Biomedical subjects

Michael Barkham

Publications and source records attributed to Michael Barkham.

At least 19 recordsLinked to original sources

PubMed2007

Submissive voices dominate in depression: assimilation analysis of a helpful session.

Using the assimilation model, we describe a theoretical paradox in which interpersonally assertive parts of the depressed person's personality are dominated and suppressed by parts that are interpersonally submissive and passive. We examine the relevance of this paradox to therapeutic work, focusing on a particularly helpful session (according to the therapist) from the case of Joan, a woman seen for depression in cognitive-behavioral therapy. We consider how the therapist intervened to enhance communication between the interpersonally submissive and dominant parts of Joan and discuss the implications of this process for therapy with such clients.

Adaptation, Psychological↗

PubMed2007

Distribution of CORE-OM scores in a general population, clinical cut-off points and comparison with the CIS-R.

BACKGROUND: Although measures of psychopathology are designed for use in clinical populations, their meaning derives from comparison with normal populations. AIMS: To compare the distribution of scores on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) from a general population sample with the distribution in an aggregated clinical sample to derive recommended cut-off points for determining clinical significance. METHOD: The CORE-OM general population sample was based on a weighted subsample of participants in the psychiatric morbidity follow-up survey who completed valid CORE-OM forms following their interview (effective n=535). RESULTS: Comparison of the CORE-OM general population sample with a clinical sample aggregated from previous studies (n=10761) yielded a cut-off score of 9.9 on the 0-40 scale of the CORE-OM. The CORE-OM was highly correlated (r=0.77) with the Clinical Interview Schedule-Revised, supporting convergent validity. CONCLUSIONS: We recommend rounding the CORE-OM cut-off score to 10. However, cut-off scores must be used thoughtfully and adjusted to fit context and purpose.

Adolescent↗

PubMed2006

Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapies as practised in UK National Health Service settings.

BACKGROUND: Psychotherapy's equivalence paradox is that treatments have equivalently positive outcomes despite non-equivalent theories and techniques. We compared the outcomes of contrasting approaches practised in routine care. METHOD: Patients (n = 1309) who received cognitive-behavioural therapy (CBT), person-centred therapy (PCT) and psychodynamic therapy (PDT) at one of 58 National Health Service (NHS) primary and secondary care sites in the UK during a 3-year period completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. Therapists indicated which treatment approaches were used on an End of Therapy form. We compared outcomes of six groups: three treated with CBT, PCT or PDT only, and three treated with one of these plus one additional approach (e.g. integrative, supportive, art), designated CBT+1, PCT+1 or PDT+1 respectively. RESULTS: All six groups averaged marked improvement (pre-post effect size = 1.36). Treatment approach and degree of purity ('only' vs. '+1') each accounted for statistically significant but comparatively tiny proportions of the variance in CORE-OM scores (respectively 1% and 0.5% as much as pre-post change). Distributions of change scores were largely overlapping. CONCLUSIONS: Results for these three treatment approaches as practised routinely across a range of NHS settings were generally consistent with previous findings that theoretically different approaches tend to have equivalent outcomes. Caution is warranted because of limited treatment specification, non-random assignment, lack of a control group, missing data and other issues.

Adult↗

PubMed2006

The prevalence of nursing staff stress on adult acute psychiatric in-patient wards. A systematic review.

BACKGROUND: Concerns about recent changes in acute in-patient mental health care environments have led to fears about staff stress and poor morale in acute in-patient mental health care staff. AIM: To review the prevalence of low staff morale, stress, burnout, job satisfaction and psychological well-being amongst staff working in in-patient psychiatric wards. METHOD: Systematic review. RESULTS: Of 34 mental health studies identified, 13 were specific to acute in-patient settings, and 21 were specific to other non-specified ward-based samples. Most studies did not find very high levels of staff burnout and poor morale but were mostly small, of poor quality and provided incomplete or non-standardised prevalence data. CONCLUSIONS: The prevalence of indicators of low morale on acute in-patient mental health wards has been poorly researched and remains unclear. Multi-site, prospective epidemiological studies using validated measures of stress together with personal and organizational variables influencing staff stress in acute in-patient wards are required.

Acute Disease↗

PubMed2006

Dose-effect relations and responsive regulation of treatment duration: the good enough level.

