A brief cognitive behavioural therapy psychoeducational group for Chinese people with chronic illnesses: an evaluation study

This pilot study attempted to examine the effectiveness of a brief cognitive behavioural therapy (CBT) psychoeducational group for Chinese people with chronic illness in Hong Kong. It adopted a single group design, and 52 participants joined the group. A questionnaire with three outcome measures, measuring general mental health, quality of life and dysfunctional attitudes and beliefs, was administered to participants at pre-test, post-test and six month follow-up. Repeated measures ANOVAs were employed and revealed positive changes in most of the outcome measures across the three time points. Cohen’s d showed a moderate to large effect size for most outcome measures. From a step care perspective, a culturally attuned brief CBT psychoeducational group may serve as an early intervention and a triage to attract suitable people with chronic illness to engage in the treatment process.     

Individual experiences of an acceptance-based pain management programme: An interpretative phenomenological analysis

Acceptance of pain has been found to play an important role in adjusting to chronic pain, and the evidence-base is growing with regards to the effectiveness of acceptance-based interventions such as acceptance and commitment therapy, mindfulness and contextual cognitive behavioural therapy within pain management settings. Despite the growing interest in such interventions, previous studies into acceptance-based pain management programmes (PMPs) are quantitative and the exact processes at work during such programmes remain unknown. This study aims to add to previous quantitative research in the area by qualitatively exploring individual experiences of attending an acceptance-based PMP and identifying the key constituents of the programme that participants felt facilitated change. Semi-structured interviews (n = 6) were analysed using interpretative phenomenological analysis, and five themes emerged: I’m not alone, others understand my pain, Freedom from pain taking over, A new self – one with pain, Parts of the programme participants felt facilitated change and Exercise is possible. These findings are then considered in relation to past research and relevant constructs in the literature. Implications for future research and clinical practice are also discussed alongside participant reflections and suggested areas for improvement.     

Internet-Delivered Acceptance and Values-Based Exposure Treatment for Fibromyalgia: A Pilot Study

Background: Acceptance and commitment therapy (ACT) is a promising treatment option for fibromyalgia (FM). Studies have shown that many cognitive behavioral protocols can be transferred to the Internet with sustained efficacy. However, no study has investigated the effect on an Internet-delivered ACT-based protocol for FM. This study evaluated the efficacy, acceptability, and the health economic effects of an Internet-delivered acceptance and values-based exposure treatment for FM. Methods: This open pilot trial included 41 self-referred women with a FM diagnosis. The 10-week Internet-delivered treatment included acceptance, mindfulness, work with life-values, and systematic exposure to FM symptoms and FM-related situations. Participants also had regular contact with an assigned online therapist. Assessments were made at pretreatment, post-treatment, and 6-month follow-up. Results: The treatment was completed by 70% of the participants. Attrition rates were low, with 98% completing the post-treatment assessment and 90% completing the 6-month follow-up assessment. Multiple imputations were used to replace missing values. Pre- to post-treatment within-group effect sizes were in the moderate to large range (Cohen's d = 0.62–1.56) on measures of FM symptoms and impact, disability, quality of life, depression, anxiety, fatigue, and psychological flexibility. All improvements were maintained at follow-up. Economical analyses revealed significant societal cost reductions that offset the treatment costs within 2 months of treatment completion. Conclusions: An Internet-delivered psychological treatment based on acceptance and exposure principles seems to be an efficacious, acceptable, and cost-effective treatment for FM. Randomized controlled trials are needed to confirm these results.     

The relationship between greater mindfulness and less subjective experience of chronic pain: Mediating functions of pain management self‐efficacy and emotional intelligence

Previous research shows a connection between greater mindfulness and less subjective experience of pain. The present study examined whether pain management self‐efficacy and emotional intelligence mediate this relationship in individuals experiencing chronic pain. Two hundred participants experiencing chronic pain completed measures of mindfulness, experience of pain, pain management self‐efficacy, and emotional intelligence. Greater mindfulness was associated with less subjective experience of pain, greater pain management self‐efficacy, and more emotional intelligence. More pain management self‐efficacy and higher emotional intelligence were associated with less subjective experience of pain. Emotional intelligence and pain management self‐efficacy significantly mediated the relationship between mindfulness and pain. The connection between greater mindfulness and less subjective experience of pain may be due to mindfulness providing a foundation for emotional functioning and behavioural regulation that result in reductions in the experience of pain.     

