Biomedical subjects

I M Blackburn

Publications and source records attributed to I M Blackburn.

At least 19 recordsLinked to original sources

PubMed2001

Moderators of trainee therapists' competence in cognitive therapy.

OBJECTIVES: A revised version of the Cognitive Therapy Scale (CTS-R) was developed and used in an ecologically valid study designed to examine the acquisition of competence in cognitive therapy (CT). The relationship of therapist and patient variables to changes in competence was examined. Unlike most previous research, this study defines effectiveness of training in terms of therapist competence rather than patient outcome. DESIGN: A longitudinal design was employed within a naturalistic setting. Trainees' competence (the dependent variable) was sampled on three occasions during a training course. METHODS: Twenty screened out-patients, who had been routinely referred to the Newcastle Cognitive Therapy Centre, were assigned to 20 postgraduate trainees receiving training in CT. Expert raters assessed trainees' competence at three points over the first 12 sessions of treatment using the CTS-R. The relationship of therapist and patient variables to changes in competence was examined. The patient measures used were the Beck Depression Inventory (BDI) and the Suitability for Short-Term Cognitive Therapy (SSCT). RESULTS: Three therapist factors were found to be related to competence: time (trainee therapists improving over the training period), previous experience with CT (those with most experience were most competent), and gender of the therapist (males improving at a greater rate than females). Therapist competence was also related to patients' suitability. CONCLUSIONS: These findings suggest that previous CT experience is an advantage prior to attending an advanced training course, and also that careful patient selection helps trainees to demonstrate therapeutic competence.

Adult↗

PubMed1999

Effectiveness of cognitive therapy training.

Despite growing demands for effective training there remains a lack of convincing evaluations. Reviews of the training literature specify the need for multiple measures, homogeneous therapies, generalization assessments and longitudinal designs. The present analysis responds by evaluating the training of 20 mental health professionals in cognitive therapy (CT). The evaluation focussed on changes in the professionals' competence and its generalization to their patients' coping strategies (N = 20). Results indicated that a 40 day training programme led to significantly higher post-training competence scores and to improved patient coping. The implications for professional training and its evaluation are discussed.

Adult↗

PubMed1998

A meta-analysis of the effects of cognitive therapy in depressed patients.

BACKGROUND: Cognitive therapy (CT) has been studied in 78 controlled clinical trials from 1977 to 1996. METHOD: The meta-analysis used Hedges and Olkin d+ and included 48 high-quality controlled trials. The 2765 patients presented non-psychotic and non-bipolar major depression, or dysthymia of mild to moderate severity. RESULTS: At post-test CT appeared significantly better than waiting-list, antidepressants (P < 0.0001) and a group of miscellaneous therapies (P < 0.01). But, CT was equal to behaviour therapy. As between-trial homogeneity was not met, the comparisons of CT with waiting-list or placebo, and other therapies should be taken cautiously. In contrast, between-trial homogeneity was high for the comparisons of CT with behaviour therapy and antidepressants. A review of eight follow-up studies comparing CT with antidepressants suggested that CT may prevent relapses in the long-term, while relapse rate is high with antidepressants in naturalistic studies. CONCLUSION: CT is effective in patients with mild or moderate depression.

Adult↗

PubMed1997

Controlled acute and follow-up trial of cognitive therapy and pharmacotherapy in out-patients with recurrent depression.

BACKGROUND: We report a randomised controlled trial, in both the acute and maintenance stage of treatment, in 75 out-patients with recurrent major depression. METHOD: Patients were allocated to three groups: 16 weeks of acute treatment and two years' maintenance treatment in the following way: antidepressants and maintenance antidepressants; cognitive therapy and maintenance cognitive therapy; antidepressants and maintenance cognitive therapy. Both completers' and end-point data were analysed. RESULTS: In the acute phase of treatment, all patients improved significantly and there was no significant difference among treatments, or in the pattern of improvement over time. In the maintenance stage of treatment, patients kept improving over time in all three groups and there was no significant difference among treatments. Cognitive therapy was consistently superior to medication. CONCLUSIONS: The results indicate that maintenance cognitive therapy has a similar prophylactic effect to maintenance medication and is a viable option for maintenance after acute treatment with medication in recurrent depression.

