1. Study examines effect of CBT on chronic pain patients

    June 26, 2017 by Ashley

    From the European League against Rheumatism press release:

    The results of a study presented today at the Annual European Congress of Rheumatology (EULAR) 2017 has shown that Acceptance and Commitment Therapy, a form of cognitive behavioural therapy (CBT) that focuses on psychological flexibility and behaviour change, provided a significant reduction in self-reported depression and anxiety among patients participating in a pain rehabilitation programme.

    This treatment also resulted in significant increases in self-efficacy, activity engagement and pain acceptance.

    To assess the potential benefits of an 8-week programme of group Acceptance and Commitment Therapy (ACT) in people with persistent pain, measures of pain acceptance and activity engagement were taken using the Chronic Pain Acceptance Questionnaire. Measures of psychological distress using the Hospital Anxiety and Depression Scale and self-efficacy were also taken at assessment, on the final day of the programme, and at the follow up six-month review.

    For those chronic pain patients with scores at all three time points, there were statistically significant improvements in all parameters between baseline and at six-months follow-up, including the change in mean score of depression, anxiety, self-efficacy, activity engagement and pain willingness (p<0.001).

    “To further validate the role of ACT in the treatment of chronic pain, specifically in a rheumatology context, a randomised controlled clinical trial that includes measures of physical and social functioning within a Rheumatology service would be desirable,” said lead author Dr. Noirin Nealon Lennox from Ulster University in Northern Ireland.

    ACT is a form of CBT that includes a specific therapeutic process referred to as “psychological flexibility”. ACT focuses on behaviour change consistent with patients’ core values rather than targeting symptom reduction alone. Evidence for this approach to the treatment of chronic pain has been mounting since the mid 2000’s. A previous systematic review had concluded that ACT is efficacious for enhancing physical function and decreasing distress among adults with chronic pain attending a pain rehabilitation programme.

    In this study, patients were referred into the ACT programme by three consultant rheumatologists over a five-year period. Over one hundred patients’ outcome measures were available for a retrospective analysis.


  2. Sleep duration impacts treatment response for depressed patients with insomnia

    June 21, 2017 by Ashley

    From the American Academy of Sleep Medicine press release:

    Preliminary results from a new study show that depressed patients with insomnia who sleep seven or more hours per night are more likely to benefit from cognitive behavioral therapy for insomnia (CBTI) and achieve depression remission.

    Results show that when insomnia and depression co-occur, longer pre-treatment objective sleep duration is predictive of remission of both disorders when patients are given a combination of CBTI for insomnia and antidepressant medication for depression.

    “A seven-hour, objective sleep duration of patients prior to entering treatment increased their chances of achieving both depression and insomnia remission by their treatment endpoints,” said lead author and co-principal investigator Jack D. Edinger, PhD, professor in the Section of Sleep Medicine at National Jewish Health in Denver, Colorado.

    The study involved 104 adults, including 75 women, who enrolled in the Treatment of Insomnia and Depression Study and completed one baseline night of polysomnography. Participants received 16 weeks of anti-depressant medication and were randomly assigned either to CBTI or sham insomnia therapy. The Hamilton Rating Scale for Depression (HAMD-17) and Insomnia Severity Index were administered at baseline and then bi-weekly during treatment to determine depression and insomnia remission.

    The study was part of a larger research project for which Edinger was co-investigator along with co-investigators Daniel Buysse, MD, from the University of Pittsburgh; Andy Krystal, MD, from Duke University and the University of California, San Francisco; and lead principal investigator Rachel Manber, PhD, professor of psychiatry and behavioral sciences at the Stanford University Medical Center.

    “Our findings highlight the importance of adequate objective sleep in the recovery from depression and insomnia,” said Manber. “The data suggest that short sleep duration may be a risk for refractory depression.”

    The research abstract was published recently in an online supplement of the journal Sleep and will be presented Monday, June 5, in Boston at SLEEP 2017, the 31st Annual Meeting of the Associated Professional Sleep Societies LLC (APSS), which is a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.


