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Using Psychoeducation and Role Induction to Improve Completion Rates in Cognitive Behavioural Therapy

Published online by Cambridge University Press:  23 February 2017

Jaime Delgadillo  and
Martin Groom
Jaime Delgadillo*
Affiliation:
Clinical Psychology Unit, University of Sheffield, Western Bank, Sheffield S10 2TN, UK
Martin Groom
Affiliation:
Leeds Community Healthcare NHS Trust, Leeds IAPT, Burmantofts Health Centre, Cromwell Mount, Leeds LS9 7TA, UK
*
Correspondence to Jaime Delgadillo, Clinical Psychology Unit, University of Sheffield, Western Bank, Sheffield S10 2TN, UK. E-mail: jaime.delgadillo@nhs.net
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Abstract

Background: Pre-treatment role induction interventions have been suggested to potentially enhance attendance and clinical outcomes in psychotherapy. Aims: This study aimed to evaluate the effects of a programme of three transdiagnostic seminars (TDS) for patients with common mental disorders accessing cognitive behavioural therapy (CBT) in primary care. TDS included CBT psychoeducation and role induction. Method: A random sample of patients (n = 49) participated in TDS followed by CBT (TDS+CBT) and they were compared with matched controls (n = 49) accessing usual CBT. TDS participants rated the relevance and quality of this intervention using an acceptability questionnaire (AQ). Treatment completion (vs dropout) rates were compared across groups using chi-square tests. Post-treatment changes in depression (PHQ-9) and anxiety (GAD-7) symptoms were compared between groups using analysis of covariance controlling for potential confounders. Analyses were based on intention-to-treat principles. Results: Mean AQ ratings of the TDS intervention were comparable across diagnostic groups (p = .05). Treatment completion rates were significantly higher (p = .02) in the TDS+CBT group (87.8%) by comparison with usual CBT (68.8%). However, no significant differences in post-treatment symptom changes were found for depression (p = .34) or anxiety measures (p = .71). Conclusions: Incorporating a psychoeducational role induction prior to CBT significantly improved treatment retention, but not overall symptom reductions.

Keywords

Cognitive behavioural therapypsychoeducationrole inductiondepressionanxiety
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 45 , Issue 2 , March 2017 , pp. 170 - 184
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