This study examined rates of improvement in psychotherapy as a function of the number of sessions attended. The clients (N=1,868; 73.1% female; 92.4% White; average age=40), who were seen for a variety of problems in routine primary care mental health practices, attended 1 to 12 sessions, had planned endings, and completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. The percentage of clients achieving reliable and clinically significant improvement (RCSI) on the CORE-OM did not increase with number of sessions attended. Among clients who began treatment above the CORE-OM clinical cutoff (n=1,472), the RCSI rate ranged from 88% for clients who attended 1 session down to 62% for clients who attended 12 sessions (r=-.91). Previously reported negatively accelerating aggregate curves may reflect progressive ending of treatment by clients who had achieved a good enough level of improvement.

Adaptation, Psychological↗

PubMed2006

Transforming between Beck Depression Inventory and CORE-OM scores in routine clinical practice.

OBJECTIVES: The Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) and the Beck Depression Inventory (BDI) are routinely used to assess emotional problems. It would be helpful to be able to compare scores when only one of the measures is available. We investigated the relationship between the measures and produced translation tables. METHODS: Level of agreement between CORE-OM and BDI-I was assessed for 2,234 clients who had completed both measures at referral for routine secondary care. Tables for predicting between the measures were constructed using several methods, including non-linear regression and non-parametric smoothing. Results were cross-validated on a separate sample of 326 clients. RESULTS: High correlations between the measures were obtained (r=.862 for female clients; r=.855 for male clients). Accuracy in predicting caseness is higher than predicting depression levels. CONCLUSIONS: CORE-OM and BDI can be compared in routine clinical settings with acceptable accuracy.

Adult↗

PubMed2006

Dimensions of variation on the CORE-OM.

BACKGROUND: The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is a self-report measure comprising 28 items tapping three domains; subjective well-being, psychological problems and functioning. In addition to the potential theoretical value of the domains for operationalizing the phase model of psychotherapy, when consulted, managers and clinicians considered the distinction between problems and functioning important for assessing case-mix and clinical outcomes. A further domain comprising six items was included to indicate possible risk. Subsequent analysis has suggested an alternative structure for CORE-OM with factors for risk and positively and negatively worded items (Evans et al., 2002). METHODS: This study compares models for the interpersonal factor structure in data from the CORE-OM in 2,140 patients receiving psychological therapy in the UK. RESULTS: A multi-method, multi-trait, nested factors solution accounted optimally for the CORE-OM item covariance, with a first-order general factor latent and residualized first-order factors of subjective well-being, psychological problems, functioning and risk and with positively and negatively worded methods factors. The general factor was labelled psychological distress. Scale quality for CORE-OM, using a scoring method in which non-risk items are treated as a single scale and risk items as a second scale is satisfactory. IMPLICATIONS: The CORE-OM has a complex factor structure and may be best scored as 2 scales for risk and psychological distress. The distinct measurement of psychological problems and functioning is problematic, partly because many patients receiving out-patient psychological therapies and counselling services function relatively well in comparison with patients receiving general psychiatric services. In addition, a clear distinction between self-report scales for these variables is overshadowed by their common variance with a general factor for psychological distress. An alternative strategy for operationalizing this distinction is proposed.

Adult↗

PubMed2006

Therapists' recall of early sudden gains in routine clinical practice.

This study followed up one by Stiles et al. (2003), which identified sudden gains -- large reductions from one session to the next on a short form of clinical outcomes in routine evaluation outcome measure (CORE-SF) -- by some clients in routine clinical practice. We interviewed the therapists who had treated sudden gain and non-sudden gain clients. Results showed that therapists could retrospectively identify which clients had or had not experienced sudden CORE-SF gains at substantially better than chance rates, although they identified only about half of the clients who had experienced such gains.

Adaptation, Psychological↗

PubMed2005

Sudden gains in cognitive therapy for depression: a replication and extension.

Of 76 clients receiving 8-20 sessions of cognitive therapy (CT) in a joint university and a national health service clinic, 31 experienced sudden gains that appeared very similar to those first reported in clinical trials of CT by T. Z. Tang and R. J. DeRubeis (1999) and subsequently replicated in other studies. The sudden gains appeared less stable in the present study's more routine clinical practice settings than they were in the clinical trials. Life events did not appear to account for sudden gains.

Adaptation, Psychological↗

PubMed2005

Predicting change for individual psychotherapy clients on the basis of their nearest neighbors.

This study extended client-focused research by using the nearest neighbor (NN) approach, a client-specific sampling and prediction strategy derived from research on alpine avalanches. Psychotherapy clients (N=203) seen in routine practice settings in the United Kingdom completed a battery of intake measures and then completed symptom intensity ratings before each session. Forecasts of each client's rate of change and session-by-session variability were computed on the basis of that client's NNs (n=10-50 in different comparisons). Alternative forecasts used linear or log-linear slopes and were compared with an alternative prediction strategy. Results showed that the NN approach was superior to the alternative model in predicting rate of change, though the advantage was less clear for predicting variability.