A randomized pilot study of mindfulness‐based cognitive therapy and group cognitive‐behavioral therapy for young adults with social phobia

Piet, J., Hougaard, E., Hecksher, M. S., & Rosenberg, N. K. (2010). A randomized pilot study of mindfulness‐based cognitive therapy and group cognitive‐behavioral therapy for young adults with social phobia. Scandinavian Journal of Psychology, 51, 403–410. Twenty‐six young participants, 18–25 years, with social phobia (SP) were randomly assigned to eight 2‐hour sessions of group mindfulness‐based cognitive therapy (MBCT) and twelve 2‐hour sessions of group cognitive‐behavioral therapy (CBT) in a crossover design with participants receiving treatments in reversed order. Outcome was assessed after treatments, and at 6‐ and 12‐month follow‐ups. MBCT achieved moderate‐high pre‐post effect sizes (d = 0.78 on a composite SP measure), not significantly different from, although numerical lower than those of CBT (d = 1.15). Participants in both groups further improved in the periods following their first and second treatment until 6‐months follow‐up (pre‐follow‐up ds = 1.42 and 1.62). Thus, MBCT might be a useful, low cost treatment for SP, although, probably, less efficacious than CBT.     

Depression Screening,Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists

Depression prevalence is between 15% and 20% in coronary heart disease patients, such as those with angina, or after a myocardial infarction or coronary artery bypass graft surgery. The presence of depression places a coronary heart disease patient at twofold higher risk for further major cardiac events and death, as well as poor quality of life and early exit from the labour force. As a consequence, several learned societies, including the National Heart Foundation of Australia, have published guidelines that recommend questionnaire screening to improve identification and management strategies for depression in coronary heart disease patients. Psychologists in hospitals, community settings, and private practice can have a key role in the realisation of the National Heart Foundation of Australia's aims. We review the recent guidelines and outline implications for psychologists to identify and manage depression in coronary heart disease patients. The evidence reviewed suggests that cognitive‐behavioural therapy and problem‐solving therapy are frontline non‐pharmacological interventions for depression in CHD patients.     

Long-Term Effects of an Internet-Based Treatment for Posttraumatic Stress

Abstract

Advances in communication technology offer additional strategies for providing psychological treatment. Previous trials of Internet-based treatment approaches reported significant reductions in posttraumatic stress and related symptoms in response to Internet-based treatments relative to control groups. However, empirical data on the long-term effects of those approaches are sparse. In order to evaluate the long-term effect of an Internet-based intervention, the authors conducted an 18-month follow-up of an Internet-based cognitive behavioural therapy for posttraumatic stress. Severity of posttraumatic stress symptoms was the primary outcome. Additional measures were depression, anxiety, mental and physical health, and health care utilization during the follow-up period. Treatment group participants (n = 34) were assessed 1.5 years after completing treatment. Results indicated that reductions in symptoms of posttraumatic stress symptoms, depression, and anxiety found at posttreatment were sustained during the 18-month follow-up period. Preliminary evidence on long-term effects of Internet-based health care as shown in this study is promising. However, research with larger and clinically more diverse samples is needed to fully assess the clinical impact and potential of Internet-based health care provision.     

Investigating the effects of a virtual reality-based stress management programme on inpatients with mental disorders: A pilot randomised controlled trial

This study aimed to examine the effects and feasibility of a virtual screen-based stress management programme (V-DESSERTS) on inpatients with mental disorders. A single-blinded, pilot randomised controlled trial was conducted in a tertiary hospital in Singapore. Convenience sampling was used and participants were randomised into either the intervention group or the waitlisted control group (WL). The intervention group received individual-based, twice-daily sessions of the programme. Each session comprised education and virtual screen-based relaxation practice. Data were collected through self-reported questionnaires and physiological measures. The intervention group showed a significant increase in perceived relaxation and knowledge in comparison with the WL group. However, inconclusive results were observed on subjective and objective stress. The findings in this study indicated that the V-DESSERTS programme is feasible to be implemented for patients with schizophrenia, depression and bipolar disorders.     

A comparison of pain management outcomes for disability compensation and non-compensation patients

Abstract

In this study, 50 men in an in-patient comprehensive rehabilitation program receiving disability compensation were compared with 25 non-recipients with respect to pre-and post-program measures of personality functioning. physical functioning and reported pain. On the pre-program measures. the only significant difference emerging between the two groups was found on the Mf scale of the MMPI, with the compensation group showing a slightly lower mean score. The two groups responded equally well on virtually all outcome measures. One interesting exception was found on the subjective measure of pain. which showed the compensation group reporting a higher level of subjective pain, and the non-compensation group a lower level than would be predicted on the basis of pre-program scores. Overall. and contrary to popular belief. the results suggest that compensation recipients can derive considerable benefit from pain management interventions despite the ostensible reinforcement provided by disability payments.     

