Publications: 2003
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Cahill, J., Barkham, M., Hardy, G., Rees A., Shapiro, D.A., Stiles, W. B., Macaskill, N., (2003). Outcomes of patients completing and not completing cognitive therapy for depression. British Journal of Clinical Psychology, 42, 133-143. 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 topost-treatment and significantly more from intake to their final session than did those of noncompleters. 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 (17.4%, 25/35), compared with just 12% (3/23) of client 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.
Paley, G., Myers, J., Patrick, S., Reid, E., & Shapiro, D.A. (2003). Practice development in psychological interventions: Mental health nurse involvement in the Conversational Model of psychotherapy. Journal of Psychiatric and Mental Health Nursing, 10, 494-498. 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 process 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.
Pote, H., Stratton, P., Cottrell, D., Shapiro, D., & Boston, P. (2003). Systemic family therapy can be manualised: Research process and findings. Journal of Family Therapy, 25, 236-262. Determining the efficacy of therapeutic interventions is becoming an increasing political and ethical necessity. Comparative therapeutic outcome trials are most powerful when there is a precise specification, or manualization, of the forms that therapies took. Manuals have begun to be developed for structural/behavioural family therapy and couple therapy. The development of these manuals is often reliant on experts' self-report, rather than a systematic analysis of the therapeutic process as it happens. This can limit their validity and applicability to standard clinical practice. In addition, no manuals exist which reflect less structured forms of family therapy aimed at incorporating systemic, postmodern and narrative frameworks. The feasibility of producing a workable manual that reflects the fluidity of such practices has been questioned. A research project to systematically create and test such a manual is reported. Multiple data sources and research methods, primarily qualitative, were applied to generate a rich specification of the therapy. In reporting these results the contents of various aspects of the final manual are indicated. Procedures to ensure that the prescribed practice is consistent with a widely used approach to systemic family therapy are also described. The manual will be an important tool for outcome research and therapeutic practice. The account of the research process should be helpful to researchers engaged in constructing a manual for other models of family therapy based on a rigorous analysis of actual practice. The manual itself is available for use by outcome researchers who wish to evaluate this widely used form of systemic family therapy.
Shapiro, D.A., Barkham, M., Stiles, W.B., Hardy, G.E., Rees, A., Reynolds, S., & Startup, M. (2003). Time is of the essence: A selective review of the fall and rise of brief therapy research. Psychology and Psychotherapy: Theory, Research and Practice, 76, 211-235. 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.
Shapiro, D.A., Cavanagh, K., & Lomas, H. (2003). Geographic inequity in the availability of cognitive behavioural therapy in England and Wales. Behavioural and Cognitive Psychotherapy, 31, 185-192. Delivery of cognitive behavioural therapy (CBT) is limited by a scarcity of resource. In England and Wales, there are not enough practitioners appropriately trained in CBT to meet the needs of those who might benefit from treatment. In addition, there are reasons to believe that available therapists are inequitably distributed across the country. We investigated the distribution of British Association for Behavioural and Cognitive Psychotherapies (BABCP) members, accredited CBT practitioners, and BABCP members who are nurses or clinical psychologists in England and Wales by postal code. This analysis demonstrated a 20-fold discrepancy in availability of accredited CBT practitioners between the best and least well-served population deciles. Despite limitations, these findings are highly indicative of "postcode availability" of the best qualified CBT practitioners. We discuss possible strategies to remedy this inequity, which further challenges the ability of conventional methods of CBT delivery to meet public health requirements.
Stiles, W.B., Leach, C., Barkham, M., Lucock, M., Iveson, S., Shapiro, D.A., Iveson, M., & Hardy, G.E. (2003). Early sudden gains in psychotherapy under routine clinic conditions: Practice-based evidence. Journal of Consulting and Clinical Psychology, 71, 14-21. 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 manualised 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 clinical 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.
Wheatley, S.K., Brugha, T.S., & Shapiro, D.A. (2003). Exploring and enhancing engagement to the psychosocial intervention, 'Planning for Parenthood'. Archives of Women's Mental Health, 6, 275-285. Background: Poor compliance by participants consenting to be randomised to receive both physical and mental health promotion interventions represents a potentially serious threat to external and internal validity of those intervention. Quantitative and qualitative investigation of possible predictors of engagement forms and appropriate basis for efforts to enhance it. Methods: Eight 'Preparing for Parenthood' intervention courses of a randomized controlled trial (RCT) underpinned a quantitative study. One 'Preparing for Parenthood' (PFP) intervnetion course, run upon completion of the RCT, formed a qualitative study. All nine courses followed identical procedures to enable clear comparisons. The three factors quantitatively explored with respect to engagement in health promoting behaviours were: locus of control (LOC), psychosocial support, and life events. The qualitative study utilised grounded theory analysis, the participants reflecting upon their experiences of the intervention and/or their reasons for not attending the course; nine interviews were completed. Results: Participants in the quantitative and qualitative studies were divided into three subgroups: compliant, non-compliant, and refusers. None of the three health promoting variables predicted compliance to a statistically significant degree. However, a vairable from the trial analysis was found to reach significance; those women who had had less contact with the National Health Service in the 12 months prior to the baseline assessment were more likely to refuse the invitation to PFP. The qualitative study produced nine main themes that had influenced participant engagement at boththe initial recruitment stage and during the course itself. Conclusions: In combination these findings may contribute to the future design of both effective and acceptable interventions to prevent postnatal depression. One such modified intervention is described and its impact on engagement outlined.
West, M.A., Borrill, C.S., Dawson, J.F., Brodbeck, F., & Shapiro, D.A. (2003). Leadership clarity and team innovation in health care. Leadership Quarterly, 14, 393-410. 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.
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© Copyright 2004