Goal Measures for psychotherapy:A systematic review of self-report, idiographic instruments

Routine outcome monitoring can support client progress in psychotherapy and provide evidence on population‐level outcomes. However, measures have been almost exclusively nomothetic. Idiographic tools provide a complementary approach, combining individually set outcomes with standardized progress ratings. Evidence suggests that goal‐focused idiographic measures may particularly facilitate client progress, and this systematic review aimed to identify and critically evaluate such measures, as used in psychotherapy. In total, 104 texts were eligible for inclusion in the review, with nine measures identified. These took the form of multidimensional tools, brief rating forms, and goal attainment scaling. Psychometric and clinical evidence suggests that these measures may be appropriate tools for supporting client progress, but there is insufficient evidence to validate their use for population‐level evaluation

Counsellors in the National Health Service: A mixed‐method study of efficacy and satisfaction from the counsellor perspective

Background: It is difficult to know how many counsellors work in the UK’s National Health Service (NHS). At a time when the British Government is pledging an expansion of the mental health workforce it is important to understand both the opportunities and barriers for counsellors to work in the NHS. Aim: To understand counsellors’ job roles, pay, perceptions of services, workplace stress, and reasons for leaving the NHS.Method: An online survey was advertised to members of the British Association for Counselling and Psychotherapy (BACP); just under 2,000 counsellors responded. The sample was majority female, white and had completed training. Mixed methods were utilised to analyse the data which incorporated use of thematic analysis. Findings: The data suggest that, as a workforce, counsellors are prone to being ‘squeezed’ out of the NHS workforce, that they are comparatively ‘underpaid’, are ‘pressurised’ by high level of work demand and are consequently experiencing concerning levels of workplace stress, and that they perceive themselves to be, in multiple ways, ‘under-valued’. Despite this, members reported high adequacy of therapist qualifications and supervision quality within NHS services. Conclusions: Counsellors have expressed a desire to undertake more work in the NHS and are a potentially cost-effective mental health workforce in comparison with other types of professionals. However, this study has evidenced significant structural, cultural and pay and promotion-related barriers that are pushing counsellors out of the NHS. Of particular concern is what appears to be a broad under-valuing of counsellors as a professional group

VARAHA: A Fast Non-Markovian sampler for estimating Gravitational-Wave posteriors

This article introduces VARAHA, an open-source, fast, non-Markovian sampler for estimating gravitational-wave posteriors. VARAHA differs from existing Nested sampling algorithms by gradually discarding regions of low likelihood, rather than gradually sampling regions of high likelihood. This alternative mindset enables VARAHA to freely draw samples from anywhere within the high-likelihood region of the parameter space, allowing for analyses to complete in significantly fewer cycles. This means that VARAHA can significantly reduce both the wall and CPU time of all analyses. VARAHA offers many benefits, particularly for gravitational-wave astronomy where Bayesian inference can take many days, if not weeks, to complete. For instance, VARAHA can be used to estimate accurate sky locations, astrophysical probabilities and source classifications within minutes, which is particularly useful for multi-messenger follow-up of binary neutron star observations; VARAHA localises GW170817 $\sim 30$ times faster than LALInference. Although only aligned-spin, dominant multipole waveform models can be used for gravitational-wave analyses, it is trivial to extend this algorithm to include additional physics without hindering performance. We envision VARAHA being used for gravitational-wave studies, particularly estimating parameters using expensive waveform models, analysing subthreshold gravitational-wave candidates, generating simulated data for population studies, and rapid posterior estimation for binary neutron star mergers

Who Attends Couples Counseling in the UK and Why?

