Publications: 2004 |
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Cavanagh, K., & Shapiro, D.A. (2004). Computer treatment for common mental health problems. Journal of Clinical Psychology, 60, 239-251. Perhaps the most complex and controversial role for the computer in clinical practice is as a treatment medium in which the computer effectively replaces the psychotherapist. This article outlines the historical development of computer treatment, from dialogue generators in the 1960s through to the interactive, multimedia programs of the 2000s. In evaluating the most recent developments in computer treatment, we present a small meta-analytic study demonstrating large effect sizes in favour of computer treatments for anxiety and depression for pre/post outcomes and treatment as usual/waitlist comparators. Next, we review studies of the cost-effectiveness of computer treatments. Finally, we outline the implications for research, policy, and practice of this new generation of treatment options.
Morley, S., Shapiro, D.A., & Biggs, J. (2004). Developing a treatment manual for attention management in chronic pain. Cognitive Behaviour Therapy, 33, 1-11. This article reports the development of a protocol for the therapeutic application of "attention control" for chronic pain. Attention control is the limitation of the impact of pain by switching or retuning attention. An expert systems approach was used to develop the protocol. In the first stage an extensive literature search retrieved published and unpublished accounts of attention control strategies and a draft treatment manual was prepared. In the second stage 6 experts were recruited and they independently read and reviewed the draft manual. The manual was then revised to accommodate the information and expertise. In addition to providing expert opinion on the manual the experts also raised issues about the process of change in psychological treatment for chronic pain. These issues were organized into a process model of change in chronic pain. Key words: chronic pain; attention control; manualized therapy; treatment process; protocol development.
McCrone, P., Knapp, M., Proudfoot, J., Ryden, C., Cavanagh, K., Shapiro, D.A., Ilson, S., Gray, J.A., Goldberg, D., Mann, A., Marks, I., Everitt, B., & Tylee, A. (2004). Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial. British Journal of Psychiatry, 185, 55-62. 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.
Proudfoot, J., Ryden, C., Everitt, B., Shapiro, D.A., Goldberg, D., Mann, A., Tylee, A., Marks, I., & Gray, J.A. (2004). Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial. British Journal of Psychiatry, 185, 46-54. Background Preliminary results have demonstrated the clinical efficacy of computerised cognitive-behavioural therapy (CBT) in the treatment of anxiety and depression in primary care. Aims To determine, in an expanded sample, the dependence of the efficacy of this therapy upon clinical and demographic variables Method A sample of 274 patients with anxiety and/or depression were randomly allocated to receive, with or without medication, computerised CBT or treatment as usual, with follow-up assessment at 6 months. Results The computerised therapy improved depression, negative attributional style, work and social adjustment, without interaction with drug treatment, duration of preexisting illness or severity of existing illness. For anxiety and positive attributional style, treatment interacted with severity such that computerised therapy did better than usual treatment for more disturbed patients. Computerised therapy also led to greater satisfaction with treatment. Conclusions Computer-delivered CBT is a widely applicable treatment for anxiety and/or depression in general practice.
Stiles, W.B., Glick, M.J., Osatuke, K., Hardy, G.E., Shapiro, D.A., Agnew-Davies, R., Rees, A., & Barkham, M. (2004). Patterns of alliance development and the rupture-repair hypothesis: Are productive relationships U-Shaped or V-Shaped? Journal of Counseling Psychology, 51, 81-92. 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.
Trepka, C., Rees, A., Shapiro, D.A., Hardy, G.E., & Barkham, M. (2004). Therapist competence and outcome of cognitive therapy for depression. Cognitive Therapy and Research, 28, 143-157. The Cognitive Therapy Scale (CTS) has been widely used in cognitive therapy training centers to assess therapist competence but competence has not previously been clearly shown to be associated with cognitive therapy outcome, possibly because an insufficient range of competence has been sampled. Competence was compared with alliance as process variables that might relate to change in therapy. A randomly selected therapy session from each of 30 courses of cognitive therapy for depression was rated using the CTS. Both therapeutic alliance and therapist competence were related to outcome. In regression analyses, the alliance remained significantly related to outcome when controlling for competence, but not vice versa. These relationships with outcome were primarily attributable to therapists rather than to clients. Associations with outcome appeared stronger for those clients who completed therapy than for those who did not. These findings suggest that measurable factors both common to diverse treatment methods and specific to particular methods should be included in efforts to account for therapy outcome.
Rees, A., Richards, A., & Shapiro, D.A. (2004). Utility of the HoNOS in measuring change in a community mental health care population. Journal of Mental Health, 13, 295-304. Background: Given that, for many community health care teams, the HoNOS is the audit tool of choice, further work is needed to establish the viability of using this instrument to assess health change. Aims: To assess the usefulness of the HoNOS in measuring change in a population on the caseloads of community mental health teams. Method: Key workers or care co-ordinators of 195 selected patients on the caseloads of a national sample of 10 generic community mental health teams rated patients on the HoNOS four times over a period of 4-6 months. Patients had previously received a primary diagnosis of anxiety, depression, psychosis, personality disorder, or substance misuse on the Manchester Audit Tool. Results: In this population, the HoNOS marginally discriminated amongst diagnoses, and was associated with severity and complexity but not chronicity. Scores on the HoNOS changed differentially over time according to diagnosis and severity. Conclusion: A change of 3 to 4 points on the HoNOS is small, but statistically significant, and may be a useful basis for tracking the clinical improvement of neurotic patients, and the clinical stability of those with psychosis. Declaration of interest: This study was supported by a grant from the UK Department of Health's Policy Research Branch, Human Resources and Effectiveness Programme, to Michael West, Simon Garrod, and David Shapiro.
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© Copyright 2004