  3. APA study suggests patients more likely to refuse drug therapy than psychotherapy for mental health

    March 23, 2017 by Ashley

    From the American Psychological Association press release:

    People seeking help for mental disorders are more likely to refuse or not complete the recommended treatment if it involves only psychotropic drugs, according to a review of research published by the American Psychological Association.

    Researchers conducted a meta-analysis of 186 studies of patients seeking help for mental health issues that examined whether they accepted the treatment that was recommended and if they did, whether they completed it. Fifty-seven of the studies, comprising 6,693 patients, had a component that reported refusal of treatment recommendations, and 182 of the studies, comprising 17,891 patients, had a component reporting premature termination of treatment.

    After diagnosis, patients in the studies were recommended to drug-only therapy (pharmacotherapy), talk therapy (psychotherapy) or a combination of the two.

    “We found that rates of treatment refusal were about two times greater for pharmacotherapy alone compared with psychotherapy alone, particularly for the treatment of social anxiety disorder, depressive disorders and panic disorder,” said lead researcher Joshua Swift, PhD, of Idaho State University. “Rates of premature termination of therapy were also higher for pharmacotherapy alone, compared with psychotherapy alone, particularly for anorexia/bulimia and depressive disorders.”

    The research was published in the APA journal Psychotherapy.

    Across all the studies, the average treatment refusal rate was 8.2 percent. Patients who were offered pharmacotherapy alone were 1.76 times more likely to refuse treatment than patients who were offered psychotherapy alone. Once in treatment, the average premature termination rate was 21.9 percent, with patients on drug-only regimens 1.2 times more likely to drop out early. There was no significant difference for refusal or dropout rates between pharmacotherapy alone and combination treatments, or between psychotherapy alone and combination treatments.

    While Swift said the findings overall were expected, the researchers were most surprised by how large the differences were for some disorders. For example, patients diagnosed with depressive disorders were 2.16 times more likely to refuse pharmacotherapy alone and patients with panic disorders were almost three times more likely to refuse pharmacotherapy alone.

    The findings are especially interesting because, as a result of easier access, recent trends show that a greater percentage of mental health patients in the U.S. are engaging in pharmacotherapy than psychotherapy, according to co-author Roger Greenberg, PhD, SUNY Upstate Medical University.

    Some experts have argued that psychotherapy should be the first treatment option for many mental health disorders. Those arguments have been largely based on good treatment outcomes for talk therapy with fewer side effects and lower relapse rates, said Greenberg. “Our findings support that argument, showing that clients are more likely to be willing to start and continue psychotherapy than pharmacotherapy.”

    Swift and Greenberg theorized that patients may be more willing to engage in psychotherapy because many individuals who experience mental health problems recognize that the source of their problems may not be entirely biological.

    “Patients often desire an opportunity to talk with and work through their problems with a caring individual who might be able to help them better face their emotional experiences,” said Greenberg. “Psychotropic medications may help a lot of people, and I think some do see them as a relatively easy and potentially quick fix, but I think others view their problems as more complex and worry that medications will only provide a temporary or surface level solution for the difficulties they are facing in their lives.”

    While the meta-analysis provides information on refusal and dropout rates, the studies did not report the patients’ reasons for their actions, Swift noted. Going forward, research designed to identify these reasons could lead to additional strategies to improve initiation and completion rates for both therapies, he said. It is also important to note that participants in the research studies initially indicated they were willing to be assigned to any therapy, and therefore may not be representative of all consumers of treatment.


  4. Talking therapy changes brain wiring, study reveals for first time

    January 23, 2017 by Ashley

    From the King’s College London media release:

    psychotherapy discussionA new study from King’s College London and South London and Maudsley NHS Foundation Trust has shown for the first time that cognitive behaviour therapy (CBT) strengthens specific connections in the brains of people with psychosis, and that these stronger connections are associated with long-term reduction in symptoms and recovery eight years later.

    CBT — a specific type of talking therapy — involves people changing the way they think about and respond to their thoughts and experiences. For individuals experiencing psychotic symptoms, common in schizophrenia and a number of other psychiatric disorders, the therapy involves learning to think differently about unusual experiences, such as distressing beliefs that others are out to get them. CBT also involves developing strategies to reduce distress and improve wellbeing.

