Abstract
Critical review of the literatureA comparison of the efficacy of psychological interventions for mania and depression in bipolar disorder: a systematic review.
According to DSM-V a diagnosis of bipolar disorder (BD) requires a history of major depression and either mania, hypomania or mixed episodes. Although there is substantial research in the field of psychological interventions for BD, including several reviews and meta-analyses, there is a lack of understanding about the differential effect of psychological intervention on depression and mania. This review sought to address this by synthesising available research of psychological interventions for BD and exploring the effects specifically on depression and mania. Systematic searches of databases were conducted and resulting studies were assessed for eligibility. In total 22 articles were included and these explored two broad psychological approaches; cognitive-behavioural therapy (CBT), which included a study of mindfulness-based cognitive therapy, and psychoeducation. One study also looked at other approaches and the effect of therapy on recovery from BD depression.
Results were reported for four key outcomes from studies that provided results separately for depression and mania; survival time to relapse, number of relapse episodes, symptom severity and time in episode. Findings from studies were highly inconsistent with some finding differential effects for depression and mania, some finding no benefit for either and others finding benefit for both. This prevented conclusions being drawn regarding the primary question of this review and instead highlighted the need for further consideration and consensus on what constitutes a meaningful outcome for individuals with BD. Furthermore, none of the interventions reported in the included studies appeared to be based upon a validated, disorder-specific theoretical model of BD. Clinical and research implications of these findings are discussed.
Service Improvement Project
A trans-diagnostic cognitive behaviour therapy group in a secondary care mental health service.
This study investigated the effectiveness of a trans-diagnostic Cognitive-Behavioural Therapy (CBT) group delivered in a secondary care community mental health service. Using a published framework for service improvement the evidence base of trans-diagnostic interventions was explored and critiqued before the routinely collected outcome data of five group programmes was analysed. Pre- and post-group data, collected using the Clinical Outcomes in Routine Evaluation (CORE-10) and the Work and Social Adjustment Scale (WSAS), were available for 51 participants. Results of those who completed the group (n=42) showed that scores on both the CORE-10 and WSAS were significantly reduced over the duration of the group. These findings remained in an intention-to-treat sample (n=51).
The results suggested that the group had a positive effect on the symptoms and social functioning of those who attended. However, firm conclusions could not be drawn due to limited information collected about participant characteristics and effects of individual sessions. Recommendations, therefore, related to improving future evaluations of the group through the collection of more information. This included participant demographics and diagnosis, the use of additional disorder-specific outcome measures, pre- and post-group session-by-session feedback, a measure of CBT skill development and the collection of follow-up data.
The group was delivered following these recommendations and a further evaluation is reported that also comments on the implementation of these recommendations. Findings and suggestions for future research are discussed.
Main research project
A test of a cognitive model of violence: a comparison of thinking in violent and non-violent men.
The cognitive model of violence proposes that the beliefs and conditional assumptions of the individual, related to self-esteem, are important in the development of violent behaviour. It is suggested that this manifests as an enduring tendency to misinterpret ambiguous social situations as indicating that other people are critical of the person in ways signifying serious disrespect. This study tested the cognitive model of violence using a new measure, the Violence Interpretation Questionnaire (VIQ), which assesses interpretation and anticipated behavioural response to interpersonal and non-social situations. Three groups of men were compared; violent offenders (offender group; n=17) and two online control groups, one that reported violence (aggressive control group; n=28) and one that did not (non-aggressive control group; n=69). It was hypothesised that the violent participants would interpret VIQ interpersonal situations in a more negatively self-reverent manner than control participants, but that there would be no difference for non-social items. It was also predicted that VIQ interpersonal scores would correlate with another measure of violent thinking, the Maudsley Violence Questionnaire (MVQ).
Results showed that, in line with the primary hypothesis, the offender and aggressive control groups interpreted interpersonal situations more negatively than non-aggressive controls but no difference was found on non-social items. Interestingly, the VIQ aggression score of the aggressive control group was significantly lower than the offender group and no different to the non-aggressive controls. This suggests that although the aggressive controls interpreted situations like the offenders they anticipated responding like non-aggressive controls. VIQ interpersonal scores significantly correlated with MVQ machismo scores, providing some concurrent validity to the VIQ. These findings provide evidence for the role of negative, self referent interpretations in the development of violence but also highlight a potential difference that comes into play after such an appraisal is made that differentiates the offenders from the aggressive controls.
| Date of Award | 16 Sept 2015 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Paul Salkovskis (Supervisor), James Gregory (Supervisor), Claire Lomax (Supervisor), Julian Walker (Supervisor) & Chris Gilmore (Supervisor) |
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