Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth—a randomized controlled trial

The aim of this study was to analyse the effects of trauma-focused guided Internet-based cognitive behaviour therapy for relieving posttraumatic stress disorder (PTSD) symptoms following childbirth, a problem that about 3% women encounter postpartum. Following inclusion, 56 traumatized women were randomized to either treatment or to a waiting list control group. Primary outcome measures were the Traumatic Event Scale (TES) and Impact of Event Scale—Reversed (IES-R). Secondary measures were Beck depression inventory II, Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory, Quality Of Life Inventory and the EuroQol 5 Dimensions. The treatment was guided by a clinician and lasted eight weeks and comprised eight modules of written text. The between-group effect size (ES) was d = .82 (p < .0001) for the IES-R. The ES for the TES was small (d = .36) and not statistically significant (p = .09). A small between-group ES (d = .20; p = .02) was found for the PHQ-9. The results from pre- to post-treatment showed large within-group ESs for PTSD symptoms in the treatment group both on the TES (d = 1.42) and the IES-R (d = 1.30), but smaller ESs in the control group from inclusion to after deferred treatment (TES, d = .80; IES-R d = .45). In both groups, the treatment had positive effects on comorbid depression and anxiety, and in the treatment group also on quality of life. The results need to be verified in larger trials. Further studies are also needed to examine long-term effects.     

Avatar‐based counselling for young people within school counselling. Qualitative analysis of client experience

Background

This study is a qualitative analysis of clients’ experiences of a new avatar based counselling intervention, based on the ‘ProReal’ software ( www.proreal.world ). The intervention was piloted in eight secondary schools in the UK in 2016.

Aims

Twenty‐nine participants (53% of the full sample) were interviewed about their use of the software, experience of the intervention, process of change and views about its helpfulness.

Materials and Methods

Interviews were semi‐structured and were analysed using thematic analysis.

Results

The analysis shows that the intervention was potentially attractive to these clients, particularly those enthusiastic about digital software and clients who found visual communication helpful. The software provided additional opportunities for clients to communicate their inner worlds to the counsellor and supported the development of insight. Male clients, in particular, commented on its helpfulness.

Discussion

There is an indication that digital imagery supported the process of change in counselling and the development of meaning bridges: both internally and with the counsellor (Stiles, 2011; Stiles et al., 1990). However, the software could be experienced as an obstacle when clients wanted to talk about specific problems or ‘vent’ their feelings. All clients who reported that they did not find the software helpful were female. There were a number of suggestions about developing the software to increase opportunities for expression as well as appropriateness for clients from different minority ethnic backgrounds.

Conclusion

Use of digital software in counselling has a potential to enhance communication and support a process of change, particularly with male clients, those who find visual communication helpful, and clients enthusiastic about digital technology. Further research is needed to develop the intervention and compare it to the use of other creative media in counselling.     

中学生欺凌受害对其内化问题的影响:有调节的中介模型

采用特拉华校园氛围量表、特拉华欺负受害量表、心理弹性量表、病人健康问卷抑郁量表和广泛性焦虑量表对3543名中学生进行调查。探讨中学生感知的校园氛围与心理弹性在其欺凌受害与内化性问题间的中介调节作用。结果表明:(1)在控制中学生的性别、年级及父母文化水平后,欺凌受害能显著正向预测学生的内化性问题。(2)心理弹性在欺凌受害与内化性问题间起部分中介作用。(3)中学生感知的校园氛围在欺凌受害以及心理弹性对内化性问题的影响中均有显著的调节作用。     

“I'm an ogre so I'm very hungry!” “I'm assistant ogre”: The Social Function of Sibling Imitation in Early Childhood

Siblings' imitative behaviors were investigated in 39 middle‐class dyads during six 90‐min home sessions at both Time 1 (M age: older sibling = 4.4 years; younger sibling = 2.4 years) and Time 2 (2 years later). Although younger siblings imitated most often at T1 and T2, older siblings' imitation increased proportionally over time in comparison to younger siblings. Findings highlight the affiliative nature of imitation that occurred during reciprocal play interactions, via positive responses, and the content of the imitation. Finally, age was controlled by comparing first‐born siblings aged 4 at T1 to second‐born siblings aged 4 at T2. Findings demonstrated that sibling imitation had distinct characteristics despite the age match and partner effects. Sibling imitation is a dynamic, interactive social behavior and may be a powerful source of learning for young children.

