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Biomedical subjects

M Barkham

Publications and source records attributed to M Barkham.

At least 19 recordsLinked to original sources
PubMed2006

The effectiveness of computerized cognitive behavioural therapy in routine care.

OBJECTIVES AND DESIGN: The efficacy of a Computerized Cognitive Behavioural Therapy (CCBT) package, Beating the Blues, has been demonstrated in a large randomized controlled trial. The current study tests the generalizability of this finding in a naturalistic non-randomized trial. METHOD: 219 patients with anxiety and/or depression were recruited to receive CCBT in routine care. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and Work and Social Adjustment scale (WSA) were administered pre-treatment, immediately on completing treatment and at 6 months post-treatment. Single-item self-report measures of anxiety and depression were also collected during each treatment session. RESULTS: Completer and intention-to-treat analysis demonstrated statistically and clinically significant improvements on the CORE-OM, WSA and in self-reported anxiety and depression. Intention-to-treat analysis indicated an average 0.29-point drop on the CORE-OM, equating to an uncontrolled pre-post effect size of 0.50. Research completers achieved an average 0.61-point drop equating to an uncontrolled pre-post size of 1.00 on the same measure. Where data was available (18%), these benefits were maintained at week 32 (6 months follow-up). CONCLUSION: CCBT can be an effective first line tool within a stepped care framework for the management of common mental health problems.

Adult↗
PubMed2005

The CORE-OM in an older adult population: psychometric status, acceptability, and feasibility.

There is a need to extend and test the feasibility and acceptability of mental health outcome measures in the older population (i.e., aged 65-100). We present data on the CORE-OM (Clinical Outcomes in Routine Evaluation-Outcome Measure) on a sample of 118 people aged 65-97 presenting for mental health treatment and 214 people aged 65-94 drawn from a non-clinical population. Results show the CORE-OM to be a reliable measure in both samples when the overall mean item is used but the reliability is not as high for the specific domains as psychometrically stable structures. The CORE-OM showed large overall differences between the non-clinical and clinical samples indicating that it is equally as sensitive to these differing populations across this older age band as with working-age adults. However, the norms for the clinical sample were consistently lower than the equivalent clinical norms for a working-age sample. These findings suggest that the collection and compilation of age-specific norms is crucial in ensuring that appropriately referenced norms are used rather than assuming that norms are generalizable across the whole adult life-span.

Aged↗
PubMed2001

Service profiling and outcomes benchmarking using the CORE-OM: toward practice-based evidence in the psychological therapies. Clinical Outcomes in Routine Evaluation-Outcome Measures.

To complement the evidence-based practice paradigm, the authors argued for a core outcome measure to provide practice-based evidence for the psychological therapies. Utility requires instruments that are acceptable scientifically, as well as to service users, and a coordinated implementation of the measure at a national level. The development of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is summarized. Data are presented across 39 secondary-care services (n = 2,710) and within an intensively evaluated single service (n = 1,455). Results suggest that the CORE-OM is a valid and reliable measure for multiple settings and is acceptable to users and clinicians as well as policy makers. Baseline data levels of patient presenting problem severity, including risk, are reported in addition to outcome benchmarks that use the concept of reliable and clinically significant change. Basic quality improvement in outcomes for a single service is considered.

Benchmarking↗
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↗
PubMed2001

Value of HoNOS in assessing patient change in NHS psychotherapy and psychological treatment services.

BACKGROUND: Little research on the value of Health of the Nation Outcome Scales (HoNOS) has occurred in out-patient settings, particularly psychotherapy services. AIMS: To determine whether HoNOS provides an adequate assessment for psychotherapy services which is sensitive to change. METHODS: HoNOS ratings from 1688 patients from eight out-patient psychotherapy services were collected. Of these, 362 also had ratings post-treatment. Mean scores, pre-to post-treatment differences, and reliable and clinically significant change criteria were calculated for HoNOS items and for total scores. RESULTS: The mean total HoNOS rating was 8.93, which is comparable to psychiatric out-patients. Only three items showed sufficient variability to use in assessing pre- to post-treatment change. CONCLUSIONS: Significant limitations were found in rating items that commonly present to psychotherapists. The lack of variability in most items limits HoNOS's usefulness in this population.

Adult↗
PubMed2000

Measurement and psychotherapy. Evidence-based practice and practice-based evidence.

