dr. thomas richardson clinical psychologist (1,2) dr. lorraine bell consultant clinical psychologist...
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Dr. Thomas Richardson Clinical Psychologist (1,2) Dr. Lorraine Bell Consultant Clinical Psychologist (1)
1. Mental Health Recovery Teams, Solent NHS Trust, Portsmouth, UK2. 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
6 pathways: Emotional Dysregulation, Psychosis, Depression, Trauma, Anxiety, Trans-Diagnostic
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!
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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)
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)
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Statistical analysisGeneral Linear Model (Mixed Factorial ANOVA)Time X ClinicianAll subscales analysed
Intent to Treat AnalysisFor 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
◦ 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
Trend for:◦ CORE Total: F=4.2, p<.10◦ CORE Functioning: F=3.7, p<.10
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 non-psychologists):◦Wilks Lambda: F(10,7)=1.8, p>.05
Drop out higher:◦ non-psychologists: 36.4% (n=4) dropped out◦ Psychologists: 12.5% (n=1) dropped out
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 trans-diagnostic 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