Highlights

• The role of sibling imitation in ongoing play in early childhood is highlighted.
• Sibling imitation is a dynamic and affiliative behavior that promotes interaction during play.
• Naturalistic observations of sibling imitation document that it is a powerful source of learning for young children.

     

Connection‐based and object‐based grouping in multiple‐object tracking: A developmental study

Developmental research on Gestalt laws has previously revealed that, even as young as infancy, we are bound to group visual elements into unitary structures in accordance with a variety of organizational principles. Here, we focus on the developmental trajectory of both connection‐based and object‐based grouping, and investigate their impact on object formation in participants, aged 9–21 years old (N = 113), using a multiple‐object tracking paradigm. Results reveal a main effect of both age and grouping type, indicating that 9‐ to 21‐year‐olds are sensitive to both connection‐based and object‐based grouping interference, and tracking ability increases with age. In addition to its importance for typical development, these results provide an informative baseline to understand clinical aberrations in this regard.

Statement of contribution

What is already known on this subject?

• The origin of the Gestalt principles is still an ongoing debate: Are they innate, learned over time, or both?
• Developmental research has revealed how each Gestalt principle has its own trajectory and unique relationship to visual experience.
• Both connectedness and object‐based grouping play an important role in object formation during childhood.

What does this study add?

• The study identifies how sensitivity to connectedness and object‐based grouping evolves in individuals, aged 9–21 years old.
• Using multiple‐object tracking, results reveal that the ability to track multiple objects increases with age.
• These results provide an informative baseline to understand clinical aberrations in different types of grouping.

     

Therapists’ and clients’ perceptions of routine outcome measurement in the NHS: A qualitative study

Primary objective: This is the first qualitative study that elicited the perceptions of both psychological therapists and their clients in the use of Clinical Outcomes in Routine Evaluation with computer software (CORE‐Net), where instant visual feedback for session tracking was given on a computer screen in the therapy room at each therapy session. The study also examined how therapists viewed its potential value in supervision and provides suggestions for improving training. Research design: The study adopted a convenience sample of four therapists in a primary care counselling setting (PCC – General Practitioner referrals) who were experienced in using CORE‐Net, and five therapists in an NHS employee/occupational support counselling service (OH) who had just begun to use CORE‐Net for session tracking with 10 of their clients. Method: A qualitative methodology was used and interview data were collected from the therapists via focus groups; the clients were interviewed individually face to face. All data was analysed inductively. Findings: The study identified six overarching themes: (i) therapists were initially anxious and resistant; (ii) therapists adapt ‘creatively’; (iii) outcome measures help the client/therapist relationship; (iv) clients perceive visual measures as helpful; (v) CORE scores inform supervision; and (vi) proper and ongoing training/support of therapists is necessary. The main limitations are comparability of data and the generalisabilty of results. Conclusions: The implementation of routine outcome measurement (ROM) is a challenge but can be made easier with proper training and supervision. Clients appear happier than their therapists when routine outcome measurement is used.     

Learning to listen to trans and gender diverse children: A Response to Zucker (2018) and Steensma and Cohen-Kettenis (2018)

ABSTRACT

The authors answer recent responses by Steensma & Cohen-Kettenis (2018 Steensma, T. D., & Cohen-Kettenis, P. T. (2018). A critical commentary on “A critical commentary on follow-up studies and “desistence” theories about transgender and gender non-conforming children”. International Journal of Transgenderism. Advance online publication. doi:10.1080/15532739.2018.1468292[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) and Zucker (2018 Zucker, K. (2018). The myth of persistence: Response to AA critical commentary on follow-up studies and “Desistance” theories about transgender and gender non-conforming children. International Journal of Transgenderism. Advance online publication. doi:10.1080/15532739.2018.1468293[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) to our critical commentary on “desistance” stereotypes and their underlying research on trans and gender diverse children (Temple Newhook et al., 2018 Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., … Pickett, S. (2018). A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children. International Journal of Transgenderism. Advance online publication. doi:10.1080/15532739.2018.1456390[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). We provide clarification in the following areas: (1) the scope of our paper; (2) our support of longitudinal studies; (3) consequences of harm to trans and gender diverse children; (4) clinical practice implications; (5) concerns about validity of research methodology; and (6) the importance of learning to listen to trans and gender diverse children.