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Biomedical subjects

G E Hardy

Publications and source records attributed to G E Hardy.

At least 19 recordsLinked to original sources
PubMed2001

Client interpersonal and cognitive styles as predictors of response to time-limited cognitive therapy for depression.

This study examined the relationship between cognitive and interpersonal styles and outcome among 24 clients who received time-limited cognitive therapy for depression. The authors hypothesized that this relationship would be mediated by therapeutic alliance. They found that clients' interpersonal style, particularly an underinvolved style, was predictive of treatment outcome. As predicted, the impact of this style on outcome was mediated through the therapeutic alliance.

Adult↗
PubMed2001

Counselling and interpersonal therapies for depression: towards securing an evidence-base.

Both generic counselling (delivered by BACP level counsellors in primary care settings) and the interpersonal therapies place a central value on the role and function of relationships--both within and outside the practice setting - as a vehicle for understanding and treating people presenting with depression. Recent studies have compared generic counselling with antidepressant medication, usual GP care, cognitive-behaviour therapy (CBT), and as an adjunct to GP care (i.e. in combination with GP care). Findings suggest either that there is no difference between generic counselling and other treatment conditions, or that there are small advantages to counselling over usual GP care but only in the short-term with such differences disappearing at 1-year. Studies investigating the interpersonal therapies (IPT) have established that the content of such therapies differ in their content from behavioural and cognitive therapies despite the outcomes being broadly similar. Considerable research effort has focused on the process of change in IP therapies. Important factors include the level of prior commitment by the patient to psychological therapy and their confidence in the therapist. Patients with well assimilated problems tend to do better in CBT than psychodynamic-interpersonal therapy. Therapists need to be flexible and responsive to patient needs particularly concerning interpersonal and attachment issues. Future research in counselling needs to identify the effective components of generic counselling and relate these to a theoretical base. In the IP therapies, there needs to be a greater focus on the change outside the therapy session and on the effectiveness of such therapies in non-research settings.

Chronic Disease↗
PubMed1999

Psychotherapy in two-plus-one sessions: outcomes of a randomized controlled trial of cognitive-behavioral and psychodynamic-interpersonal therapy for subsyndromal depression.

A total of 116 clients with a range of subsyndromal depression received 3 therapy sessions: 2 sessions 1 week apart followed by a 3rd session 3 months later (the 2 + 1 model). Clients were stratified for severity on the Beck Depression Inventory (BDI) as stressed, subclinical, or low-level clinically depressed. In a 2 x 2 design, they received either cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) therapy, either immediately or after a 4-week delay. An initial advantage for the immediate condition disappeared once the delayed-condition clients received treatment. Improvement rates at the end of treatment were 67% (stressed), 72% (subclinical), and 65% (low-level clinically depressed). There were no significant differences between CB and PI treatment methods, with the exception at 1-year follow-up, when the BDI showed a significant advantage for CB. Implications for designing very brief planned interventions are discussed.

Adult↗
PubMed1998

Therapist responsiveness to client interpersonal styles during time-limited treatments for depression.

Effective treatment involves therapists responding appropriately to their clients' varying requirements, including clients' predominant interpersonal styles. In 2 manualized time-limited treatments for depression, psychodynamic-interpersonal (PI) and cognitive-behavioral (CB) clients were assigned to 1 of 3 interpersonal style groups. Therapists, who were not told their clients' interpersonal style, nevertheless responded with systematically different interventions depending on clients' interpersonal style. Consistent with predictions, therapists tended to use more affective and relationship-oriented interventions with overinvolved clients, particularly in PI therapy. Therapists tended to use more cognitive treatment methods with underinvolved clients, particularly in CB therapy. Outcomes of the interpersonal style groups were approximately equivalent, consistent with a view that the differences in treatment implementation reflected appropriate responsiveness to clients' interpersonal styles.

Adult↗
PubMed1998

Relations of the alliance with psychotherapy outcome: findings in the Second Sheffield Psychotherapy Project.