Anderson, E. M. and Lambert, M. J. (2001). A survival analysis of clinically significant change in outpatient psychotherapy. Journal of Clinical Psychology, 57, 875–888.Google Scholar
Butler, A. C., Chapman, J. E., Forman, E. M. and Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17–31.CrossRefGoogle ScholarPubMed
Clark, D. M. (2005). A cognitive perspective on social phobia. In Crozier, W. R. and Alden, L. F. (eds), The Essential Handbook of Social Anxiety for Clinicians (pp. 406–427). New York, NY: John Wiley and Sons.Google Scholar
Clark, D. M., Layard, R., Smithies, R., Richards, D. A., Suckling, R. and Wright, B. (2009). Improving access to psychological therapy: Initial evaluation of two UK demonstration sites. Behaviour Research and Therapy, 47, 910–920.Google Scholar
Cuijpers, P., van Straten, A., Andersson, G. and van Oppen, P. (2008). Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology, 76, 909–922.CrossRefGoogle ScholarPubMed
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A. and Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry, 58, 376–385.CrossRefGoogle ScholarPubMed
Delgadillo, J., McMillan, D., Lucock, M., Leach, C., Ali, S. and Gilbody, S. (2014). Early changes, attrition, and dose-response in low intensity psychological interventions. British Journal of Clinical Psychology, 53, 114–130.Google Scholar
Delgadillo, J., Moreea, O. and Lutz, W. (2016). Different people respond differently to therapy: A demonstration using patient profiling and risk stratification. Behaviour Research and Therapy, 79, 15–22.Google Scholar
Frank, E., Cassano, G. B., Rucci, P., Thompson, W. K., Kraemer, H. C., Fagiolini, A., Maggi, L., Kupfer, D. J., Shear, M. K., Houck, P. R., Calugi, S., Grochocinski, V. J., Scocco, P., Buttenfield, J. and Forgione, R. N. (2011). Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy. Psychological Medicine, 41, 151–162.Google Scholar
Garrison, J. E. (1978). Written vs. verbal preparation of patients for group psychotherapy. Psychotherapy: Theory, Research and Practice, 15, 130–134.Google Scholar
Gloaguen, V., Cottraux, J., Cucherat, M. and Blackburn, I. M. (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders, 49, 59–72.Google Scholar
Hammond, G., Croudace, T., Radhakrishnan, M., Lafortune, L., Watson, A., McMillan-Shields, F. and Jones, P. B. (2012). Comparative effectiveness of cognitive therapies delivered face-to-face or over the telephone: an observational study using propensity methods. PLoS ONE, 7, e42916.Google Scholar
Hansen, N. B., Lambert, M. J. and Forman, E. M. (2002). The psychotherapy dose response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9, 329–343.Google Scholar
Harvey, A., Watkins, E., Mansell, W. and Shafran, R. (2004). Cognitive Behavioural Processes Across Psychological Disorders: A Transdiagnostic Approach to Research and Treatment. Oxford, UK: Oxford University Press.Google Scholar
Heitler, J. B. (1973). Preparation of lower-class patients for expressive group psychotherapy. Journal of Consulting and Clinical Psychology, 41, 251–260.Google Scholar
Heitler, J. B. (1976). Preparatory techniques in initiating expressive psychotherapy with lower-class, unsophisticated patients. Psychological Bulletin, 83, 339–352.Google Scholar
Hofmann, S. G. and Smits, J. A. J. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69, 621–632.Google Scholar
Howard, K. I, Kopta, S. M., Krause, M. S. and Orlinsky, D. E. (1986). The dose–effect relationship in psychotherapy. American Psychologist, 41, 159–164.Google Scholar
IAPT National Programme Team (2011). The IAPT Data Handbook: Guidance on Recording and Monitoring Outcomes to Support Local Evidence-Based Practice (2nd edn). London: National IAPT Programme Team.Google Scholar
Jacobs, D., Charles, E., Jacobs, T., Weinstein, H. and Mann, D. (1972). Preparation for treatment of the disadvantaged patient: Effects on disposition and outcome. American Journal of Orthopsychiatry, 42, 666–674.Google Scholar
Jacobson, N. S. and Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.Google Scholar
Kozak, M. J. and Foa, E. B. (1997). Mastery of Obsessive Compulsive Disorder: a Cognitive Behavioural Approach Therapist Guide. New York, NY: Oxford University Press.Google Scholar
Kraemer, H. C. and Kupfer, D. J. (2006). Size of treatment effects and their importance to clinical research and practice. Biological Psychiatry, 59, 990–996.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L. and Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.Google Scholar
Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O. and Löwe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146, 317–325.Google Scholar
Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L. and Smart, D. W. (2003). Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10, 288–301.Google Scholar