BACKGROUND: Measurement is the foundation of evidence-based practice. Advances in measurement procedures should extend to psychotherapy practice. AIMS: To review the developments in measurement relevant to psychotherapy. METHOD: Domains reviewed are: (a) interventions; (b) case formulation; (c) treatment integrity; (d) performance (including adherence, competence and skillfulness); (e) treatment definitions; (f) therapeutic alliance; and (g) routine outcome measurement. RESULTS: Modern methods of measurement can support 'evidence-based practice' for psychological treatments. They also support 'practice-based evidence', a complementary paradigm to improve clinical effectiveness in routine practice via the infrastructure of Practice Research Networks (PRNs). CONCLUSIONS: Advances in measurement derived from psychotherapy research support a model of professional self-management (practice-based evidence) which is widely applicable in psychiatry and medicine.

Clinical Competence↗
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

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

The therapeutic alliance in psychodynamic-interpersonal and cognitive-behavioral therapy.

The quality of the therapeutic alliance was compared in sessions of psychodynamic-interpersonal and cognitive-behavioral therapy, and the alliance's relationship to various session impacts was investigated. As part of the Sheffield Psychotherapy Project 2 (D. A. Shapiro, M. Barkham, A. Rees, G. E. Hardy, S. Reynolds, & M. Startup, 1994), 57 clients diagnosed with major depression received 16 sessions of either psychodynamic-interpersonal or cognitive-behavioral therapy. Coders used the Working Alliance Inventory to rate 1 high-impact and 1 low-impact session from each client. Results indicated significantly greater alliance scores for cognitive-behavioral therapy sessions on the whole. Also, for the samples as a whole, high-impact sessions were characterized by higher alliance scores than those for low-impact sessions, and alliance was positively related to therapists' ratings of session depth and smoothness and to clients' ratings of mood.

Adult↗
PubMed1997

Confirmatory factor analysis of the personality disorder subscales from the Inventory of Interpersonal Problems.

The purpose of this study was to identify the best fitting hierarchical factor structure of the subscales for personality disorders developed from the Inventory of Interpersonal Problems (IIP). In earlier work, 5 subscales associated with a diagnosis of personality disorder (PD) had been developed. With data collected from 5 additional samples at 4 sites (N = 1004), relations among the IIP-PD subscales were investigated using confirmatory factor analysis. Several competing models were tested, and a second-order model with 1 second-order factor and 5 first-order factors provided the best fit to the data. The results support the hypothesis of a single latent construct reflecting general personality dysfunction. Measures of this construct may be useful for screening patients into yes versus no PD groups.

Adult↗
PubMed1996

Acceleration of changes in session impact during contrasting time-limited psychotherapies.

Following the suggestion that therapeutic change is accelerated in time-limited psychotherapy, this study investigated the across-session patterns of session impact in the treatments of 117 depressed clients who were randomly allocated to 8 or 16 sessions of cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) therapy. After each session, all clients completed the Session Evaluation Questionnaire and 75 of the clients completed the Session Impacts Scale. Session ratings indicated that sessions were perceived increasingly positively on most impact dimensions (e.g., session depth and smoothness, relationship with the therapist, feelings of understanding and problem solving, postsession positive mood) as treatment progressed. Early in treatment, PI therapy sessions were less smooth (i.e., more tense and uncomfortable) and less focused on problem solving, but PI sessions changed more rapidly than CB sessions on these dimensions, so that later in treatment, sessions of both treatments were equivalently positive. In both treatments, the trend toward more positive sessions was more rapid (i.e., the across-session slope was steeper) in 8-session treatments than in 16-session treatments. Such accelerated changes in session impact may reflect the suggested acceleration of therapeutic change associated with shorter time limits.

Adaptation, Psychological↗
PubMed1996

Outcomes of time-limited psychotherapy in applied settings: replicating the Second Sheffield Psychotherapy Project.

In a replication and extension of the Second Sheffield Psychotherapy Project (SPP2), a collaborative psychotherapy project (CPP) was carried out at 3 sites within the National Health Service of the United Kingdom. Clients (N = 36) stratified at 3 levels of severity of depression were randomly assigned to one of 2 treatment approaches (psychodynamic-interpersonal or cognitive-behavioral) of 2 time-limited durations (8 or 16 sessions). Gains in both treatment approaches were approximately equivalent and were similar for CPP and SPP2 clients when measured at the end of treatment. However, CPP patients did not maintain their gains to the extent that the SPP2 clients did at 3-month and 1-year follow-up assessments. In the CPP, clients given 16 sessions showed a statistically significant advantage over clients given 8 sessions on some measures at some assessments; in the SPP2, similar effects were noted only among some subgroups of clients.

Adult↗
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↗