Telephone-delivered group CBT for anxiety: Experiences of group members

Cognitive behavioural therapy (CBT) for common mental health problems is increasingly being delivered by telephone, over the internet and via guided self-help. This thesis examines telephone-delivered interventions for anxiety and depression and is presented in three parts. Part I is a literature review of the effectiveness of telephone interventions for anxiety and depression. Sixteen studies met criteria for the review. Overall, study quality was good and there was reasonable evidence that telephone interventions show promise in reducing symptoms of anxiety and depression. Further research is required to determine the characteristics of people who find telephone-delivered interventions beneficial. Part II presents the findings from a qualitative study of recipients’ experiences of a 14-week telephone-delivered CBT group for anxiety disorders. Seventeen people completed a telephone interview. Interview transcripts were analysed using the ‘framework’ approach and yielded 10 themes organised into three domains. There were therapeutic benefits from taking part in the groups, even in the absence of symptom change. However, a number of barriers and challenges (e.g. difficulties in connecting with others over the telephone) sometimes prevented people from making full use of the groups. Further research is needed to understand the impact of delivering group CBT by telephone, in order to guide the delivery of similar low-intensity interventions for anxiety. Part III is a reflection on the research process and focuses on the impact of using the telephone for semi-structured interviews, the advantages and challenges of conducting research with external organisations, and the implications for the delivery of low-intensity interventions

Measurement Issues: The measurement of obsessive compulsive disorder in children and young people in clinical practice

BACKGROUND: If left untreated, obsessive compulsive disorder (OCD) can cause significant distress and impact on functioning throughout the lifespan. Despite the severity of the disorder, there is often a significant delay between the onset of symptoms and successful treatment. This is in part due to delays in recognising OCD symptoms in young people, particularly if the symptom forms are less common. Once OCD is accurately diagnosed, cognitive behavioural therapy (CBT) is known to be an efficacious treatment, sometimes in combination with medication, producing good long-term prognosis. It is therefore important to accurately detect OCD in children and young people so that they can be offered timely intervention. Use of the best tools in clinical and research settings improves detection and diagnosis, as well as enabling the tracking of progress through treatment. The aim of this current paper was to review measurement tools for OCD in young people with a focus on the practicalities of using tools in busy child mental health clinical settings. METHOD: To discover what measurement tools are available for OCD in young people, we conducted a pragmatic literature of measurement tools for OCD in young people. We searched PsycINFO, Med-Line and the Cochrane databases for reports relating to the measurement of OCD. Additionally, we sought information from the National Institute for Health and Care Excellence (NICE) guidance, the Child Outcomes Research Consortium (CORC) website and the Children and Young People's Improving Access to Psychological Therapies (CYP IAPT) Programme. We also reviewed large trials and meta-analyses of the treatment of OCD in young people and communicated with relevant researchers/clinicians. RESULTS: Seventeen questionnaire measurement tools, with variable psychometric properties, and four commonly used semistructured clinician administered interview measures were identified. CONCLUSIONS: There are several measurement tools with good psychometric properties that are useful for initial screening/identification of OCD, as well as formal diagnosis, symptom tracking and treatment evaluation. With the availability of brief screens, as well as online diagnostic measures, such tools should not be a burden on clinical practice, but rather a helpful aid to support clinicians' assessment and treatment of OCD

A Mental Health Drop-In Centre Offering Brief Transdiagnostic Psychological Assessment and Treatment in a Paediatric Hospital Setting: A One-Year Descriptive Study

Aim: This study was part of a broader project to examine the acceptability, feasibility and impact of a transdiagnostic mental health drop-in centre offering brief psychological assessment and treatment for children and young people and/or their families with mental health needs in the context of long-term physical health conditions (LTCs). The aims of this investigation were to characterise: (i) the use of such a centre, (ii) the demographics and symptoms of those presenting to the centre, and (iii) the types of support that are requested and/or indicated. Methods: A mental health “booth” was located in reception of a national paediatric hospital over one year. Characteristics of young people with LTCs and their siblings/parents attending the booth were defined. Emotional/behavioural symptoms were measured using standardised questionnaires including the Strengths and Difficulties Questionnaire (SDQ). Participants subsequently received one of four categories of intervention: brief transdiagnostic cognitive behaviour therapy (CBT), referral to other services, neurodevelopmental assessment or signposting to resources. Results: One hundred and twenty-eight participants were recruited. The mean age of young people was 9.14 years (standard deviation: 4.28); 61% identified as white and 45% were male. Over half of young people recruited scored in the clinical range with respect to the SDQ. Presenting problems included: anxiety (49%), challenging behaviour (35%), low mood (22%) and other (15%). Conclusions: A considerable proportion of young people with LTC in a paediatric hospital scored in the clinical range for common mental health problems, indicating a potential for psychological interventions

