Mike Startup

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.

Risk factors for transition to first episode psychosis among individuals with 'at-risk mental states'

Recently developed criteria have been successful at identifying individuals at imminent risk of developing a psychotic disorder, but these criteria lead to 50-60% false positives. This study investigated whether measures of family history, peri-natal complications, premorbid social functioning, premorbid personality, recent life events and current symptoms would be able to improve predictions of psychosis in a group of young, help-seeking individuals who had been identified as being at risk. Individuals (N=74) were followed up at least 1 year after initial assessment. Half the sample went on to develop a psychotic disorder. The most reliable scale-based predictor was the degree of presence of schizotypal personality characteristics. However, individual items assessing odd beliefs/magical thinking, marked impairment in role functioning, blunted or inappropriate affect, anhedonia/asociality and auditory hallucinations were also highly predictive of transition, yielding good sensitivity (84%) and specificity (86%). These predictors are consistent with a picture of poor premorbid functioning that further declines in the period up to transition.

The concurrent validity of the Global Assessment of Functioning (GAF)

BACKGROUND Few studies of the validity of the Global Assessment of Functioning (GAF) have been published and none has shown how GAF ratings are associated with concurrent ratings of symptoms and social functioning. This article provides such data. METHOD Patients suffering from schizophrenia were assessed at admission to hospital and at six- and 12-month follow-up, using the GAF, the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS) and the Social Behaviour Schedule. RESULTS GAF ratings were highly correlated with ratings of symptoms and social behaviour at both follow-ups but not at initial assessment, although the inter-rater reliabilities for the measures were good. CONCLUSIONS The GAF can be rated reliably after minimal training. It provides a valid summary of symptoms and social functioning among schizophrenic patients provided they are not assessed when suffering from acute psychotic episodes.

Autobiographical memory and dissociation in borderline personality disorder.

BACKGROUND This study investigated whether individuals with borderline personality disorder (BPD) tend to be overgeneral in their autobiographical recall and whether the extent of their overgeneral recall covaries with their susceptibilities to dissociative experiences, as expected on theoretical grounds. METHODS Twenty-three patients with BPD and 23 matched controls completed the Autobiographical Memory Test (AMT) and self-report measures of depression, anxiety, trait anger and dissociative experiences. RESULTS Participants with BPD scored significantly higher than the control group on the measures of depression, anxiety, trait anger, and dissociative experiences and also retrieved significantly more general memories on the AMT. The number of general memories retrieved by the BPD group correlated significantly with their dissociation scores but not with their scores on mood measures. CONCLUSIONS Patients with BPD have difficulties in recalling specific autobiographical memories. These difficulties are related to their tendency to dissociate and may help them to avoid episodic information that would evoke acutely negative affect.

Schizotypy, dissociative experiences and childhood abuse: Relationships among self‐report measures

OBJECTIVES The traits and experiences that are seen as defining the schizophrenic and the dissociative disorders have been found to be present in continuously variable, non-pathological forms in the general population. Although the theoretical accounts that have been offered for the two kinds of disorder differ radically, there are reasons to expect that the measures that have been developed to assess schizotypal traits and dissociative experiences will be correlated. The aims of this study were to investigate the degree of correlation between measures and the extent to which the covariation can be explained by questionnaire items with similar content and experiences of childhood sexual and physical abuse. DESIGN Cross-sectional data from self-report measures completed by 224 participants were subjected to multivariate analyses. METHOD The Dissociative Experiences Scale (DES), three subscales from the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE) and two items assessing childhood abuse were mailed to all adult members of a volunteer participant panel. RESULTS Moderately large correlations were found between the DES and both the Cognitive Disorganization and the Unusual Experiences subscales of the O-LIFE. These correlations were hardly affected when items with overlapping content were excluded. Hierarchical multiple regression analyses showed that the measures of abuse accounted for small but significant proportions of the variance in both the DES and the Unusual Experiences subscale, but large proportions of the covariation between the measures of dissociative experiences and schizotypy remained unexplained. CONCLUSION The substantial correlations between measures point to limitations in the discriminant validity of the DES and two of the O-LIFE subscales. Three possible explanations are offered for the observed associations between dissociative experiences and schizotypal traits.

