Adherence to psychological interventions in MS ISSUES TO CONSIDER in clinical trials and practice Person affection by MS paMS presenting for initial session paMS attendance at sessions paMS completion of homework or practice tasks ID: 785138
Download The PPT/PDF document "Professor Rona Moss-Morris" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Professor Rona Moss-Morris
Adherence to psychological interventions in MS
Slide2ISSUES TO CONSIDER in clinical trials and practice
Person affection by MS (paMS) presenting for initial session paMS attendance at sessionspaMS completion of homework or practice tasks.
Therapist adherence to therapy protocol (treatment fidelity)
Slide31. Presenting for the initial sessionStigma of psychology/mental health
Integrated care versus separate physical and mental health services. Importance of referral‘Psychology as last port of call’‘Nothing else I can do….’ After first session – maintaining paMS in sessions
engagement
r
elevance of treatment model for MS
c
ollaborative approach
Slide42. Attendance At sessions.
Slide5Slide6Slide7CBT for MS adjustmentIntroduction to adjusting to MS
Adapting to living with MSSetting goals and problem solving
Managing symptoms
How to tackle negative and unhelpful thoughts
Improving the quality of your sleep
Managing stress
Managing social relationships
Preparing for the future
Slide8CONSENTED
N=122
RANDOMISATION
8 not eligible
10 changed their minds
Slide9Primary outcome measures
General Health Questionnaire (GHQ-12, Goldberg, 1992)improvements in both groups but changes in CBT significantly greater than in SL at end of treatment and 12 months follow-up
Work and Social Adjustment Scale (WSAS, Mundt et al., 2002)
greater improvement in CBT group but differences not significant.
Slide10ADHERENCE TO Sessions completed
85% of trial participants completed all 8 sessions CBT – 7 participants (14.6%) dropped out before completing all eight sessions SL – 7 participants (15.2%)
Reasons
too busy
finding therapy unhelpful or not useful
feeling they had already gained benefit.
Slide11Change in GHQ moderated by Sessions Completed
Slide12Slide13Change in WSAS moderated by Sessions Completed
Slide143. HOMEWORK
Slide15Homework in Cognitive Behavioural Therapy
Homework tasks are a core and crucial feature of CBTplanned therapeutic activities undertaken by clients between sessionsBased on content from the cognitive behavioural model but individualised to client formulationdesigned collaboratively
(Kazantzis et al., 2005)
Slide16Purpose of homework tasks Self assess thoughts, moods, physiology and behaviours
Allow clients to experience behavioural and cognitive change in vivoExperiment with new behavioursPractice and maintain new skills or techniques
(Judith Beck, 1995)
Slide17Meta-analysis of effects of homework Tasks on trial outcome
27 psychotherapy studies of mental health conditions. Effects size on treatment outcome inclusion of homework tasks (.36)compliance with those tasks (.22)
(Kazantzis, Deane, & Ronan, 2000)
Is it about quality (i.e. doing the homework correctly) or quantity
Slide18Homework ratings Completed each session by therapists1 – 10 scale of how well patients completed homework
Significantly predicted improvements in WSAS at 12 months, but not GHQ
Slide19Slide2015 – 20% of the population suffer from IBS
Symptomsabdominal pain or discomfortaltered stool frequency altered stool formaltered stool passage
abdominal bloating
Slide21Slide22Global Ratings of Relief: intention-to-treat (n=64)
Slide23Change in IBS-SSS across Groups
Slide24Adherence TO AMOUNT OF HOMEWORK
Only 1 out of 30 self management patients did not complete therapy24 out of the 30 (80%) participants in the self-management group returned their homework sheets. Quantity score – number of sheets completed
The mean score for the quantity completed was 6.94 (S.D.=2.66) out of a total of 10 sheets.
Slide25Quality scoreGenerated an ideal formulation for each of the homework tasks following Schmidt and Woolaway-Bickel (2000)
e.g. an ideal answer for goals around bowel symptom management. the goal was specific to time, place, frequency
the participant set realistic goals for each area
the participant completed self-monitoring of goals
Rating done by two independent raters (kappa .64)
Slide26Slide27ConclusionsAdherence of paMS does affect outcome in CBT based treatments.
For therapist delivered CBT – number of sessions completed is important Homework appears important for improvements at longer term follow up, particularly for impact of MS on life rolesFor self-management based on CBT – completing homework (quantity and quality) is associated with better outcome in IBS.