Paul Farrand

Functional equivalence of verbal and spatial information in serial short-term memory.

Performance on a test of serial memory for the spatial position of a sequence of dots showed similarities to typical results from the serial recall of verbal material: a marked increase in error with increasing list length, a modest rise in error as retention interval increased, and bow-shaped serial position curves. This task was susceptible to interference from both a spatial task (rote tapping) and a verbal task (mouthed articulatory suppression) and also from the presence of irrelevant speech. Effects were comparable to those found with a serial verbal task that was generally similar in demand characteristics to the spatial task. As a generalization, disruption of the serial recall of visuospatial material was more marked if the interference conditions involved a changing sequence of actions or materials, but not if a single event (tap, mouthed utterance, or sound) was repeated.

Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial

Summary Background Depression is a common, debilitating, and costly disorder. Many patients request psychological therapy, but the best-evidenced therapy—cognitive behavioural therapy (CBT)—is complex and costly. A simpler therapy—behavioural activation (BA)—might be as effective and cheaper than is CBT. We aimed to establish the clinical efficacy and cost-effectiveness of BA compared with CBT for adults with depression. Methods In this randomised, controlled, non-inferiority trial, we recruited adults aged 18 years or older meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for major depressive disorder from primary care and psychological therapy services in Devon, Durham, and Leeds (UK). We excluded people who were receiving psychological therapy, were alcohol or drug dependent, were acutely suicidal or had attempted suicide in the previous 2 months, or were cognitively impaired, or who had bipolar disorder or psychosis or psychotic symptoms. We randomly assigned participants (1:1) remotely using computer-generated allocation (minimisation used; stratified by depression severity [Patient Health Questionnaire 9 (PHQ-9) score of <19 vs ≥19], antidepressant use, and recruitment site) to BA from junior mental health workers or CBT from psychological therapists. Randomisation done at the Peninsula Clinical Trials Unit was concealed from investigators. Treatment was given open label, but outcome assessors were masked. The primary outcome was depression symptoms according to the PHQ-9 at 12 months. We analysed all those who were randomly allocated and had complete data (modified intention to treat [mITT]) and also all those who were randomly allocated, had complete data, and received at least eight treatment sessions (per protocol [PP]). We analysed safety in the mITT population. The non-inferiority margin was 1·9 PHQ-9 points. This trial is registered with the ISCRTN registry, number ISRCTN27473954. Findings Between Sept 26, 2012, and April 3, 2014, we randomly allocated 221 (50%) participants to BA and 219 (50%) to CBT. 175 (79%) participants were assessable for the primary outcome in the mITT population in the BA group compared with 189 (86%) in the CBT group, whereas 135 (61%) were assessable in the PP population in the BA group compared with 151 (69%) in the CBT group. BA was non-inferior to CBT (mITT: CBT 8·4 PHQ-9 points [SD 7·5], BA 8·4 PHQ-9 points [7·0], mean difference 0·1 PHQ-9 points [95% CI −1·3 to 1·5], p=0·89; PP: CBT 7·9 PHQ-9 points [7·3]; BA 7·8 [6·5], mean difference 0·0 PHQ-9 points [–1·5 to 1·6], p=0·99). Two (1%) non-trial-related deaths (one [1%] multidrug toxicity in the BA group and one [1%] cancer in the CBT group) and 15 depression-related, but not treatment-related, serious adverse events (three in the BA group and 12 in the CBT group) occurred in three [2%] participants in the BA group (two [1%] patients who overdosed and one [1%] who self-harmed) and eight (4%) participants in the CBT group (seven [4%] who overdosed and one [1%] who self-harmed). Interpretation We found that BA, a simpler psychological treatment than CBT, can be delivered by junior mental health workers with less intensive and costly training, with no lesser effect than CBT. Effective psychological therapy for depression can be delivered without the need for costly and highly trained professionals. Funding National Institute for Health Research.

Direction of Report in Spatial and Verbal Serial Short term Memory

Four experiments examined the role played by item and order information in determining the effects of order of report of a sequence from short-term memory. Experiments in which list items were re-presented prior to recall so that only their order had to be reported showed no differences in performance between the forward and backward direction of report. This result was found with lists of auditory-verbal, visual-verbal, and spatial stimuli. When the list items were not re-presented, so that recall of both items and order was required, recall in the backward direction of report was significantly worse than in the forward direction of report, both in spatial and verbal tasks. The results point to the symmetry of inter-item associations, though only equivocally so, but they suggest strongly that the processes of spatial and verbal serial recall share many functional characteristics.

Involving service users in intervention design: a participatory approach to developing a text-messaging intervention to reduce repetition of self-harm.

Objective  To engage a group of people with relevant lived experience in the development of a text‐messaging intervention to reduce repetition of self‐harm.

Risk perception in novice drivers: the relationship between questionnaire measures and response latency

The extent to which questionnaire based measures of driving risk, driving ability and accident likelihood are associated with response latency based measures obtained on a hazard perception test was examined. In Experiment 1 questionnaire evaluations of driving in general were obtained and correlated with hazard perception performance. In Experiment 2 questionnaire evaluations and hazard perception performance were obtained when drivers viewed the same driving scenes. In neither experiment did questionnaire responses correlate significantly with hazard perception performance. Additionally while in both experiments no difference in hazard perception performance arose between males and females, females rated driving as more risky and their ability to be lower than males. The results indicate independence between questionnaire and response latency measures of hazard perception. However the possibility that both approaches should be adopted within a single framework is raised.