Adult↗

PubMed1995

Cognitive therapy with obsessive-compulsive disorder.

BACKGROUND: People with obsessive-compulsive disorders (OCD) are widely treated with a combination of medication and behavioural techniques. The success rate is 50-85%, but both relapse and drop-out rates appear high. The use of cognitive therapy (CT) for the treatment of OCD has been suggested. The empirical evidence supporting the use of CT for OCD is examined. METHOD: A manual and computer (Medline) literature search was performed. RESULTS: Fifteen empirical studies were found: ten non-controlled, and five controlled. CONCLUSIONS: There are few controlled CT studies, and these show little evidence of improvement when CT is added to existing therapeutic techniques.

Adult↗

PubMed1994

The relationship of sociotropy and autonomy to symptoms, cognition and personality in depressed patients.

A growing body of research suggests that the two personality characteristics of sociotropy and autonomy confer vulnerability to depression in response to interpersonal or achievement-related events. This study examined the relationships of these characteristics to severity of symptoms, measures of negative cognition, neuroticism and extraversion in a sample of 118 unipolar depressed patients. Sociotropy was found to be associated with self-reported depressive symptoms independently of anxiety level, with frequency of negative automatic thoughts, with dysfunctional attitudes and neuroticism. It was more strongly related to dysfunctional attitudes reflecting a need for social approval than to those reflecting perfectionism. Autonomy was not associated with self-reported symptoms of depression or of anxiety. It was, however, associated with low extraversion and significantly more associated with perfectionism than social approval. The results support the need for further research to examine the precise roles of a number of psychological factors in the vulnerability to interpersonal life events but also suggest limitations in the relevance of the construct of autonomy to depression.

Achievement↗

PubMed1993

Neuropsychological and P300 abnormalities in schizophrenics and their relatives.

Schizophrenic subjects (N = 30) performed less well than controls (N = 30) on neuropsychological tests sensitive to frontal and temporal lobe impairment and showed prolonged latency of the P300 event-related potential. Relatives of schizophrenic probands were also tested. Relatives with an abnormal P300 had a similar range of neuropsychological deficits as were found in the schizophrenic group and relatives with a normal P300 response performed as well as the normal control group. The results suggest that neurophysiological and neuropsychological testing of relatives may help to clarify the mode of inheritance of schizophrenia in some families.

Adult↗

PubMed1993

Sociotropy, autonomy and personal memories in depression.

Recent research suggesting an association of sociotropy and autonomy with vulnerability to depression in response to different types of event remains to be integrated with the cognitive model. This study investigated the relationship of sociotropy and autonomy to specific cognitive processes in a sample of 20 unipolar depressed patients. In the autobiographical memory paradigm used, the hypothesis that sociotropy would be associated with faster recall of sociotropic negative memories was supported. No support was found for the predicted relationship of autonomy with speed of recall of autonomous memories. The implications of the results for cognitive vulnerability to specific events are discussed and recommendations for replication stressed.

Adult↗

PubMed1992

How specific are negative automatic thoughts to a depressed population? An exploratory study.

This paper is concerned with the relationship between negative or dysfunctional automatic thoughts and dysphoric mood in a non-clinical population. It addresses the question of how specific are these automatic thoughts to a depressed population. Negative automatic thoughts were obtained from 27 normal subjects via a thought-sampling method using the Daily Record of Dysfunctional Thoughts Form (Beck, Rush, Shaw & Emery, 1979) over a two-week period. A thought-content analysis was conducted. The resultant data were compared using X2 with Blackburn & Eunson's (1989) data from depressed patients. The results presented in this paper indicate that basic cognitive distortions occur in a normal population, but differ qualitatively and quantitatively from those found in depressed patients.

Adult↗

PubMed1990

Perceptual and physiological dysfunction in depression.

P300 responses to emotive words of different hedonic tones were assessed in depressed patients (unipolar major), patients recovered from the same type of depression and normal controls. Depressed patients showed a smaller amplitude of P300 in response to negatively toned words than to positive words; normal controls showed the opposite pattern and recovered patients showed a pattern of response which resembled that of depressed patients. The experimental trials comparing responses to negative and positive stimuli in relation to neutral words showed significant differences for negative as compared with neutral stimuli, but not for positive as compared with neutral stimuli. Latencies of P300 did not differentiate depressed patients from normal controls. The results are discussed within the context of the 'expectancy' theory of information processing.

