Insensitivity to the effectiveness of talking-therapy: the impact of the baseline-risk

Objectives. People suffering from mental health conditions, often do not seek professional help. One of the reasons for this is that they do not consider talking-therapies sufficiently effective. It has been shown that among physical health conditions the rate at which people recover by themselves from a condition, as compared to those who do not (i.e. baseline-risk), unduly influences how effective people judge respective treatments. Treatments for conditions from which many people recover by themselves are considered as more effective than they actually are, as people credit the treatments for those that have recovered by themselves; the reverse is true for conditions from which many people do not recover by themselves. People may judge talking-therapy on the basis of the baseline-risk, to the detriment of the actual treatment effect of talking-therapy, conceptualised as the absolute or relative reduction of risk. Design. A mixed factorial within-between subjects experiment. Participants. A general population sample (N=202), in which 75.8% of participants had symptoms of depression and anxiety indicating a mental health condition. Methods. Participants took part in a web-based experiment during which they were shown six vignettes about common mental health conditions and the effect of talking-therapy on these compared to no treatment. The six vignettes varied in the baseline-risk (high vs. low), the absolute risk reduction (high vs. low), and the relative risk reduction (high vs. low). The dependent variable was the perceived effectiveness of talking-therapy, measured on a visual analogue scale from 0 (ineffective) to 100 (extremely effective). Analysis of covariance was conducted to control for potential confounding variables, including numeracy and mood. Results. Talking-therapies were judged on the basis of the baseline-risk of the condition. A higher baseline-risk was associated with a lower perceived effectiveness. This impact of the baseline-risk was not moderated by numeracy or mood. Talking-therapies were also judged on the basis of the absolute risk reduction but not by the relative risk reduction. There was some evidence that those with lower numeracy were less sensitive to differences in the treatment effect, that is, their judgments of effectiveness decreased less with a decreasing treatment effect. Conclusion. The evidence suggests that the effectiveness of talking-therapy is influenced by the baseline-risk of common mental health conditions. To address people’s judgement that talking-therapy is insufficiently effective may require considering the negative impact of the high baseline-risk inherent to common mental health conditions. In turn, this may increase uptake of talking-therapy for common mental health conditions

Transferring Innovation From Corporate Incubators To Its Parent Company: Derivation Of Requirements For The Interfaces

The transfer of innovations into the parent company is one of the major challenges that separate innovation paths, such as corporate incubators, are facing these days. So far there is no specific design model for the transfer of innovation from corporate incubators. This research paper therefore focusses on the development of requirements for the configuration of the interfaces between these two entities. Based on an intensive literature study as well as interviews within a German automotive supplier, requirements for the transfer process between corporate incubator and its parent company are derived and discussed

Cognitive Behavioural Therapy for Tinnitus-Related Insomnia:: Evaluating a New Treatment Approach

Objective: Insomnia frequently occurs alongside distressing tinnitus, and greater tinnitus severity is associated with more sleep disturbance. Insomnia and tinnitus probably share common underlying processes and sleep studies show striking similarities between primary and tinnitus-related insomnia. This is the first study to evaluate outcomes following insomnia-specific Cognitive Behavioural Therapy (CBTi) for tinnitus-related insomnia in a ‘real world’ clinic.Design: Treatment was six-sessions of group-based CBTi. Measures of insomnia, sleep diaries, tinnitus distress, psychological distress, anxiety and depression were completed pre-intervention, post-intervention and at six-weeks follow up.Study sample: Participants were 24 adults with chronic, distressing tinnitus and associated sleep disturbance. Twenty-two completed treatment.Results: CBTi was associated with significant improvements from pre-intervention to post-intervention maintained at follow up in insomnia, sleep-diary measures, tinnitus distress, psychological distress, anxiety and depression, largely maintained at follow-up. Reliable improvements were reported in insomnia (by 67% of patients), tinnitus distress (by 50% of patients) and psychological distress (by 38% of patients) post-intervention.Conclusions: The results suggest that CBTi is associated with reduced insomnia and distress for patients reporting chronic and distressing tinnitus with related insomnia. Further research into CBTi for this population, using utilizing robust, randomized controlled designs, is warranted

