A naturalistic pilot study assessing the impact of assessment pathways and intake methods within Improving Access to Psychological Therapies services

Fast access pathways characterise many Improving Access to Psychological Therapy (IAPT) services, allowing them to see increasing numbers of referrals year on year. At the same time, emerging research is highlighting potential care inefficiencies, including early treatment disengagement, inappropriate treatment allocation, less than optimal clinical outcomes, and repeat referrals. Integrating more stratified models based on in‐depth and comprehensive assessment techniques which include some therapeutic input could help better target interventions. This could lead to improved engagement and clinical outcomes, while also providing enough therapeutic support to those attending one session only. This pilot study assesses the impact of assessment pathways and intake methods involving a 90‐min face‐to‐face therapeutic consultation, compared with a 45‐min over‐the‐phone assessment session across two IAPT providers in the south of England, and three assessment pathways involving elements of either method and service. Using an observational analysis of routinely collected data across 12 months, intake scores, attendance data and clinical measures of reliable recovery and improvement were considered. The comparisons of intake method reported no significant differences when both services were included; however, there were significant differences in treatment effect sizes and session attendance on an assessment pathway basis. Where assessment sessions were delivered, there was a higher rate of disengagement between sessions one and two, indicating increased attrition. Based on the initial findings and supporting literature, there appears to great promise in exploring pathway modelling and intake processes within IAPT services.     

Creating Structure in a Time of Intense Stress: Treating Intimate Partner Violence

Violence is an increasingly visible problem in the United States, with the news and other forms of media bringing this into the forefront of the public’s awareness. Violence comes in many different forms, including intimate partner violence (IPV), which occurs for about 36% of women and about 29% of men across the United States. Given the high incidence in the United States, it is imperative to consider the best ways for mental health professionals to treat violence in relationships. Some professionals in the field have developed and utilized conjoint treatment models for working with couples who have a history of violence. This article presents the application of attachment theory to a conjoint treatment model for couples that have experienced violence. A case study is included to demonstrate the implementation of an emotionally focused therapy framework and provide a sample outcome of this treatment approach. The framework of this article provides clinicians with insight into how to approach working with violent couples in a safe and productive way. Mental health professionals are at the front lines of implementing evidence-based interventions and creating lasting change for the clients whom they work with.     

Suicide ideation as a predictor of treatment outcomes in cognitive-behavioral therapy for unipolar mood disorders

Background/Objective: Suicide ideation is common in depressed patients. However, no studies to date have examined whether pretreatment suicide ideation is associated with poorer outcomes after cognitive-behavioral therapy for adult depression. Method: 475 depressed outpatients (age: M = 39.9 years, SD = 11.71; 60.2% female) took part in a pre-treatment and a post-treatment assessment. Pre-treatment suicide ideation measured with the BDI suicide item was considered as a predictor of treatment outcomes – controlling for age, gender, number of attended therapy sessions, as well as pre-treatment depression severity. Results: Hierarchical regression revealed that age, gender, number of completed therapy sessions and depression severity at baseline could explain 25% of the variance in post-treatment BDI-scores. Adding suicide ideation significantly improved the amount of variance explained to 27%. Treatment outcomes were worse for patients with more severe depression, suicidal patients, patients receiving more therapy-sessions and older patients. Conclusions: Suicide ideation added only little incremental variance to the prospective prediction of post-treatment depression severity. Depressed patients with suicide ideation can attain almost as good treatment outcomes as patients without suicide ideation, which is a clinically encouraging result.     

Gender, Internet identification, and Internet anxiety: correlates of Internet use.

This paper reports a study that investigated the effects of gender, Internet anxiety, and Internet identification on use of the Internet. The study involved 608 undergraduate students (490 females and 118 males). We surveyed the students' experience with the Internet, as well as their levels of Internet anxiety and Internet identification. We found a number of gender differences in participants' use of the Internet. Males were proportionally more likely to have their own web page than were females. They used the Internet more than females; in particular, they were more likely to use game websites, to use other specialist websites, and to download material from the Internet. However, females did not use the Internet for communication more than males. There was a significant positive relationship between Internet identification and total use of the Internet, and a significant negative relationship between Internet anxiety and total use of the Internet. Controlling for Internet identification and Internet anxiety, we found a significant and negative correlation between gender and use of the Internet. In total, all three of our predictors accounted for 40% of the variance in general Internet use: with Internet identification accounting for 26%, Internet anxiety accounting for 11%, and gender accounting for 3%.     

