British Journal of Clinical Psychology最新文献

Background: While the National Health Service (NHS) in the United Kingdom (UK) is increasing provisions for psychological interventions in primary care for patients with long-term conditions (LTCs), there is limited knowledge of effective implementation. This study reports on outcomes of an open pilot trial implementing the Accessible Depression and Anxiety Psychological Therapies for Long Term Conditions (ADAPT-LTC) programme in Scottish primary care services.

Methods: This study entails a pragmatic, real-world implementation evaluation of ADAPT-LTC in primary care using data collected from routine outcome monitoring. Analysis focused on implementation (feasibility, suitability), service (clinical outcomes) and client (care experiences and satisfaction) outcomes. Rates of recovery, reliable improvement, reliable recovery and reliable deterioration were used as indicators of clinical outcomes.

Results: Approximately half of referred patients progressed to treatment. Patient engagement in treatment was split into groups of patients who attended few treatment sessions (approximately <4 sessions) or patients who accessed 6-8 sessions or more. Among patients who participated in treatment, CBT was associated with large pre- to post-treatment effects in reducing depression, anxiety, and functional impairment, with 35%-40% of patients no longer meeting criteria for psychiatric diagnosis and 60% reporting clinically reliable improvements. Patients reported positive care experiences and satisfaction.

Conclusion: Delivering brief psychological intervention in primary care was effective for most patients with LTCs. However, a subgroup of patients did not start treatment or struggled to attend treatment suggesting the programme may not be suitable for all patients. Methods for enhancing engagement and implementation of ADAPT-LTC are discussed.

Objectives: There is evidence that over one quarter of patients return to National Health Service (NHS) talking therapies (TT) services, and the needs of these patients are poorly understood and catered for. This project investigated the acceptability and effectiveness of delivering cognitive analytic therapy (CAT) for patients with depression returning to a TT service with childhood trauma and associated relational difficulties.

Methods: A case-controlled pilot study using TT sessional outcome measures. A 16-session CAT was offered to N = 76 patients who had previously received a high-intensity intervention (mainly cognitive-behavioural therapy; CBT) in the same TT service. Dropout rates, recovery rates and when recovery occurred during the CAT treatment episode were calculated. CAT outcomes were compared against the previous treatment episodes (n = 47) and also benchmarked against the evidence base. Patients were followed up after receiving CAT (n = 16) to assess the durability of change. The number then returning to the TT service after receiving CAT was also tracked.

Results: The dropout rate for CAT was 16.9% and the reliable recovery rate was 40%. Reliable and/or clinically significant reductions in depression tended to occur during early CAT sessions. At a group level, there were significant reductions in depression during CAT. There was no evidence of relapse at follow-up. The return rate to the service following CAT was 28.94%.

Conclusions: CAT appears useful to consider in the offer for patients returning to TT services. Clinical trials now need to focus on the treatment return patient group in TT services across the stepped care model.

Objectives: Studies of unusual sensory experiences, like hallucinations, in people at risk of psychosis usually focus on auditory experiences. This study explored how common experiences across a range of sensory modalities were in people at an ultra-high risk of developing psychosis. Particular attention was paid to the number of modalities reported and their impact. It was hypothesised that people reporting a greater number of modalities of hallucinations would report greater levels of general distress, more delusional ideation, lower emotional well-being and poorer functioning. In addition, the contribution of sleep problems and post traumatic stress disorder (PTSD) symptoms in the reporting of hallucinations in different modalities was explored.

Design: A single-group cross-sectional design was used.

Methods: People at an ultra-high risk of developing psychosis completed measures of hallucinations, delusions, general distress, functioning, emotional well-being, trauma and sleep.

Results: Nearly all participants reported hallucinations in the auditory domain. They also reported a range of other unusual sensory experiences, with visual and somatic/tactile hallucinations being reported by over half. Single sensory experiences or unimodal hallucinations were less common than hallucinations in two or more modalities, which were reported by 88% of the participants. The number of modalities of hallucinations was significantly associated with greater general distress, delusional ideation, reduced emotional well-being and to some extent functioning. PTSD and sleep were identified as potential causal factors for hallucinations across modalities.

Conclusions: Psychological therapies need to account for these experiences and could feasibly target them with treatments that focus on sleep or trauma.

Objectives: To document the steps undertaken in a full collaborative co-production design process undertaken between a group of lived experience, clinical and research collaborators to determine the selection and design of three large-scale, multisite, clinically focused studies (including two clinical trials) targeting eating disorders. This work formed part of a grant supporting the development of a National Centre for Research and Translation in Eating Disorders (AEDRTC) funded by the Australian Government. We highlight the phases and activities, principles and values that informed practice - as has been called for recently within the scientific community, in addition to emerging themes and lessons learnt. The paper aimed to contribute to the limited body of published literature on practical approaches to co-production in large-scale research studies and teams.

