Abigail Millings

Classroom based cognitive behavioural therapy in reducing symptoms of depression in high risk adolescents: pragmatic cluster randomised controlled trial.

Objective To compare the effectiveness of classroom based cognitive behavioural therapy with attention control and usual school provision for adolescents at high risk of depression. Design Three arm parallel cluster randomised controlled trial. Setting Eight UK secondary schools. Participants Adolescents (n=5030) aged 12-16 years in school year groups 8-11. Year groups were randomly assigned on a 1:1:1 ratio to cognitive behavioural therapy, attention control, or usual school provision. Allocation was balanced by school, year, number of students and classes, frequency of lessons, and timetabling. Participants were not blinded to treatment allocation. Interventions Cognitive behavioural therapy, attention control, and usual school provision provided in classes to all eligible participants. Main outcome measures Outcomes were collected by self completed questionnaire administered by researchers. The primary outcome was symptoms of depression assessed at 12 months by the short mood and feelings questionnaire among those identified at baseline as being at high risk of depression. Secondary outcomes included negative thinking, self worth, and anxiety. Analyses were undertaken on an intention to treat basis and accounted for the clustered nature of the design. Results 1064 (21.2%) adolescents were identified at high risk of depression: 392 in the classroom based cognitive behavioural therapy arm, 374 in the attention control arm, and 298 in the usual school provision arm. At 12 months adjusted mean scores on the short mood and feelings questionnaire did not differ for cognitive behavioural therapy versus attention control (−0.63, 95% confidence interval −1.85 to 0.58, P=0.41) or for cognitive behavioural therapy versus usual school provision (0.97, −0.20 to 2.15, P=0.12). Conclusion In adolescents with depressive symptoms, outcomes were similar for attention control, usual school provision, and cognitive behavioural therapy. Classroom based cognitive behavioural therapy programmes may result in increased self awareness and reporting of depressive symptoms but should not be undertaken without further evaluation and research. Trial registration Current Controlled Trials ISRCTN19083628.

School connectedness, peer attachment, and self-esteem as predictors of adolescent depression

Recent literature suggests that school connectedness (SC) may be a key determinant of adolescent mental health. Specifically, SC has been found to have a negative relationship with adolescent depression. In the current, cross sectional study, we examine whether the relationship between SC and symptoms of low mood is dampened or moderated by self-esteem (SE) and peer attachment style. Participants were 5022 adolescents (aged 11-16) who completed a battery of questionnaires in school, including measures of low mood, SC, SE, and peer attachment style. The relationship between SC and low mood was reduced by the inclusion of SE and peer attachment style. Peer attachment style was the largest predictor of low mood. The relationship between SC and low mood was not moderated by SE or peer attachment style. Interventions for adolescent depression may be most effective by focussing on increasing SE and fostering secure attachments, rather than solely focussing on increasing SC.

(Inter)personal Computing: The Role of the Therapeutic Relationship in E-mental Health

E-mental health technologies are rapidly expanding the reach of psychological interventions around the globe. There is a growing evidence base supporting the potential benefits of these new technologies for psychological and behavioural health. Most of this evidence to date has focused on evaluating the feasibility and outcomes from such interventions, whilst limited research has begun to explore the change processes associated with their impact. In traditional psychological therapies the quality of common factors, including the therapeutic relationship, are widely held to be important for engagement and outcomes. E-mental health interventions present a challenge to the importance of these factors, as therapeutic interactions are typically remote, limited, or even absent in the case of fully automated e-mental health programmes. This paper explores the role of the therapeutic relationship in e-mental health. Where measured, it appears that the relationship is fairly robust to distance and limited contact, but may be less intimately associated with therapy outcomes than in traditional therapies. Where the intervention comprises little or no therapeutic contact, we explore how some of the variance in engagement and outcomes may still be accounted for by common and relational factors offered through a supportive frame or embedded within the technologies themselves. Implications for theory, research and practice are presented.

