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Article
Publication date: 2 September 2014

Patrick McHugh, Michael Gordon and Michael Byrne

– The purpose of this paper is to evaluate the clinical effectiveness of a brief CBT intervention within a primary care adult mental health service.

Abstract

Purpose

The purpose of this paper is to evaluate the clinical effectiveness of a brief CBT intervention within a primary care adult mental health service.

Design/methodology/approach

In total, 92 participants with mild to moderate mental health difficulties were provided with five sessions of brief CBT. Clinical improvement was measured using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment, mid-treatment and post-treatment, and on the Beck Depression Inventory-II (BDI-II) at pre-treatment and post-treatment.

Findings

The planned five sessions of CBT were completed by 48.9 percent (n=45) of participants. Treatment completers with full clinical data (n=31) showed large statistically significant improvements on the CORE-OM and BDI-II from pre-therapy to post-therapy. Of treatment completers and non-completers with post-therapy and mid-therapy CORE-OM data, respectively (n=34), 61.8 percent showed reliable and clinically significant change. No statistically significant differences were found between treatment completers (n=45) and non-completers (n=47) in their pre-therapy clinical scores or socio-demographic characteristics.

Practical implications

Brief CBT can be a clinically effective primary care intervention but needs to be implemented in a way that ensures high treatment engagement across a range of service users.

Originality/value

This paper contributes to the evidence base of a primary care psychological intervention and demonstrates the importance of assessing treatment completion when evaluating clinical effectiveness.

Details

Mental Health Review Journal, vol. 19 no. 3
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 7 April 2015

Peter E. Langdon

– The purpose of this paper is to provide a commentary on “The use of cognitive-behaviour therapy to treat depression in people with learning disabilities: a systematic review”.

Abstract

Purpose

The purpose of this paper is to provide a commentary on “The use of cognitive-behaviour therapy to treat depression in people with learning disabilities: a systematic review”.

Design/methodology/approach

Drawing on the literature, as well as both clinical and research experience, some reasons are outlined for the lack of attention given to psychological therapies to treat depression amongst people with intellectual disabilities (IDs).

Findings

More research is needed, but existing evidence is promising regarding the effectiveness of adapted cognitive-behaviour therapy for depression amongst people with IDs.

Originality/value

The commentary draws attention to the scope for developing a range of effective cognitive, behavioural and cognitive-behavioural treatments.

Details

Tizard Learning Disability Review, vol. 20 no. 2
Type: Research Article
ISSN: 1359-5474

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Article
Publication date: 1 October 2006

Kevin Gournay

This article sets out to provide information regarding the evidence base for psychological treatments and to demonstrate that the number of mental health professionals who…

Abstract

This article sets out to provide information regarding the evidence base for psychological treatments and to demonstrate that the number of mental health professionals who are available and competent to deliver these treatments is very small compared with the numbers of people who might benefit. The article also considers the prevalence of conditions that are amenable to psychological treatment and then explores how ‘stepped care’ may be one solution for providing available treatment resources in a way that is fairest and most effective for the population at large.

Details

The Journal of Mental Health Training, Education and Practice, vol. 1 no. 2
Type: Research Article
ISSN: 1755-6228

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Article
Publication date: 2 September 2021

Nicola Walker, Madeleine Vernon-Smith and Michael Townend

No current psychotherapeutic intervention is designed to enhance job retention in employees with moderate–severe recurrent depression. The aim of this study is to test the…

Abstract

Purpose

No current psychotherapeutic intervention is designed to enhance job retention in employees with moderate–severe recurrent depression. The aim of this study is to test the feasibility of a new, interdisciplinary work-focused relational group cognitive behavioural therapy (CBT) treatment programme for moderate–severe depression.

Design/methodology/approach

The programme was based on a theoretical integration of occupational stress, psychological, social/interpersonal and bio-medical theories. It consisted of up to four 1:1 psychotherapy sessions; 12 work-focused, full-day, weekly CBT sessions facilitated by a cognitive behavioural therapist and occupational therapist; and up to four optional 1:1 sessions with an occupational therapist. Depression severity (primary outcome) and a range of secondary outcomes were assessed before (first CBT session) and after (twelfth CBT session) therapy using validated instruments.

Findings

Eight women (26–49 years) with moderate–severe depression participated. Five were on antidepressant medication. While there was no statistically significant change in Hamilton Depression Rating Scale depression scores after therapy (n = 5; p = 0.313), Beck Depression Inventory-II depression scores significantly decreased after therapy (n = 8; –20.0 median change, p = 0.016; 6/8 responses, 7/8 minimal clinically important differences, two remissions). There were significant improvements in the secondary outcomes of overall psychological distress, coping self-efficacy, health-related quality of life and interpersonal difficulties after therapy. All clients in work at the start of therapy remained in work at the end of therapy. The intervention was safe and had 100% retention.