North Wales randomized controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders: outcomes at 6 and 12 months

BACKGROUND Recent reviews of randomized controlled trials have concluded that cognitive behaviour therapy (CBT) is effective, as an addition to standard care, in the treatment of people suffering from schizophrenia. Most of the trials have been conducted with stabilized out-patients. The aim of this trial was to evaluate the effectiveness of CBT for in-patients suffering acute psychotic episodes, when delivered under conditions representative of current clinical practice. METHOD Consecutive admissions meeting criteria were recruited. After screening, 43 were assigned at random to a treatment-as-usual (TAU) control group and 47 were assigned to TAU plus CBT. At baseline, 6 months and 12 months, patients were rated on symptoms and social functioning. CBT (maximum 25 sessions) began immediately after baseline assessment. RESULTS The CBT group gained greater benefit than the TAU group on symptoms and social functioning. A larger proportion of the CBT group (60%) than the TAU group (40%) showed reliable and clinically important change, and none of them (v. 17%) showed reliable deterioration compared with baseline. CONCLUSIONS CBT for patients suffering acute psychotic episodes can produce significant benefits when provided under clinically representative conditions.

Insight and cognitive deficits in schizophrenia : evidence for a curvilinear relationship

Both motivational and defect theories have been offered to explain variations in insight among schizophrenic individuals but the results of tests of these theories have been inconclusive and inconsistent. The present study was designed to test the hypothesis that both motivation and cognitive deficits affect insight, with a trade-off between the two processes, giving rise to quadratic relationships between insight and cognitive deficits. Twenty-six schizophrenic patients completed a battery of neuropsychological tests and participated in an interview designed to assess insight. In a multiple regression analysis predicting test results from insight scores, the linear component was non-significant while the quadratic component accounted for a highly significant 56% of the variance. Theoretical and clinical implications of this result are discussed briefly.

Autobiographical memory and parasuicide in borderline personality disorder.

BACKGROUND Several studies have found that parasuicidal patients are poor at recalling specific autobiographical memories when tested with the word-cueing paradigm and two studies have reported some evidence that over-general recall is a risk factor for repetition of parasuicide. The aim of the present study was to test whether this association could be replicated with a sample of patients suffering from borderline personality disorder (BPD). METHOD Twenty-three patients with BPD completed a version of the Autobiographical Memory Test (AMT) and self-report measures of depression, anxiety and trait anger. In a structured interview, they also reported the number of times they had engaged in parasuicidal acts during the previous 4 months. RESULTS The number of general memories produced on the AMT made a significant contribution to the prediction of the frequency of parasuicidal acts in a multiple regression analysis but the partial correlation in the final equation was negative. That is, those who showed greatest over-general recall reported fewest parasuicidal acts. Anxiety and depression, but not trait anger, also made significant independent contributions to the prediction of parasuicide. CONCLUSION Over-general autobiographical recall may help to protect borderline individuals from parasuicidal acts by helping them to avoid distressing memories.

Measuring Therapist Adherence in Exploratory Psychotherapy

The demonstration of treatment integrity in comparative outcome research requires measurement of the therapists adherence to the treatment protocol. Prior research has accomplished this via ratings of sessions of such explicitly structured methods as Cognitive Behavior Therapy and Interpersonal Psychotherapy. This paper presents a scale designed to measure adherence to Exploratory therapy, a psychodynamic/experiential method with an interpersonal focus, that has been studied within the Sheffield Psychotherapy Projects. Acceptable inter-rater reliability was obtained for the scale and it was found to contribute significantly to the discrimination of Exploratory and Prescriptive therapies. Factor analysis indicated that the Exploratory scale was largely indpendent of the common factors tapped by a Facilitative Conditions scale, and yielded an interpretable structure highlighting Exploratory therapys integration of psychodynamic, experiential, and interpersonal constructs.

North Wales randomized controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders: two-year follow-up and economic evaluation.

BACKGROUND There is good evidence now that cognitive behaviour therapy (CBT) is effective in the treatment of people suffering from schizophrenia. There is also some evidence that the benefits of CBT persist after the end of treatment and that the direct costs of providing CBT as an adjunct to standard care are no higher than the direct costs of standard care alone. The aims of the present study were to discover if the benefits of CBT for acute schizophrenia which were found 1 year after index admission persist for another year, and to evaluate the comparative costs of providing CBT. METHOD Consecutive admissions meeting criteria were recruited. After screening, 43 were assigned at random to a treatment-as-usual (TAU) control group and 47 were assigned to TAU plus CBT. Patients (73% of original) were rated on symptoms and social functioning 2 years after index admission. An evaluation of the direct costs of services was also completed. RESULTS The CBT group had maintained its advantage over the TAU group on negative symptoms and social functioning but had lost the advantage it previously enjoyed in positive symptoms. The difference between groups in total direct costs over the 2 years was not statistically significant despite the cost of providing CBT. CONCLUSIONS Some of the benefits of CBT for patients suffering acute psychotic episodes persist for 2 years. After the end of regular treatment, CBT should probably be targeted on the appearance of early signs of relapse to forestall the re-emergence of positive symptoms.