    The findings, published in the journal Translational Psychiatry, follow the same researchers’ previous work which showed that people with psychosis who received CBT displayed strengthened connections between key regions of the brain involved in processing social threat accurately.

    The new results show for the first time that these changes continue to have an impact years later on people’s long-term recovery.

    In the original study, participants underwent fMRI imaging to assess the brain’s response to images of faces expressing different emotions, before and after six months of CBT. Participants were already taking medication when they took part in the study, and so were compared to a group receiving medication only. The group receiving medication only did not show any increases in connectivity, suggesting that the effects on brain connections could be attributed to the CBT.

    For the new study, the health of 15 of the 22 participants who received CBT was tracked for eight years through their medical records. They were also sent a questionnaire at the end of this period to assess their level of recovery and wellbeing.

    The results show that increases in connectivity between several brain regions — most importantly the amygdala (the brain’s threat centre) and the frontal lobes (which are involved in thinking and reasoning) — are associated with long-term recovery from psychosis. This is the first time that changes in the brain associated with CBT have been shown to be associated with long-term recovery in people with psychosis.

    Lead author of the study Dr Liam Mason from King’s College London, who is a clinical psychologist at the Maudsley Hospital where the research took place, said: “This research challenges the notion that the existence of physical brain differences in mental health disorders somehow makes psychological factors or treatments less important. Unfortunately, previous research has shown that this ‘brain bias’ can make clinicians more likely to recommend medication but not psychological therapies. This is especially important in psychosis, where only one in ten people who could benefit from psychological therapies are offered them.”

    The researchers now hope to confirm the results in a larger sample, and to identify the changes in the brain that differentiate people who experience improvements with CBT from those who do not. Ultimately, the results could lead to better, and more tailored, treatments for psychosis, by allowing researchers to understand what determines whether psychological therapies are effective.

     


  5. Active-duty military find PTSD relief through individual cognitive therapy

    November 29, 2016 by Ashley

    From the Duke University Medical Center media release:

    military_soldierAlthough both group and individual therapy can ease post-traumatic stress disorder (PTSD) symptoms in active-duty military service members, individual therapy relieved PTSD symptoms better and quicker, according to a study led by a Duke University School of Medicine researcher.

    The randomized clinical trial is the largest to date to examine an evidence-based treatment for active-duty military service members, with 268 participants from the U.S. Army’s Fort Hood in Killeen, Texas. Findings will be published Nov. 23 in JAMA Psychiatry.

    The study analyzed the effectiveness of six weeks of Cognitive Processing Therapy (CPT), and found that nearly half the participants in one-on-one therapy improved so much they no longer carried a PTSD diagnosis. Almost 40 percent of the participants in group sessions also dropped their PTSD diagnoses after six weeks.

    For some of the participants, you can see a change just by looking at them — as though they have been unburdened,” said Patricia Resick, Ph.D., the study’s lead author, who developed CPT in the 1980s for victims of rape and other interpersonal trauma and is now a professor of psychiatry and behavioral sciences at the Duke University School of Medicine.

    “Some people think you have to go to therapy for years to address PTSD, but in this large-scale clinical trial with CPT, we saw a large percentage of patients show significant improvements and even recover from PTSD in a matter of weeks,” Resick said.

    CPT examines how an individual thinks about a traumatic event and how that affects their emotions, Resick said.

    “We look at what people have been saying to themselves about the trauma, which in people with PTSD can be distorted,” Resick said. “Many of them think there’s something they could have done differently to prevent the trauma. We teach them how to examine their thoughts and feel their natural emotions instead of feelings, such as guilt or blame that may result from distorted thinking. We go back and look at the evidence. Once they think in a more balanced, factual way, their emotions and symptoms of PTSD subside.”

    To measure effectiveness in active-duty military members, the trial was established through STRONG STAR Consortium, a multi-institutional initiative to develop and evaluate effective prevention, detection and treatment of combat-related PTSD. The consortium is funded by the U.S. Department of Defense.

    “Cognitive-behavioral therapies such as CPT and Prolonged Exposure therapy are the leading treatments for PTSD, with the most scientific support for their effectiveness,” said Alan Peterson, Ph.D., director of the STRONG STAR Consortium and professor of psychiatry at the University of Texas Health Science Center San Antonio.

