Gary O'Reilly

Attachment Styles and Psychological Profiles of Child Sex Offenders in Ireland

When 29 child sex offenders, 30 violent offenders, 30 nonviolent offenders, and 30 community controls were compared, a secure adult attachment style was 4 times less common in the child sex offender group than in any of the other three groups. Ninety-three percent of sex offenders had an insecure adult attachment style. Compared with community controls, the child sex offender group reported significantly lower levels of maternal and paternal care and significantly higher levels of maternal and paternal overprotection during their childhood. Compared with all three comparison groups, the child sexual offenders reported significantly more emotional loneliness and a more external locus of control. With respect to anger management, the child sexual offenders’ profile more closely approximated those of nonviolent offenders and community controls than that of violent offenders.

Exploratory evaluations of a computer game supporting cognitive behavioural therapy for adolescents

The need to provide effective mental health treatments for adolescents has been described as a global public health challenge [27]. In this paper we discuss the exploratory evaluations of the first adolescent intervention to fully integrate a computer game implementing Cognitive Behavioural Therapy. Three distinct studies are presented: a detailed evaluation in which therapists independent of the design team used the game with 6 adolescents experiencing clinical anxiety disorders; a study in which a member of the design team used the game with 15 adolescents; and finally a study assessing the acceptability of the game and intervention with 216 practicing therapists. Findings are presented within the context of a framework for the design and evaluation of complex health interventions. The paper provides an in-depth insight into the use of therapeutic games to support adolescent interventions and provides stronger evidence than previously available for both their effectiveness and acceptability to stakeholders.

A randomized controlled trial of the computerized CBT programme, MoodGYM, for public mental health service users waiting for interventions

OBJECTIVES To evaluate the effectiveness of the computerized CBT (cCBT) programme, MoodGYM, for the reduction in symptoms of general psychological distress (the primary outcome), depression, anxiety, stress, and impaired daily functioning. DESIGN A randomized controlled trial, with a waiting list control condition, in a routine clinical setting. METHODS Participants were 149 public mental health service users (aged 18-61 [M = 35.3 years; SD = 10.3]) waiting for interventions. Self-report outcome measures were administered online at baseline and post-intervention (i.e., after 32 days). RESULTS After high dropout rates, a post-intervention completers analysis examined 28 MoodGYM participants and 38 waiting list control participants. MoodGYM was significantly more effective than the waiting list control for the reduction of symptoms of general psychological distress (F[1, 64] = 4.45; p < .05) and stress (F[1, 64] = 5.35; p < .05) but not depression, anxiety, or impaired daily functioning. CONCLUSIONS Due to their high associated dropout rates, self-help cCBT programmes such as MoodGYM should not be provided as front-line treatments. However, as it is likely to be agreeable and beneficial to some service users, perhaps self-help cCBT should be provided as an additional treatment option.

Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review

Background Diagnostic error incurs enormous human and economic costs. The dual-process model reasoning provides a framework for understanding the diagnostic process and attributes certain errors to faulty cognitive shortcuts (heuristics). The literature contains many suggestions to counteract these and to enhance analytical and non-analytical modes of reasoning. Aims To identify, describe and appraise studies that have empirically investigated interventions to enhance analytical and non-analytical reasoning among medical trainees and doctors, and to assess their effectiveness. Methods Systematic searches of five databases were carried out (Medline, PsycInfo, Embase, Education Resource Information Centre (ERIC) and Cochrane Database of Controlled Trials), supplemented with searches of bibliographies and relevant journals. Included studies evaluated an intervention to enhance analytical and/or non-analytical reasoning among medical trainees or doctors. Findings Twenty-eight studies were included under five categories: educational interventions, checklists, cognitive forcing strategies, guided reflection, instructions at test and other interventions. While many of the studies found some effect of interventions, guided reflection interventions emerged as the most consistently successful across five studies, and cognitive forcing strategies improved accuracy and confidence judgements. Significant heterogeneity of measurement approaches was observed, and existing studies are largely limited to early-career doctors. Conclusions Results to date are promising and this relatively young field is now close to a point where these kinds of cognitive interventions can be recommended to educators. Further research with refined methodology and more diverse samples is required before firm recommendations may be made for medical education and policy; however, these results suggest that such interventions hold promise, with much current enthusiasm for new research.

PSYCHOLOGICAL PROFILES OF SEXUALLY ABUSIVE ADOLESCENTS IN IRELAND

OBJECTIVE This study aimed to profile the psychological and psychosocial characteristics of a group of Irish adolescents who had sexually abused other youngsters. METHOD Levels of behavior problems, personal adjustment, anger management, and psychosocial adjustment were compared in 27 Irish adolescents with a history of sexually abusing another youngster (SA group), 20 clinical controls who had significant behavioral problems but no history of sexual offending (CC group), and 29 normal controls who were without significant psychological problems (NC group). Measures used included the Child Behavior Checklist (CBCL), the Youth Self-Report Form (YSR), selected scales from Beckett (1997) Adolescent Sex Offender Assessment Pack (ASOAP), and the Family Environment Scale (FES). RESULTS Compared with the CC group, the SA group displayed fewer problems overall on the CBCL and the YSR. The SA group showed problems with self-esteem, emotional loneliness, and perspective-taking similar to those of the CC group, but their impulsivity scores were similar to those of the NC group. The locus of control scores of the SA group fell between those of the CC and NC groups. The SA group showed an anger management profile that fell at an intermediate position between those of the NC and CC groups. The SA group showed problematic family functioning in the areas of expressiveness, behavior control, and social support, similar to those of the CC group. Their difficulties with family cohesion were less severe than those of the CC group but worse than those of the NC group. CONCLUSIONS Overall, the psychological adjustment of adolescents with a history of sexually abusing others was more problematic than that of normal controls but less problematic than that of youngsters who had significant behavioral problems but no history of sexual offending.

