Week 3 - Third Wave Therapies Flashcards
What year is Chiesa and Sierretti?
2011
What are the strengths of chiesa and sierretti?
Addition of MCBT - useful for reducing residual dep symptoms in pps with MD + reducing anxiety in pps with bipolar
What are the weaknesses of chiesa and sierreti?
Self assessment —> reliable
- need for rigorous external testing
Small sample sizes, non RCT, some poor quality, absence of control groups
Westernised - only used English published
What are the results of chiesa and sierretti?
Main findings
- MCBT + usual care better than Tau alone for reducing MDD in patients 3+ dep episodes (x3 RCTs - 32% v 60% @ 12 mths)
- MCBT + discontinuation of maintenance = similar relapse at 1 year of ADM
What year was Kuyken et al.? (1st one)
2008
What are the strengths of Kuyken et al.? (1st one)
MCBT siginifcantly better at reducing residual dep. symptoms + quality of life
Better quality of life
What are the results of Kuyken et al.? (1st one)
Outcome study (RCT) MCBT vs ADM vs discontinued ADM —> relapse rates at 15 months MCBT (stopped ADM —> MCBT) = 47% vs ADM at 60% - not significant but showed MCBT doing something
What year was Kuyken et al.? And what was it all about? (2nd and later one)
2010
Mechanism of change RCT
How does MCBT work - changes in mindfulness and self compassion mediated effect of MCBT at follow up
MCBT (targets acceptance/compassion -> mediating variables -> mediates relapse of dep.)
What year was Hayes?
2006
What are the weaknesses of Hayes?
Not enough well controlled studies to conclude that ACT is more effective than other treatments for range of diagnoses - conflicting evidence
Interventions short with limited scope - due to funding of research programs
Lack of data publishing their psychometric properties
Mediation studies often use measures
Taken after outcomes began to improve significantly
What are the strengths of Hayes?
Covers large range of ethnic groups and classes
What are the results of Hayes?
States x6 processes of Helaflex which contribute to psychological flexibility - x2 behavioural, x4 mindfulness
Mediational + process results in favour of act —> working across a broad range of psychological problems —> effect sizes larger for more severe problems
What year was Ruiz?
2010
What were the weaknesses of Ruiz?
Varied in size and quality
What were the results of Ruiz?
Reviewed 30 RCTs - all favoured ACTs, including depression, psychosis, work stress, social anxiety. Typically large effect sizes
What year was Clarke, Kingston, James etc.?
2014
What were the strengths of Clarke, Kingston, James etc.?
Significant reduction in symp in both conditions immediately after -> but improve with ACT at 6 months follow up completely sustained -> ACT appears to be transdiagnostic
What were the results of Clarke, Kingston, James etc.?
Small RCT
- 16 week ACT vs 16 week CBT style Tau -> people with mixed diagnosis, treatment resistant
What year was Panos?
2013
What are the weaknesses of Panos?
By APA standards - RCTs used failed to show whether efficacy derived from specific ingredients of DBT
Small no. of studies, small no of pps
Not long term to tell if sufficient to improve quality of life
What are the strengths of Panos?
DBT named in Nice - BPD has x response to tradit. therapy -> high impatient due to parasuidical behaviour (50%+)
What are the results of Panos?
Meta analysis + systematic review of efficacy of DBT - quantitative + qualitative
- DBT better than Tau for parasuicidal behav.
- DBT marginally better than Tau for attrition
- DBT = same as Tau for comorbidd - but still does something
- DBT decreases quality of life in interfering behaviours, despite pos. improvement
- DBT = efficacy in controlling self destructive behaviour
What year is Lynch et al.? What is it all about?
2006
Process research
Suggested several mech of change
- the reduction in effective action tendencies linked with dysregulated emotions
- but currently no research testing proposals
What year is Brazier? What is it all about?
2006
Limitations of DBT
- poor quality RCTs
- even though parasuicidal behav. may decrease, still high levels of anx/dep
- almost all evidence female, but BPD also mainly female (some male though)
What year was Mace?
2007
What was Mace all about?
Intro to mindfulness
- way of paying attention that is sensitive, accepting + independent of present thoughts
- depends heavily on relationship between patient and therapist
MCBT
- adds training in specific cog skills
- taught in smaller groups
- 3 min breathing to restore mindful attitude
DBT
- mindfulness skill training for patients in groups + individual therapeutic work
- primarily pps with BPD
- suitable for people with attention issues
ACT
- based on radical behavioural analysis of patients difficulties
What year was Khoury?
2013
What were the weaknesses of Khoury?
Excluded ACT and DBT as couldn’t mediate what the mindfulness elements were
Mindfulness only measured in 45% of studies
What were the strengths of Khoury?
PPs more mindful at end of treatment vs start. Strong positive correlation between mindfulness levels + clinical outcomes - but little known about treatment moderators e.g. therapist training
What were the results of Khoury?
Mindfulness meta analysis - 209 studies, 12,145 pps, diverse age, genders + clinical profiles
Moderately effective in pre/post comparisons vs waiting list vs other active treatment
- didn’t differ from CBT / BA
- MBT + effective at treating psychological problems rather than medical / physical
- large clinical effect sizes for dep. and anx.
why were mindfulness interventions developed
westbrook and Kirk 2005:
although some people benefit from CBT- only 50% of people significantly benefit
complex presentations such as comorbid and personality disorders respond less well
relapse rates still high - vittengl
mechanisms of change for CBT disputed still
