Patient experiences of psychological therapy for depression: a qualitative metasynthesis

Background Globally, national guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research concerning patient experience of treatments. A review of patient experience research can provide a comprehensive overview of this important form of evidence and thus enable the voices and subjectivities of those affected by depression to have an impact on the treatments and services they are offered. This review aims to seek a comprehensive understanding of patient experiences of psychological therapies for depression using a systematic and rigorous approach to review and synthesis of qualitative research. Method PsychINFO, PsychARTICLES, MEDLINE, and CINAHL were searched for published articles using a qualitative approach to examine experiences of psychological therapies for depression. All types of psychological therapy were included irrespective of model or modes of delivery (e.g. remote or in person; group or individual). Each article was assessed following guidance provided by the Critical Appraisal Skill Programme tool. Articles were entered in full into NVIVO and themes were extracted and synthesized following inductive thematic analysis. Results Thirty-seven studies, representing 671 patients were included. Three main themes are described; the role of therapy features and setting; therapy processes and how they impact on outcomes; and therapy outcomes (benefits and limitations). Subthemes are described within these themes and include discussion of what works and what’s unhelpful; issues integrating therapy with real life; patient preferences and individual difference; challenges of undertaking therapy; influence of the therapist; benefits of therapy; limits of therapy and what happens when therapy ends. Conclusions Findings point to the importance of common factors in psychotherapies; highlight the need to assess negative outcomes; and indicate the need for patients to be more involved in discussions and decisions about therapy, including tailoring therapy to individual needs and taking social and cultural contexts into account

Teleconferencing as a Source of Social Support for Older Spousal Caregivers: Initial Explorations and Recommendations for Future Research

Teleconferencing is increasingly being used as a medium of delivering social support for dementia caregivers. Further direction is required from pilot studies before the optimal clinical service can be delivered. Following a 6-week pilot support group for spousal caregivers, delivered via teleconferencing software, we interviewed 8 participants for their feedback. Semi-structured interviews were conducted and analyzed using grounded theory analysis. Themes of ‘‘group processes’’ and ‘‘barriers,’’ containing subcategories of ‘‘functions of the group,’’ ‘‘responsibilities of facilitators,’’ and ‘‘barriers to communication’’ were discussed. According to caregivers, successful teleconferencing support groups should acknowledge the caregiver as the dementia expert, allow participants to meet before the deployment of the support group, provide active facilitation and leadership via the researcher, employ user-friendly technologies, and facilitate for the group to self-maintain following the pilot deployment period. These issues should be taken into consideration when designing future teleconferencing applications for caregivers