A controlled evaluation of a prison-based sexual offender intervention program

The effectiveness of a prison-based cognitive behavioral program designed to modify psychological risk factors associated with sexual offending was evaluated. The Irish Prison Service Sexual Offender Intervention Programme, is a manualized 10-month Cognitive Behaviour Therapy [CBT] program involving three 2-hour group sessions per week, which are facilitated by a team of clinical psychologists and probation officers. Improvements in 38 consecutive referrals to the program were compared with the status of 38 untreated offenders who were similar in marital status, age when they left school, occupational status prior to imprisonment, offence type, presence of previous convictions, and current sentence length. All research participants completed the same assessment protocol, which evaluated psychological factors associated with sexual offending at times equivalent to pre- and postintervention. Compared with the untreated control group, program participants showed statistically significant improvement on some but not all self-report measures of cognitive distortions, empathy, interpersonal skills, self-regulation, and relapse prevention. Motivation to change among the untreated control group was not associated with change in psychological functioning in the absence of the assistance of the treatment program. Implications for sexual offender intervention delivery are considered.

Computerised cognitive behavioural therapy: helping Ireland log on

OBJECTIVES The aim of this article is to review and highlight evidence-based computerised cognitive behavioural therapy (cCBT) programmes that can potentially be used in Ireland for the treatment of mild-to-moderate mental health difficulties. METHODS The authors undertook a literature search using three databases, and consulted a recognised, university-developed web portal. For a programme to be included in this review, it had to (a) have at least one randomised controlled trial demonstrating its efficacy; (b) be available on the internet; and (c) be delivered in English. Findings Twenty-five cCBT programmes that met the inclusion criteria were profiled. Taken together, these programmes target various anxiety difficulties (i.e. generalised anxiety, panic/phobia, social anxiety and post-traumatic stress), depression (or low mood), eating problems, stress, insomnia, pain and alcohol misuse. CONCLUSIONS cCBT programmes, preferably administered as part of a stepped-care model, offer effective, low-cost and low-intensity interventions for a wide range of psychological problems. Their use could be beneficial given how underdeveloped primary care mental health services are in Ireland.

Computerised cognitive–behavioural therapy for adults with intellectual disability: randomised controlled trial

BackgroundDespite the evidence base for computer-assisted cognitive-behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability.AimsTo evaluate the utility of a CBT computer game for adults who have an intellectual disability.MethodA 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis.ResultsA significant group × time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU.ConclusionsAs the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.

Effectiveness of Cognitive Behavioural Therapy for Anxiety and Depression in Primary Care: a Meta-analysis

Abstract Background Cognitive behavioural therapy (CBT) is increasingly being delivered in primary care, in a variety of delivery formats such as guided self-help CBT, telephone-based CBT, computerized CBT and standard, one-to-one CBT. However, the vast majority of research has focused on CBT in specialized services, and no previous meta-analysis has examined CBT’s effectiveness across delivery formats in primary care. Objective To determine the effectiveness of multi-modal CBT (i.e. CBT across delivery formats) for symptoms of anxiety and depression, in primary care. Methods A meta-analysis of CBT-focused RCTs, for symptoms of anxiety or depression, in primary care. The authors searched four databases. To be included, RCTs had to be set in primary care or have primary care participants. Results. Twenty-nine RCTs were included in three separate meta-analyses. Results showed multi-modal CBT was more effective than no primary care treatment (d =0.59), and primary care treatment-as-usual (TAU) (d = 0.48) for anxiety and depression symptoms. Moreover, multimodal CBT in addition to primary care TAU was shown to be more effective than primary care TAU for depression symptoms (no comparisons of this kind were available for anxiety) (d = 0.37). Conclusions The results from conducted meta-analyses indicate that multi-modal CBT is effective for anxiety and depression symptoms in primary care. Furthermore, based on CBT’s economic viability, increasing the provision of CBT in primary care seems justified. Future research should examine if varying levels of qualification among primary care CBT practitioners impacts on the effectiveness of CBT in this setting.

Comparing young people's experience of technology-delivered v. face-to-face mindfulness and relaxation: two-armed qualitative focus group study

BackgroundThe current popularity of mindfulness-based practices has coincided with the increase in access to mobile technology. This has led to many mindfulness apps and programs becoming available, some specifically for children. However, little is known about the experience of engaging with mindfulness through these mediums.AimsTo explore childrens experience of mindfulness delivered both face-to-face and through a computer game to highlight any differences or similarities.MethodA two-armed qualitative focus groups design was used to explore childrens experiences. The first arm offered mindfulness exercises in a traditional face-to-face setting with guided meditations. The second arm offered mindfulness exercises through a computer game avatar.ResultsThemes of relaxation, engagement, awareness, thinking, practice and directing attention emerged from both arms of focus groups. Subthematic codes highlight key differences as well as similarities in the experience of mindfulness.ConclusionsThese results indicate that mindfulness delivered via technology can offer a rich experience.