Transcript - ePrints Soton - University of Southampton

Dr. Thomas Richardson Clinical Psychologist (1,2)
Dr. Lorraine Bell Consultant Clinical Psychologist (1)
1. Mental Health Recovery Teams, Solent NHS Trust, Portsmouth, UK
2. School of Psychology, University of Southampton, UK
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National Health Service (NHS)
Community Mental Health Recovery Team for Adults
Secondary Care: Severe and Enduring problems
Service covers whole of Portsmouth
Wide range of problems: psychosis, bipolar disorder,
personality disorders etc.
Comorbidity the norm
Most band 6 staff (nurses, occupational therapists and
social workers) required to train in a therapy: DBT, CBT for
psychosis or ACT
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Psychological therapies service offers CBT, DBT, Schema
Focused Therapy, CAT, EMDR, Mindfulness and
Psychoeducation Groups
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6 pathways: Emotional Dysregulation, Psychosis,
Depression, Trauma, Anxiety, Trans-Diagnostic
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ACT placed on transdiagnostic pathway (alongside CAT) and
depression pathway (alongside CBT)
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Between Oct 2013 – Feb 2014, over 5 days
n=9 psychological therapists (2 from Eating Disorders)
n=11 non-psychologist staff (psychiatric nurses, OTs and
SWs)
Training delivered by two Consultant Clinical Psychologists:
experienced in using ACT in secondary mental health
Dr. Helen Bolderston and Prof. Sue Clarke, Bournemouth
University Department of Mental Health
Fortnightly supervision
12-16 sessions of individual ACT
Attempted to identify patients who were less complex but
didn’t find many!
At present ACT currently delivered by:
 5/11 of non-psychologist staff originally trained
(2 maternity leave, 1 retired, 1 left service, 2 opted out)
6/9 psychologist staff originally trained
(2 maternity, 1 adoption leave)
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Five remaining staff committed: agreed to attend
regular supervision and take on two cases (with support
from managers)
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Aims: Determine if evaluation effective and whether
differences in psychologists versus non-psychologist staff
Case series: measures given pre and post therapy, 3-month
follow up.
CORE: A 34 item measure of global mental health (e.g. I
have felt OK about myself)
PHQ-9: A 9 item measure of depression (e.g. Little pleasure
in doing things)
Valued Living Questionnaire: how important values such as
family are, how much currently living in line with values
Cognitive Fusion Questionnaire: 7 item measure of
‘Cognitive Fusion’ (e.g. I struggle with my thoughts)
Statistical analysis
 General Linear Model (Mixed Factorial ANOVA)
 Time X Clinician
 All subscales analysed
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Intent to Treat Analysis
For Follow-Up: Last Observation Carried Forward
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18 participants in service evaluation so far
14 women, 4 men
Recurrent depression most common primary diagnosis (one
bipolar disorder)
Most had co-morbidity: PTSD, Anxiety Disorder, Personality
Disorder Traits, Physical Health problems, Alcohol Problems,
Transient Psychotic Disorder.
A number had attempted suicide in past
One Anorexia and Two Bulimia cases
Majority had had other therapies in past
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Statistically significant improvement for:
◦ CORE Total: F=10.2, p<.01
◦ CORE Total (-Risk): F=12.9, p<.01
◦ CORE Functioning: F=14.7, p<.001
◦ CORE Problems and Symptoms: F=18.5, p<.001
◦ CORE Well-Being: F=18.9, p<.001
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PHQ (Depression): F=18.8, p<.001
Valued Living: Importance: F=7.6 p<.05
Valued Living: Action: F=7.7, p<.05
Cognitive fusion: Valued: F=14.6, p<.01
No improvement for:
◦ CORE Risk: F=.08, p>.05
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Statistically significant improvement for:
◦ CORE Problems and Symptoms: F=7.9, p<.05
◦ CORE Total (-Risk) F=14.9, p<.01
◦ PHQ (Depression): F=7.0, p<.05
◦ Cognitive fusion: F=7.7, p<.05
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Trend for:
◦ CORE Total: F=4.2, p<.10
◦ CORE Functioning: F=3.7, p<.10
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No improvement for:
◦ CORE Risk: F=0.0, p>.05
◦ CORE WellBeing F=3.0, p>.05
◦ Valued Living: Importance: F=1.1, p>.05 or Action: F=0.2, p>.05
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Post-Treatment, no significant interaction between
changes over time and clinician (8 psychologists, 10 nonpsychologists):
◦ Wilks Lambda: F(10,7)=1.8, p>.05
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Drop out higher:
◦ non-psychologists: 36.4% (n=4) dropped out
◦ Psychologists: 12.5% (n=1) dropped out
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Psychologists also took on the more complex cases: high
risk, co-morbid personality disorder, physical health
problems etc.
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At three months (7 psychologists, 8 non-psychologists)
◦ Trend for outcomes on CORE Total (-Risk) better for
psychologists than non-psychologists: F=3.6, p<.10
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ACT effective as a component of depression and transdiagnostic pathways for complex secondary care
population
Improvements in global mental health, depression,
cognitive fusion and values post-treatment
Partially maintained at follow- up (data collection ongoing)
High rates of therapist attrition for non-psychologist staff
Higher drop out for non-psychologist staff
non-psychologist staff who stay committed to delivering
ACT have good outcomes similar to psychologists
Possibility that longer-term outcomes better for
psychologists