Adult↗

PubMed1989

Specificity of the salivary cortisol dexamethasone suppression test across psychiatric diagnoses.

One hundred forty-eight psychiatric inpatients, 12 outpatients, and 17 normal controls were given the 1.0-mg overnight Dexamethasone Suppression Test (DST), with salivary cortisol concentrations being measured as the dependent variable. Based on the Structured Clinical Interview for DSM-III, the patients were diagnosed as having major depression with melancholia (n = 21), nonmelancholic major depression (n = 50), mania (n = 15), schizophrenia (n = 32), dementia (n = 6), substance dependence/abuse n = 18), and miscellaneous (n = 18). Neither the melancholic major depressives nor the entire group of major depressives had significantly higher salivary cortisol pre- or postdexamethasone as compared with all the other patients combined, nor did the melancholic patients have significantly higher cortisol than the nonmelancholic depressives. The inpatients as a group had significantly higher pre- and postdexamethasone cortisol values than the normal controls; cortisol values for the outpatients were intermediate between these two groups. Illness severity (in the depressives), length of time in hospital before the DST, and medication regimen were all unrelated to DST outcome. Thus, in this study, the salivary cortisol DST showed little clinical utility in discriminating major depressives with and without melancholia from other patients with a broad range of psychiatric diagnoses. The test did distinguish between hospitalized psychiatric patients and normal control subjects and between depressed inpatients and depressed outpatients, indicating that hospitalization-related variables contributed to DST outcome.

Adult↗

PubMed1989

A content analysis of thoughts and emotions elicited from depressed patients during cognitive therapy.

A sample of 200 thoughts obtained from 50 depressed patients at the beginning of a course of cognitive therapy were analysed within the context of Beck's cognitive theory of depression. The results indicated that, of the three elements of the negative cognitive triad, negative view of self and of the world occurred more frequently than negative view of the future. Correspondingly, the principal themes referred to self-deprecation and a hostile world, with hopelessness occurring less frequently; inter- and intra-personal situations were equally represented. Anxious mood was reported as often as depressed mood with anger, directed inwards or outwards, being less frequent. Two raters were able to label the five logical errors listed by Beck reliably, although there was a certain degree of overlap; arbitrary inferences were the most frequent and personalization the least frequent. Emotions, themes and errors were not indiscriminately related; anger was predominantly associated with themes of hostile world and 'shoulds'; 'selective abstraction' was predominantly associated with depression and 'arbitrary inference' with anxiety; 'selective abstraction' was predominantly associated with 'shoulds' and 'arbitrary inference' with 'illness' themes. The conclusion was that Beck's early analysis of depressed thinking is valid cross-culturally and across time.

Adult↗

PubMed1989

Disturbed endocrine function in the psychoses. I: Disordered homeostasis or disease process?

Plasma concentrations of prolactin, growth hormone, cortisol, TSH, and the neurophysins were measured over 17 hours in 98 newly admitted psychiatric patients and 35 control subjects. Seventy patients had been free of psychotropic medication for three months. Patients with schizoaffective mania (SAM) differed significantly from control subjects by increased plasma cortisol concentrations and decreased night-time TSH concentrations. The latter were also significantly lower than in both schizophrenic and manic disorder patients. Plasma cortisol was increased to a lesser extent in other psychotic subgroups, and increases in prolactin were most marked in the affective psychoses. There was little diagnostic specificity for psychoses other than SAM. Higher cortisol and prolactin levels may be due to the stimulatory effect of serotonergic pathways, but the neural mechanisms underlying lower night-time TSH levels in SAM are not known. The findings are not consistent with the view (a) that the hormonal changes of the psychoses simply reflect a non-specific response to stress, or (b) that the biological abnormalities of the psychoses can be accounted for by a single continuum of disturbance.

Adult↗

PubMed1989

Disturbed endocrine function in the psychoses. II: Discriminant function analysis of multihormone data.