Methods: We undertook a 1-year full co-production process to collaboratively ideate, choose and design the research studies to be funded and conducted by a nationally-funded centre for research in eating disorders.

Results and conclusion: This manuscript documents all the key stages of the co-production process for the shared agenda setting, choice and design of the three complex research studies, including the establishment of governance and structure, novel IP clauses, processes and principles of shared ideation and collaborative design. We also discuss natural push and pull factors creating tension in a co-production process, reflecting on themes and learnings.

Objectives: Self-beliefs and other-regarding beliefs are related to attachment experiences and may contribute to paranoid beliefs and social functioning difficulties in psychosis. However, their relationships have not been examined jointly from an ecological perspective, while considering different degrees of psychosis risk.

Design: Relationships between avoidant and anxious attachment, self-beliefs and other-regarding beliefs, paranoia, and social functioning in daily-life were examined across the psychosis continuum of familial risk.

Methods: The sample comprised 29 patients with non-affective psychotic disorders (M_age = 39.07, SD = 9.91, 20.68% female), 17 first-degree relatives (M_age = 37.36, SD = 13.86, 64.71% female) and 26 controls (M_age = 36.15, SD = 8.1, 34.6% female). Avoidant and anxious attachment were assessed with the Psychosis Attachment Measure. Self-beliefs, beliefs about others, paranoia, and time spent alone were assessed for one week in participants' daily lives using the Experience Sampling Method. Multilevel models were used to investigate cross-sectional and temporal relationships between the variables.

Results: Less positive self-beliefs and beliefs about others were related to paranoia, but only self-beliefs mediated the association between attachment insecurity and paranoia. People who were alone more frequently held less positive self-beliefs and beliefs about others, and being alone at a specific point in time was related to less positive self-beliefs. Attachment insecurity was unrelated to the amount of time spent alone.

Conclusions: Less positive self-beliefs and beliefs about others were related to higher paranoia levels and fewer social interactions in daily-life. These associations were present in all groups, supporting their utility as cognitive treatment targets in diverse therapeutic contexts.

Objectives: Attention deficit hyperactivity disorder (ADHD), autism, and personality disorder (PD) often present with overlapping symptom profiles, complicating diagnostic assessment and treatment planning. Yet, few studies have examined the extent and nature of these overlaps, or the mechanisms that may underpin them. The current study aimed to address this gap by investigating overlapping symptom profiles of ADHD, autism, and PD, and the potential transdiagnostic mechanisms contributing to such in a community sample.

Design and methods: A total of 512 adults with a history of mental health diagnosis residing in the United States or United Kingdom completed self-report questionnaires assessing ADHD, autism, and PD symptoms, alongside measures of adverse childhood experiences, executive functioning, and mentalization.

Results: We found substantial symptom overlap across ADHD, autism, and PD, with executive functioning emerging as the strongest predictor of shared variance.

Conclusions: Given symptom overlaps in areas related to interpersonal, behavioural, and emotional control, we propose that self-regulation may underlie the common symptoms of ADHD, autism, and PD. Finally, our results support the integration of neurodevelopmental conditions into broader models of psychopathology structure, such as the Hierarchical Taxonomy of Psychopathology (HiTOP), and highlight specific symptom dimensions that can help differentiate between these conditions.

Objectives: There is a crucial need for an evidence-based intervention for young people presenting with moderate complex emotional needs (CEN). UK CEN care has been described as variable and poor quality, with its improvement a UK policy priority. Briefer-versions of full-programme therapy packages utilizing stepped-care models offer a clear and contained pathway for this population, though their current availability in services is scarce. This service evaluation aims to evaluate the efficacy of 'IDEAS' as a piloted brief psychological intervention for young people aged 16-25 presenting with moderate CEN.

Method: A pre-test/post-test design was used to explore clinical outcomes for participants and services via paired sample t-tests, mixed-model ANOVAS and frequency statistics.

Results: Exploratory pre/post-intervention analyses revealed significant reductions in mean scores for the severity of borderline personality disorder symptoms (d = .83), emotion regulation (d = 1.15) and overall wellbeing (reflecting improvement; d = .97) and increases in mean scores for quality of life (d = -.67), including level of satisfaction in one's quality of life and of therapeutic treatment received (d = -.65). These outcomes were maintained at 3-month follow-up, were little influenced by clinician training and supported readiness for discharge post-intervention for more (68.65%) participants.

