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Low educational literacy is associated with high rates of mental health problems. In Pakistan, only 60% of the population is literate. Traditional CBT requires literacy skills. Interventions to address the literacy barriers need to be developed.
Aims:
To evaluate the feasibility, acceptability, and preliminary efficacy of a culturally adapted CBT-based animated ‘Shorts’ series for depression and anxiety in individuals with no or low educational literacy.
Method:
This randomized, rater-blind randomized controlled trial (RCT) compared an animated Shorts series and treatment as usual (TAU) with TAU alone in Pakistan. The primary outcomes were feasibility (recruitment, retention, adherence to treatment and trial processes) and acceptability (drop-outs and participants’ feedback). The secondary outcomes included the Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule 2 (WHODAS 2). Thirty consenting participants were randomly allocated to one of the groups in a 1:1 ratio and were assessed at baseline and the end of the intervention at 12 weeks.
Results:
The intervention was feasible and acceptable and was successful in reducing the symptoms of depression and anxiety. However, these findings need to be further confirmed in a larger RCT.
Conclusions:
These preliminary findings are encouraging, and if future studies confirm that this approach can work, we should be able to overcome the literacy barrier in low- and middle-income countries.
Approximately 24% of stroke survivors develop post-stroke depression (PSD), which is associated with poor psychological recovery, identity disruption, and reduced self-esteem. Psychological interventions often fail to address these broader challenges. The Wisdom Enhancement Timeline technique, which facilitates autobiographical reflection, has shown promise for depression in older adults. It has not yet been studied in a post-stroke population.
Aims:
This study evaluated the effectiveness of the Wisdom Enhancement Timeline technique in stroke. It was hypothesised that wisdom would improve first, followed by identity/self-esteem and mood.
Method:
A multiple-baseline single-case experimental design (SCED) was used across three stroke survivors. Daily visual analogue scale (VAS) ratings measured mood, identity, self-esteem, and wisdom during the trial. The Patient Health Questionnaire-9 (PHQ-9) measured depressive symptoms at pre- and post-intervention. Visual analysis, Tau-U, generalised least squares regression (adjusting for autocorrelation), and piecewise regression evaluated intervention effects.
Results:
Improvements were observed across all participants and outcomes. Tau-U analysis indicated small-to-large effect sizes across outcomes (effect size range: 0.30–0.92). Breakpoints confirmed wisdom improved first, followed by identity/self-esteem and mood last. Regression confirmed significant level shifts across all outcomes. All participants showed clinically meaningful reductions in PHQ-9 scores, operationalised as a shift from pre-intervention scores above 10 to post-intervention scores below 10.
Conclusions:
Wisdom-based interventions could be beneficial in a stroke population, promoting improvements in mood, identity coherence, self-esteem and wisdom. The Wisdom Enhancement Timeline technique shows promise for PSD treatment, although further research is needed to validate these effects.
Coercive control (CC) represents a significant proportion of intimate partner violence (IPV) cases in the UK and globally. While theoretical models on CC exist, none so far includes a psychological perspective. As cognitive behavioural theory (CBT) has a robust evidence base as an IPV intervention for women survivors, it can also be used in the development of a psychological model for CC, from the perspective of survivors. Such a model may have utility as a psychotherapeutic formulation tool and providing training on psychological aspects and impact of CC to other professionals involved in survivors’ care.
Method:
Fourteen women with self-identified experience of CC were screened and interviewed. Constructivist grounded theory was used to analyse the interviews.
Results:
Six theoretical codes were developed: vulnerability factors (difficult childhood experiences, negative previous romantic relationships, and low self-esteem), cognitions (thoughts about worthlessness, isolation, being deserving of the abuse, confusion, hope, being treated unfairly, and suicidal ideation), affect (shame, fear, sadness, and anger), maintaining factors (perceived consequences of leaving, financial situation, low self-esteem, and social norms), behaviours (unhelpful coping strategies of dissociation, subjugation, avoidance, and substance misuse, and protective factors were spending time with loved ones, physical activity, and committing to career and interests), and impact (poor physical health, depression, anxiety, trauma, financial difficulties, and chronic mistrust).
Conclusions:
The results of this study constitute a preliminary CBT model of women survivors’ experiences of CC. Further research is required to test and further develop the model, especially the vulnerability factors and mental health implications of experiencing CC.
Key learning aims
(1) To provide information that supports the need for healthcare professionals to be aware of and receive training on coercive control.
(2) To provide insight into women survivors’ experiences of coercive control within heterosexual relationships.
(3) To provide guidance on how psychological professionals can work with women survivors of coercive control to formulate their experiences and plan interventions.
CBT for psychosis is an established and evolving psychological therapy. Historical controversies about the nature of psychosis persist, and more recent debates about the outcome literature lack precision, muddying the waters further. Based on our experience as clinicians, teachers and supervisors, and following NHS and national lead roles, we describe ten common misconceptions about CBT for psychosis. These include misconceptions about the evidence, the focus of therapy, ‘thinking positively’, and the nature of collaboration and the therapeutic relationship. We refute these misconceptions based on current theory, research, and best practice guidelines. We highlight the need to get out of the clinic room, measure the impact of therapy on personal recovery and autonomy, and meet training and governance requirements. It is essential that clinicians, service leads, and our professional bodies uphold core standards of care if people with psychosis are to have access to high quality CBT of the standard we would be happy to see offered to our own family and friends.
