There is a significant evidence base for the role of brief therapies in working with attachment disorder. Attachment disorder can appear in a number of guises within therapy and can manifest wherever individuals consider themselves in relation to the other in a relationship. Cognitive–behavioural therapy (CBT) has demonstrated that it can be effective in clients with attachment avoidance and depressive symptoms compared to interpersonal therapy whereas a comparative study with anxious adolescents demonstrated equivalent outcomes when CBT was combined with family therapy. Eye movement desensitization and reprocessing is probably one of the most effective evidence-based therapies for working with attachment disorders. Neurolinguistic psychotherapy (NLPt) has demonstrated effectiveness in enabling self-care behaviours and de Miranda and colleagues were able to demonstrate positive changes in …

Objectives and design. The efficacy of a Computerized Cognitive Behavioural Therapy (CCBT) package, Beating the Blues, has been demonstrated in a large randomized controlled trial. The current study tests the generalizability of this finding in a naturalistic non-randomized trial.Method. 219 patients with anxiety and/or depression were recruited to receive CCBT in routine care. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and Work and Social Adjustment scale (WSA) were administered pretreatment, immediately on completing treatment and at 6 months post-treatment. Single-item self-report measures of anxiety and depression were also collected during each treatment session.Results. Completer and intention-to-treat analysis demonstrated statistically and clinically significant improvements on the CORE-OM, WSA and in self-reported anxiety and depression. Intention-to-treat analysis indicated an average 0.29-point drop on the CORE-OM, equating to an uncontrolled pre-post effect size of 0.50. Research completers achieved an average 0.61-point drop equating to an uncontrolled pre-post size of 1.00 on the same measure. Where data was available (18%), these benefits were maintained at week 32 (6 months follow-up).Conclusion. CCBT can be an effective first line tool within a stepped care framework for the management of common mental health problems.

OBJECTIVE:A systematic review of all studies (controlled and uncontrolled) to evaluate psychological interventions with treatment-resistant depression. METHOD:A systematic search to identify studies evaluating a psychological intervention with adults with a diagnosis of major depressive disorder who had not responded to at least one course of antidepressant medication. RESULTS:Twelve studies met inclusion criteria, of which four were controlled and eight uncontrolled. Treatment effect sizes were computable for four studies and ranged from 1.23 to 3.10 with a number of better quality studies demonstrating some improvements in patients following a psychological intervention. CONCLUSION:Psychological treatments for depression are commonly delivered and often recommended following the failure of medication. The paucity of evidence for their effectiveness in these situations is a significant problem. There is a need for studies with a strong controlled design investigating the effectiveness of psychological treatments for patients with treatment-resistant depression.

The authors attempted to replicate and extend D. M. Kivlighan and P. Shaughnessy's (2000) findings of (a) 3 distinctive patterns of alliance development across sessions and (b) a differential association of one of these, a U-shaped quadratic growth pattern, with positive treatment outcome. In data drawn from a clinical trial of brief psychotherapies for depression (N = 79 clients), the authors distinguished 4 patterns of alliance development. These matched 2 of Kivlighan and Shaughnessy's patterns, but not the U-shaped pattern, and none was differentially associated with outcome. However, further examination of the data identified a subset of clients (n = 17) who experienced rupture-repair sequences-brief V-shaped deflections rather than U-shaped profiles. These clients tended to make greater gains in treatment than did the other clients.

Computerized cognitive-behaviour therapy (CCBT) programmes have been developed to help meet the enormous need for evidence-based psychological treatment of common mental health problems in the context of a severe shortage of trained therapists to meet that need. Randomized controlled trials have confirmed the efficacy of such programmes. We present the experience of a community mental health team (CMHT) resource centre with one such programme, Beating the Blues, together with outcome data on a small sample of its clients. We conclude that experience and data, taken together, demonstrate the practical benefits of CCBT in routine practice.

