A qualitative study with healthcare staff exploring the facilitators and barriers to engaging in a self-help mindfulness-based intervention

In order to increase the cost-efficiency, availability and ease of accessing and delivering mindfulness-based interventions (MBIs), clinical and research interest in mindfulness-based self-help (MBSH) interventions has increased in recent years. Several studies have shown promising results of effectiveness of MBSH. However, like all self-help interventions, drop-out rates and disengagement from MBSH is high. The current study explored the facilitators and barriers of engaging in a MBSH intervention. Semi-structured interviews with members of healthcare staff who took part in an MBSH intervention (n = 16) were conducted. A thematic analysis approach was used to derive central themes around engagement from the interviews. Analyses resulted in four overarching themes characterising facilitation and hindrance to engagement in MBSH. These are: “Attitude towards Engagement”, “Intervention Characteristics”, “Process of Change” and “Perceived Consequences”. Long practices, emerging negative thoughts and becoming self-critical were identified as the key hindrances, while need for stress reduction techniques, shorter practices and increased sense of agency over thoughts were identified as the key facilitators. Clinical and research implications are discussed

Improving employee wellbeing and effectiveness: a systematic review and meta-analysis of workplace psychological interventions delivered online

Background: Stress, depression and anxiety amongst working populations can result in reduced work performance and increased absenteeism, but while there is evidence that these common mental health problems are preventable and treatable in the workplace, uptake of psychological treatments amongst the working population is low. One way to address this may be the delivery of occupational digital mental health interventions, but while there is convincing evidence for delivering digital psychological interventions within a health and community context, there is no systematic review or meta-analysis of these interventions in an occupational setting. Objective: This review aims to identify the effectiveness of occupational digital mental health interventions in enhancing employee psychological wellbeing and increasing work effectiveness, and to identify intervention features associated with the highest rates of engagement and adherence. Methods: A systematic review of the literature was conducted using Cochrane guidelines. Papers published between 2000 and May 2016 were searched in 2 the PsychINFO, MEDLINE, PubMed, Science Direct and the Cochrane databases, as well as the databases of the researchers and relevant websites. Unpublished data was sought using the Conference Proceedings Citation Index and the Clinical Trials and ISRCTN research registers. A metaanalysis was conducted by applying a random-effects model to assess the pooled effect size for psychological wellbeing and the work effectiveness outcomes. A positive deviance approach was used to identify those intervention features associated with the highest rates of engagement and adherence. Results: In total 21 RCTs met the search criteria. Occupational digital mental health interventions had a statistically significant effect post intervention on both psychological wellbeing (g = 0.37, 95% CI: 0.23 to 0.50) and work effectiveness (g = 0.25, 95% CI: 0.09 to 0.41) compared to the control condition. No statistically significant differences were found on either outcome between studies using CBT approaches (as defined by the authors) compared with other psychological approaches, offering guidance compared with selfguidance, or recruiting from a targeted workplace population compared with a universal workplace population. In depth analysis of the interventions identified by the positive deviance approach suggests that interventions that offer guidance, are delivered over a shorter timeframe (6 to 7 weeks), utilise secondary modalities for delivering the interventions and engaging users (i.e. emails and text messages), and use elements of persuasive technology (i.e. self-monitoring and tailoring) may achieve greater engagement and adherence. Conclusions: This review provides evidence that occupational digital mental health interventions can improve workers’ psychological wellbeing and increase work effectiveness. It identifies intervention characteristics that may increase engagement. Recommendations are made for future research, practice and intervention development. Registration: The protocol for this systematic review and meta-analysis was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42016033935)

Development and psychometric properties of the Sussex-Oxford compassion scales (SOCS)

Compassion has received increasing societal and scientific interest in recent years. The science of compassion requires a tool that can offer valid and reliable measurement of the construct to allow examination of its causes, correlates, and consequences. The current studies developed and examined the psychometric properties of new self-report measures of compassion for others and for the self, the 20-item Sussex-Oxford Compassion for Others Scale (SOCS-O) and 20-item Sussex-Oxford Compassion for the Self Scale (SOCS-S). These were based on the theoretically and empirically supported definition of compassion as comprising five dimensions: (a) recognizing suffering, (b) understanding the universality of suffering, (c) feeling for the person suffering, (d) tolerating uncomfortable feelings, and (e) motivation to act/acting to alleviate suffering. Findings support the five-factor structure for both the SOCS-O and SOCS-S. Scores on both scales showed adequate internal consistency, interpretability, floor/ceiling effects, and convergent and discriminant validity

Increasing access to CBT for psychosis patients: a feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2)

Background: The National Institute for Health and Care Excellence (NICE) recommends that Cognitive Behaviour Therapy for psychosis (CBTp) is offered to all patients with a psychosis diagnosis. However, only a minority of psychosis patients in England and Wales are offered CBTp. This is attributable, in part, to the resource-intensive nature of CBTp. One response to this problem has been the development of CBTp in brief formats that are targeted at a single symptom and the mechanisms that maintain distress. We have developed a brief form of CBTp for distressing voices and reported preliminary evidence for its effectiveness when delivered by highly trained therapists (clinical psychologists). This study will investigate the delivery of this intervention by a cost-effective workforce of assistant psychologists following a brief training and evaluate the acceptability and feasibility of conducting a future, definitive, randomised controlled trial (RCT). Methods: This is a feasibility study for a pragmatic, three-arm, parallel-group, superiority 1:1:1 RCT comparing a Guided self-help CBT intervention for voices and treatment as usual (GiVE) to Supportive Counselling and treatment as usual (SC) to treatment as usual alone (TAU), recruiting across two sites, with blinded post-treatment and follow-up assessments. A process evaluation will quantitatively and qualitatively explore stakeholder experience. Discussion: Expected outcomes will include an assessment of the feasibility of conducting a definitive RCT, and data to inform the calculation of its sample size. If evidence from a subsequent, fully powered RCT suggests that GiVE is clinically and cost-effective when delivered by briefly trained assistant psychologists, CBTp offered in these less resource-intensive forms has the potential to generate benefits for individual patients (reduced distress, enhanced recovery and enhanced quality of life), service-level patient benefit (increased access to evidence-based psychological therapies) and economic benefits to the NHS (in terms of the reduced use of mental health inpatient services). Trial registration: Current Controlled Trials, ISRCTN registration number: 16166070. Registered on 5 February 2019

The Australian Memory Project: Postcards from the Edge of South Australia. [abstract].

