19 research outputs found
Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation.
Published onlineJournal ArticleThis is the final version of the article. Available from BMJ Publishing Group via the DOI in this record.OBJECTIVE: To explore participant views on acceptability, mechanisms of change and impact of behavioural activation (BA) delivered by junior mental health workers (MHWs) versus cognitive behavioural therapy (CBT) delivered by professional psychotherapists. DESIGN: Semistructured qualitative interviews analysed using a framework approach. PARTICIPANTS: 36 participants with major depressive disorder purposively sampled from a randomised controlled trial of BA versus CBT (the COBRA trial). SETTING: Primary care psychological therapies services in Devon, Durham and Leeds, UK. RESULTS: Elements of therapy considered to be beneficial included its length and regularity, the opportunity to learn and not dwelling on the past. Homework was an important, although challenging aspect of treatment. Therapists were perceived as experts who played an important role in treatment. For some participants the most important element of therapy was having someone to talk to, but for others the specific factors associated with BA and CBT were crucial, with behavioural change considered important for participants in both treatments, and cognitive change unsurprisingly discussed more by those receiving CBT. Both therapies were considered to have a positive impact on symptoms of depression and other areas of life including feelings about themselves, self-care, work and relationships. Barriers to therapy included work, family life and emotional challenges. A subset (n=2) of BA participants commented that therapy felt too simple, and MHWs could be perceived as inexperienced. Many participants saw therapy as a learning experience, providing them with tools to take away, with work on relapse prevention essential. CONCLUSIONS: Despite barriers for some participants, BA and CBT were perceived to have many benefits, to have brought about cognitive and behavioural change and to produce improvements in many domains of participants' lives. To optimise the delivery of BA, inexperienced junior MHWs should be supported through good quality training and ongoing supervision. TRIAL REGISTRATION NUMBER: ISRCTN27473954, 09/12/2011.This work was funded by the UK National Institute for Health Research (NIHR) Health Technology Assessment programme grant number 10/50/14. DAR is also supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula
Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA) : a qualitative process evaluation
OBJECTIVE: To explore participant views on acceptability, mechanisms of change and impact of behavioural activation (BA) delivered by junior mental health workers (MHWs) versus cognitive behavioural therapy (CBT) delivered by professional psychotherapists. DESIGN: Semistructured qualitative interviews analysed using a framework approach. PARTICIPANTS: 36 participants with major depressive disorder purposively sampled from a randomised controlled trial of BA versus CBT (the COBRA trial). SETTING: Primary care psychological therapies services in Devon, Durham and Leeds, UK. RESULTS: Elements of therapy considered to be beneficial included its length and regularity, the opportunity to learn and not dwelling on the past. Homework was an important, although challenging aspect of treatment. Therapists were perceived as experts who played an important role in treatment. For some participants the most important element of therapy was having someone to talk to, but for others the specific factors associated with BA and CBT were crucial, with behavioural change considered important for participants in both treatments, and cognitive change unsurprisingly discussed more by those receiving CBT. Both therapies were considered to have a positive impact on symptoms of depression and other areas of life including feelings about themselves, self-care, work and relationships. Barriers to therapy included work, family life and emotional challenges. A subset (n=2) of BA participants commented that therapy felt too simple, and MHWs could be perceived as inexperienced. Many participants saw therapy as a learning experience, providing them with tools to take away, with work on relapse prevention essential. CONCLUSIONS: Despite barriers for some participants, BA and CBT were perceived to have many benefits, to have brought about cognitive and behavioural change and to produce improvements in many domains of participants' lives. To optimise the delivery of BA, inexperienced junior MHWs should be supported through good quality training and ongoing supervision. TRIAL REGISTRATION NUMBER: ISRCTN27473954, 09/12/2011
Cost and Outcome of BehaviouRal Activation (COBRA) : a randomised controlled trial of behavioural activation versus cognitiveâbehavioural therapy for depression
Background
Depression is a common, debilitating and costly disorder. The best-evidenced psychological therapy â cognitiveâbehavioural therapy (CBT) â is complex and costly. A simpler therapy, behavioural activation (BA), may be an effective alternative.
Objectives
To determine the clinical effectiveness and cost-effectiveness of BA compared with CBT for depressed adults at 12 and 18 monthsâ follow-up, and to investigate the processes of treatments.
Design
Randomised controlled, non-inferiority trial stratified by depression severity, antidepressant use and recruitment site, with embedded process evaluation; and randomisation by remote computer-generated allocation.
Setting
Three community mental health services in England.
Participants
Adults aged â„ 18 years with major depressive disorder (MDD) recruited from primary care and psychological therapy services.
Interventions
BA delivered by NHS junior mental health workers (MHWs); CBT by NHS psychological therapists.
