A systematic review of recommended modifications of CBT for people with cognitive impairments following brain injury

Due to diverse cognitive, emotional and interpersonal changes that can follow brain injury, psychological therapies often need to be adapted to suit the complex needs of this population. The aims of the study were to synthesise published recommendations for therapy modifications following brain injury from non-progressive traumatic, vascular, or metabolic causes and to determine how often such modifications have been applied to cognitive behavioural therapy (CBT) for post-injury emotional adjustment problems. A systematic review and narrative synthesis of therapy modifications recommended in review articles and reported in intervention studies was undertaken. Database and manual searches identified 688 unique papers of which eight review articles and 16 intervention studies met inclusion criteria. The review articles were thematically analysed and a checklist of commonly recommended modifications composed. The checklist items clustered under themes of: therapeutic education and formulation; attention; communication; memory; and executive functioning. When this checklist was applied to the intervention studies, memory aids and an emphasis on socialising patients to the CBT model were most frequently reported as adaptations. It was concluded that the inconsistent reporting of psychological therapy adaptations for people with brain injury is a barrier to developing effective and replicable therapies. We present a comprehensive account of potential modifications that should be used to guide future research and practice

Preparing individuals with severe head injury for a brief compassionate imagery exercise & Clinical Research Portfolio

Objective: Head injury can result in problems with the ability to empathise and connect with others emotionally. Compassion-focused techniques have been used within a general adult population to develop soothing and affiliative emotions. A recent trial found a trend for increased self-compassion following a compassion-focused and relaxation-based imagery intervention within a severe head injury (SHI) sample (O’Neill and McMillan, 2012). The present pilot study aimed to determine whether providing a short preparatory task could enhance effectiveness of a compassion-focused imagery intervention within a SHI sample. Methods: The study employed a repeated measures design. All participants (n=24) completed a preparatory task, which involved viewing a 20-minute preparatory video and a short discussion of examples of imagery. Fears of compassion, motivation for an imagery intervention, state anxiety and negative affect were measured pre- and post- preparatory tasks. All participants then entered a follow-on treatment study, where they were randomised to a compassionate-imagery intervention or a relaxation-imagery intervention. Results: There was a significant increase in motivation for an imagery task following preparatory information, but no significant change on other outcome measures. Fears of compassion were high within the present sample, when compared to norms. Self-compassion and empathy scores following a compassionate-imagery task were not significantly different from those following a relaxation-imagery task. Conclusions: Preparatory tasks can enhance motivation to engage participants in therapy. Thereafter, it is likely that more work on fears of compassion or more prolonged exposure to imagery exercises may be required in order for a similar sample of individuals to benefit from compassion-focused imagery

Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (Capability, Opportunity, Motivation-Behaviour) model

Background: Health behaviours during pregnancy and the early years of life have been proven to affect long term health, resulting in investment in interventions. However, interventions often have low levels of completion and limited effectiveness. Consequently, it is increasingly important for interventions to be based on both behaviour change theories and techniques, and the accounts of pregnant women. This study engaged with pregnant women from deprived communities, to understand their subjective experiences of health in pregnancy. Methods: The study adopted a women-centred ethos and recruited a purposive sample of ten pregnant women, who lived in deprived areas and were on low incomes. Participants engaged with three creative techniques of visual data production (timelines, collaging and dyad sandboxing), followed by elicitation interviews. One participant only engaged in the initial activity and interview, resulting in a total of 28 elicitation interviews. This in-depth qualitative approach was designed to enable a nuanced account of the participants’ thoughts, everyday experiences and social relationships. Data were deductively coded for alcohol, smoking and infant feeding and then mapped to the COM-B model (Capability, Opportunity, Motivation – Behaviour). Results: Five participants had experience of smoking during pregnancy, four had consumed alcohol during pregnancy, and all participants, except one who had exclusively formula fed her child, disclosed a range of infant feeding experiences and intentions for their current pregnancies. Considerable variation was identified between the drivers of behaviour around infant feeding and that related to abstinence from tobacco and alcohol during pregnancy. Overall, knowledge and confidence (psychological capability), the role of partners (social opportunity) and support from services to overcome physical challenges (environmental opportunity) were reported to impact on (reflective) motivation, and thus women’s behaviour. The role of the public in creating and reinforcing stigma (social opportunity) was also noted in relation to all three behaviours. Conclusions: When designing new interventions to improve maternal health behaviours it is important to consider the accounts of pregnant women. Acknowledging pregnant women’s subjective experiences and the challenges they face in negotiating acceptable forms of motherhood, can contribute to informed policy and practice, which can engage rather than isolate potential user groups

