Stephen Kellett

Increasing attendance for psychotherapy: Implementation intentions and the self-regulation of attendance-related negative affect.

The present study evaluated an implementation intention intervention that aimed to increase attendance at scheduled, initial appointments for psychotherapy by helping clients to manage negative feelings about attendance. Participants received a postal questionnaire that measured their views about attending psychotherapy. One half of the sample was randomly assigned to an implementation intention induction that was embedded in the questionnaire. Intention-to-treat analysis (N=390) indicated that participants who formed implementation intentions were more likely to attend compared to controls (75% vs. 63%), and this effect was even stronger among participants who returned the questionnaire (83% vs. 57%). Whereas anticipated affective costs (e.g., shame) had a negative impact on attendance for most participants, this effect was attenuated when participants formed implementation intentions and perceived that attendance would be beneficial. Thus, implementation intention formation can help clients to deal effectively with negative feelings that might otherwise prevent them attending their first psychotherapy appointment.

Delivering group psychoeducational CBT in Primary Care: comparing outcomes with individual CBT and individual psychodynamic-interpersonal psychotherapy.

Within psychological services in Primary Care, service providers are expected and required to deliver clinical services that are prompt, safe and effective. However, long wait-times for treatment are common, with attendant clinical chronicity and risk issues. Evaluations of group-based treatments in Primary Care, which are clinically more efficient than individual treatments, are extremely scarce. The current evaluation attempted to appraise the effectiveness of a service innovation of introducing group-based psychoeducational cognitive-behaviour therapy (CBT; N=43), by comparing outcomes with clients treated in individual CBT (N=68) and individual psychodynamic-interpersonal psychotherapy (N=65). Group psychoeducational participants completed validated scales of psychological functioning (Beck Depression Inventory - 2, BDI-2; Brief Symptom Inventory, BSI; Inventory of Interpersonal Problems, IIP-32; and General Health Questionnaire, GHQ-12) at assessment, start of group, termination of group and 3-month follow-up, whereas participants in the individual therapies completed measures only at initiation and termination of treatment. The results indicate broad similarities between the outcomes achieved by the three services, with rates of clinically significant improvements and deteriorations comparable in the main across services. The results are discussed in terms of identified methodological limitations, service implications and models of service delivery for the psychological therapies in Primary Care.

Measuring Interpersonal Problems in People with Mental Retardation.

Despite interpersonal problems being commonplace in the clinical presentations of people with mental retardation, previous efforts to index interpersonal difficulties have tended to unsatisfactorily rely on external ratings. The Inventory of Interpersonal Problems-32 is a psychometrically robust self-report measure of interpersonal problems in adult populations. We found that this instrument retained many of its psychometric properties when used with a sample of 255 respondents with mild mental retardation. Results indicate four usable subscales alongside the full-scale when employed with this population. The subscales produced generally satisfactory internal and test-retest reliabilities and sound concurrent and internal-external criterion-related validities. Results are discussed with reference to further development of the measure in relation to people with mental retardation.

Eliciting mixed emotions: a meta-analysis comparing models, types, and measures

The idea that people can experience two oppositely valenced emotions has been controversial ever since early attempts to investigate the construct of mixed emotions. This meta-analysis examined the robustness with which mixed emotions have been elicited experimentally. A systematic literature search identified 63 experimental studies that instigated the experience of mixed emotions. Studies were distinguished according to the structure of the underlying affect model—dimensional or discrete—as well as according to the type of mixed emotions studied (e.g., happy-sad, fearful-happy, positive-negative). The meta-analysis using a random-effects model revealed a moderate to high effect size for the elicitation of mixed emotions (dIG+ = 0.77), which remained consistent regardless of the structure of the affect model, and across different types of mixed emotions. Several methodological and design moderators were tested. Studies using the minimum index (i.e., the minimum value between a pair of opposite valenced affects) resulted in smaller effect sizes, whereas subjective measures of mixed emotions increased the effect sizes. The presence of more women in the samples was also associated with larger effect sizes. The current study indicates that mixed emotions are a robust, measurable and non-artifactual experience. The results are discussed in terms of the implications for an affect system that has greater versatility and flexibility than previously thought.

Utility of the Rosenberg Self-Esteem Scale

The Rosenberg Self-Esteem Scale (RSES) continues to be used to purportedly measure self-esteem of people with intellectual disabilities, despite the lack of sound evidence concerning its validity and reliability when employed with this population. The psychometric foundations of the RSES were analyzed here with a sample of 219 participants with intellectual disabilities. The factor analytic methods employed revealed two factors (Self-Worth and Self-Criticism) and more specific problems with RSES Items 5 and 8. Overall, this scale showed only moderate temporal and moderate internal reliability and poor aspects of criterion validity. Results are discussed with reference to either developing a new measure of self-esteem or redesigning and simplifying the RSES in order to increase its initial face validity in intellectual disability samples.