Clients (n = 79) and therapists (n = 5) rated their alliance using parallel forms of the Agnew Relationship Measure (ARM) after every session of their time-limited psychodynamic-interpersonal or cognitive-behavioral treatments for depression. The ARM assesses 5 dimensions of the alliance: Bond, Partnership, Confidence, Openness, and Client Initiative. Treatment outcome was assessed as residual gain from pretreatment assessment to end of treatment, 3-month follow-up, and 1-year follow-up on 6 standard measures. Some aspects of the alliance as measured by the ARM were correlated with clients' gains in treatment. The strength of the association varied across assessment measures, occasions of outcome assessment, ARM scales, and the session number when the alliance was measured.

Adult↗
PubMed1998

Alliance structure assessed by the Agnew Relationship Measure (ARM).

OBJECTIVES: We used a new instrument, the Agnew Relationship Measure (ARM), to examine the alliance's dimensionality and to construct scales for use in future studies. DESIGN: We studied the alliance as reported on the ARM by both clients and therapists in the Second Sheffield Psychotherapy Project, a randomized comparison of two contrasting time-limited psychotherapies for depression. METHODS: Clients (N = 95) and therapists (N = 5) completed parallel forms of the (ARM) after every session (N = 1120). RESULTS: Five scales were constructed, based on results of simultaneous components analyses and considerations of conceptual coherence and comparability across client and therapist perspectives. CONCLUSIONS: Bond, partnership, and confidence overlapped statistically (consistent with previous studies), but there are conceptual and empirical reasons for retaining the distinctions. Openness represented a relatively independent dimension. The client initiative scale had low internal consistency but the items may have value for future investigations.

Adult↗
PubMed1997

Fatigue in the workforce of National Health Service Trusts: levels of symptomatology and links with minor psychiatric disorder, demographic, occupational and work role factors.

The aims of this study were: (1) to obtain a systematic estimate of the levels of fatigue in representative samples of the major occupational groups of health care workers; (2) to examine the relationship between fatigue and mental health as a function of occupational and work role factors; and (3) to test the proposition that fatigue arises from a combination of poor mental health and high job stress. Questionnaire data from 7720 NHS Trust staff was used. Higher levels of fatigue were reported among health care workers in comparison with general population figures. Highest levels of general fatigue, the subjective sensation of tiredness, were experienced by doctors (especially women doctors), professions allied to medicine and managers. Highest levels of fatigability, the onset of symptoms after exertion, were experienced by ancillary and nursing staff. Both general fatigue and fatigability were associated with high levels of psychological distress. Support was also found for the proposition that fatigue arises from a combination of poor mental health and high work demands.

Demography↗
PubMed1997

Covariance in the measurement of depression/anxiety and three Cluster C personality disorders (avoidant, dependent, obsessive-compulsive).

One hundred and eight-four clients referred to a research outpatient psychological clinic, and meeting the acceptance criterion of 16 or more on the BDI at screening, were diagnosed as either-depressed and/or anxious using both Present State Examination and the Diagnostic and Statistical Manual of Mental State Disorders criteria. Clients were assessed for the presence of Cluster C personality disorders using the Personality Disorder Examination of Loranger et al. (1985). Twenty-two per cent made diagnosis of avoidant, dependent or obsessive-compulsive personality disorder. Significant correlation was found between screening/intake depression index scores and total scores on the three Cluster C personality disorders, although little correlation was found between diagnostic criteria for affective and personality disorders. Some association was shown between the clinical components of personality disorder traits in the anxious-fearful group and current anxiety symptoms, although not as clearly as expected.

Adult↗
PubMed1997

Minor psychiatric disorder in NHS trust staff: occupational and gender differences.