    However, both were developed primarily for civilians, and until the STRONG STAR Consortium was developed, they had never been evaluated in clinical trials with an active-duty military population,” said Peterson, who is also a retired lieutenant colonel of the U.S. Air Force. “This study shows that CPT is effective, but it still needs to be adapted and tailored in ways that increase its effectiveness with combat-related PTSD so that more patients can fully recover.”

    About half of the participants were assigned to group therapy, attending 90-minute sessions twice a week for six weeks. The other half met one-on-one with a therapist for 60-minute sessions twice a week for six weeks.

    Independent evaluators used standard PTSD diagnostic tools to measure the severity of PTSD and associated conditions such as depression and suicidal thoughts. The participants were evaluated before and during treatment, with a follow-up six months after the treatment was over.

    For all participants, PTSD-related symptoms such as nightmares, intrusive thoughts or being easily startled improved. Overall, about 50 percent of participants experienced such improvement that they no longer met the criteria for a PTSD diagnosis, although many still had some symptoms, particularly trouble sleeping, Resick said.

    Those who attended individual therapy saw more significant improvements in the severity of their PTSD symptoms and the improvements were seen more quickly, Resick said.

    The study also showed that whether subjects received group or individual therapy, they had equal reductions in depression and suicidal thinking. These results continued through a six-month follow-up.

    The findings are based on the total 268 participants who enrolled and intended to complete the full six-week program. Overall results include about 9 percent of participants who did not begin treatment due to military deployment or other reasons, and participants who received fewer than 12 sessions (full details included in manuscript).

    The findings, although encouraging, show that many participants still had lingering symptoms after six weeks of treatment, and about half retained their PTSD diagnosis. Further research will allow researchers to refine the therapy, considering any specific adjustments for active-duty service members such as varying the number of weeks patients would participate. Researchers with the STRONG STAR Consortium will also expand on the research by evaluating the roles of substance abuse and traumatic brain injury on patients’ outcomes.


  6. Use of mindfulness-based stress reduction for chronic low back pain

    October 20, 2016 by Ashley

    From the The JAMA Network Journals media release:

    senior business teacher meditatingAmong adults with chronic low back pain, both mindfulness-based stress reduction [MBSR] and cognitive behavioral therapy [CBT] resulted in greater improvement in back pain and functional limitations when compared with usual care, according to a study appearing in the March 22/29 issue of JAMA.

    Low back pain is a leading cause of disability in the United States. There is need for treatments with demonstrated effectiveness that are low risk and have potential for widespread availability. Mindfulness-based stress reduction (MBSR) focuses on increasing awareness and acceptance of moment-to-moment experiences including physical discomfort and difficult emotions. Only 1 large randomized clinical trial has evaluated MBSR for chronic low back pain, and that trial was limited to older adults.

    Daniel C. Cherkin, Ph.D., of Group Health Research Institute, Seattle, and colleagues randomly assigned 342 adults age 20 to 70 years with chronic low back pain to receive MBSR (n = 116), cognitive behavioral therapy (CBT; n = 113), or usual care (n = 113). CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. Usual care included whatever other treatment, if any, the participants received. The average age of the participants was 49 years; the average duration of back pain was 7.3 years.

    The researchers found that at 26 weeks, the percentage of participants with clinically meaningful improvement on a measure of functional limitations was higher for those who received MBSR (61 percent) and CBT (58 percent) than for usual care (44 percent). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 44 percent in the MBSR group and 45 percent in the CBT group, vs 27 percent in the usual care group. Findings for MBSR persisted with little change at 52 weeks for both primary outcomes.

    “The effects were moderate in size, which has been typical of evidence-based treatments recommended for chronic low back pain. These benefits are remarkable given that only 51 percent of those randomized to receive MBSR and 57 percent of those randomized to receive CBT attended at least 6 of the 8 sessions,” the authors write.

    “These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.”

    Editorial: Is It Time to Make Mind-Body Approaches Available for Chronic Low Back Pain?