Acne : A biopsychosocial and evolutionary perspective with a focus on shame

PURPOSE Hypotheses regarding the psychological factors implicated in the development and maintenance of acne first emerged in the middle of the eighteenth century. However, the psychodermatological literature from this date relating to acne has variously been described as confusing, overly prone to conjecture and, in particular, atheoretical. The current paper has two key objectives; first, to present a biopsychosocial model of acne development and maintenance and, secondly, to understand the psychosocial strain imposed by acne from an evolutionary perspective with a particular emphasis on body shame reactions. METHODS The psychodermatological literature relating to acne is reviewed with the data analysed for potential biopsychosocial interactions and shame eliciting responses. RESULTS The review indicates that acne can be reconceptualized as a biopsychosocial phenomena which, in turn, provides the field with innovative hypotheses for empirical inquiry and the potential for expanding and evaluating treatment options. The evolutionary analysis illustrates that acne provides the potential for distressing body shame reactions due to the skin diseases potential for damaging self-other evaluations of attractiveness. CONCLUSIONS Acne has tended to be viewed as a minor dermatological complaint which imposes minimal psychological distress upon sufferers. The paper concludes that acne has the ability to elicit in some sufferers significant mental health concerns due to a heightened sense of shame relating to appearance.

The treatment of dissociative identity disorder with cognitive analytic therapy : Experimental evidence of sudden gains

ABSTRACT The central aim of this study was to assess the effectiveness of cognitive analytic therapy (CAT) with a patient presenting with DID. The methodology employed an A/B single case experimental design with six-months continuous follow-up in seven experimental measures. A and B represent the assessment of seven dissociative experimental variables under two conditions: baseline (A) and treatment (B). Treatment consisted of 24 sessions of CAT with four follow-up sessions, which is standard within the CAT model for personality disorder patients. A battery of measures of general psychological functioning was also completed at assessment, termination, and follow-up. During treatment the intensity of a range of dissociative symptoms was observed to be reduced, with sudden gains evident due to specific CAT interventions in specific dissociative symptoms. The long-term effectiveness of the intervention was established by the illustration of either continued stability or continued improvement in experimental variables across the follow-up period. Analysis of the general measures illustrates clinically significant change across a variety of robust psychometric measures. The study illustrates the utility of single-case approaches with dissociative disorders and the potential for utilizing CAT generally with such presentations.

The clinical and occupational effectiveness of condition management for Incapacity Benefit recipients

OBJECTIVES. The aim of the Condition Management Programme (CMP) is to help Incapacity Benefit recipients manage their health conditions more effectively and return to work. This paper seeks to examine the clinical and employment outcomes from a group-based and mixed-condition CMP. DESIGN. In a prospective cohort design, measures of employment status and psychological well-being were taken at three time points; pre-CMP, post-CMP, and at 3-month follow-up. METHOD. Participants (N= 2,064) with a variety of physical and mental health conditions voluntarily attended a seven session cognitive-behaviourally informed psychoeducational group intervention. The psychological measures used were the Clinical Outcomes in Routine Evaluation - Outcome Measure, Work and Social Adjustment Scale, Self-Efficacy Scale, and the Intrinsic Motivation Scale. The employment status of participants was also measured at the three time points of the evaluation. RESULTS. Following CMP, 50% of participants experienced a reliable improvement in psychological well-being and 26% had either taken some steps towards work or returned to work at follow-up. Participants with a mental health condition were more likely to experience a reliable improvement in psychological well-being compared to those with physical health conditions. CONCLUSIONS. The results suggest that participation in CMP may be helpful in facilitating more effective self-management of the health conditions contributing to unemployment. The results have implications for whether formal employment assistance should be available in mental health services.

Investigating goal conflict as a source of mixed emotions

This research investigated whether (1) the experience of mixed emotions is a consequence of activating conflicting goals and (2) mixed emotions are distinct from emotional conflict. A preliminary experiment (Study 1, N = 35) showed that an elicited goal conflict predicted more mixed emotions than a condition where the same goals were not in conflict. The second experiment was based on naturally occurring goal activation (Study 2, N = 57). This illustrated that mixed emotions were experienced more following conflicting goals compared with a facilitating goals condition—on both a direct self-report measure of mixed emotions and a minimum index measure. The results also showed that mixed emotions were different to emotional conflict. Overall, goal conflict was found to be a source of mixed emotions, and it is feasible that such states have a role in resolving personal dilemmas.

The clinical effectiveness of stepped care systems for depression in working age adults: a systematic review.

BACKGROUND Stepped care service delivery models involve treatments that become increasingly intense through successive steps, with patients re-assigned via pre-defined decision criteria. This article reviews the clinical effectiveness of stepped care systems for depression in working age adults. METHODS Systematic literature review of quantitative clinical outcome evidence comprising 14 controlled and uncontrolled studies meeting specified criteria. Principal outcomes were (a) recovery rates, defined as patients no longer meeting clinical cut-off criteria for the specific outcome measure and (b) treatment response rates, defined as a 50% decrease in outcome measure score. RESULTS Stepped care systems had recovery rates ranging predominantly between 40% and 60% and response rates approximating 60%. Studies comparing stepped care with usual/enhanced usual care tended to find significant differences favouring stepped care. The median recovery odds ratio was 1.31 (interquartile intervals of 1.05 and 1.66; k=7 studies). The median comparative Cohens d effect size estimate was 0.41 (interquartile intervals 0.25 and 0.45; k=5 studies). LIMITATIONS The inclusion of uncontrolled studies could be seen as reducing the overall quality of evidence and a meta-analysis was not included due to limitations with the available data. CONCLUSIONS Evidence suggested that stepped care interventions for depression are at least as effective as usual care. However, the clinical and organisational superiority of stepped care is yet to be scientifically verified. Differential benefits of stepped care may ultimately depend on service quality. Further research investigating and comparing the specific components and configurations of stepped care interventions are indicated.