Gillian E. Hardy

Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy

A total of 117 depressed clients, stratified for severity, completed 8 or 16 sessions of manualized treatment, either cognitive-behavioral psychotherapy (CB) or psychodynamic-interpersonal psychotherapy (PI). Each of 5 clinician-investigators treated clients in all 4 treatment conditions. On most measures, CB and PI were equally effective, irrespective of the severity of depression or the duration of treatment. However, there was evidence of some advantage to CB on the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). There was no evidence that CBs effects were more rapid than those of PI, nor did the effects of each treatment method vary according to the severity of depression. There was no overall advantage to 16-session treatment over 8-session treatment. However, those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions.

ASSIMILATION OF PROBLEMATIC EXPERIENCES BY CLIENTS IN PSYCHOTHERAPY

DAVID A. SHAPIRO AND GILLIAN HARDYMRC/ESRC Social and Applied Psychology UnitUniversity of SheffieldIn successful psychotherapy,problematic experiences (threatening orpainful thoughts, feelings, memories,etc.) are gradually assimilated intoschemata that are introduced by thetherapist or developed in the therapist-client interaction by modification of oldschemata. As it is assimilated, aproblematic experience passes throughpredictable stages. The client movesfrom being oblivious, to experiencingthe content as acutely painful, then asless distressing, merely puzzling, thenunderstood, and finally as confidentlymastered.

Patterns of alliance development and the rupture-repair hypothesis: Are productive relationships U-shaped or V-shaped?

The authors attempted to replicate and extend D. M. Kivlighan and P. Shaughnessys (2000) findings of (a) 3 distinctive patterns of alliance development across sessions and (b) a differential association of one of these, a U-shaped quadratic growth pattern, with positive treatment outcome. In data drawn from a clinical trial of brief psychotherapies for depression (N = 79 clients), the authors distinguished 4 patterns of alliance development. These matched 2 of Kivlighan and Shaughnessys patterns, but not the U-shaped pattern, and none was differentially associated with outcome. However, further examination of the data identified a subset of clients (n = 17) who experienced rupture-repair sequences-brief V-shaped deflections rather than U-shaped profiles. These clients tended to make greater gains in treatment than did the other clients.

The impact of psychological distress on absence from work.

The aims of this study were to examine the impact of psychological distress on absence from work; to compare psychological distress and job satisfaction as predictors of absence; and to compare the relative effects of 2 components of psychological distress, depression and anxiety, on absence. Organizational records of absence over a 3-year period were obtained for 323 health service staff in the United Kingdom, who also completed self-report measures of psychological distress and job satisfaction at the beginning of the study and 2 years later. Psychological distress, particularly depression, was found to predict absence, with higher levels of distress predicting a greater number of days and number of times absent. Job satisfaction and psychological distress independently predicted levels of absence. The psychological distress-absence relationship was not moderated by demographic variables.

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.

Validation of the General Health Questionnaire-12: Using a sample of employees from England's health care services.

Psychiatric interviews were carried out to validate the General Health Questionnaire-12 (GHQ-12; Goldberg, 1972) for use with staff of Englands National Health Service (NHS), and to determine the appropriate threshold score to identify probable cases. In a sample of 551 NHS staff, the correlation between the GHQ-12 and the Clinical Interview Schedule-Revised (CIS-R) was found to be .70. The receiver operating characteristic showed that a 3/4 threshold, higher than used in all but one previous study, gave the best conservative estimate of minor psychiatric morbidity. This threshold gave an estimated sensitivity of the GHQ-12 of.69 and specificity of.88. It reduced case rates by between 8% and 17% as compared with lower possible thresholds. Convergent and discriminant validation of the GHQ-12 was demonstrated through comparison with other measures of mental and physical health.

Fatigue in the workforce of national health service trusts: Levels of symptomatology and links with minor psychiatric disorder, demographic, occupational and work role factors

The aims of this study were: (1) to obtain a systematic estimate of the levels of fatigue in representative samples of the major occupational groups of health care workers; (2) to examine the relationship between fatigue and mental health as a function of occupational and work role factors; and (3) to test the proposition that fatigue arises from a combination of poor mental health and high job stress. Questionnaire data from 7720 NHS Trust staff was used. Higher levels of fatigue were reported among health care workers in comparison with general population figures. Highest levels of general fatigue, the subjective sensation of tiredness, were experienced by doctors (especially women doctors), professions allied to medicine and managers. Highest levels of fatigability, the onset of symptoms after exertion, were experienced by ancillary and nursing staff. Both general fatigue and fatigability were associated with high levels of psychological distress. Support was also found for the proposition that fatigue arises from a combination of poor mental health and high work demands.

Therapist Competence and Outcome of Cognitive Therapy for Depression

The Cognitive Therapy Scale (CTS) has been widely used in cognitive therapy training Centers to assess therapist competence but competence has not previously been clearly shown to be associated with cognitive therapy outcome, possibly because an insufficient range of competence has been sampled. Competence was compared with alliance as process variables that might relate to change in therapy. A randomly selected therapy session from each of 30 courses of cognitive therapy for depression was rated using the CTS. Both therapeutic alliance and therapist competence were related to outcome. In regression analyses, the alliance remained significantly related to outcome when controlling for competence, but not vice versa. These relationships with outcome were primarily attributable to therapists rather than to clients. Associations with outcome appeared stronger for clients who completed therapy than for those who did not. These findings suggest that measurable factors both common to diverse treatments methods and specific to particular methods should be included in efforts to account for therapy outcome.

An Exploration of Psychological Well-being with Young Somali Refugee and Asylum-seeker Women:

The aims of this study were to explore individual and collective understandings of psychological well-being among young Somali (black African Muslim) asylum-seeker or refugee women. Three groups and five individual semi-structured interviews were undertaken and themes were identified using Interpretative Phenomenological Analysis. Themes included resilience and protection; identity and beliefs; and concealment, distancing and secrets; which reflected acculturation, Islamic and Somali cultures. Spirit possession was explored in relation to culture and religion, mental health, protection and treatment. The women ‘get on’, cope with life, and value support from family, services and religion. However, the pressures to navigate conflicting and changing cultural and religious positions, and to conceal distress, frustrate accessing support. The young Somali refugees’ understandings of mental health and psychological well-being provide an insight for clinicians into the complexities of approaching services for help, and developing shared understandings transculturally. Clinically, the findings raise the paradox of how Somali women value support, yet also value concealment and fear disclosures. The variation and tensions reflected in the data from a small number of women highlight the importance of not stereotyping refugees, but exploring their individual beliefs and providing a range of service options.

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 studys more routine clinical practice settings than they were in the clinical trials. Life events did not appear to account for sudden gains.