Background Cognitive-behavioural therapy (CBT) is effective for treating anxiety and depression in primary care, but there is a shortage of therapists. Computer-delivered treatment may be a viable alternative. Aims To assess the cost-effectiveness of computer-delivered CBT. Method A sample of people with depression or anxiety were randomised to usual care ( n = 128) or computer-delivered CBT ( n = 146). Costs were available for 123 and 138 participants, respectively. Costs and depression scores were combined using the net benefit approach. Results Service costs were £40 (90% CI-£28 to £148) higher over 8 months for computer-delivered CBT. Lost-employment costs were £407 (90% CI £196 to £586) less for this group. Valuing a 1-unit improvement on the Beck Depression Inventory at £40, there is an 81% chance that computer-delivered CBT is cost-effective, and it revealed a highly competitive cost per quality-adjusted life year. Conclusions Computer-delivered CBT has a high probability of being cost-effective, even if a modest value is placed on unit improvements in depression.

This paper describes a mental health nurse led practice development initiative in psychotherapy. Four mental health nurses have been trained to deliver the Conversational Model of psychotherapy (also known as psychodynamic-interpersonal (PI) psychotherapy) a non-cognitive behavioural therapy (CBT) with a robust evidence base. We report on the robust range of both processes and outcome measures being used to evaluate this initiative. We conclude that good quality evidence-based practice requires careful planning and preparation, adequate financial resources from Trusts, as well as commitment and motivation from the staff expected to be involved in such initiatives.

OBJECTIVES:The aims of this study were to use symptom intensity measures collected at each session (1) to describe the outcomes of clients who received cognitive therapy (CT) for depression in a clinically representative sample, and (2) to compare the outcomes of clients who completed the agreed number of sessions with those who did not.DESIGN AND METHOD:Clients (N = 58) contracted to attend between 12 and 20 sessions of CT completed the Beck Depression Inventory (BDI) immediately prior to each therapy session. The BDI and other measures were collected at intake and, for those who completed therapy, at a post-therapy assessment.RESULTS:Completers' BDI scores improved significantly from intake to post-treatment and significantly more from intake to their final session than did those of non-completers. However, when non-completers' final session scores were matched with scores of randomly selected completers at the corresponding session, the difference in improvement was not significant. A significantly higher proportion of clients who completed the agreed number of sessions achieved reliable and clinically significant change (71.4%, 25/35), compared with just 13% (3/23) of clients who did not.CONCLUSIONS:(1) CT for depression can be effective in a clinically representative population. (2) Attrition from clinical trials may bias estimates of treatment effectiveness.

For compelling reasons of equity and the advance of public health, brief psychotherapy has become the dominant format in both practice and research. One consequence of this is the apparent decline of a distinct stream of brief therapy research. However, much of the agenda formerly identified with that research stream is of increasing importance to the field. Time is indeed of the essence in current psychotherapy research. For example, factors conducive to the time efficiency of brief psychodynamic therapy have been described recently. The important question 'How much therapy is enough?' has been addressed by studies inspired by the dose-response analysis of Howard and colleagues. The value of ultra-brief interventions has been examined. These issues are considered in a selective review, drawing in particular on the work of the Sheffield/Leeds psychotherapy of depression research group. This research treats the number of treatment sessions as an independent variable, thereby providing a causal analysis of the dose-response relationship over a range from two to 16 sessions, illuminated by a comparative analysis of change processes in treatments of different durations. Its results enable some specification of the extent and nature of incremental benefit derived from additional sessions in the psychotherapy of depression.

Sudden gains-large, enduring reductions in symptom intensity from one session to the next-were identified by T. Z. Tang and R. J. DeRubeis (1999b) on the basis of data from 2 manualized clinical trials of cognitive therapy for depression. The authors found similar sudden gains among clients with a variety of disorders treated with a variety of approaches in routine clinic settings. Clients (N = 135 who met inclusion criteria) completed short forms of the Clinical Outcomes in Routine Evaluation (CORE-SF) preceding 7 to 74 individual sessions. Those who experienced sudden gains within their first 16 sessions (n = 23) had significantly lower CORE-SF scores in their final 3 sessions than did the other clients.