Research limitations/implications

A major limitation was recruitment shortfall, resulting in a small sample of middle-aged women, which reduces representativeness and increases the possibility of methodological weaknesses in terms of the statistical analysis. A definitive trial would need much larger samples to improve statistical power and increase confidence in the findings. Another major limitation was that two of the authors were involved in delivering the intervention such that its generalisability is uncertain.

Practical implications

This novel programme was evaluated and implemented in the real world of clinical practice. It showed promising immediate positive outcomes in terms of depressive symptoms, interpersonal difficulties and job retention that warrant further exploration in a longer-term definitive study.

Social implications

Empirical studies focused on enhancing job retention in employees with moderate–severe recurrent depression are lacking, so this study was highly relevant to a potentially marginalised community.

Originality/value

While limited by a recruitment shortfall, missing data and client heterogeneity, this study showed promising immediate positive outcomes for the new programme in terms of depressive symptoms, interpersonal difficulties and job retention that warrant exploration in a definitive study.

Details

Mental Health Review Journal, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 22 June 2012

Philip Hyland and Daniel Boduszek

The field of cognitive-behavioural therapy contains many different theoretical models of psychopathology, with each discipline ascribing greater emphasis to a particular…

Abstract

Purpose

The field of cognitive-behavioural therapy contains many different theoretical models of psychopathology, with each discipline ascribing greater emphasis to a particular cognitive process or organisation of beliefs. This paper seeks to propose a method of integrating the two most widely practiced and researched schools of CBT; Beck ' s cognitive therapy (CT) and Ellis ' s rational emotive behaviour therapy (REBT).

Design/methodology/approach

Although there exist a large degree of similarity between the two therapeutic approaches, the two models do differ in relation to their respective hypothesises regarding the core psychological variable in psychopathology. Cognitive theory hypothesises that negative representational beliefs are of central importance whereas rational emotive behaviour theory hypothesises that negative evaluative demands lie at the core of psychological disturbance. This paper evaluates these competing predictions on the basis of the available empirical literature.

Results

The empirical literature provides greater support for the organisation and interrelations of the irrational beliefs proposed by REBT theory over CT theory, however the research data clearly indicate the importance of the cognitive variables stressed by CT theory in the pathogenesis of psychological distress. Based on the available evidence an integrated CBT model which incorporates elements of both CT and REBT theory is presented. It is proposed that this integrated model can serve as the stepping-stone toward a larger, single, coherent CBT model of psychopathology.

Research limitations/implications

Few empirical studies have directly compared the competing predictions of CT and REBT theory. If future research supports the findings presented in this paper, the proposed model can serve as a template for the development of a unified, general-CBT theory of psychopathology.

Practical implications

The integrated model presented in this paper can serve as a guiding theoretical model for therapeutic practice which takes into account therapeutic methods from both CT and REBT.

Originality/value

This paper proposes the first theoretical model which incorporates the competing theoretical conceptualizations of psychological distress from the two main schools of CBT.

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Article
Publication date: 1 March 2010

Jon Taylor

People with learning disabilities have traditionally been denied access to a range of psychological therapies. Similarly, offenders with learning disabilities…

Abstract

People with learning disabilities have traditionally been denied access to a range of psychological therapies. Similarly, offenders with learning disabilities, particularly in prison settings, have largely been unable to access treatment strategies that are provided for offenders who do not have such disabilities. As a consequence these individuals are denied the opportunity to address their criminogenic needs and/or attend to their psychological welfare. This paper provides a brief exploration of the reasons and evidence for such practice, alongside the evidence that people with learning disabilities can successfully engage in psychotherapy. It is concluded that there is no evidence that would support the exclusion of people with disabilities from treatment options.

Details

Journal of Learning Disabilities and Offending Behaviour, vol. 1 no. 3
Type: Research Article
ISSN: 2042-0927

Keywords

Content available
Article
Publication date: 13 June 2008

Abstract

Details

International Journal of Health Care Quality Assurance, vol. 21 no. 4
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 3 September 2012

Lia Ahonen and Jürgen Degner

This article aims to analyze and discuss the role of moral development in treatment of behavior problems and, further, to describe differences and similarities between two…

Abstract

Purpose

This article aims to analyze and discuss the role of moral development in treatment of behavior problems and, further, to describe differences and similarities between two different methods – milieu therapy (MT) and cognitive behavioral therapy (CBT) – in terms of addressing criminogenic needs and promoting moral development.