Lutz, W., Leon, S. C., Martinovich, Z., Lyons, J. S. and Stiles, W. B. (2007). Therapist effects in outpatient psychotherapy: A three level growth curve approach. Journal of Counseling Psychology, 54, 32–39.Google Scholar
Lutz, W., Lowry, J., Kopta, S. M., Einstein, D. A. and Howard, K. I. (2001). Prediction of dose–response relations based on patient characteristics. Journal of Clinical Psychology, 57, 889–900.Google Scholar
Macaskill, N. D. (1989). Educating clients about rational-emotive therapy. In Dryden, W. and Trower, E. (eds), Cognitive Psychotherapy: Stasis and Change (pp. 87–98). New York: Springer.Google Scholar
Macaskill, N. D. and Macaskill, A. (1983). Preparing patients for psychotherapy. British Journal of Clinical and Social Psychiatry, 2, 80–84.Google Scholar
Maling, M. S., Gurtman, M. B. and Howard, K. I. (1995). The response of interpersonal problems to varying doses of psychotherapy. Psychotherapy Research, 5, 63–75.Google Scholar
Martell, C. R., Addis, M. E. and Jacobson, N. S. (2001). Depression in Context: Strategies for Guided Action. New York, NY: Norton.Google Scholar
Mundt, J. C., Marks, I. M., Shear, M. K. and Greist, J. H. (2002). The work and social adjustment scale: a simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461–464.Google Scholar
National Institute for Health and Care Excellence (2007). Anxiety (amended): Management of Anxiety (Panic Disorder, with or without Agoraphobia, and Generalised Anxiety Disorder) in Adults in Primary, Secondary and Community Care. London: NICE.Google Scholar
National Institute for Health and Care Excellence (2010). Depression: the Treatment and Management of Depression in Adults (updated edn). London: The British Psychological Society and The Royal College of Psychiatrists.Google Scholar
National Institute for Health and Care Excellence (2011). Common Mental Health Disorders: Identification and Pathways to Care. London: National Collaborating Centre for Mental Health.Google Scholar
Richards, D. A. and Borglin, G. (2011). Implementation of psychological therapies for anxiety and depression in routine practice: two year prospective cohort study. Journal of Affective Disorders, 133, 51–60.Google Scholar
Roth, A. D. and Pilling, S. (2008). Using an evidence-based methodology to identify the competencies required to deliver effective cognitive and behavioural therapy for depression and anxiety disorders. Behavioural and Cognitive Psychotherapy, 36, 129–147.Google Scholar
Schafer, J. L. and Olsden, M. K. (1998). Multiple imputation for multivariate missing-data problems: A data analyst's perspective. Multivariate Behavioral Research, 33, 545–571.Google Scholar
Sheeran, P., Aubrey, R. and Kellett, S. (2007). Increasing attendance for psychotherapy: implementation intentions and the self-regulation of attendance-related negative affect. Journal of Consulting and Clinical Psychology, 75, 853–863.Google Scholar
Shimokawa, K., Lambert, M. J. and Smart, D. W. (2010). Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology, 78, 298–311.Google Scholar
Smith, J. and Todd, P. (2005). Does matching overcome LaLonde's critique of non-experimental estimators? Journal of Econometrics, 125, 305–353.Google Scholar
Spitzer, R., Kroenke, K., Williams, J. B. W. and Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 66, 1092–1097.Google Scholar
Stark, M. J. and Kane, B. J. (1985). General and specific psychotherapy role induction with substance-abusing clients. International Journal of the Addictions, 20, 1135–1141.Google Scholar
Stiles, W. B., Barkham, M., Twigg, E., Mellor-Clark, J. and Cooper, M. (2006). Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapies as practised in UK National Health Service settings. Psychological Medicine, 36, 555–566.Google Scholar
Stiles, W. B., Barkham, M., Mellor-Clark, J. and Connell, J. (2008). Effectiveness of cognitive-behavioural, person-centred, and psychodynamic therapies in UK primary-care routine practice: replication in a larger sample. Psychological Medicine, 38, 677–688.Google Scholar
Swift, J. K. and Callahan, J. L. (2011). Decreasing treatment dropout by addressing expectations for treatment length. Psychotherapy Research, 21, 193–200.Google Scholar
Swift, J. K. and Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80, 547–559.Google Scholar
Vogel, D. L., Wester, S. R. and Larson, L. M. (2007). Avoidance of counseling: Psychological factors that inhibit seeking help. Journal of Counseling and Development, 85, 410–422.Google Scholar
Walitzer, K. S., Dermen, K. H. and Connors, G. J. (1999). Strategies for preparing clients for treatment. Behavior Modification, 23, 129–151.Google Scholar
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