Outcomes
Primary: depression severity (as measured via the Patient Health Questionnaire-9; PHQ-9) at 12 months. Secondary: MDD status; number of depression-free days; anxiety (as measured via the Generalised Anxiety Disorder-7); health-related quality of life (as measured via the Short Form questionnaire-36 items) at 6, 12 and 18 months; and PHQ-9 at 6 and 18 months, all collected by assessors blinded to treatment allocation. Non-inferiority margin was 1.9 PHQ-9 points. We undertook intention-to-treat (ITT) and per protocol (PP) analyses. We explored cost-effectiveness by collecting direct treatment and other health- and social-care costs and calculating quality-adjusted life-years (QALYs) using the EuroQol-5 Dimensions, three-level version, at 18 months.
Results
We recruited 440 participants (BA, n = 221; CBT, n = 219); 175 (79%) BA and 189 (86%) CBT participants provided ITT data and 135 (61%) BA and 151 (69%) CBT participants provided PP data. At 12 months we found that BA was non-inferior to CBT {ITT: CBT 8.4 PHQ-9 points [standard deviation (SD) 7.5 PHQ-9 points], BA 8.4 PHQ-9 points (SD 7.0 PHQ-9 points), mean difference 0.1 PHQ-9 points, 95% confidence interval (CI) â1.3 to 1.5 PHQ-9 points, p = 0.89; PP: CBT 7.9 PHQ-9 points (SD 7.3 PHQ-9 points), BA 7.8 PHQ-9 points (SD 6.5 PHQ-9 points), mean difference 0.0 PHQ-9 points, 95% CI â1.5 to 1.6 PHQ-9 points, p = 0.99}. We found no differences in secondary outcomes. We found a significant difference in mean intervention costs (BA, ÂŁ975; CBT, ÂŁ1235; p
Limitations
In this pragmatic trial many depressed participants in both groups were also taking antidepressant medication, although most had been doing so for a considerable time before entering the trial. Around one-third of participants chose not to complete a PP dose of treatment, a finding common in both psychotherapy trials and routine practice.
Conclusions
We found that BA is as effective as CBT, more cost-effective and can be delivered by MHWs with no professional training in psychological therapies.
Future work
Settings and countries with a paucity of professionally qualified psychological therapists, might choose to investigate the delivery of effective psychological therapy for depression without the need to develop an extensive and costly professional infrastructure.</p
Automatic target recognition based on cross-plot
Automatic target recognition that relies on rapid feature extraction of real-time target from photo-realistic imaging will enable efficient identification of target patterns. To achieve this objective, Cross-plots of binary patterns are explored as potential signatures for the observed target by high-speed capture of the crucial spatial features using minimal computational resources. Target recognition was implemented based on the proposed pattern recognition concept and tested rigorously for its precision and recall performance. We conclude that Cross-plotting is able to produce a digital fingerprint of a target that correlates efficiently and effectively to signatures of patterns having its identity in a target repository.Kelvin Kian Loong Wong and Derek Abbot
Engaging Mothers to Implement Nonpharmacological Care for Infants With Neonatal Abstinence Syndrome
âThis Isnât Just About Usâ: Articulations of Feminism in Media Narratives of Athlete Activism
Parentsâ experiences of an inpatient pediatric integrative medicine service for symptom management
Exploring young pregnant smokers' experiences with a self-nominated non-smoking buddy
Introduction psychosocial interventions can increase the proportion of women who stop smoking in pregnancy. There is limited research exploring self-nominated, non-smoking buddy support, to assist young pregnant smokers to quit. Methods this qualitative descriptive study was embedded within a randomised controlled study assisting young (16 to 24 years) pregnant smokers to quit. Women were recruited from two public maternity hospitals in Western Australia. Interviews were performed every two weeks from recruitment to six weeks post birth. The study aim was to explore women's experiences with a self-nominated non-smoking buddy. Thematic analysis was utilised to identify common themes. Findings a total of 204 interviews were performed with 36 women, who had a mean of six interviews, with four conducted in pregnancy and two post birth. Two themes were revealed. The first âChallenges of finding the right buddyâ reflected the experiences women had in finding a non-smoking buddy to provide support and encompassed three sub themes; 'The only non-smoker I know', âReluctance to alter the existing relationship' and âLimited discussion around expectations of buddy supportâ. The second theme âSustaining the buddy relationshipâ centred on the continuing relationship the woman had with her buddy and encompassed three sub themes; âConsistent relationshipâ, âChangeable buddiesâ and âUnofficial buddiesâ. Conclusion our findings reveal the complexity of incorporating nonâsmoking buddy support into smoking cessation programs for young pregnant smokers. The characteristics and social environment of individual women may have the capacity to influence their ability to engage and sustain a relationship with a non-smoking buddy