A comparison of two online cognitive‐behavioural interventions for symptoms of depression in a student population: The role of therapist responsiveness

Objectives: The study aimed to compare the efficacy of eight weekly sessions of a self‐administered online CBT treatment (cCBT; n=51) to a therapist‐assisted email CBT treatment (eCBT; n=50) in University students. Design: The design was a randomised parallel group trial. The study randomised participants with symptoms of depression to one of two available treatments. Method: Participants were offered eight weekly sessions of either cCBT or eCBT. Participants completed the Beck Depression Inventory‐II (BDI‐II) and the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM) at pre‐and post‐treatment, at weeks 16 and 32 follow‐up. The Working Alliance Inventory‐Short Form (WAI‐SR) was completed at weeks 2, 4, and 6. Results: For both groups, pre‐post within group effect sizes reported were large for the BDI‐II and the CORE‐OM and these were maintained at follow‐up. Perceptions of working alliance were similar in each group, but Bond was significantly stronger for the eCBT condition. WAI scores correlated more positively with the outcome on BDI‐II for those in the eCBT condition than the cCBT condition, but not significantly. Conclusion: There were no significant differences between the two online treatments, both reduced depressive symptoms and improved general functioning. Similarly, at post‐treatment and follow‐up, clinical improvement and recovery was demonstrated for both groups equally. The study demonstrates the possibility for cCBT in a university setting that may contribute to addressing the shortcomings in meeting increasing demands that mental health services presently face.     

The effect of Multi Convergent Therapy on the psychopathology,mood and performance of Chronic Fatigue Syndrome patients: A preliminary study

Objectives: Multi Convergent Therapy combines approaches such as Cognitive Behaviour Therapy and Graded Exercise Therapy in an holistic treatment of Chronic Fatigue Syndrome. Initial follow‐up data showed that patients were benefiting from this individualised form of therapy. The objective of the present study was to evaluate this Multi Convergent approach, developed at a specialised Chronic Fatigue Syndrome Outpatient clinic in Cardiff, and compare it to Relaxation Therapy and control groups using multiple outcome measures. Design: Thirty‐five participants fitting the Centre for Disease Control criteria for Chronic Fatigue Syndrome were recruited from two outpatient clinics and members of our existing patient panel. Patients were assigned to Multi Convergent Therapy (N=12), Relaxation Therapy (N=14) or recruited as controls (N=9). Methods: Each patient completed a battery of mood and performance tasks along with comprehensive set of questionnaires at baseline, post‐treatment and at six‐month follow‐up. These measures had been validated in previous studies on untreated patients and matched healthy controls. Results: Patients attending the Multi Convergent Therapy clinic showed statistically significant improvements in many of our measures. Most importantly we have produced data indicating that Multi Convergent Therapy provides improvements in objective measures of psychomotor performance and cognition. Discussion: The outcomes of this small study are encouraging. Multi Convergent Therapy has not only produced results indicating significant improvements in standardised questionnaire based measures but also in objective cognitive performance tasks. The next step would be to assess Multi Convergent Therapy at the primary medical care level, with a greater number of patients to further evaluate its efficacy as a treatment for Chronic Fatigue Syndrome.     

Comparison of outcomes across low-intensity psychological interventions for depression and anxiety within a stepped-care setting: A naturalistic cohort study using propensity score modelling

Low-intensity interventions for common mental disorders (CMD) address issues such as clinician shortages and barriers to accessing care. However, there is a lack of research into their comparative effectiveness in routine care. We aimed to compare treatment effects of three such interventions, utilizing four years' worth of routine clinical data. Users completing a course of guided self-help bibliotherapy (GSH), internet-delivered cognitive behavioural therapy (iCBT) or psychoeducational group therapy (PGT) from a stepped-care service within the NHS in England were included. Propensity score models (stratification and weighting) were used to control for allocation bias and determine average treatment effect (ATE) between the interventions. 21,215 users comprised the study sample (GSH = 12,896, iCBT = 6862, PGT = 1457). Adherence-to-treatment rates were higher in iCBT. All interventions showed significant improvements in depression (PHQ-9), anxiety (GAD-7) and functioning (WSAS) scores, with largest effect sizes for iCBT. Both propensity score models showed a significant ATE in favour of iCBT versus GSH and PGT, and in favour of GSH versus PGT. Discernible differences in effectiveness were seen for iCBT in comparison with GSH and PGT. Given variance in delivery mode and human resources between different low-intensity interventions, building on these findings would be valuable for future service provision and policy decision making.     