Guided self-help for mental health disorders in children and young people with chronic neurological conditions: A qualitative evaluation

Objective: Children with neurological conditions such as epilepsy are at high risk of developing mental health disorders. Guided self-help can be used to increase access to psychological therapies. When developing and evaluating interventions, it is important to obtain the views of service-users about their acceptability. A telephone-guided self-help intervention was used to treat common mental health difficulties in children and young people with neurological conditions. The intervention was not adapted in content to account for chronic illness. This study therefore reports on qualitative interviews with participants to determine the acceptability of the intervention. // Methods: Semi-structured interviews were conducted with 27 participants (25 parents and 2 young people) who had undertaken a telephone-delivered guided self-help intervention for common mental health difficulties in the context of a paediatric neurological condition. Transcripts were analysed thematically using the framework approach. // Results: Thirteen themes were extracted, organised into three main domains, which covered: the practicalities of telephone guided self-help treatment; the outcomes of the intervention; and the extent to which adaptation was needed for chronic illness. Most families found the intervention helpful in working towards their specific goals and noticed changes for the child and/or parents and family. // Conclusions: Participants had a positive experience of the intervention and the majority of parents found the standard intervention with individualised goals sufficient to meet the young person's mental health needs

The effectiveness of telephone-delivered psychological therapies for depression and anxiety: A systematic review.

Objectives The telephone is increasingly used to deliver psychological therapies for common mental health problems. This review addressed the following question: are evidence-based psychological therapies for adults with depression and/or anxiety effective in reducing psychological symptoms when delivered over the telephone? Method A systematic search for articles published over a 25-year period (January 1991-May 2016) was performed using the databases PsycINFO, PubMed and Web of Science. Citation searches, manual searches of bibliographies of relevant papers, and hand searches of key journals were also conducted. The quality of the studies included for review was assessed using the Effective Public Health Practice Project Quality Assessment Tool. Results Fourteen studies met inclusion criteria for the review. Ten reported findings from telephone treatment for depression and four for anxiety. Nine studies used randomised controlled designs, two used quasi-experimental designs and three used uncontrolled designs. Thirteen studies reported reductions in symptoms of depression or anxiety. Cohen's d ranged from 0.25-1.98 (median = 0.61) for controlled studies and from 1.13-1.90 (median = 1.26) for uncontrolled studies. Only four studies reported clinically significant change. Conclusions The findings indicate that telephone-delivered interventions show promise in reducing symptoms of depression and anxiety. Further research is required to establish the types of interventions that are most effective and the characteristics of clients who find them beneficial

Looking at or through rose-tinted glasses? Imagery perspective and positive mood.

We can imagine looking at ourselves (observer perspective) or through our own eyes (field perspective). Cognitive and clinical theories suggest that compared to field perspective, observer perspective imagery reduces emotional intensity, for example, of trauma memories. Tests of causality are lacking and less is known about perspective and positive emotion. Using contrasting experimental manipulations, participants imagined 100 positive descriptions from either (1) a field perspective or (2) an observer perspective, or (3) thought about their verbal meaning. Affect was more positive after field than observer imagery and verbal conditions, with mood deterioration within the latter two. Findings are the first to demonstrate causality of imagery perspective on emotion. Further, the results demonstrate that imagining positive events from one's own perspective is critical to improving positive affect. Treatment implications include promoting field imagery to facilitate a more rose-tinted view of positive events

The current status of mental contamination in obsessive compulsive disorder: A systematic review