Mindfulness Based Cognitive Therapy for tinnitus: Evaluation of long-term outcomes

Mindfulness Based Cognitive Therapy for tinnitus (MBCT-t) alleviates distress associated with tinnitus but long-term outcomes are unknown. A retrospective survey with people completing MBCT-t over the past nine years found that benefits often continued or improved for years after therapy. Qualitative analysis indicated that key changes supporting such improvements were a result of new, more helpful ways of responding to tinnitus, profound holistic benefits, reduced isolation and enhanced self-compassion and gratitude

Cognitive Behavioural Therapy for Tinnitus-Related Insomnia:: Evaluating a New Treatment Approach

Objective: Insomnia frequently occurs alongside distressing tinnitus, and greater tinnitus severity is associated with more sleep disturbance. Insomnia and tinnitus probably share common underlying processes and sleep studies show striking similarities between primary and tinnitus-related insomnia. This is the first study to evaluate outcomes following insomnia-specific Cognitive Behavioural Therapy (CBTi) for tinnitus-related insomnia in a ‘real world’ clinic.Design: Treatment was six-sessions of group-based CBTi. Measures of insomnia, sleep diaries, tinnitus distress, psychological distress, anxiety and depression were completed pre-intervention, post-intervention and at six-weeks follow up.Study sample: Participants were 24 adults with chronic, distressing tinnitus and associated sleep disturbance. Twenty-two completed treatment.Results: CBTi was associated with significant improvements from pre-intervention to post-intervention maintained at follow up in insomnia, sleep-diary measures, tinnitus distress, psychological distress, anxiety and depression, largely maintained at follow-up. Reliable improvements were reported in insomnia (by 67% of patients), tinnitus distress (by 50% of patients) and psychological distress (by 38% of patients) post-intervention.Conclusions: The results suggest that CBTi is associated with reduced insomnia and distress for patients reporting chronic and distressing tinnitus with related insomnia. Further research into CBTi for this population, using utilizing robust, randomized controlled designs, is warranted

Dispositional mindfulness, gratitude and self-compassion: factors affecting tinnitus distress

Objective: Evidence is growing in support of the benefits of ‘positive’ psychology qualities such as self-compassion, mindfulness and gratitude in mitigating distress and disability related to various chronic health conditions. These qualities have not yet been explored in people with tinnitus. This study aimed to test whether dispositional mindfulness, gratitude and self-compassion are related to distress in a tinnitus sample. Design: This cross-sectional study involved the completion of a battery of online questionnaires. Study sample: A total of 159 participants with tinnitus completed questionnaires assessing tinnitus severity, psychological distress, negative thoughts, mindfulness, gratitude and self-compassion. Results: There were significant associations between each of the constructs, tinnitus severity and psychological distress. Multiple regressions found that all three positive qualities contributed to variance in psychological distress. Post hoc analysis revealed an indirect effect of the three positive qualities on tinnitus severity and psychological distress, mediated by thoughts about tinnitus. Conclusions: Dispositional mindfulness, gratitude and self-compassion may play a role in distress experienced by people with tinnitus. Future research could explore the contribution of these qualities to distress in a help-seeking sample and whether interventions that enhance these qualities might lead to better clinical outcomes

General practitioners' perceptions of the effectiveness of medical interventions: an exploration of underlying constructs.