Adolescent↗

PubMed2005

Suitability and utility of the CORE-OM and CORE-A for assessing severity of presenting problems in psychological therapy services based in primary and secondary care settings.

BACKGROUND: There is a need for reliable assessment tools that are suitable for the counselling and the psychological therapy services in primary and secondary care settings. AIMS: To test the suitability and utility of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and CORE-Assessment (CORE-A) assessment tools. METHOD: Service intake data were analysed from counselling and psychological therapy services in 32 primary care settings and 17 secondary care settings. RESULTS: Completion rates exceeded 98% in both of the settings sampled. Intake severity levels were similar but secondary care patients were more likely to score above the risk cut-off and the severe threshold and to have experienced their problems for a greater duration. CONCLUSIONS: The CORE-OM and CORE-A are suitable assessment tools that show small but logical differences between psychological therapy services in primary- and secondary-based care.

Adult↗

PubMed2003

Practice-based outcomes of dialectical behaviour therapy (DBT) targeting anger and violence, with male forensic patients: a pragmatic and non-contemporaneous comparison.

OBJECTIVE: To examine the effectiveness of an eighteen-month treatment based on dialectical behaviour therapy (DBT) targeting anger and violence, on a group of male forensic patients. METHOD: Eight male forensic patients in a high security hospital who met the criteria for borderline personality disorder measured by the Personality Assessment Inventory underwent 18 months of treatment. They completed three psychometric tests at pre-, mid- and post-treatment and at a six-month follow up. A comparison group (TAU) of nine patients, assessed as having similar personality disorders, received the usual treatment available in the hospital but excluding DBT. They completed the same tests at the same time intervals corresponding to the pre-, mid- and post-testing of the DBT group. In both groups, all instances behaviours related to anger and violence were monitored for three six-month periods, prior to, during and post-treatment. RESULTS: Overall, patients in the DBT group made greater gains than patients in the TAU group in reducing the seriousness of violence-related incidents, and in self report measures of hostility, cognitive anger, disposition to anger, outward expression of anger and anger experience. CONCLUSION: The results suggest a potential for DBT to impact positively and lastingly on violent behaviour and components of anger in male forensic patients when compared with standard treatment. The power of the current study to detect group differences was reduced by small ns, large confidence intervals, and a non-contemporaneous comparison group. Cost-effective strategies are proposed to take forward research on DBT with this population.

Adult↗

PubMed2003

Appraisal of published reviews of research on psychotherapy and counseling with adults 1990-1998.

Reviews and meta-analyses of research on adult psychotherapy and counseling with adults published in English from 1990 to 1998 (N = 255) were rated according to the criteria advanced by A. D. Oxman and G. H. Guyatt (1988). A majority of the reviews fell substantially short of these basic standards; on average, review articles met only half of the 8 criteria, and only 20% met 7 or more of the criteria. Common deficiencies included failure to describe comprehensive search methods used to locate studies; failure to explain inclusion and exclusion criteria for studies; and failure to provide reliable, unbiased assessments of the studies reviewed. The reviews showed no tendency to improve over the period studied.

Adult↗

PubMed2003

Outcomes of patients completing and not completing cognitive therapy for depression.

OBJECTIVES: The aims of this study were to use symptom intensity measures collected at each session (1) to describe the outcomes of clients who received cognitive therapy (CT) for depression in a clinically representative sample, and (2) to compare the outcomes of clients who completed the agreed number of sessions with those who did not. DESIGN AND METHOD: Clients (N = 58) contracted to attend between 12 and 20 sessions of CT completed the Beck Depression Inventory (BDI) immediately prior to each therapy session. The BDI and other measures were collected at intake and, for those who completed therapy, at a post-therapy assessment. RESULTS: Completers' BDI scores improved significantly from intake to post-treatment and significantly more from intake to their final session than did those of non-completers. However, when non-completers' final session scores were matched with scores of randomly selected completers at the corresponding session, the difference in improvement was not significant. A significantly higher proportion of clients who completed the agreed number of sessions achieved reliable and clinically significant change (71.4%, 25/35), compared with just 13% (3/23) of clients who did not. CONCLUSIONS: (1) CT for depression can be effective in a clinically representative population. (2) Attrition from clinical trials may bias estimates of treatment effectiveness.