The relationships among leadership clarity (i.e., team members' consensual perceptions of clarity of and no conflict over leadership of their teams), team processes, and innovation were examined in health care contexts. The sample comprised 3447 respondents from 98 primary health care teams (PHCTs), 113 community mental health teams (CMHTs), and 72 breast cancer care teams (BCTs). The results revealed that leadership clarity is associated with clear team objectives, high levels of participation, commitment to excellence, and support for innovation. Team processes consistently predicted team innovation across all three samples. Team leadership predicted innovation in the latter two samples, and there was some evidence that team processes partly mediated this relationship. The results imply the need for theory that incorporates clarity and not just style of leadership. For health care teams in particular, and teams in general, the results suggest a need to ensure leadership is clear in teams when innovation is a desirable team performance outcome.

Current mental health policy documents highlight the need for mental health nurses to become increasingly involved in the delivery of evidence-based psychological interventions. However, substantial evidence exists indicating that there is a paucity of training to adequately equip nurses to deliver these interventions and, even when training is available, there are barriers to their implementation into routine clinical practice. This paper reports on the personal reflections and experiences of a group of four mental health nurses undertaking training in the Conversational Model of psychotherapy (also known as psychodynamic-interpersonal 'PI' psychotherapy). These reflections highlight the rewards and challenges arising from the effort to undertake training in an evidence-based model of psychological intervention and from attempting to implement and sustain this training into routine practice.

The convergent validity of the Agnew Relationship Measure (ARM) and the Working Alliance Inventory (WAI) was assessed in samples drawn from 2 comparative clinical trials of time-limited psychotherapies for depression. In 1 sample, clients (n = 18) and therapists (n = 4) completed self-report versions of both measures after every session (n = 198). In the other sample, clients (n = 39) and therapists (n = 6) completed the ARM, and observers subsequently rated selected audiotaped sessions (n = 78) using the WAI. In both samples, the ARM's core alliance scales (Bond, Partnership, and Confidence) were correlated with the WAI's scales (Bond, Tasks, and Goals) strongly when assessed within client and therapist perspectives and, with some qualifications, moderately when assessed between client, therapist, and observer perspectives, supporting the assumption that the ARM and the WAI measure some of the same core constructs.

Clients (N = 105) presenting with mild depression were assigned to receive 2, 8, or 16 sessions of psychotherapy in a quasi-experimental design involving 2 clinical trials. Rates of recovery were estimated as the proportion of each group achieving reliable and clinically significant change at the end of treatment (shortly after the prescribed dose had been administered) and at a follow-up assessment 2 to 3 months later. Results supported the hypothesis that recovery from interpersonal problems typically requires higher doses of psychotherapy than does recovery from symptoms of depression or broader distress.

This article argues that psychological interventions for people with schizophrenia could be developed by being informed by research from the wider psychotherapy literature. We specifically argue that research on these interventions has ignored two key themes from this wider literature: first, the contention that differing models of intervention broadly result in similar outcomes, known as the ‘equivalent outcomes paradox’ and second, the phenomenon of ‘investigator allegiance’ whereby the conclusions that may safely be drawn from comparative research are compromised by researchers' unwitting bias. We present evidence indicating that both these themes from the wider literature may be applicable to the literature on psychological interventions for schizophrenia and that schizophrenia treatment research should incorporate some of the lessons already learned in studies of other disorders. We conclude by arguing that psychological interventions for people with schizophrenia should be based on unbiased evidence and that interpretation of the evidence base should not be hindered by dogma or ideology from any quarter.

This study examined the relationship between cognitive and interpersonal styles and outcome among 24 clients who received time-limited cognitive therapy for depression. The authors hypothesized that this relationship would be mediated by therapeutic alliance. They found that clients' interpersonal style, particularly an underinvolved style, was predictive of treatment outcome. As predicted, the impact of this style on outcome was mediated through the therapeutic alliance.

This study (a) used an established comprehensive process measure to uncover a latent pattern of therapeutic focus in cognitive-behavioral and psychodynamic-interpersonal sessions; (b) used these results to develop the coding system of Therapeutic Focus on Action and Insight, which makes it possible to evaluate therapists' relative emphasis on the Constructing Meaning and Facilitating Action domains of in-session focus; and (c) evaluated its reliability and validity.