Key learning aims
(1) To recognise common misconceptions about CBT for psychosis.
(2) To counter these misconceptions theoretically and empirically – to inform ourselves, colleagues and service leads committed to ensuring high quality CBT for psychosis.
(3) To highlight statutory and professional body responsibilities to ensure parity of esteem for people with psychosis, who deserve high quality, ‘full dose’ treatments delivered by appropriately trained clinicians, and supported by robust governance systems, just as we would expect for people with physical health conditions.
The chapter will help you to be able to explain what BDD is and how it typically presents, including a preoccupation with either imagined or minor physical flaws, and the resultant safety behaviours to manage the feared impact of others perceiving this flaw, describe and use Veale & Neziroglu’s CBT protocol for BDD, explain the importance of using mirror retraining in treatment, develop a treatment plan for CBT for BDD, using appropriate measures, and take account of comorbidity in managing CBT for BDD, including that of depression, social anxiety and OCD.
The chapter will help you to be able to explain what OCD is and how it typically presents, describe and use evidence-based CBT protocols for OCD, choose and use appropriate formulation models for CBT for OCD, describe the importance of using Exposure and Response Prevention and/or Behavioural Experiments in any treatment plan, develop a treatment plan for CBT for OCD, using appropriate measures, and take account of comorbidity in managing CBT for OCD
The chapter will help you to be able to describe the evolution of disorder specific CBT protocols, explain the value of using a disorder specific protocol over a generic CBT approach, consider the relative efficacy of CBT in different populations, and so choose whether CBT is appropriate for your patient, and if so, which adaptation of CBT would be most helpful
The chapter will help you to be able to describe NICE recommendations for responding immediately after trauma, utilise guidelines in your clinical practice and developing service policy, offer pragmatic and compassionate responses to individuals presenting with very recent trauma exposure
This chapter acts as a clear guide to your theoretical understanding of CBT to enhance your knowledge across protocols, clinical populations and clinical presentations.
You will gain a working knowledge of the theoretical basis of Beck’s model CBT and how theories and models remain important for advancing clinical practice.
You will be able to more effectively apply CBT across protocols as you will have a better elaborated account of how this therapy has integrated elements across conditions and client presentations.
You will become knowledgeable about the theoretical mechanism of change in CBT
You will become more skilled in using theoretical principles of CBT to stay true to execution of treatment protocols.
Access essential information to add to your existing clinical knowledge and skills so as to more effectively work with older people using CBT.Work collaboratively with older people using CBT, planning treatment interventions unencumbered by stereotypical beliefs about ageing and older people and expect symptom reduction consistent with standard treatment protocols.Apply ideas from theories of the science of ageing (gerontology), such as wisdom and emotional development, in order to help your client make use of lifeskills when helping themselves overcome common mental health problems.Use and apply new techniques associated with a developmentally appropriate frame of reference when working with older people.
The chapter will help you to be able to describe the development of remote delivery CBT, both by phone, videoconferencing, and text-based systems, explain the costs and benefits of the various remote formats to both the provider and client, and help your clients choose the most appropriate format for their therapy
The chapter will help you to be able to define Cognitive Behaviour Therapy, explain the key processes within CBT, describe the key features of good CBT as described in therapy rating scales such as the CTSr and CTRS, and consider how to best incorporate the key components of CBT in terms of structure, style and content
The chapter will help you to be able to explain the structure of CBT as a whole, including the purpose of each stage of therapy, effectively structure a treatment session of CBT, so as to ensure the best possible experience for patients, and develop a strong therapeutic alliance with this process, based on active collaboration and genuine empathy, warmth and unconditional positive regard
The chapter will help you to be able to explain what PTSD is and how it typically presents, including the nature of trauma memories and associated re-experiencing, describe and use evidence-based CBT protocols for PTSD, choose and use appropriate formulation models for CBT for PTSD, describe the importance of reprocessing in any treatment plan, develop a treatment plan for CBT for PTSD, and take account of comorbidity in managing CBT for PTSD.
The chapter will help you to be able to describe the different techniques available in CBT, consider the purpose of any given technique in relation to the maintenance cycles it interrupts, and tailor interventions to individual patients, considering their unique strengths and needs.
The chapter will help you to be able to explain the rationale for the development of a national Primary Care Mental Health Service, describe the concept of stepped care, and reflect on the progress and future for NHSTT both in England and worldwide
The chapter will help you to be able to explain what Social Anxiety Disorder is and how it typically presents, including distorted mental representations and selective focus of attention, describe and use evidence-based CBT protocols for Social Anxiety Disorder, choose and use appropriate formulation models for CBT for Social Anxiety Disorder, describe the importance of using exposure to social situations in any treatment plan, develop a treatment plan for CBT for Social Anxiety Disorder, using appropriate measures, and take account of comorbidity in managing CBT for Social Anxiety Disorder
The chapter will help you to be able to explain what panic disorder is and how it typically presents, including unexpected panic attacks, and subsequent fear and attempted avoidance of further attacks, describe and use evidence-based CBT protocols for panic disorder, choose and use appropriate formulation models for CBT for panic disorder, describe the importance of using exposure to panic symptoms in any treatment plan, develop a treatment plan for CBT for panic disorder, using appropriate measures, and take account of comorbidity in managing CBT for panic disorder
The chapter will help you to be able to describe the impact of preoccupation, a sense of responsibility and locus of control in these related disorders, and explain how anxiety disorder interventions were further modified to better aid these populations