BACKGROUND: It is widely suggested that many National Health Service (NHS) workers experience high levels of minor psychiatric disorder. However, inadequacies of sampling and measurement in studies to date have not allowed this suggestion to be properly evaluated. METHOD: The present study was designed to overcome these methodological weaknesses by using a sample of over 11,000 employees from 19 NHS trusts and a well-established measure of minor psychiatric disorder for which there are comparative data. RESULTS: The findings show that 26.8% of the health service workers reported significant levels of minor psychiatric disorder, compared with 17.8% of people in the general population. Psychiatric morbidity was highest among managers, doctors, nurses and professions allied to medicine, with each of these groups recording higher rates than their professional counterparts outside the health service. It was lower among those in support occupations, such as administrative and ancillary staff. A feature of the findings was that female doctors and managers showed a much higher prevalence of minor psychiatric disorder than their male colleagues. CONCLUSION: Studies are required to establish the organisational, occupational and individual determinants of minor psychiatric disorder among NHS employees.

Administrative Personnel↗
PubMed1996

Dose-effect relations in time-limited psychotherapy for depression.

Criteria for reliable and clinically significant improvement were applied to standard and individually tailored outcome measures data from 212 depressed clients who had been randomly assigned to receive either 8 or 16 sessions of time-limiting psychotherapy. The data were used to address 2 questions: (a) Is the dose-effect curve for psychological symptoms negatively accelerated? and (b) is there a differential rate of response for acute, chronic, and characterological/interpersonal components of depression? The results supported the differential rate of response of different components of depression and suggested qualifications to the acute, chronic, and characterological/interpersonal components and evidence that both supported and qualified previous suggestions that the dose-effect curve is negatively accelerated.

Adult↗
PubMed1996

The IIP-32: a short version of the Inventory of Interpersonal Problems.

Three related studies are presented focusing on the development of a short 32-item version of the Inventory of Interpersonal Problems (IIP). Study 1 presents the procedures for item selection on the IIP short version; Study 2 presents a confirmatory analysis of the IIP short version on an independent sample; and Study 3 provides preliminary normative (general population and out-patient) data and additional evidence of the psychometric properties of the IIP short form. The results suggest that the short version sacrifices little compared to the original 127-item version in terms of its psychometric properties while being considerably more convenient for routine clinical practice.

Adolescent↗
PubMed1995

Impact of Cluster C personality disorders on outcomes of contrasting brief psychotherapies for depression.

Twenty-seven of 114 depressed clients, stratified for severity of depression, obtained a Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III; American Psychiatric Association, 1980) diagnosis of Cluster C personality disorder--that is, avoidant, obsessive-compulsive or dependent personality disorder (PD clients)--whereas the remaining 87 did not (non-personality-disorder [NPD] clients). All clients completed either 8 or 16 sessions of cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) psychotherapy. On most measures, PD clients began with more severe symptomatology than NPD clients. Among those who received PI therapy, PD clients maintained this difference posttreatment and at 1-year follow-up. Among those who received CB therapy, posttreatment differences between PD and NPD groups were not significant. Treatment length did not influence outcome for PD clients. PD clients whose depression was also relatively severe showed significantly less improvement after treatment than either PD clients with less severe depression or NPD clients.

Adult↗
PubMed1995

Credibility and outcome of cognitive-behavioural and psychodynamic-interpersonal psychotherapy.

Depressed psychotherapy clients (N = 117) rated the treatment principle credibility of cognitive-behavioural (CB) and psychodynamic-interpersonal (PI) before they were randomly assigned to receive either eight or 16 sessions of one of these treatments, and they rated their expectations of the treatment to which they were assigned immediately before (initial credibility) and immediately after their first session (emergent credibility). Results indicated that before they were assigned to a treatment, clients rated CB treatment principle credibility higher than PI treatment principle credibility. After assignment, however, clients rated initial credibility similar regardless of whether they were assigned to CB or PI therapy, and their ratings of emergent credibility increased to a similar degree from immediately before to immediately after the first session in both treatments. Clients' endorsement of CB and PI treatment principle credibility predicted improvement in PI therapy but not improvement in CB therapy. Initial and emergent credibility of clients' assigned treatment predicted improvement for clients who received eight sessions of therapy, but not for clients who received 16 sessions of therapy. The implications of these findings are discussed.