    “Although understanding the specificity of treatment effects, mechanisms of action, and role of mediators are important issues for researchers, they are merely academic for many clinicians and their patients. For patients with chronic painful conditions, options are needed to help them live with less pain and disability now,” write Madhav Goyal, M.D., M.P.H., and Jennifer A. Haythornthwaite, Ph.D., of Johns Hopkins University School of Medicine, Baltimore.

    The challenge is how to ensure that these mind-body interventions are available, given the existing evidence demonstrating they may work for some patients with chronic low back pain. Most physicians encounter numerous obstacles finding appropriate referrals for mind-body therapies that their patients can access and afford. High-quality studies such as the clinical trial by Cherkin et al create a compelling argument for ensuring that an evidence-based health care system should provide access to affordable mind-body therapies.”

     


  7. Behavioral activation as effective as CBT for depression, at lower cost

    July 25, 2016 by Ashley

    From the University of Exeter media release:

    relaxation_hypnotherapyA simple and inexpensive therapy is equally as effective at treating depression as the “gold standard” of Cognitive Behavioural Therapy (CBT), a largescale study has concluded.

    Behavioural Activation (BA) is relatively simple, meaning it can be delivered by more junior staff with less training, making it a cost-effective option. It is around 20 per cent cheaper than CBT, meaning it could help ease current difficulties in accessing therapy, and could make it more realistic to deliver for a wider range of countries worldwide. BA encourages people to focus on meaningful activities driven by their own personal values as a way of overcoming depression.

    Led by researchers from the University of Exeter, the multi-centre COBRA study is one of the largest in the world to assess psychological treatments of depression through a randomised controlled trial, by comparing different treatments between groups.

    The study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme and published in The Lancet. A collaborative team of researchers from the Universities of Exeter, York, Kings College London and Tees Esk and Wear Valleys NHS Foundation Trust worked with clinical services, to investigate the effectiveness and cost effectiveness of BA. The treatments were delivered by NHS mental health workers and therapists in NHS Mental health Trusts in Devon (Devon Partnership NHS Trust), County Durham (Tees, Esk and Wear Valley’s NHS Foundation Trust) and Leeds (Leeds and York Partnership NHS Foundation Trust).

    Professor David Richards, NIHR Senior Investigator at the University of Exeter Medical School, led the study. He said: “Effectively treating depression at low cost is a global priority. Our finding is the most robust evidence yet that Behavioural Activation is just as effective as CBT, meaning an effective workforce could be trained much more easily and cheaply without any compromise on the high level of quality. This is an exciting prospect for reducing waiting times and improving access to high-quality depression therapy worldwide, and offers hope for countries who are currently struggling with the impact of depression on the health of their peoples and economies.”

    Clinical depression is the second largest cause of disability globally, affecting around 350 million people worldwide. The impact on economic output across the world is projected to be US$5.36 trillion between 2011 and 2030. Although CBT is known to be effective, access is often restricted, with long waiting lists. In England, 1 in 10 people have been waiting over a year to receive talking therapy, whilst in the USA, only about a quarter of people with depression have received any type of psychological therapy in the last 12 months.

    Part of the reason for this is the cost of delivery. Typically, in the UK, a CBT therapist earns £31,383 to £41,373, while a BA therapist earns £21,909 to £28,462, making BA much cheaper to deliver. On average, CBT cost £1,235 per participant, while BA cost £975 per head — a saving of £260 per patient.

    Yet, until now, the UK’s National Institute for Health and Clinical Excellence (NICE) has said there is insufficient evidence to recommend behavioural activation as a first-line treatment in clinical guidelines, and has called for more robust research to investigate the benefits. The Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA) trial, one of the largest of its kind in the world, was designed to meet this need.

    The trial recruited participants from primary care and psychological services in three sites in Devon, Durham, and Leeds. The 440 participants were split into two groups — 219 were given CBT and 221 received BA. The groups were followed up and assessed at six, 12 and 18 months. The researchers found no difference between the groups at follow-up, providing the strongest evidence to date that BA is just as effective as CBT.

    Behavioural activation is an ‘outside in’ treatment that focusses on helping people with depression to change the way they act. BA helps people make the link between their behaviour and their mood. Therapists help people to seek out and experience more positive situations in their lives. The treatment also helps people reduce the amount of times they avoid difficult situations and helps them find alternatives to unhelpful habitual behaviours.