Discriminant function analyses were performed on plasma concentrations of prolactin, growth hormone, cortisol, TSH, and the neurophysins measured over 17 hours in 70 newly admitted drug-free psychiatric patients and 35 control subjects. The hormone data distinguished between patients with different classes of drug-free psychosis (26 schizophrenic, 12 with manic disorder, 10 with major depressive disorder, psychotic subtype, 9 with schizoaffective mania (SAM]. Higher plasma cortisol and lower TSH concentrations separated eight of nine SAM patients from all others.

Bipolar Disorder↗

PubMed1988

Magnetic resonance imaging in pre-senile dementia of the Alzheimer-type, multi-infarct dementia and Korsakoff's syndrome.

Magnetic resonance imaging T1 values in Alzheimer's disease (ATD) were similar to age-matched controls although frontal T1 values tended to increase intraindividually with progression of the dementia. T1 values were raised, in both cortical grey and white matter, in Korsakoff's syndrome and multi-infarct dementia. T1 values appear of little value in studying the neuropathological changes in ATD in relationship to the neuropsychological deficits, but can assist in the differential diagnosis of pre-senile dementia.

Aged↗

PubMed1987

Cognitive brain potentials and psychological deficits in Alzheimer's dementia and Korsakoff's amnesic syndrome.

Auditory-event-related potentials, including the P300 response, were recorded from 20 patients with Alzheimer-type dementia (ATD), 17 patients with Korsakoff's syndrome (KS) and 23 age-matched control subjects. Each of the subjects was assessed using a version of the Luria Neuropsychological Investigation. Prolonged P300 latency and reduced P300 latency and reduced P300 amplitude, which are features of normal ageing and which also occur, to a greater degree, in ATD, correlated significantly with degree of impairment of language ability in both Alzheimer patients and controls. On the other hand, the association between P300 latency changes and various tests of memory was not consistent across the three subject groups; there was a significant negative correlation between P300 latency and visual memory in ATD and a significant positive correlation in KS, whereas in controls no significant correlation was found. By contrast, P300 latency and memory for words were significantly negatively correlated in controls, but in neither of the patient groups. Detailed studies of language function may further elucidate the complex relationships between neuropsychological measures and P300 changes in normal ageing and dementia.

Aged↗

PubMed1987

Changes in auditory P3 event-related potential in schizophrenia and depression.

Event-related potentials during a two-tone discrimination task were recorded in 24 schizophrenic patients, 16 depressed patients and 59 control subjects. Recordings were made when patients were medication-free. Fourteen schizophrenic and 13 depressed patients were retested at 1 and 4 weeks after the start of treatment, and 13 schizophrenic patients were also tested between 6 and 24 months after the initial recordings. In the schizophrenic group, the P3 latency was significantly prolonged compared with that in the control and the depressed groups, and remained unchanged both after 4 weeks treatment with therapeutic doses of neuroleptic drugs and at long-term follow-up. In the depressed group, the P3 latency did not differ from that of controls. P3 amplitude by contrast was reduced in both the acutely depressed and schizophrenic groups and following treatment became normal in the depressed group but remained reduced in the schizophrenic group. It is suggested that a prolonged P3 latency and reduced P3 amplitude indicate an impairment of auditory information processing in some patients with schizophrenia which is independent of the presence of acute psychotic symptoms and is not influenced by neuroleptic medication.

Adult↗

PubMed1987

Characteristic plasma hormone changes in Alzheimer's disease.

A systematic endocrine investigation in dementia, depression and control subjects showed that plasma growth hormone (GH) was higher in the morning and plasma TSH concentrations were higher throughout the day in Alzheimer-type dementia (ATD) than in age-matched depressed patients (MDD), and plasma TSH concentrations were also higher throughout the day in female ATD compared with age-matched female control subjects. The increased plasma TSH concentrations could not be due to reduced negative feedback because plasma T3, T4 and rT3 were in the normal range. Plasma concentrations of oestrogen-stimulated neurophysin (ESN) were lower throughout the day in ATD compared with MDD and controls and lower in the morning compared with other dementias. The high plasma GH and TSH concentrations in ATD may reflect the reduced hypothalamic content of somatostatin in ATD, and the reduced concentrations of ESN may reflect reduced cholinergic activity in ATD brain. These selective hormonal changes provide a useful diagnostic test for Alzheimer's disease.

Adult↗