Smoking during pregnancy, stigma and secrets: Visual methods exploration in the UK

Background: Moral judgements are commonly directed towards mothers through reference to health behaviour in pregnancy, and working-class mothers are particularly subject to this moral gaze. Aim: To gain an in-depth understanding of the health issues affecting 10 low income pregnant women from deprived areas of south Wales, UK. Methods: Participants completed visual activities (timelines, collaging or thought bubbles and dyad sandboxing) prior to each interview. Participants’ visual representations were used in place of a topic guide, to direct the interview. Guided by feminist principles, 28 interviews were completed with 10 women. Data were analysed thematically. Findings: Smoking was discussed at length during interviews, and this paper focuses on this issue alone. Five of the participants had smoked during pregnancy. Negative reactions were directed towards pregnant women who smoked in public, resulting in maternal smoking being undertaken in private. Participants also reported awkward relationships with midwives and other health professionals, including receipt of public health advice in a judgemental tone. Discussion: Smoking during pregnancy is a particularly demonised and stigmatised activity. This stigma is not always related to the level of risk to the foetus, and instead can be seen as a moral judgement about women. We urgently need to move from individualised neo-liberal discourses about the failure of individual smokers, to a more socio-ecological view which avoids victim blaming. Conclusion: Stigma from friends, family, strangers and health professionals may lead to hidden smoking. This is a barrier to women obtaining evidence based stop smoking support

Transit in Montgomery County

This project improved the reliability of Montgomery County, Maryland\u27s public bus system by analyzing the system\u27s bus arrival prediction software with respect to operator behavior between bus trips. Through a series of interviews and data analysis, this behavior was quantified into an algorithm that would better account for schedule deviations between bus trips, making predictions more accurate for customers. Operator concerns with the bus schedule and future improvements to the algorithm were also documented to further enhance system reliability

The Darwinian shortfall in plants : phylogenetic knowledge is driven by range size

The Darwinian shortfall, i.e. the lack of knowledge of phylogenetic relationships, significantly impedes our understanding of evolutionary drivers of global patterns of biodiversity. Spatial bias in the Darwinian shortfall, where phylogenetic knowledge in some regions is more complete than others, could undermine eco- and biogeographic inferences. Yet, spatial biases in phylogenetic knowledge for major groups – such as plants – remain poorly understood. Using data for 337 023 species (99.7%) of seed plants (Spermatophyta), we produced a global map of phylogenetic knowledge based on regional data and tested several potential drivers of the observed spatial variation. Regional phylogenetic knowledge was defined as the proportion of the regional seed plant flora represented in GenBank's nucleotide database with phylogenetically relevant data. We used simultaneous autoregressive models to explain variation in phylogenetic knowledge based on three biodiversity variables (species richness, range size and endemism) and six socioeconomic variables representing funding and accessibility. We compared observed patterns and relationships to established patterns of the Wallacean shortfall (the lack of knowledge of species distributions). We found that the Darwinian shortfall is strongly and significantly related to the macroecological distribution of species' range sizes. Small-ranged species were significantly less likely to have phylogenetic data, leading to a concentration of the Darwinian shortfall in species-rich, tropical countries where range sizes are small on average. Socioeconomic factors were less important, with significant but quantitatively small effects of accessibility and funding. In conclusion, reducing the Darwinian shortfall and smoothen its spatial bias will require increased efforts to sequence the world's small-ranged (endemic) species