The effectiveness of psychodynamic therapy in an NHS psychotherapy service: outcomes for service-users with complex presentations

© 2024 The Association for Psychoanalytic Psychotherapy in the Public Sector. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1080/02668734.2023.2295437Complex and enduring mental health problems require greater treatment resources, usually in the form of multidisciplinary support, including providing psychological therapies. This paper reports on an NHS, tertiary-level specialist psychotherapy service offering Psychodynamic therapies with longer-term, exploratory transdiagnostic approaches to support complexity and sustained personality functioning. This paper adopts a naturalistic study design evaluating the effectiveness of Psychodynamic therapy using pre- and post-outcomes across a 10-year period. A total of n = 474 participants self-report pre- and post-outcome measures were used as the marker of effectiveness along with therapist assessments during intake and engagement. The findings showed that Psychodynamic therapy was effective in reducing psychological distress based on service-user self-report and therapist assessments. While intake scores varied by socio-demographic factors, the rate of change across most groups was similar. There were several limitations relating to data quality and completeness which reflect the naturalistic design. Despite the limits of a naturalistic design, this study provides evidence of support for the place of Psychodynamic therapies within NHS mental health care, catering to those with complex and enduring mental health problems.Peer reviewe

Racial differences in prediabetes prevalence by test type for the US pediatric and adult population: NHANES 1999‐2016

BackgroundPrevious studies have shown that US estimates of prediabetes or diabetes differ depending on test type, fasting plasma glucose (FPG) vs hemoglobin A1c (HbA1c). Given age, race, and test differences reported in the literature, we sought to further examine these differences in prediabetes detection using a nationally representative sample.MethodsUsing the National Health and Nutrition Examination Survey (NHANES) 1999‐2016, individuals were identified as having prediabetes with an HbA1c of 5.7% to 6.4% or a FPG of 100 to 125 mg/dL. We excluded individuals with measurements in the diabetic range. We ran generalized estimating equation logistic regressions to examine the relationship between age, race, and test type with interactions, controlling for sex and body mass index. We compared the difference in predicted prediabetes prevalence detected by impaired fasting glycemia (IFG) vs HbA1c by race/ethnicity among children and adults separately using adjusted Wald tests.ResultsThe absolute difference in predicted prediabetes detected by IFG vs HbA1c was 19.9% for white adolescents, 0% for black adolescents, and 20.1% for Hispanic adolescents; 21.4% for white adults, −1.2% for black adults, and 19.2% for Hispanic adults. Using adjusted Wald tests, we found the absolute differences between black vs white and black vs Hispanic individuals to be significant, but, not between Hispanic and white individuals among children and adults separately.ConclusionsThese observations highlight differences in test performance among racial/ethnic groups. Our findings corroborate the need for further studies to determine appropriate HbA1c cutoff levels for diagnosis of prediabetes by age group and race.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163459/2/pedi13083_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163459/1/pedi13083.pd

Site identification in high-throughput RNA-protein interaction data

Motivation: Post-transcriptional and co-transcriptional regulation is a crucial link between genotype and phenotype. The central players are the RNA-binding proteins, and experimental technologies [such as cross-linking with immunoprecipitation-(CLIP-) and RIP-seq] for probing their activities have advanced rapidly over the course of the past decade. Statistically robust, flexible computational methods for binding site identification from high-throughput immunoprecipitation assays are largely lacking however.Results: We introduce a method for site identification which provides four key advantages over previous methods: (i) it can be applied on all variations of CLIP and RIP-seq technologies, (ii) it accurately models the underlying read-count distributions, (iii) it allows external covariates, such as transcript abundance (which we demonstrate is highly correlated with read count) to inform the site identification process and (iv) it allows for direct comparison of site usage across cell types or conditions. © The Author 2012. Published by Oxford University Press. All rights reserved

Small individual loans and mental health: a randomized controlled trial among South African adults

<p>Abstract</p> <p>Background</p> <p>In the developing world, access to small, individual loans has been variously hailed as a poverty-alleviation tool – in the context of "microcredit" – but has also been criticized as "usury" and harmful to vulnerable borrowers. Prior studies have assessed effects of access to credit on traditional economic outcomes for poor borrowers, but effects on mental health have been largely ignored.</p> <p>Methods</p> <p>Applicants who had previously been rejected (n = 257) for a loan (200% annual percentage rate – APR) from a lender in South Africa were randomly assigned to a "second-look" that encouraged loan officers to approve their applications. This randomized encouragement resulted in 53% of applicants receiving a loan they otherwise would not have received. All subjects were assessed 6–12 months later with questions about demographics, socio-economic status, and two indicators of mental health: the Center for Epidemiologic Studies – Depression Scale (CES-D) and Cohen's Perceived Stress scale. Intent-to-treat analyses were calculated using multinomial probit regressions.</p> <p>Results</p> <p>Randomization into receiving a "second look" for access to credit increased perceived stress in the combined sample of women and men; the findings were stronger among men. Credit access was associated with reduced depressive symptoms in men, but not women.</p> <p>Conclusion</p> <p>Our findings suggest that a mechanism used to reduce the economic stress of extremely poor individuals can have mixed effects on their experiences of psychological stress and depressive symptomatology. Our data support the notion that mental health should be included as a measure of success (or failure) when examining potential tools for poverty alleviation. Further longitudinal research is needed in South Africa and other settings to understand how borrowing at high interest rates affects gender roles and daily life activities. CCT: ISRCTN 10734925</p

Conceptual structure among real-world moral violations

A project to discover organization, based on morally relevant features, within a dataset of moral violations drawn from news article

When my wrongs are worse than yours: behavioral and neural asymmetries in first-person and third-person perspectives of accidents

In this project, we explored how a person’s perspective ⁠— as either the actor or the observer ⁠— influences their moral judgments of accidental harm. We use fMRI to investigate how brain regions involved in the inference of intent and the perception of harm differentially respond when participants either cause (first-person) or observe (third-person) accidental harm

Mindfulness-based cognitive therapy as a treatment for chronic depression: A preliminary study

This pilot study investigated the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT), a treatment combining mindfulness meditation and interventions taken from cognitive therapy, in patients suffering from chronic-recurrent depression. Currently symptomatic patients with at least three previous episodes of depression and a history of suicidal ideation were randomly allocated to receive either MBCT delivered in addition to treatment-as-usual (TAU; N = 14 completers) or TAU alone (N = 14 completers). Depressive symptoms and diagnostic status were assessed before and after treatment phase. Self-reported symptoms of depression decreased from severe to mild levels in the MBCT group while there was no significant change in the TAU group. Similarly, numbers of patients meeting full criteria for depression decreased significantly more in the MBCT group than in the TAU group. Results are consistent with previous uncontrolled studies. Although based on a small sample and, therefore, limited in their generalizability, they provide further preliminary evidence that MBCT can be used to successfully reduce current symptoms in patients suffering from a protracted course of the disorder