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.     

The Role of Culture and Contextual Risk for Maternal Parenting and Children’s Behavior Regulation in Chile and Germany

Journal of Child and Family Studies - Children’s behavior regulation development takes place in diverse sociocultural settings. In this study, we take a multilayer ecological perspective and...     

The CORE‐10: A short measure of psychological distress for routine use in the psychological therapies

Background: There is a need for a generic, short, and easy‐to‐use assessment measure for common presentations of psychological distress in UK primary care mental health settings. This paper sets out the development of the CORE‐10 in response to this need. Method: Items were drawn from the CORE‐OM and 10 items were selected according to a combination of usefulness, coverage of item clusters, and statistical procedures. Three CORE‐OM datasets were employed in the development phase: (1) a primary care sample, (2) a sample from an MRC platform trial of enhanced collaborative care of depression in primary care, and (3) a general population sample derived from the Office of National Statistics Psychiatric Morbidity Follow‐up survey. A fourth dataset comprising a sample from an occupational health setting was used to evaluate the CORE‐10 in its standalone format. Results: The internal reliability (alpha) of the CORE‐10 was .90 and the score for the CORE‐10 correlated with the CORE‐OM at .94 in a clinical sample and .92 in a non‐clinical sample. The clinical cut‐off score for general psychological distress was 11.0 with a reliable change index (90% CI) of 6. For depression, the cut‐off score for the CORE‐10 was 13 and yielded sensitivity and specificity values of .92 (CI=.83–1.0) and 0.72 (CI=.60–.83) respectively. Conclusion: The CORE‐10 is an acceptable and feasible instrument that has good psychometric properties and is practical to use with people presenting with common mental health problems in primary care settings.     

Space-based and object-based capacity limitations in visual search

Space-based accounts of visual attention assume that we select a limited spatial region independent of the number of objects it contains. In contrast, object-based accounts suggest that we select objects independent of their location. We investigated the boundary conditions on the selection modes of attention in a series of tachistoscopic visual search tasks, where the nature of capacity limitations on search was examined. Observers had to search for a horizontally oriented target ellipse among differently oriented distractor ellipses. Across four experiments, we orthogonally manipulated target-distractor (TD) similarity and distractor-distractor (DD) similarity. Each experiment consisted of a two-way design: Firstly, with a central cue, we indicated the spatial extent of the relevant search area. Secondly, we varied the number and spatial proximity of items in the display. Performance could be accounted for in terms of capacity limited object-based attention, assuming also that the spatial proximity of items enhances performance when there is high DD-similarity (and grouping). In addition, the cueing effect interacted with spatial proximity when DD-similarity was high, suggesting that grouping was influenced by attention. We propose that any capacity limits on visual search are due to object-based attention, and that the formation of perceptual objects and object groups is also subject to attentional modulation.     

Die stationäre Behandlung von Zwangsstörungen mit multimodaler Verhaltenstherapie

The results of a 1-year-follow-up study concerning the treatment of 30 in-patients suffering from obsessive-compulsive disorder (OCD) are presented. This prospective study was carried out at the Psychosomatic Hospital Windach. Beside a multimodal setting the central treatment component was flooding and response prevention. Group analysis showed significant improvements in all measures (BDI, STAI-X1, Y-BOCS and self-ratings). The results of the follow-up indicate, that more than 70% of the patients maintained their positive treatment response over 1 year (symptom improvement >30%). The average reduction of symptoms was 42%. Average treatment duration was 12 weeks. A high initial depression score (BDI >18) predicted a worse outcome.     

Dynamic integration: affect, cognition, and the self in adulthood

Positive self- and emotional development is often measured by optimization of happiness, but a second aspect of positive development—the ability to tolerate tension and negativity in the interest of maintaining objective representations—needs to be integrated with this hedonic emphasis. The integration of these two aspects, optimization and differentiation, reflects a dynamic balance. Such integration is possible when emotional activation or arousal is moderate, but is impaired at very high levels of activation. From youth to middle adulthood, the capacity for integration increases, but later in life, limitations or poor regulation strategies foster compensatory processes that compromise integration.