Conclusions: The current evaluation provides preliminary evidence that IDEAS may offer a feasible, lower-cost alternative to full-programme treatment packages, with benefits for young people, services and Trusts. Given this evaluation of IDEAS being from a small, uncontrolled pilot, the findings are exploratory. Further evaluation is therefore warranted upon its larger-scale implementation.

Background: Parents of autistic children support their children through additional challenges, often experiencing adversity as a result. Such parents report high support needs, yet service provision is often limited. Services often support children through providing various psychological interventions to parents. Quantitative evidence for such interventions is mixed and qualitative evidence is sparse. This review therefore aimed to synthesise the perspectives of UK parents regarding interventions for their autistic child.

Method: The databases Scopus, Embase, Medline, PubMed, PsycInfo, CINAHL, Web of Science and ASSIA were searched in February 2025. Inclusion criteria constituted qualitative articles published in English from 2004 onwards exploring UK parents' perspectives of interventions aimed at supporting autistic children. Articles were evaluated using Standard Quality Assessment Criteria. Thematic meta-synthesis was conducted.

Results: Fourteen papers were identified: eight high-quality, one medium-quality, and four low-quality. Interventions were psychoeducational behavioural, communication-based, sensory-related or mental-health based in nature. Themes included change, relationship with help, parents' need to process and solidarity.

Conclusions: Facilitators of positive change included learning, empowerment, structure and rigour, while barriers included delivery issues and unhelpful information. Parents reported finding solidarity amongst similar parents helpful. Reflective space was deemed useful in facilitating new understanding of autistic lives. Methodological quality varied, with more reflexive and theoretically grounded research encouraged. Future research should also consider implementing embedding processes into qualitative designs.

Objectives: Despite numerous psychotherapy trials, knowledge on service-system efficiency in terms of return to treatment is limited, especially regarding internet-delivered cognitive behavioural therapy (iCBT). We estimated the hazard ratio (HR) of subsequent psychological treatment over several years following the initial psychological intervention.

Methods: This naturalistic register follow-up study in Finland included patients receiving therapist-guided iCBT (2013-2021, n = 30,934) or ≤20-session psychotherapy (2018-2021, n = 3348), and matched population controls (n = 92,846). Their long-term psychotherapy data (≤200 sessions/3 years, requiring prior treatment) were obtained from the Social Insurance Institution. We used Cox proportional hazard regression, adjusting for age, sex, first purchase of psychotropic drugs and onset of the first psychiatric diagnosis.

Results: Given the adjustments, the hazard of subsequent long-term psychotherapy was fourfold after iCBT (HR = 4.08; 95% CI 3.81-4.37) and nearly ninefold after ≤20-session psychotherapy (HR = 8.94; CI 7.79-10.26), compared to those without these prior treatments. Prior ≤20-session psychotherapy was associated with reduced hazard of entering subsequent iCBT (HR .12, CI .09-.16), while prior long-term psychotherapy was not (p = .087). Prior iCBT was associated with a lower hazard of subsequent ≤20-session psychotherapy (HR = .41, CI = .35-.47), while prior long-term psychotherapy was not (p = .332).

Conclusions: Mapping the succession of psychological treatments added knowledge and revealed surprises. For example, patients receiving therapist-guided iCBT were less likely to access subsequent face-to-face psychotherapy than those initially treated face-to-face. While past services are used as a convenience indicator for future services, future research on successive psychological treatments should continue to disentangle clinical need from service systems effects.

Objectives: Team formulation is associated with better working relationships between staff and service users. However, there is a need for greater standardization of practice. We aimed to investigate the inter-rater reliability of the Team Formulation Quality Rating Scale (TFQS) and explore what aspects of team formulation practices were most frequently adhered to.

Method: Staff at nine acute mental health wards participated in team formulation sessions facilitated by Health Care Professions Council registered psychologists. Formulation sessions were audio recorded, and raters used recordings to complete the TFQS. At least two raters rated 19 team formulation sessions.

Results: The TFQS demonstrated excellent inter-reliability for the total scale (ICC = .926, 95% CI = .820 to .971) and moderate inter-rater reliability for subsection A (ICC = .660; 95% CI = .278 to .862) and subsection B (ICC = .733; 95% CI = .361 to .898). Overall, the items for 'collaboration' and 'consideration of life events' were rated better in terms of quality, compared with items relating to 'close of meeting' and 'consideration of goals and values' which tended to receive lower quality ratings.

Conclusion: The TFQS is a reliable tool for measuring quality of team formulation within inpatient settings and should be used in future research and clinical practice. Psychometric properties should be assessed across different clinical settings. Training and supervision should ensure that psychologists' formulations incorporate a focus on the individual's goals and values impacting problem development and resolution.