Good Partner, Good Parent Responsiveness Mediates the Link Between Romantic Attachment and Parenting Style

This cross-sectional, dyadic questionnaire study examined the contribution of romantic attachment and responsive caregiving to parenting style, investigating both gender and partner effects. One hundred and twenty-five couples with children aged 7 to 8 years completed measures of attachment styles, responsive caregiving toward partner, and parenting styles. Structural Equation Modeling was used to examine the intra- and interpersonal associations between romantic attachment, caregiving responsiveness, and parenting styles. Attachment avoidance and anxiety were both negatively associated with responsive caregiving to partner, which in turn was positively associated with authoritative (optimal) parenting styles and negatively associated with authoritarian and permissive (nonoptimal) parenting styles. Responsive caregiving mediated all links between attachment and parenting, with an additional direct association between attachment anxiety and nonoptimal parenting styles that was not explained by caregiving responsiveness. Findings are discussed with reference to attachment theory.

Increasing engagement with computerised cognitive behavioural therapies

The evidence base for computerised cognitive behavioural therapy (CCBT) in common mental health problems is expanding rapidly. Recent reviews and meta-analyses have produced promising findings with regard to CCBT’s effectiveness and acceptability, but developing and supporting effective and sustainable models of CCBT service implementation presents a challenge – not least due to barriers to uptake and engagement. This paper considers CCBT usage and explores the challenges to uptake and engagement with CCBT. We propose a simple model of engagement factors associated with the programme, the problem, the person and the provider and highlight some actions that service developers and providers can take that might increase uptake and engagement with the CCBT services that they provide. Factors relating to discontinuation of use or ‘drop-out’ will also be explored. Managing expectations and promoting hope in both service users and providers is emphasised.

E-therapies in England for stress, anxiety or depression: what is being used in the NHS? A survey of mental health services

Objective To document the range of web and smartphone apps used and recommended for stress, anxiety or depression by the National Health Service (NHS) in England. Design The study was conducted using Freedom of Information (FOI) requests and systematic website searches. Data sources Data were collected via FOI requests to NHS services between 13 February 2015 and 31 March 2015, and searches conducted on NHS apps library websites between 26 March 2015 and 2 November 2015. Data collection/extraction methods Data were compiled from responses to: (1) FOI requests sent to all Improving Access to Psychological Therapies (IAPT) services and NHS Mental Health Trusts in England and (2) NHS apps library search results. Results A total of 61 (54.95%) out of the then 111 IAPT service providers responded, accounting for 191 IAPT services, and all 51 of the then NHS Mental Health Trusts responded. The results were that 13 different web apps and 35 different smartphone apps for depression, anxiety or stress were available through either referral services or the online NHS Apps Libraries. The apps used and recommended vary by area and by point of access (online library/IAPT/trust). Conclusions Future research is required to establish the evidence base for the apps that are being used in the NHS in England. There is a need for service provision to be based on evidence and established guidelines.

Internet-delivered cognitive behavior therapy for anxiety and insomnia in a higher education context

ABSTRACT Background and Objectives: Anxiety and insomnia can be treated with internet-delivered Cognitive Behavioral Therapy (iCBT). iCBT may be well-suited to students who are known to be poor help-seekers and suffer these symptoms. iCBT can offer easy access to treatment and increase service availability. The aim of this study was to evaluate the efficacy of anxiety and insomnia iCBT programs in students. Design: A randomized, controlled study. Methods: Students were randomly allocated to intervention (“Anxiety Relief”: n = 43; “Insomnia Relief”: n = 48; control: n = 47). Interventions lasted six weeks. Outcome measures were the State-Trait Anxiety Inventory and the Pittsburgh Sleep Quality Index. Results: Significant within-group reductions in anxiety (t(31) = 2.00, p = .03) with moderate between-groups (compared to control) effect size (d = .64) and increases in sleep quality (t(31) = 3.46, p = .002) with a moderate between-groups effect size (d = .55) were found for completers of the anxiety program from pre- to post-intervention. Significant within-group increases in sleep quality were found for completers of the insomnia program from pre- to post-intervention (t(35) = 4.28, p > .001) with a moderate between-groups effect size (d = .51). Conclusions: Findings support the use of iCBT for anxiety and insomnia in students, and indicate that further research is needed.