BACKGROUND: Many interventions shown to be effective through clinical trials are not readily implemented in clinical practice. Unfortunately, little is known regarding how clinicians construct their perceptions of the effectiveness of medical interventions. This study aims to explore general practitioners' perceptions of the nature of 'effectiveness'. METHODS: The design was qualitative in nature using the repertory grid technique to elicit the constructs underlying the perceived effectiveness of a range of medical interventions. Eight medical interventions were used as stimuli (diclophenac to reduce acute pain, cognitive behaviour therapy to treat depression, weight loss surgery to achieve weight loss, diet and exercise to prevent type 2 diabetes, statins to prevent heart disease, stopping smoking to prevent heart disease, nicotine replacement therapy to stop smoking, and stop smoking groups to stop smoking). The setting involved face-to-face interviews followed by questionnaires in London Primary Care Trusts. Participants included a random sample of 13 general practitioners. RESULTS: Analysis of the ratings showed that the constructs clustered around two dimensions: low patient effort versus high patient effort (dimension one), and small impact versus large impact (dimension two). Dimension one represented constructs such as 'success requires little motivation', 'not a lifestyle intervention', and 'health-care professional led intervention'. Dimension two represented constructs such as 'weak and/or minimal evidence of effectiveness', 'small treatment effect for users', 'a small proportion of users will benefit' and 'not cost-effective'. Constructs within each dimension were closely related. CONCLUSIONS: General practitioners judged the effectiveness of medical interventions by considering two broad dimensions: the extent to which interventions involve patient effort, and the size of their impact. The latter is informed by trial evidence, but the patient effort required to achieve effectiveness seems to be based on clinical judgement. Some of the failure of evidence-based medicine to be implemented may be more explicable if both dimensions were attended to

Die Urlinie als Schlüssel zur hermeneutischen Analyse: Schuberts Lied Sprache der Liebe

In Verbindung mit der Juxtaposition der Tonarten E- und G-Dur wird die Urlinie über ihre Funktion als struktureller Hintergrund hinaus hinsichtlich ihrer Bedeutung für eine hermeneutische Interpretation diskutiert. Daran schließen sich Beobachtungen zum Verhältnis zwischen Text und Musik in Schuberts Komposition an.In this article the Urlinie is discussed in connection with the juxtaposition of keys E major and G major. The discussion goes above and beyond the Urlinie’s function as structural background in order to address its significance for hermeneutical interpretation. Observations regarding the relationship between text and music in Schubert follow

Financial incentives for increasing uptake of HPV vaccinations: a randomized controlled trial.

OBJECTIVE: Uptake of human papillomavirus (HPV) vaccinations by 17- to 18-year-old girls in England is below (<35%) target (80%). This trial assesses (a) the impact of financial incentives on uptake and completion of an HPV vaccination program, and (b) whether impacts are moderated by participants' deprivation level. It also assesses the impact of incentives on decision quality to get vaccinated, as measured by attitudes toward the vaccination and knowledge of its consequences. METHOD: One thousand 16- to 18-year-old girls were invited to participate in an HPV vaccination program: 500 previously uninvited, and 500 unresponsive to previous invitations. Girls randomly received either a standard invitation letter or a letter including the offer of vouchers worth £ 45 (€ 56; $73) for undergoing 3 vaccinations. Girls attending their first vaccination appointment completed a questionnaire assessing decision quality to be vaccinated. Outcomes were uptake of the first and third vaccinations and decision quality. RESULTS: The intervention increased uptake of the first (first-time invitees: 28.4% vs. 19.6%, odds ratio [OR] = 1.63, 95% confidence interval [CI; 1.08, 2.47]; previous nonattenders: 23.6% vs. 10.4%, OR = 2.65, 95% CI [1.61, 4.38]) and third (first-time invitees: 22.4% vs. 12%, OR = 2.15, 95% CI [1.32, 3.50]; previous nonattenders: 12.4% vs. 3%, OR = 4.28, 95% CI [1.92, 9.55]) vaccinations. Impacts were not moderated by deprivation level. Decision quality was unaffected by the intervention. CONCLUSIONS: Although the intervention increased completion of HPV vaccinations, uptake remained lower than the national target, which, in addition to cost effectiveness and acceptability issues, necessitates consideration of other ways of achieving it