Adult↗
PubMed1994

Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy.

A total of 117 depressed clients, stratified for severity, completed 8 or 16 sessions of manualized treatment, either cognitive-behavioral psychotherapy (CB) or psychodynamic-interpersonal psychotherapy (PI). Each of 5 clinician-investigators treated clients in all 4 treatment conditions. On most measures, CB and PI were equally effective, irrespective of the severity of depression or the duration of treatment. However, there was evidence of some advantage to CB on the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). There was no evidence that CB's effects were more rapid than those of PI, nor did the effects of each treatment method vary according to the severity of depression. There was no overall advantage to 16-session treatment over 8-session treatment. However, those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions.

Adult↗
PubMed1994

The structure, validity and clinical relevance of the Inventory of Interpersonal Problems.

This paper presents preliminary data on the psychometric and clinical properties of the Inventory of Interpersonal Problems (IIP: Horowitz, Rosenberg, Baer, Ureno & Villasenor, 1988) obtained from a UK sample of clients presenting with depression/anxiety for individual psychotherapy as part of two concurrent outcome studies: the Second Sheffield Psychotherapy Project (SPP2) and the Medical Research Council/NHS Collaborative Psychotherapy Project (CPP). The factor structure of the IIP is reported on a sample of 250 clients and eight factor-analytically derived scales are presented. Data on the reliability of the IIP together with its relationship to the Symptom Checklist-90R (SCL-90R: Derogatis, 1983) are investigated in a subsample of 143 clients. In addition, data are presented on the clinical relevance of the IIP using case material. The structure of the IIP was further analysed using ipsatized scores. Four bipolar factors were extracted and these findings are discussed with reference to four primary sets of social competencies.

Adult↗
PubMed1990

The Second Sheffield Psychotherapy Project: rationale, design and preliminary outcome data.

The cost-efficiency of psychotherapy research can be enhanced by (a) dissemination of the rationale and design of large-scale investigations whilst still under way, (b) incorporation of process measures within comparative outcome studies, (c) cumulative development of a series of related studies, and (d) sharing of recordings and other data with other investigators. We present the rationale and design, including full details of process and outcome measures, of the second Sheffield psychotherapy project, in which 120 white-collar, professional and managerial employees presenting with major depressive disorder receive either eight or 16 sessions of either prescriptive (cognitive/behavioural) or exploratory (relationship-oriented) therapy in a 2 x 2 design. Ethical considerations prompted the analysis of preliminary outcome data on 48 clients. Results suggested substantial clinical improvement, of similar magnitude for both methods and both durations of treatment, except that exploratory therapy appeared more effective than prescriptive in relation to interpersonal difficulties. Other workers are invited to build collaboratively on this research by making their own process analyses of recordings available from this study, relating these analyses to the existing impact and outcome data, and developing comparable data sets based on the design and initial results of this project.

Depressive Disorder↗
PubMed1985

Therapist response modes in prescriptive vs. exploratory psychotherapy.

Therapists' use of verbal response modes was compared in two forms of psychotherapy offered to 27 clients in a crossover design, where each client saw the same therapist throughout both treatments. This design isolated effects due to treatment techniques, specified in manuals followed by therapists, from those due to therapist or client differences. As predicted, therapists used more interpretation and exploration in an exploratory, relationship-oriented therapy, and asked more closed and open questions, and gave more general advisements and information, during a prescriptive, cognitive/behavioural therapy. The magnitude of the differences obtained ranged from a twofold to a sixfold difference in the percentages of each response mode offered in the two treatments. Also as predicted, therapists were more verbally active in the prescriptive therapy. These findings confirm previous research showing large differences in therapist contributions to different types of psychotherapy, demonstrating that these are not attributable to personal characteristics of therapists or clients.

Adult↗