    In contrast, CBT is an ‘inside out’ treatment where therapists focus on the way a person thinks. Therapists help people to identify and challenge their thoughts and beliefs about themselves, the world and their future. CBT helps people to identify and modify negative thoughts and the beliefs that give rise to them.

    A year after the start of treatment, BA was found to be non-inferior (not worse than) than CBT, with around two-thirds of participants in both groups reporting at least a 50% reduction in depressive symptoms. Participants in both groups also reported similar numbers of depression free days and anxiety diagnoses, and were equally likely to experience remission. Cost of delivery for BA therapy was found to be around 20% cheaper than CBT.

    In line with other trials of a similar nature, drop-out rates were around 20% and around a third of participants in both groups did not attend the minimum number of therapy sessions.

    Dr Peter Aitken, Director of Research and Development at Devon Partnership NHS Trust, said: “Research into psychological therapies and mental health is incredibly important and we are always looking for treatments and approaches that offer people better outcomes and, wherever possible, improved cost efficiency. Last year our Depression and Anxiety Service in Devon, which supports people with mild to moderate needs, received 20,000 referrals and we know that the incidence of depression is steadily increasing. Contributing to the research agenda and taking forward treatments such as Behavioural Activation is vital if our services are to keep pace with this rising demand and offer value for money.”

    Dr David Ekers, nurse consultant from TEWV, who led the Durham study site, said: “The practical nature of BA and the relative simplicity of delivery makes it an attractive option for NHS services. We have already seen considerable interest within TEWV to make this effective intervention more available to its service users. Whilst we must ensure ongoing quality to reflect what was provided in the COBRA study, this intervention will offer a cost effective option to provide evidence based psychological interventions for depression across a range of clinical teams.”


  8. Blending therapies improves treatment of severe anxiety

    March 22, 2016 by Ashley

    From the York University media release:

    psychotherapy discussionMotivating willingness to change is important in treating a person with severe worry. For this, integrating motivational interviewing (MI) techniques into the commonly practised cognitive behavioral therapy (CBT) is the ideal option, a study led by a York University researcher reveals.

    Our research shows that therapists need to have two sets of skills — to help people become ready for change, and then to help them accomplish that change,” says Dr. Henny Westra, a psychology professor in the Faculty of Health at York U. “The study results suggest that integrating motivational interviewing (MI) with CBT is more effective than CBT alone for long-term improvement.”

    It is normal to feel conflicted about change, and motivational interviewing is an approach that therapists can use to help patients understand and validate the fear of change. It offers a patient-centered way of helping individuals work through their conflicting feelings in order to enhance motivation for change.

    “Because MI is focused on listening and drawing out client ideas, patients feel more confidence in coping with issues facing them even after therapy ends in contrast to having to rely on the therapist’s expertise,” says Dr. Westra, who led the study with Ryerson University Professor Dr. Martin Antony and Professor Dr. Michael Constantino, University of Massachusetts Amherst.

    The five-year study was conducted with grant support from the Canadian Institutes of Health Research. During the randomized clinical trial, 85 participants underwent treatment for severe generalized anxiety disorder (GAD). Cognitive behavioral therapy alone was given to 43 participants and the rest received a combination of CBT and MI from therapists trained in both.

    Although the participants responded well to both the motivationally enhanced CBT and standard CBT during the 15-week treatment phase, those who received the motivationally enhanced treatment continued to improve, the results indicate. Those in the MI-CBT were five times more likely to be free of the diagnosis of generalized anxiety one year after treatment ended.

    According to Dr. Antony, “this study highlights the importance of studying the long term impact of our treatments, as the enhanced improvements seen in people who received the integrated MI and CBT treatment were greatest sometime after treatment had ended.”

    The study titled Integrating Motivational Interviewing with Cognitive-Behavioral Therapy for Severe Generalized Anxiety Disorder: An Allegiance-Controlled Randomized Clinical Trial is published online in the Journal of Consulting and Clinical Psychology.


  9. Group therapy helps autistic children to cope better with everyday life

    January 25, 2016 by Ashley

    From the Goethe-Universität Frankfurt am Main media release:

    autism metaphorIn the framework of group therapy developed at Goethe University Frankfurt, children and adolescents with high functioning ASD can learn how to cope better in the social world and also achieve a lasting effect.