Musical preference, deviance, and attitudes towards music celebrities

Two studies investigated the relationship among British students between liking for ‘problem’ music, indices of deviance, and scores on a slightly modified version of the Celebrity Attitude Scale (CAS). Study 1 indicated a positive relationship between liking for ‘problem’ music styles and psychoticism scores. Study 2 indicated that fans of ‘problem’ music scored higher than non-fans on measures of psychoticism, reactive rebelliousness, and two specific problem behaviours; that liking for ‘problem’ music was related only to psychoticism when all the indices of deviance were considered together in a multiple regression; and that fans of ‘problem’ music did not score higher on CAS measures of identification with the participants’ favourite musicians. The present data indicate a relationship outside North America between ‘problem’ music and deviance, that this might be attributable primarily to elevated psychoticism scores among listeners to this music, but that liking for ‘problem’ music was not associated with a greater tendency for participants to identify closely with licentious behaviours carried out by pop musicians.     

Stereotype distinctiveness: how counterstereotypic behavior shapes the self-concept

Three experiments examined the relationship between distinctiveness and self-schematicity. Experiment 1 revealed that people were more likely to be self-schematic in domains of strong performance when they felt distinct from family and peers in those domains. Experiments 2 and 3 extended this finding into the arena of stereotypes by demonstrating that people were more likely to be self-schematic in domains of strong performance when their performance was counterstereotypic rather than stereotypic. In particular, African Americans and women were more likely to be schematic for intelligence than Caucasians and men if they performed well academically, whereas Caucasians-especially men-were more likely than African Americans to be schematic for athletics if they performed well athletically. These results suggest that counterstereotypic behavior plays a uniquely powerful role in the development of the self-concept.     

Dyslexia and visual-spatial talents: compensation vs deficit model

There are both theoretical and empirical reasons to support the hypothesis that dyslexia is associated with enhancement of right-hemisphere, visual-spatial skills. However, the neurological evidence is neutral with respect to whether dyslexic visual-spatial abilities should be superior (a compensation model) or inferior (a deficit model). In three studies we tested the hypothesis that dyslexia is associated with superior visual-spatial skills. Individuals with dyslexia not only failed to show superiority on a range of visual-spatial tasks, even when tasks were presented without time constraints, but also demonstrated a deficit on many tasks. Whereas we found attentional problems associated with dyslexia, these did not explain our findings. Results are discussed in terms of the apparent conflict between the failure to find any visual-spatial talent associated with dyslexia and the fact that dyslexia is overrepresented in certain visual-spatial professions.     

Experimental modification of beliefs in obsessive-compulsive disorder: a test of the metacognitive model

Metacognitive beliefs about the threatening meaning and significance of intrusions are fundamental to the development and maintenance of obsessive-compulsive disorder (OCD) in the metacognitive model (Cognitive therapy of anxiety disorders: a practice manual and conceptual guide, Chichester, UK, Wiley, 1997; Emotional disorders and metacognition: innovative cognitive therapy, Chichester, UK, Wiley, 2000). This predicts that reductions in metacognitive beliefs about intrusions will result in decreased anxiety and compulsions. It was hypothesized that brief (5min) exposure and response prevention configured as a behavioural experiment to challenge metacognitive beliefs would lead to reductions in anxiety, thought fusion beliefs and the urge to neutralize. Furthermore, these reductions would be greater than the effects observed in the same exposure and response prevention task, accompanied by a habituation rationale. The results were consistent with the hypotheses. The clinical implications for the treatment of OCD are discussed.     

Cortical plasticity associated with stuttering therapy

Neuroimaging studies have indicated that persistent developmental stuttering (PDS) may be associated both with an abnormality in white matter of left-hemispheric speech areas and a right-hemispheric hyperactivity. The latter may compensate for the deficient structural connectivity in the left hemisphere. To investigate the effects of stuttering therapy on brain activity nine male adults with PDS underwent functional magnetic resonance imaging (fMRI) before and within 12 weeks after fluency shaping therapy. Brain response differences during overt sentence reading before and after therapy were assessed by utilizing random effects analyses. After therapy, a more widespread activation was observed in frontal speech and language regions and temporal areas of both hemispheres, particularly and more pronounced on the left side. Interestingly, distinct posttreatment left-sided activation increases were located directly adjacent to a recently detected area of white matter anomaly [M. Sommer, M.A. Koch, W. Paulus, C. Weiller, C. Buchel (2002). Disconnection of speech-relevant brain areas in persistent developmental stuttering. The Lancet, 360, 380-383] suggesting that fluency shaping techniques reorganize neuronal communication between left-sided speech motor planning, motor execution, and temporal areas. Hence, a therapeutic mechanism can be assumed to remodel brain circuitry close to the source of the dysfunction instead of reinforcing compensation via homologous contralateral brain networks. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to: (1) describe brain activation changes detected shortly after fluency-shaping therapy; (2) identify left-hemispheric regions where a (re)functionalization after fluency-shaping therapy seems to occur adjacent to a recently described abnormal white matter region in PDS subjects; and (3) discuss how an effective cerebral compensation mechanism for stuttering could work.