Individuals' Long Term Use of Cognitive Behavioural Skills to Manage their Depression: A Qualitative Study

Background: Cognitive Behavioural Therapy (CBT) aims to teach people skills to help them self-manage their depression. Trial evidence shows that CBT is an effective treatment for depression and individuals may experience benefits long-term. However, there is little research about individuals’ continued use of CBT skills once treatment has finished. Aims: To explore whether individuals who had attended at least 12 sessions of CBT continued to use and value the CBT skills they had learnt during therapy. Method: Semi-structured interviews were held with participants from the CoBalT trial who had received CBT, approximately 4 years earlier. Interviews were audio-recorded, transcribed and analysed thematically. Results: 20 participants were interviewed. Analysis of the interviews suggested that individuals who viewed CBT as a learning process, at the time of treatment, recalled and used specific skills to manage their depression once treatment had finished. In contrast, individuals who viewed CBT only as an opportunity to talk about their problems did not appear to utilize any of the CBT skills they had been taught and reported struggling to manage their depression once treatment had ended. Conclusions: Our findings suggest individuals may value and use CBT skills if they engage with CBT as a learning opportunity at the time of treatment. Our findings underline the importance of the educational model in CBT and the need to emphasize this to individuals receiving treatment

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

Racism as a determinant of health: a systematic review and meta-analysis

Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants.<br /

Tracking India within precambrian supercontinent cycles

The term supercontinent generally implies grouping of formerly dispersed continents and/or their fragments in a close packing accounting for about 75% of earth’s landmass in a given interval of geologic time. The assembly and disruption of supercontinents rely on plate tectonic processes, and therefore, much speculation is involved particularly considering the debates surrounding the applicability of differential plate motion, the key to plate tectonics during the early Precambrian. The presence of Precambrian orogenic belts in all major continents is often considered as the marker of ancient collisional or accretionary sutures, which provide us clues to the history of periodic assembly of ancient supercontinents. Testing of any model assembly/breakup depends on precise age data and paleomagnetic pole reconstruction. The record of dispersal of the continents and release of enormous stress lie in extensional geological features, such as rift valleys, regionally extensive flood basalts, granite-rhyolite terrane, anorthosite complexes, mafic dyke swarms, and remnants of ancient mid-oceanic ridges. Indian shield with extensive Precambrian rock records is known to bear signatures of the past supercontinents in a fragmentary manner. Vast tracts of Precambrian rocks exposed in peninsular India and in the Lesser Himalaya and the Shillong plateau further north and east provide valuable clues to global tectonic reconstructions and the geodynamics of the respective periods. The Indian shield is a mosaic of Archean cratonic nuclei surrounded by Proterozoic orogenic belts, which preserve the records of geologic events since the Paleoarchean/Eoarchean. Here we discuss the sojourn of the Indian plate from the Archean through Proterozoic, in light of available models for supercontinent assembly and breakup in the Precambrian. We also discuss the issues in constraining the configuration, which is mainly due to scanty exposures, lack of reliable paleomagnetic poles from different cratons, and their time of formation or amalgamation. In this chapter, we briefly review Precambrian geology of India to track her participation in the making of the supercontinents through time.Sarbani Patranabis-Deb, Dilip Saha, and M. Santos