    Social difficulties are one of the main problems for children and adolescents with Autism Spectrum Disorder (ASD). Especially when their intelligence is unaffected, they become more and more conscious in the course of their development of the fact that they are different.

    In the framework of group therapy developed at Goethe University Frankfurt, children and adolescents with high functioning ASD can learn how to cope better in the social world and also achieve a lasting effect. This is confirmed by clinical trials which examined 209 children and adolescents between the ages of 8 and 18 over the course of three years.

    “We often encounter children and adolescents with Autism Spectrum Disorder in clinical practice who would like to communicate with youngsters of their own age and at the same time experience every day that they meet with rejection because they are unable to understand many of their classmates’ behaviour patterns. And this causes them to despair,” explains Professor Christine Freitag, Head of the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy. Together with Dr. Hannah Cholemkery, she has developed a behavioural group therapy programme with instructions and exercises for the improvement of social skills.

    To date, group therapies for the training of social skills for people with ASD have predominantly been investigated in the USA in the framework of smaller trials without any measurement of stability. The objective of the “SOSTA-net Trial,” led by Christine Freitag and coordinated by Hannah Cholemkery and in which six university hospitals in Germany participated, was to examine whether the social responsiveness of children and adolescents with ASD could be raised by means of group-based behavioural therapy. This took place with the aid of a standardized questionnaire (on the basis of a Social Responsiveness Scale — SRS), in which 65 behaviour patterns were evaluated by the parents before the start of group therapy, at the end of the intervention as well as three months after the end of the intervention in order to measure stability.

    Therapy took place once a week over the course of three months in a group with four to five youngsters of the same age and two therapists. There were also three parent evenings. The results were compared with those of a wait list control group. There was a clear improvement in social behaviour in the intervention group, which also remained stable after three months when examined again.

    In particular children with severe symptoms and a higher IQ at the beginning of the therapy were able to profit from it.


  10. How, when and where could affect outcome of psychological treatment

    January 21, 2016 by Ashley

    From the BioMed Central media release:

    support_group_therapyMeeting patients’ preferences for the time and place of their psychological treatment may affect their perception of treatment outcome, a cross-sectional survey by researchers from the Royal College of Psychiatrists and Imperial College London involving 14,587 respondents suggests.

    The study, published in the open access journal BMC Psychiatry, examined treatment preferences of patients involved in the National Audit of Psychological Therapies according to five aspects: venue, time of day, gender of therapist, language that the treatment was delivered in, and therapy type. For each of these features, patients were asked to rate whether or not they had a strong preference and if they were given enough choice. They were also asked to evaluate their satisfaction with treatment outcome using a five-point scale.

    A total of 86% of patients expressed a preference for at least one of the five aspects — time of day and location being the two most popular preferences. Out of those patients, 36.7% said that at least one of their preferences had not been met. Lead researcher, Mike Crawford, said: “People who have preferences for how, when and where psychological treatment is delivered that are not met, are less likely to report that they were helped by the treatment.”

    The researchers analyzed data from anonymous survey results of patients who received treatment from 184 NHS services in England and Wales in 2012-13. They wanted to determine to what degree patients express preferences regarding certain aspects of their psychological treatment, whether they feel that these preferences are met and how that impacts their perception of the treatment outcome.

    The study relied on quantitative survey data based on patient recall rather than qualitative interviews and evaluated perception of outcome, rather than evaluating the outcome itself. Thus, it could not explore whether patients whose preferences were not met went on to benefit less from treatment, or whether the perception of poor outcome was attributed to unmet preferences retrospectively when patients completed the survey.

    Providers of psychological treatment in the UK are encouraged to offer patients choices about their treatments, despite limited information on people’s preferences and a lack of evidence of how meeting these preferences affects therapy outcome. The researchers suggest that their findings highlight the importance of assessing and meeting patient preferences and offering patients adequate choice.

    Mike Crawford said: “Psychological treatment services need to recognize that people often have preferences for how, when and where treatment is delivered. Treatment may be more effective when patient preferences are met by the service.”