An evaluation of support groups for patients with long-term chronic pain and complex psychosocial difficulties

There is a significant group of chronic pain patients with complex psychosocial needs who are frequent users of hospital outpatient departments and who do not participate in or benefit from traditional pain management treatments and are convinced there is a medical solution to their problems. They are a particularly challenging group of patients to help, often shunned by medical and psychological professionals. A new type of ten-session psycho-social group for these patients that is less demanding than traditional pain management group programmes is investigated. It is designed to foster the development into community-based self-help groups and reduce the need for professional support and unnecessary medical intervention. Accounts of four groups of patients who participated in support groups and successfully established their own groups is presented. To assess changes in motivation, mood and pain disability standardized questionnaire measures were given before and after group attendance. Findings suggest that patients benefited and took increased responsibility for their pain management but did not demonstrate positive changes on measures of mood or level of pain disability. Patients experienced satisfaction with the groups and established their own self-help community groups. The positive experience of participants and staff suggests further work with support groups would be productive for this group of patients.     

Heroes on the Hill: A qualitative study of the psychosocial benefits of an intercultural arts programme for youth in Northern Ireland

The current study investigates the psychosocial benefits of a cross‐community, intercultural dance programme for youth in Northern Ireland. Psychological theories, including contact theory and the ecology of childhood development, underpin the study, and results are discussed in relation to the programme's aims. The present study used qualitative, inductive methods; data consisted of interviews before and after the programme with facilitators (n = 2) and 10 (n = 10) programme participants (11–15 years old) of diverse races and nationalities. Latent themes were identified using thematic analysis. Findings reveal that participants have complex senses of identity. Worryingly, they also reported many instances of bullying, relating both to themselves and others. Results reveal three main psychosocial benefits of the programme, all of which promote positive mental health in adolescents. The benefits are increased self‐confidence, the formation of new cross‐community friendships, and improved intercultural awareness and pride. It is argued that the programme is an exemplar of how the arts can promote peace as well as resilience in the face of adversity. Recommendations for future research are included.     

A comparison of coping strategies in patients with fibromyalgia,chronic neuropathic pain,and pain‐free controls

Patients suffering from chronic pain may benefit from learning adaptive coping strategies. Consensus on efficient strategies for this group of patients is, however, lacking, and previous studies have shown inconsistent results. The present study has examined coping strategies in two distinctly different groups of chronic pain patients and a group of healthy controls. Thirty neuropathic pain (NP) patients, 28 fibromyalgia (FM) patients, and 26 pain‐free healthy controls completed the Coping Strategy Questionnaire (CSQ‐48/27) and rated their daily pain. The results showed that FM and NP patients did not cope differently with pain. The only difference between the groups was that FM patients felt more in control of their pain than NP patients. Both patient groups used more maladaptive/passive coping strategies, but surprisingly also more adaptive/active coping strategies than healthy controls. However, FM patients with high levels of passive strategies felt less in control than FM patients with low levels of passive strategies. This was not seen in NP patients. An important implication for clinical practice is therefore that passive coping strategies should be restructured into active ones, especially for FM patients. Otherwise, the same psychological treatment model can be applied to both groups since they use similar coping styles.     

The acceptability and feasibility of an anxiety reduction intervention for emergency department patients with non-cardiac chest pain

Despite good physical prognosis, patients who receive a diagnosis of non-cardiac chest pain (NCCP) may experience persistent pain and distress. While cognitive-behavioural interventions have been found to be effective for this group, they are difficult to deliver in busy emergency department (ED) settings. Addressing the acceptability and relevance of self-help interventions is an important initial step in addressing this need. This study sought to examine the acceptability and relevance of an evidence-based self-help intervention for ED patients with persistent NCCP and anxiety. Patient (interviews: N = 11) and specialist chest pain nurse (focus group: N = 4) views on acceptability and feasibility were examined. Data were analysed using thematic analysis. Patients and nurses reported that there was a need for the intervention, as stress and anxiety are common among patients with NCCP, and provision of psychosocial support is currently lacking. Both patients and nurses reported that the intervention was relevant, acceptable, and potentially useful. Some changes to the intervention were suggested. Nurses reported that the intervention could be used within the existing staff resources available in an ED setting. This study represents an important first step towards developing a brief self-help intervention for ED patients with NCCP and anxiety. Further research should seek to determine the efficacy of the intervention in a pilot trial.