In England, publicly funded couples therapy is reserved for couples where one or both partners present with psychological disorders, rather than relationship distress, despite evidence of a bidirectional relationship between the two. Demographics and presenting issues for 14,726 couples who received counseling through a third-sector counseling organization in England and Wales were investigated. Clients were often White, aged 25–54, and presented with interpersonal issues. “Mental health problems” were identified as an issue by about a quarter of all clients. This suggests that many couples seeking relationship counseling wish to address relational versus psychological distress, which has implications for publicly funded services

Needs of parents and carers of children and young people with mental health difficulties: protocol for a systematic review

Introduction Having a child or young person (CYP) with mental health problems can be highly distressing for parents/carers. The impact can include parental/carer depression, anxiety, lost productivity and poor family relationships. Currently, there is no synthesis of this evidence, which is needed to provide clarity around what support parents/carers may need, to meet the needs of family mental health. This review aims to identify the needs of the parents/carers of CYP who are receiving mental health services. Methods and analysis A systematic review will be conducted to identify potentially relevant studies that provide evidence concerning the needs and impact on parents/carers linked to their CYP having mental health difficulties. CYP mental health conditions included are anxiety disorders, depression, psychoses, oppositional defiant and other externalising disorders, labels of emerging personality disorders, eating disorders and attention deficit (hyperactive) disorders. The following databases were searched on November 2022 with no date restriction applied: Medline; PsycINFO; CINAHL; AMED; EMBASE; Web of Science; Cochrane Library; WHO International Clinical Trials Registry Platform; Social Policy and Practice; Applied Social Sciences Index and Abstracts; and Open Grey. Only studies reported in English will be included. The quality of the included studies will be assessed using Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies and the Newcastle Ottawa Scale for quantitative studies. Qualitative data will be analysed thematically and inductively

Spatially Resolved Stellar Spectroscopy of the Ultra-diffuse Galaxy Dragonfly 44. III. Evidence for an Unexpected Star-Formation History

We use the Keck Cosmic Web Imager integral-field unit spectrograph to: 1) measure the global stellar population parameters for the ultra-diffuse galaxy (UDG) Dragonfly 44 (DF44) to much higher precision than previously possible for any UDG, and 2) for the first time measure spatially-resolved stellar population parameters of a UDG. We find that DF44 falls below the mass--metallicity relation established by canonical dwarf galaxies both in and beyond the Local Group. We measure a flat radial age gradient ($m_{\rm age} \sim +0.01_{-0.08}^{+0.07}$ log Gyr kpc$^{-1}$) and a flat-to-positive metallicity gradient ($m_{\rm [Fe/H]} \sim +0.08_{-0.11}^{+0.11}$ dex kpc$^{-1}$), which are inconsistent with the gradients measured in similarly pressure-supported dwarf galaxies. We also measure a flat-to-negative [Mg/Fe] gradient ($m_{\rm [Mg/Fe]} \sim -0.18_{-0.17}^{+0.17}$ dex kpc$^{-1}$) such that the central $1.5$ kpc of DF44 has stellar population parameters comparable to metal-poor globular clusters. Overall, DF44 does not have internal properties similar to other dwarf galaxies and is inconsistent with it having been puffed up through a prolonged, bursty star-formation history, as suggested by some simulations. Rather, the evidence indicates that DF44 experienced an intense epoch of "inside-out" star formation and then quenched early and catastrophically, such that star-formation was cut off more quickly than in canonical dwarf galaxies.Comment: Accepted to Ap

Humanistic counselling plus pastoral care as usual versus pastoral care as usual for the treatment of psychological distress in adolescents in UK state schools (ETHOS):a randomised controlled trial