Recruitment into a guided internet based CBT (iCBT) intervention for depression: Lesson learnt from the failure of a prevalence recruitment strategy

INTRODUCTION Internet based Cognitive Behavioural Therapy (iCBT) represents a significant development in the way psychological interventions are delivered. Studies tend to recruit via common media channels leading to criticisms of biased sample sizes and limited generalisability to primary care settings. AIM To evaluate the use of a prevalence recruitment strategy within primary care to recruit into an RCT examining a free to use iCBT intervention. METHODS Fully randomised controlled trial (RCT), utilising a prevalence based recruitment strategy, comparing the iCBT intervention with telephone support provided by NHS Direct Health Advisors with treatment-as-usual (TAU) control. RESULTS Recruitment rates were low with only 7 participants recruited over 8 months. Overall only 14% of expected study invitations were sent, with only 1% undertaking the consent and initial screening process. DISCUSSION Key differences with successful prevalence recruitment strategies highlight four main issues to consider when recruiting participants from primary care into iCBT studies--lack of equipoise, a need for an assertive approach, coding of depression in GP databases and help seeking behaviour in depression which can all act as potential contributors to failure to recruit. However other non-primary care recruitment methods, such as the use of media channels, which are already shown to be effective in non-primary care settings should be considered if these methods more accurately target the population who would be willing to adopt iCBT more generally.

Community dentistry: Prevalence, age of onset and demographic relationships of different areca nut habits amongst children in Tower Hamlets, London

Objective To examine prevalence and demographic relationships of different areca nut habits amongst children.Design Self-administered questionnaire.Subjects Children aged between 11 and 15. Of 800 questionnaires distributed, 704 were fully completed (88%).Setting Two secondary schools in the London district of Tower Hamlets.Measures Demographic, areca nut habits used, age first used, still using, frequency of use.Results Users of any areca nut habit were exclusively from the South Asian population. Of this population, 77% had engaged in a habit, and dependent upon habit between 54 and 92% of these still remained current users. The highest prevalence of current use for boys and girls respectively was for areca nut alone (36%, 43%), followed by mistee pan (35%, 29%), betel-quid (27%, 26%) and pan masala (14%, 16%). Of the current users, 44% engaged in one habit only, 24% two, 20% three and 13% all four. The highest period of risk for starting to use areca nut alone, betel-quid and mistee pan was between ages 5 and 12, whilst for pan masala it was after 10. Boys had a significantly higher risk of beginning use before 10 (P < .001) and a higher frequency of use for pan masala (P < .01), areca nut alone (P < .05) and betel-quid (P = .06) than girls. The frequency of using each habit was between 3 and 5 episodes per week, however boys use pan masala approximately 10 times per week.Conclusion South Asian children may already be experienced users of areca nut. Greater attention should be directed towards identifying signs of oral submucous fibrosis, oral cancer and other potentially malignant lesions within the South Asian population.

Temporal-spatial memory: retrieval of spatial information does not reduce recency

Factors influencing the shape of serial position curves in non-verbal serial short-term memory were examined, using a task testing memory for the position of dots. Similar recency slopes were found when both position and order were recalled (Experiment 1A) and when order only was required (Experiment 1B). This observation was confirmed and tested further in conditions requiring the same encoding but different amounts of spatial information at retrieval (Experiment 2). However, Experiment 2 also revealed an effect of spatial information retrieval on the overall level of memory for recency items. Overall, the results indicate that spatial items produce bow-shaped serial positions curves in tasks requiring the maintenance of order information and that recency is affected by the demand on spatial information retrieval in terms of the overall level of performance but not in terms of the recency slope. These findings are contrary to what is found in the literature on serial verbal recall when both item and order information are required.

Greater professional empathy leads to higher agreement about decisions made in the consultation

OBJECTIVE To examine the relationship between professional expression of empathy and agreement about decisions made in the consultation. METHODS Consultations between 86 individuals with diabetes and four dieticians were audio-recorded. Immediately following consultations patients and dieticians independently reported decisions made in a booklet. Audio-recordings were coded directly for empathy using an amended version of the empathic communication coding system (ECCS). RESULTS Empathy correlated significantly with patient and professional agreement about decisions made in the consultation (τ=.283, p=.0005). Multiple regression analysis indicates that for each dietician the greater the empathy the higher the level of agreement about decisions (p<.0005). Professional empathic response to patients statements of challenge was a significant factor in increasing agreement about decisions (p=.008). CONCLUSION Results support the hypothesis that greater professional empathy will result in greater agreement about decisions made in consultations. PRACTICE IMPLICATIONS Findings have implications for empathy training and provide guidance on the communication skills needed to support expression of empathy. Patient and professional agreement about decisions made provides a simple marker of effectiveness and highlights the importance of empathy as a seminal component of professional communication skills during a patient consultation.

Enhancing Self-Practice/Self-Reflection (SP/SR) Approach to Cognitive Behaviour Training Through the Use of Reflective Blogs

BACKGROUND Self-Practice/Self-Reflection (SP/SR) is increasingly beginning to feature as a central component of CBT training programmes (Bennett-Levy et al., 2001). Programmes including a reflective element, however, are not unproblematic and it has been documented that simply setting time aside for reflection does not necessarily result in trainees using such time to reflect. Such limitations may be overcome by including a requirement to post reflections on reflective blogs. AIM To examine the effect that a requirement to contribute to a reflective blog had upon a SP/SR approach to CBT training. METHOD A focus group methodology was adopted with data analyzed using a general inductive qualitative approach. RESULTS The requirement to use blogs to reflect upon the self-practice of CBT techniques enhanced SP/SR, established a learning community, and improved course supervision, although some technical difficulties arose. CONCLUSIONS Consideration should be given towards using reflective blogs to support a SP/SR approach to CBT training. Benefits afforded by the use of reflective blogs further establish SP/SR as a valid and flexible training approach.