Adult↗

PubMed2003

Time is of the essence: A selective review of the fall and rise of brief therapy research.

For compelling reasons of equity and the advance of public health, brief psychotherapy has become the dominant format in both practice and research. One consequence of this is the apparent decline of a distinct stream of brief therapy research. However, much of the agenda formerly identified with that research stream is of increasing importance to the field. Time is indeed of the essence in current psychotherapy research. For example, factors conducive to the time efficiency of brief psychodynamic therapy have been described recently. The important question 'How much therapy is enough?' has been addressed by studies inspired by the dose-response analysis of Howard and colleagues. The value of ultra-brief interventions has been examined. These issues are considered in a selective review, drawing in particular on the work of the Sheffield/Leeds psychotherapy of depression research group. This research treats the number of treatment sessions as an independent variable, thereby providing a causal analysis of the dose-response relationship over a range from two to 16 sessions, illuminated by a comparative analysis of change processes in treatments of different durations. Its results enable some specification of the extent and nature of incremental benefit derived from additional sessions in the psychotherapy of depression.

History, 20th Century↗

PubMed2003

Early sudden gains in psychotherapy under routine clinic conditions: practice-based evidence.

Sudden gains--large, enduring reductions in symptom intensity from one session to the next--were identified by T. Z. Tang and R. J. DeRubeis (1999b) on the basis of data from 2 manualized clinical trials of cognitive therapy for depression. The authors found similar sudden gains among clients with a variety of disorders treated with a variety of approaches in routine clinic settings. Clients (N = 135 who met inclusion criteria) completed short forms of the Clinical Outcomes in Routine Evaluation (CORE-SF) preceding 7 to 74 individual sessions. Those who experienced sudden gains within their first 16 sessions (n = 23) had significantly lower CORE-SF scores in their final 3 sessions than did the other clients.

Adult↗

PubMed2003

PHASE: a randomised, controlled trial of supervised self-help cognitive behavioural therapy in primary care.

BACKGROUND: Common mental health problems account for up to 40% of all general practitioner (GP) consultations. Patients have limited access to evidence-based psychological therapies. Cognitive behavioural therapy self-help strategies offer one potential solution. AIM: To determine differences in clinical outcome, patient satisfaction and costs, between a cognitive behavioural-based self-help package facilitated by practice nurses compared to ordinary care by GPs for mild to moderate anxiety and depression. DESIGN OF STUDY: Randomised controlled trial. SETTING: Seventeen primary healthcare teams. METHOD: Patients presenting to their GP with mild to moderate anxiety and/or depression were recruited to the study and randomised to receive either a self-help intervention facilitated by practice nurses or ordinary care. The self-help intervention consisted of up to three appointments: two 1 week apart and a third 3 months later. There were no restrictions on ordinary care. RESULTS: Intention-to-treat analysis showed that patients treated with practice nurse-supported cognitive behavioural therapy self-help attained similar clinical outcomes for similar costs and were more satisfied than patients treated by GPs with ordinary care. On-treatment analysis showed patients receiving the facilitated cognitive behavioural therapy self-help were more likely to be below clinical threshold at 1 month compared to the ordinary care group (odds ratio [OR] = 3.65, 95% confidence interval [CI] = 1.87 to 4.37). This difference was less well marked at 3 months (OR = 1.36, 95% CI = 0.52 to 3.56). CONCLUSION: Facilitated cognitive behavioural self-help may provide a short-term cost-effective clinical benefit for patients with mild to moderate anxiety and depression. This has the potential to help primary care provide a choice of effective psychological as well as pharmacological treatments for mental health problems.

Adolescent↗

PubMed2002

Convergent validity of the Agnew Relationship Measure and the Working Alliance Inventory.

The convergent validity of the Agnew Relationship Measure (ARM) and the Working Alliance Inventory (WAI) was assessed in samples drawn from 2 comparative clinical trials of time-limited psychotherapies for depression. In 1 sample, clients (n = 18) and therapists (n = 4) completed self-report versions of both measures after every session (n = 198). In the other sample, clients (n = 39) and therapists (n = 6) completed the ARM, and observers subsequently rated selected audiotaped sessions (n = 78) using the WAI. In both samples, the ARM's core alliance scales (Bond, Partnership, and Confidence) were correlated with the WAI's scales (Bond, Tasks, and Goals) strongly when assessed within client and therapist perspectives and, with some qualifications, moderately when assessed between client, therapist, and observer perspectives, supporting the assumption that the ARM and the WAI measure some of the same core constructs.

Adult↗