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.     

Extended problem solving treatment for depression

Introduction: Effective brief psychological approaches for depression that can be delivered by a variety of health professionals with minimal training increase access to treatment by patients. Problem Solving Treatment (PST) was developed for primary care and was modified for this study (EPST) to better meet the needs of mental health patients. Method: A total of 92 therapists from different professional backgrounds completed EPST workshops and treated 92 patients with major depression with interval clinical and treatment process assessments. Results: EPST achieved a significant reduction in depressive symptom scores, life problem scores, and there were few treatment non‐completers. Treatment outcome was predicted by process and therapist variables. Discussion: EPST is an effective and easy to teach treatment that can be delivered by a variety of practitioners and suitable for busy primary mental health care settings.     

Psychosomatic Health: The Body and the Word

Abstract

Why do men get firsts and women gets seconds? This question is currently being debated by some in Oxford University, but not elsewhere, where men's educational under-achievement - in secondary-school league tables, for instance (see, e.g., Phillips 1993) - is more often a matter of concern. Stephen Frosh (1998) has considered both issues in terms of the way young men are constructed and construct themselves through performing and acting on prevailing stereotypes about men and masculinity. These stereotypes include recklessness, not caution, which Maryanne Martin (1998) says contributes to men getting firsts at Oxford by virtue of this trait being rewarded by Oxford University's tutorial and examination system.

In the following pages I too will talk about the equation of men with recklessness. Or, more accurately, I will talk about the way in which men and women act on nightmares and dreams that often glorify men, not least as reckless heroes, in large part because, despite the gains of feminism, glory is still more often men's than women's prerogative in male-dominated society, of which Oxford University is a prime example. I too will consider how this might contribute to men more often getting firsts, and to women more often getting seconds in finals in Oxford. I will end with some implications of my findings for therapy - at least, for the kind of therapy I do as a Freudian therapist. I will therefore begin with Freud.     

Do Patients With Psychosis Experience Loss and Grief As a Result of Their Illness?

BACKGROUND: Depression and suicidality are frequently reported in patients with psychosis and schizophrenia, but the grief process that may be associated with this illness has not been systematically studied. In this study, we examined whether patients diagnosed with psychosis identify, grieve, and mourn losses engendered by the illness. METHOD: 24 patients diagnosed with psychosis in the past five years were surveyed to indicate whether their illness led to losses, and to describe their responses to the losses. Psychosis-related perceived losses were surveyed using three subscales of a loss and grief questionnaire (loss of self, self-care, and roles). Their relationship with beliefs about the illness, symptomatology, coping style, and self-efficacy and insight was studied. RESULTS: 23 (96%) patients named specific losses, and 16 patients (67%) reported feelings associated with grief and mourning. More than half reported loss of self-esteem at the onset of illness and only half saw themselves as having improved in the past month. Patients reported more loss within the past month than at the onset of illness. In the past month, patients with an intact sense of self experienced greater self-efficacy (r = .568, p < .004) while those with loss of self reported feelings of shame (r = ?.582, p < .003). Only patients with insight associated the onset of illness with loss. In the past month, most patients saw themselves as experiencing loss. DISCUSSION: The study results suggest that at some distance from diagnosis, patients still experience themselves as having much loss due to their illness. These unresolved feelings may indicate complicated mourning. Insight appears to be associated with the ability to look back at the onset of the illness and recognize that it engendered losses. Further study of the process of and barriers to grief and mourning is recommended. In clinical practice, the assessment of grief as a part of post-psychotic recovery could lead to providing more appropriate treatment and lead to a positive outcome.     

Failure to Mentalize Self and Masochistic Functioning

Mentalization includes the ability to apprehend and reflect upon one's subjective state, as well as an appreciation of one's agency (Fonagy & Target, 2006 Fonagy, P. and Target, M. 2006. The mentalization-focused approach to self pathology. Journal of Personality Disorders, 20(6): 544–576. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Masochism is a character pattern that is traditionally defined as pleasure in pain or suffering (Million, 1996 Million, T. M. 1996. Disorders of personality: DSM-IV and beyond , 2nd, New York: John Wiley and Sons.  [Google Scholar]). In some cases the etiology of this character pattern may mirror failures on the part of the caregiving surround that contribute to deficits in the ability to mentalize self (Fonagy, Gergely, & Target, 2007 Fonagy, P., Gergely, G. and Target, M. 2007. The parent-infant dyad and the construction of the subjective self. Journal of Child Psychology and Psychiatry, 48(3/4): 288–328. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Benjamin, 1988 Benjamin, J. 1988. The bonds of love: Psychoanalysis, feminism, and the problem of domination, New York: Pantheon Books.  [Google Scholar]). When this occurs masochism may be more profitably understood as an inability to register pain, rather than pleasure in pain. A case example demonstrates that when a deficit in mentalization underlies masochistic functioning, treatment may include interventions aimed at helping the patient improve the ability to reflect upon his or her mental state, especially negative affect such as pain and anger, and connect to a sense of agency.     