Background and objectives: Over the past 25 years Mental Contamination (MC) has become recognised as a distinct construct, particularly in relation to Obsessive Compulsive Disorder (OCD). MC is defined as feelings of contamination, often located internally, that arise in the absence of contact with a contaminant, with the source proposed to be human. Despite considerable interest from researchers and clinicians, there has not been a systematic review on the relationship between MC and OCD. Therefore, a systematic review was conducted to summarise and synthesise the current status of phenomenological and experimental evidence, mechanisms, assessment, measurement, and treatment of MC in OCD (PROSPERO: CRD42021223119). Methods: All study designs were eligible provided the focus of the study was on MC and the implications of the study were linked to OCD. We searched PsychINFO, Embase, Medline, Ethos, ProQuest, conference abstracts and trial registries between 1990 and 2021. The Mixed Methods Appraisal tool was used to assess methodological quality of included studies. Results: We found 58 reports with a total of 67 studies that met criteria for inclusion in the review. Twenty-three of these studies used clinical samples, 28 were experimental, 12 focused on phenomenology and 8 addressed treatment. The quality of the studies was variable. Limitations: Grey literature was not included, thus there may be further unpublished MC studies that have not been included in the review. Conclusions: Based on the findings, mental contamination is a robust clinical construct within OCD that has important implications for understanding and treating the disorder

Health Professionals' Perspectives on the Nature of Distress and Low Mood in Young People with Cancer

PURPOSE: Young people with cancer are at increased risk of depression, yet evidence-based psychological interventions that are tailored to the specific needs of young people with cancer are scarce, and depression in this group may be particularly challenging to recognize and treat. The aims of this study were to (1) explore the views of health professionals in recognizing and treating low mood in young people with cancer and (2) identify the key components of an effective online treatment package for depression in this population. METHODS: Eighteen NHS health professionals with a range of professional backgrounds working directly with young people with cancer were interviewed using a semi-structured interview schedule. Responses were analyzed using thematic analysis. RESULTS: Five themes emerged: (1) one size doesn't fit all-the nature of depression is complex and varied, and symptoms fluctuate greatly in relation to physical health; (2) distress is completely understandable-it is important not to pathologize a normal reaction; (3) a stepping stone intervention-online interventions may promote engagement with face-to-face therapy; (4) connecting with others-the intervention should promote sharing experiences with others to reduce isolation; and (5) ownership and empowerment-lack of independence may be a cause of distress, and young people should have control of the intervention. CONCLUSION: The nature of depression in young people with cancer is complex and multifaceted. Online guided self-help may be useful when added as a component or first step of a treatment package including face-to-face talking therapies

Debate: Lessons learned in lockdown – a one‐day remotely delivered training on low‐intensity psychological interventions for common mental health conditions

The coronavirus pandemic has highlighted the need for remote technologies to be used in child and adolescent mental health services. With the UK being placed in lockdown one week before a scheduled ‘face‐to‐face’ low‐intensity CBT training day due to COVID‐19, there was a need for rapid adaptations to be made to the content, structure and format of a training day for practitioners in mental health services, to suit the online environment. The content covered the core areas of low‐intensity CBT in children and adolescents. Findings showed that the one‐day low‐intensity training day increased knowledge and understanding in all key areas measured, and was positively received, providing further evidence for the effectiveness and acceptability of remote delivery. Given discussed benefits of remote delivery, as well as rapid developments in technologies helping to address some of the challenges raised, going forward, remote delivery could continue to be beneficial for increasing access to much needed evidence‐based interventions

Brief psychological interventions for psychiatric disorders in young people with long term physical health conditions: A systematic review and meta-analysis

Objectives: Rates of psychiatric disorders are considerably elevated in young people with long term physical health conditions. Currently few children obtain effective mental health treatments in the context of long term physical health conditions, and ways to improve access to evidence-based mental health interventions are urgently needed. One approach is to deploy briefer, more economical, yet still evidence-based, treatments. The objective of this review was to evaluate the efficacy of brief interventions targeting psychiatric disorders in children and young people with long term physical health conditions. / Methods: Predefined terms relating to brief psychological interventions for psychiatric disorders in children with long term physical health conditions were used to search relevant databases. A systematic review and meta-analysis was carried out in accordance with the Cochrane guidelines. Two reviewers independently screened titles and abstracts, extracted the data and conducted risk of bias assessments. / Results: A total of 12 randomised controlled trials were found to meet the inclusion criteria of the review. Of those, three studies were suitable for meta-analysis. A large effect size in favour of brief cognitive behavioural therapy for anxiety was found (g = − 0.95, CI -1.49 to −0.041; p < .001) with non-significant moderate-substantial heterogeneity (I2 = 58%; p = .09). / Conclusion: This review suggests there is preliminary evidence that brief interventions, based on cognitive behavioural principles, may benefit young people with an anxiety disorder in the context of a long term physical health condition. There was insufficient evidence to assess whether this held true for depression and disruptive behaviour