Background About one in seven adolescents have a mental health disorder in England, UK. School counselling is one of the most common means of trying to address such a problem. We aimed to determine the effectiveness and cost-effectiveness of school-based humanistic counselling (SBHC) for the treatment of psychological distress in young people in England, UK. Methods We did a two-arm, individually randomised trial in 18 secondary state-funded schools across the Greater London area of the UK. Participants were randomly assigned (1:1) using a centrally secure randomisation procedure with random permuted blocks to either SBHC plus schools' pastoral care as usual (PCAU), or PCAU alone. Participants were pupils aged 13–16 years who had moderate-to-severe levels of emotional symptoms (measured by a score of ≥5 on the Strengths and Difficulties Questionnaire Emotional Symptoms scale) and were assessed as competent to consent to participate in the trial. Participants, providers, and assessors (who initially assessed and enrolled participants) were not masked but testers (who measured outcomes) were masked to treatment allocation. The primary outcome was psychological distress at 12 weeks (Young Person's Clinical Outcomes in Routine Evaluation measure [YP-CORE]; range 0–40), analysed on an intention-to-treat basis (with missing data imputed). Costs were assessed at 24 weeks (Client Service Receipt Inventory and service logs). The trial was registered with ISRCTN, number ISRCTN10460622. Findings 329 participants were recruited between Sept 29, 2016, and Feb 8, 2018, with 167 (51%) randomly assigned to SBHC plus PCAU and 162 (49%) to PCAU. 315 (96%) of 329 participants provided data at 12 weeks and scores were imputed for 14 participants (4%). At baseline, the mean YP-CORE scores were 20·86 (SD 6·38) for the SBHC plus PCAU group and 20·98 (6·41) for the PCAU group. Mean YP-CORE scores at 12 weeks were 16·41 (SD 7·59) for the SBHC plus PCAU group and 18·34 (7·84) for the PCAU group (difference 1·87, 95% CI 0·37–3·36; p=0·015), with a small effect size (0·25, 0·03–0·47). Overall costs at 24 weeks were £995·20 (SD 769·86) per pupil for the SBHC plus PCAU group and £612·89 (1224·56) for the PCAU group (unadjusted difference £382·31, 95% CI £148·18–616·44; p=0·0015). The probability of SBHC being more cost-effective reached 80% at a willingness to pay of £390 for a 1-point improvement on the YP-CORE. Five serious adverse events occurred for four participants in the SBHC plus PCAU group, all involving suicidal intent. Two serious adverse events occurred for two participants in the PCAU group, one involving suicidal intent. Interpretation The addition of SBHC to PCAU leads to small reductions in psychological distress, but at an additional economic cost. SBHC is a viable treatment option but there is a need for equally rigorous evaluation of alternative interventions. Funding This work was supported by the Economic and Social Research Council (grant reference ES/M011933/1)

A randomised, feasibility trial of an Exercise and Nutrition-based Rehabilitation programme (ENeRgy) in people with cancer

From Wiley via Jisc Publications RouterErna Haraldsdottir - ORCID: 0000-0003-4891-0743 https://orcid.org/0000-0003-4891-0743Background: Despite rehabilitation being increasingly advocated for people living with incurable cancer, there is limited evidence supporting efficacy or component parts. The progressive decline in function and nutritional in this population would support an approach that targets these factors. This trial aimed to assess the feasibility of an exercise and nutrition based rehabilitation programme in people with incurable cancer. Methods: We randomized community dwelling adults with incurable cancer to either a personalized exercise and nutrition based programme (experimental arm) or standard care (control arm) for 8 weeks. Endpoints included feasibility, quality of life, physical activity (step count), and body weight. Qualitative and health economic analyses were also included. Results: Forty‐five patients were recruited (23 experimental arm, 22 control arm). There were 26 men (58%), and the median age was 78 years (IQR 69–84). At baseline, the median BMI was 26 kg/m2 (IQR: 22–29), and median weight loss in the previous 6 months was 5% (IQR: −12% to 0%). Adherence to the experimental arm was >80% in 16/21 (76%) patients. There was no statistically significant difference in the following between trial arms: step count − median % change from baseline to endpoint, per trial arm (experimental −18.5% [IQR: −61 to 65], control 5% [IQR: −32 to 50], P = 0.548); weight − median % change from baseline to endpoint, per trial arm (experimental 1%[IQR: −3 to 3], control −0.5% [IQR: −3 to 1], P = 0.184); overall quality of life − median % change from baseline to endpoint, per trial arm (experimental 0% [IQR: −20 to 19], control 0% [IQR: −23 to 33], P = 0.846). Qualitative findings observed themes of capability, opportunity, and motivation amongst patients in the experimental arm. The mean incremental cost of the experimental arm versus control was £‐319.51 [CI −7593.53 to 6581.91], suggesting the experimental arm was less costly. Conclusions: An exercise and nutritional rehabilitation intervention is feasible and has potential benefits for people with incurable cancer. A larger trial is now warranted to test the efficacy of this approach.12pubpub

The impact of different DNA extraction kits and laboratories upon the assessment of human gut microbiota composition by 16S rRNA gene sequencing

Peer reviewedPublisher PD

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