The Counseling Center Assessment of Psychological Symptoms (CCAPS‐62): Acceptance, feasibility, and initial psychometric properties in a UK student population

BACKGROUND The burden and severity of student mental health continue to increase in parallel with increasing financial pressures on students and services alike. There is a need for a student-specific measure of distress that acknowledges their unique context. This study examined the feasibility, acceptance, and initial psychometric properties of a US measure, the Counseling Center Assessment of Psychological Symptoms (CCAPS), in a UK student sample. METHODS A sample of 294 UK help-seeking students from two universities completed the CCAPS-62 and Clinical Outcomes in Routine Evaluation (CORE-10) as a comparator. The factor solution and reliability of the CCAPS-62 were examined. Correlations and clinical boundaries were determined between the CCAPS-62 subscales and CORE-10, and comparisons were made with US published norms. RESULTS The CCAPS-62 demonstrated a strong factor solution that matched the intended subscales. All subscales had good reliability and correlated significantly with the CORE-10. The agreement on caseness between the two measures was 92.8% with 86.3% reaching clinical threshold on both the CCAPS-62 and CORE-10. Severity was most noticeable for academic distress, depression, anxiety, and social anxiety. Compared to US data, UK students showed higher clinical severity for all psychological symptoms. CONCLUSIONS The CCAPS-62 is a reliable and psychometrically valid assessment measure to use with UK students without revision. The overall distress indicated is similar to that of the CORE-10, but the individual subscales are more informative of specific student concerns including academic distress, social anxiety, and substance abuse. Potential benefits of administering a student-focused assessment measure in student counselling services are discussed. KEY PRACTITIONER MESSAGE University students attending counselling in the UK demonstrate clinical severity for academic distress, depression, anxiety, and social anxiety. Compared to university students in the US, UK students present with higher clinical severity on all contextual measures of student psychological distress. It is advantageous for university counselling services to administer a student-specific clinical measure over measures intended for the general clinical population. CCAPS-62 is an acceptable, feasible, and psychometrically valid measure of student psychological distress that can be used in the UK without revision. It is important for university counselling services to continue to provide support from therapists that are trained and experienced in the university context over services intended for the general clinical population.

Congratulations, It’s a Boy! Bench-Marking Children’s Perceptions of the Robokind Zeno-R25

This paper explores three fundamental attributes of the Robokind Zeno-R25 (its status as person or machine, its ‘gender’, and intensity of its simulated facial expressions) and their impact on children’s perceptions of the robot, using a one-sample study design. Results from a sample of 37 children indicate that the robot is perceived as being a mix of person and machine, but also strongly as a male figure. Children could label emotions of the robot’s simulated facial-expressions but perceived intensities of these expressions varied. The findings demonstrate the importance of establishing fundamentals in user views towards social robots in supporting advanced arguments of social human-robot interaction.

Holding Back the Tears: Individual Differences in Adult Crying Proneness Reflect Attachment Orientation and Attitudes to Crying.

Despite being a universal human attachment behavior, little is known about individual differences in crying. To facilitate such examination we first recommend shortened versions of the attitudes and proneness sections of the Adult Crying Inventory using two independent samples. Importantly, we examine attachment orientation differences in crying proneness and test the mediating role of attitudes toward crying in this relationship. Participants (Sample 1 N = 623, Sample 2 N = 781), completed online measures of adult attachment dimensions (avoidance and anxiety), attitudes toward crying, and crying proneness. Exploratory factor analyses in Sample 1 revealed four factors for crying attitudes: crying helps one feel better; crying is healthy; hatred of crying; and crying is controllable; and three factors for crying proneness: threat to self; sadness; and joy. Confirmatory factor analyses in Sample 2 replicated these structures. Theoretically and statistically justified short forms of each scale were created. Multiple mediation analyses revealed similar patterns of results across the two samples, with the attitudes “crying is healthy” and “crying is controllable” consistently mediating the positive links between attachment anxiety and crying proneness, and the negative links between attachment avoidance and crying proneness. Results are discussed in relation to attachment and emotion regulation literature.