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.     

Learning and teaching (briefly)

This paper was given as the Annual Ellen Noonan Counselling Lecture on July 2012 and retains some of the spoken style of the lecture. It uses examples of Ellen Noonan’s work to examine aspects of the process of teaching and learning psychodynamic practice. The difficulties of how to embed theoretical knowledge with its clinical application are discussed and the question of what are the key skills of the self-reflective practitioner is raised with reference to whether, and how, they can be taught or learnt. It is suggested that part of this process consists in helping students, and their teachers, to be more comfortable with not knowing, a concept that is both counter intuitive and counter cultural. From this aspects of contemporary therapeutic practice, with specific reference to psychodynamic short-term therapy, are addressed. The paper looks at the ambivalence felt by many psychodynamic clinicians towards working within a short-term paradigm in current workplace settings and how this might be addressed. The paper discusses the intrinsic qualities of a psychodynamic short-term approach and its relation to contemporary therapeutic modalities. It is suggested that the increasing managerial culture, leading to the ascendance of protocol driven, manualised and structured therapies, represents an attack on the relational and must be challenged.     

Investigating the Role of Emotion in Science Center Visitor Learning

ABSTRACT

A number of investigators have argued that emotion plays an important role in free-choice learning in settings such as museums, science centers, zoos, and aquariums, particularly given the relationship between emotion and cognition. Despite considerable research on the cognitive aspects of visits, empirical studies on emotion in such settings are virtually non-existent. This study investigated the role that emotion plays in facilitating and enhancing learning at a science center. Three major research questions were addressed: (a) Can emotion be measured using Russell's Affect Grid in a non-laboratory setting such as an interactive science center? (b) If so, do different types of science center experiences create measurably different levels of emotional arousal and/or valence in visitors? and (c) If so, was there evidence that elevated arousal and/or valence enhanced or retarded visitors' long-term cognitive science learning? The study provided evidence that emotion could be measured using a modified Affect Grid technique and that a particular traveling exhibition generated arousal levels above baseline levels as determined by a control group. Findings suggest a relationship between emotional arousal and positive changes in visitor long-term cognition, attitudes, and behaviors.     

Assessing research on workplace violence, 2000–2012

Since the highly publicized U.S. Postal violence cases in the 1980s, workplace aggression and workplace violence have been the source of much public discussion and concern. Yet, the topic has only recently received sustained empirical attention—most of which has come from the organizational management and business fields. This article provides a review of the empirical research literature on workplace violence in several databases from 2000 to 2012. Our review uncovers that different occupational domains have different experiences with workplace violence, while some occupations are subject to distinct types of violence by unique aggressors. Directions for future theoretical and empirical research are highlighted.     

Adventure based counselling,individual counselling and object relations: a critical evaluation of a qualitative study

Adventure based counselling is a short-term experiential psychotherapeutic approach, which utilises adventurous activities and being in natural environmental in order to facilitate therapeutic change in clients. The present paper critically appraises the results of a qualitative study that investigated how clients with self-reported anxiety and depression experienced participating in an innovative counselling intervention with combined individual counselling with such an adventurous outdoor transaction. Interpretative Phenomenological Analysis, as described by Smith and Osborn (2008), was used in order record and analyse the experiences of four male and six female students who were treated at the Teesside's University Counselling Service. Interviewees perceived the counselling sessions as offering a safe therapeutic space within which they could unveil their anxieties and achieve inner healing, whereas the outdoor transaction as providing an experiential venue for achieving personal change. Interviewees felt that without the outdoor transaction the therapeutic significance of the counselling process would not have reached its full potential. Likewise, without the individual counselling, the outdoor transaction would just have an entertaining event and not a venue for personal change. These findings are discussed in relation to object relations theory.     

Saving What We Love at Any Cost: The Rhetoric of Heroic Medicine as Diversion

Discussion of the worldwide corporate development of biotechnologies is sometimes diverted through the introduction of images of heroic medical intervention, exemplified by the statement, “I would do anything to save my daughter.” Such heroic images seem to justify virtually any deployment of resources and nearly any health or environmental risk. But it is instructive for future public discussions to examine the use of such images, and to note that those advocating a prominent role for biotechnologies in an expanding global economy welcome such diversionary patterns. Our responsibility to do our own thinking is beset by conditions that may lead us astray. In a time burdened by profound worry—crushing inequalities among the world's peoples, an ecological crisis, and threat of nuclear war—it is tempting to avert our eyes when we are faced with grave new dangers. Moreover, in our increasingly visual culture, images have come to function as a facsimile of and substitute for real thinking. If we are to have significant discussions about the potential of biotechnology, we must not only be wary of promises of economic growth but must also be mindful of sources of diversion and the appeals of image-thinking. We should strive to become more critical of our own ways of thinking, thus opening the discussion to a fuller consideration of what needs to be saved.