Design/methodology/approach

By performing a literature review, the study shows that even though there are both pros and cons using MT and CBT in institutional care, relationships strong enough to restructure a young person's moral reasoning require time, and involves not only the young person's parents and social network members, but also a genuine therapeutic alliance with clinical staff at the institution.

Findings

These are central factors articulated in both CBT and MT, but are more explicitly expressed in MT. The results presented in this article highlight some important practical implications: in order to redevelop moral self and societal values, an overly narrow focus on criminogenic needs might exclude other components or processes of treatment and behavioral change. Together with a treatment program that views close staff‐resident interactions as of secondary importance, this could impair the possibility to obtain positive and long‐lasting treatment results.

Originality/value

In practice, moral development itself should be considered as an overall treatment goal, integrated into the daily life at the institution, 24 hours a day. Finally, the possibility to work with moral development in institutional settings is discussed.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 33 no. 1
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 7 September 2015

Mauro Leoni, Serafino Corti and Roberto Cavagnola

The purpose of this paper is mainly to present a general review of third generation cognitive-behavioural therapies (CBTs), and to debate whether these approaches are…

Abstract

Purpose

The purpose of this paper is mainly to present a general review of third generation cognitive-behavioural therapies (CBTs), and to debate whether these approaches are applicable to persons with neurodevelopmental disorders (NDD).

Design/methodology/approach

Despite the lack of consistent literature focused on this population, the authors have considered the available general literature on the third generation of CBTs and analysed core issues of the processes within the context of intellectual disabilities and Autism spectrum disorder.

Findings

The evidence from typical developing population studies and the emerging literature specific to people with NDD is convincing, but there is a need for studies exploring how and when these therapeutic approaches can be applicable. Two behavioural approaches of third generation therapies – acceptance and commitment therapy and mindfulness-based CBT – appear to have the most potential to be adapted for robust intervention for the broad spectrum of persons with NDD.

Research limitations/implications

The number of studies and methodologies applied are a clear limitation and the present paper is only exploratory.

Originality/value

The paper supports clinicians to use the emerging protocols, and to replicate and implement procedures and techniques.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 9 no. 5
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 4 February 2014

Emma Williams, Martha Ferrito and James Tapp

The efficacy of cognitive-behavioural therapy (CBT) for schizophrenia in community and general psychiatric settings has been widely investigated and its practice…

Abstract

Purpose

The efficacy of cognitive-behavioural therapy (CBT) for schizophrenia in community and general psychiatric settings has been widely investigated and its practice recommended in primary and secondary care. In secure forensic mental health services the evidence is less established. The purpose of this paper is to evaluate the effectiveness of group CBT for schizophrenia in a high secure hospital.

Design/methodology/approach

In all, 27 male forensic patients completed a manualised CBT group and were compared on primary and secondary outcomes to patients receiving treatment as usual (TAU). Primary outcomes were positive and negative symptoms as measured by the Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS) and the Psychotic Symptom Rating Scales (PSYRATS). A secondary outcome was interpersonal functioning as measured by the Inventory of Interpersonal Problems (IIP-64).

Findings

CBT participants showed improvement on negative symptoms; affective flattening, alogia, anhedonia and avolition; in comparison to participants in TAU. CBT participants also showed reductions in delusions and hallucinations on the SAPS but not the PSYRATS. TAU participants improved on positive symptoms as measured by the PSYRATS. CBT participants showed reductions in overall interpersonal problems, and most notably in being socially inhibited and self-sacrificing. No iatrogenic effects of treatment were found; improvements in depression anxiety and stress were reported by group completers, which contrasted to experiences of the TAU group.

Research limitations/implications

Absence of random allocation to CBP or TAU groups retains the risk of recruitment bias. Findings are preliminary given the sample size. Multiple outcome assessments increase risk of a type I error.

Practical implications

CBT for schizophrenia can be effective with clients in secure forensic mental health settings. Improvements in negative symptoms and interpersonal functioning appear to be particular gains. Self-report measures might be subject to specific demand characteristics in such settings.

Originality/value

The evaluation includes a comparator group in a high secure setting, which is typically absent in reported evidence for this population (Blackburn, 2004). The study also investigated changes in interpersonal functioning, which has previously been noted as an important but absent outcome in CBT for psychosis (Haddock et al., 2009). Iatrogenic outcomes were also considered in the evaluation to ensure no adverse effects were experienced from treatment.

Details

Journal of Forensic Practice, vol. 16 no. 1
Type: Research Article
ISSN: 2050-8794

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