Week 9 - patient relevant outcomes

Question 1

definition of recovery

Answer 1

Returning to more normal life

Question 2

types of recovery

Answer 2

clinical and personal

Question 3

clinical recovery

Answer 3

what is medically important

Question 4

personal recovery

Answer 4

patient centred
returning to something the patient wants

Question 5

NICE guidance about what is recommended in treatment for recovery

Answer 5

• CBT for depression and anxiety (Clark, 2011) with other therapies are recommended for depression (brief dynamic therapy, counselling, and interpersonal psychotherapy) but not for anxiety disorders.
  • Stepped care model recommended, use of case formulation in CBT to reduce stress, combination of CBT and medication.

Question 6

psychological interventions

Answer 6

• Routines with necessary and pleasurable activities.
  
  • Identification of activities already doing, what is avoided and what is wanted and then separate into routine, necessary and pleasurable.
    Hierarchy of difficulty of activities

Question 7

behavioural activation in CBT - explain focus

Answer 7

• What is happening now and what is wanted and then work in challenging the steps, building confidence and trying to break free of negative feelings and experiences.
  
  • Thought challenging

Question 8

evidence for BA in CBT

Answer 8

• Ciharova 2021: cog restructuring or behavioural activation along and their combination in CBT are all effective in treating adult depression with no differences in effectiveness.

Question 9

evidence for cognitive strategies: thought challenging and cog restructuring

Answer 9

• As effective as each other for depression and anxiety and as CBT
  
  • Quality of studies on cog restructuring not great
  • Behavioural activation more cost effective
    (ciharova 2021)

Question 10

sleep and MH outcomes evidence

Answer 10

• Meta-analysis of 65 studies and over 8000 people showed causal link with improved sleep leading to improved mental health outcomes
  ○ Scott 2021: sleep causally related to MH difficulties as greater improvements in sleep quality lead to greater MH improvements.

Question 11

relapse prevention

Answer 11

• set of strategies that aim to maintain treatment gains and prevent an initial lapse; and provide skills and strategies for managing a lapse and preventing further lapses (Witkiewitz & Kirouac, 2015)
  
  • Wellness and recovery action plans (Copeland 2002)

Question 12

unhelpful things in CBT/improvements

Answer 12

• Overwhelming info
  
  • Should work on prevention plan over time not just in end session
  • More guidance and support on external factors like eating
  • If there is something the doctor can’t help with then redirection needed