Paternal Postnatal and Subsequent Mental Health Symptoms and Child Socio‐Emotional and Behavioural Problems at School Entry

Research on the effect of paternal mental health problems, particularly on young children, is based predominantly on clinical levels of depression. Furthermore, potential mediators such as marital discord have often been overlooked. This longitudinal community study assessed the association between paternal mental health symptoms in a community sample (N = 705) assessed at 3 months postnatally (Edinburgh Postnatal Depression Scale) and 36 months (General Health Questionnaire) and children's socio‐emotional and behavioural problems at 51 months (Strengths and Difficulties Questionnaire) as reported by mother, father and teacher. Controlling for socioeconomic status and maternal mental health symptoms at 3 and 36 months, paternal postnatal depressive symptoms predicted more father‐reported child problems at 51 months but, in contrast to previous findings, not mother‐reported problems. Paternal mental health symptoms at 36 months predicted both maternal and paternal reports of child problems at 51 months controlling for both paternal and maternal postnatal symptoms. Paternal mental health symptoms at 3 and 36 months were not significant predictors of teacher‐reported child problems. Postnatal marital discord and paternal mental health problems at 36 months both mediated the relationship between paternal postnatal symptoms and later child emotional and behavioural problems. Child gender did not moderate the relationship. Implications for interventions are discussed. Copyright © 2013 John Wiley & Sons, Ltd.     

Using Themes from Mystical Traditions to Enhance Self-Acceptance in Life Review Groups

ABSTRACT

This article presents a model in which facilitators of life review groups can enhance the self-acceptance of members troubled by memories that seem to confirm their self-as-failed. By incorporating into the group's agenda discussions based on readings from religious mystical traditions East and West, the themes of True-Self, Mystical Night, and Engaged Detachment can move reviewers to own their past, celebrate it as gift, and feel purposeful about their future.     

"Involving the Elderly in Mission" -A Service Project

As one church grew from a small immigrant church to a conglomerate of 1,200 members, the natural social networks were no longer adequate to support the population of older persons. Networks had to be made intentional through programming. A needs assessment of the senior population identified specific subgroups and their needs. Recognizing the diversity of the senior population, a broad spectrum of programs was established. An effort was made to maintain a balance between traditional and innovative. The senior program has strengthened the networking among seniors, increased their integration with the other age groups in the church, and provided an entry level for those new to the church. The program has also become known in the community, which has resulted in cooperation with other senior service organizations who provide education and training. The Area Agency on Aging, realizing the importance of the church to the senior population, has selected a member of the church community to serve on its Advisory Board.     

Diagnosing depression in patients with physical diseases using the beck depression inventory (BDI)

Abstract

Four-hundred-and-forty-three patients with a physical illness (355 with coronary heart disease and 88 with chronic pain), 150 unemployed persons and 623 subjects from the normal population in Jämtland, Sweden were tested using the BDI (Beck Depression Inventory). The aim of the study was to investigate whether scores on both the physical and non-physical components of the BDI differed between the patients and the other groups, or whether only the physical component was significantly higher in the patient group, and in such a case whether this could be interpreted as symptomatic of physical disease and not of depression. A cutoff score of ≥ 10 to determine mild depression and two different alternative physical and non-physical components were used. Forty-three percent of the patients with coronary heart disease and 50% of patients with chronic pain were categorized as being at least mildly depressed. Factor analyses indicated that a physical component comprising five items was the most meaningful and could best discriminate the physical symptoms. The patients' scores were significantly higher than those of the other two groups on the physical component but only higher than the normal population sample on the nun-physical component. This supports the idea that the items for physical symptoms in the BDI might be confounding when determining depression in patients with physical diseases. The non-physical component seems to be the best indicator of depression and is recommended as a complement to the total BDI scale when determining the degree of depression in patients suffering from a physical disease.     

A Burden to Others: A Common Source of Distress for the Terminally Ill

Recent research into the desire for death among people with terminal illness has begun to recognize the importance of “feeling oneself a burden to others” as a factor in suicidal behaviour. In this study, 69 patients with advanced cancer underwent semi‐structured interviews. The sense of self‐perceived burden was found to be a common experience, reported by 39.1% of participants as a minimal or mild concern and by 38% as a moderate to extreme concern. The sense of burden showed a low correlation with physical symptoms (r = 0.02–0.24) and higher correlations with psychological problems (r = 0.35–0.39) and existential issues (r = 0.45–0.49). Comparisons of participants with high or low levels of self‐perceived burden showed the importance of this factor for overall quality of life. In summary, self‐perceived burden is an important but underestimated dimension of social cognition in the medically ill.