This paper will establish the purpose, reasoning, research context, and initial findings of the Australian Memory Project’s “Postcards in South Australia” digital archive and exhibition. Placing our project in the framework of similar “memory” projects, and describing some of the theoretical underpinnings and outcomes of such projects, goes some way towards building a picture of memory work in the Australian context and the place of our project within that broader framework

My care manager, my computer therapy and me: the relationship triangle in computerized cognitive behavioural therapy

Previous research has reported mixed findings regarding the relationship between therapeutic alliance, engagement and outcomes in e-mental health. This study aims to overcome some of the methodological limitations of previous research and extend our understanding of alliance-outcome relationships in e-mental health by exploring the nature of the relationship triangle between the patient, their care manager and their computerized cognitive behavioural therapy (CCBT) program, accessed with or without an Internet Support Group (ISG). Positive patient-rated alliance with both their care manager and the CCBT program itself was found and these were significantly associated with measures of engagement and clinical outcome. The magnitude of this association was moderate, and within the range of that reported for traditional face-to-face psychotherapies in recent meta-analyses. Limitations of the study, including the reliance on completer data and a cross-sectional design, and directions for future research are presented. Our findings suggest that both the training and supervision of support staff and the optimization of CCBT interventions themselves to enhance alliance and experience may lead to improved engagement and outcomes

Examining the factor structure of the 39-item and 15-item versions of the five facet mindfulness questionnaire before and after mindfulness-based cognitive therapy for people with recurrent depression

Research into the effectiveness and mechanisms of mindfulness-based interventions (MBIs) requires reliable and valid measures of mindfulness. The 39-item Five Facet Mindfulness Questionnaire (FFMQ-39) is a measure of mindfulness commonly used to assess change before and after MBIs. However, the stability and invariance of the FFMQ factor structure have not yet been tested before and after an MBI; pre to post comparisons may not be valid if the structure changes over this period. Our primary aim was to examine the factor structure of the FFMQ-39 before and after mindfulness-based cognitive therapy (MBCT) in adults with recurrent depression in remission using confirmatory factor analysis (CFA). Additionally, we examined whether the factor structure of the 15-item version (FFMQ-15) was consistent with that of the FFMQ-39, and whether it was stable over MBCT. Our secondary aim was to assess the general psychometric properties of both versions. CFAs showed that pre-MBCT, a 4-factor hierarchical model (excluding the “observing” facet) best fit the FFMQ-39 and FFMQ-15 data, whereas post-MBCT, a 5-factor hierarchical model best fit the data for both versions. Configural invariance across the time points was not supported for both versions. Internal consistency and sensitivity to change were adequate for both versions. Both FFMQ versions did not differ significantly from each other in terms of convergent validity. Researchers should consider excluding the Observing subscale from comparisons of total scale/subscale scores before and after mindfulness interventions. Current findings support the use of the FFMQ-15 as an alternative measure in research where briefer forms are needed. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Is clinician-supported use of a mindfulness smartphone app a feasible treatment for depression? A mixed-methods feasibility study

This article relates to a research study that included patients or members of the workforce as study participants from GP practices in Nottingham and Nottinghamshire.Depression is the leading cause of disability globally and has serious consequences for the individual, their family and for society. Effective, accessible and affordable treatments are urgently needed. In-person group-based mindfulness-based interventions are an effective treatment for depression, but are not widely available and can be costly. Clinician supported use of mindfulness self-help resources such as mindfulness smartphone applications could widen access at a reduced cost, but there are key feasibility questions that need answering. This is a mixed-methods feasibility study of a blended intervention involving the mindfulness smartphone app Headspace alongside six clinician support sessions with mental health treatment seeking adults experiencing moderate to moderately severe symptoms of depression. In line with recommendations for feasibility studies, we examine whether: (1) it is possible to recruit participants to this novel intervention, (2) participants engage with the intervention, (3) participants and clinicians find the intervention acceptable, and (4) pre-post outcomes on measures of depression (primary outcome), anxiety, wellbeing, mindfulness, self-compassion, rumination and worry indicate effectiveness. Findings show that recruitment is feasible with 54 participants enrolled in the intervention within a 6-month window. In terms of engagement, 44.4% completed at least 80% of recommended Headspace sessions and 72.2% of participants attended at least three clinician support sessions. Clinician-supported Headspace was deemed acceptable by participants and clinicians. Pre-post effect sizes were statistically significant and in the small-medium or medium-large range on all outcomes, with an effect size of d = 0.69 (95% CI: 0.34-1.04) for the primary outcome of depression symptom severity. The number of Headspace sessions engaged with was associated with greater reduction in depression symptom severity. Findings suggest that a blended intervention combining Headspace with clinician support has potential as a first-line treatment for moderate/moderately severe depression, but findings are too preliminary to recommend the intervention outside of a research trial. Important caveats are noted including the need for future research to examine predictors of engagement with Headspace sessions so that engagement can be enhanced, to measure the longer term effects of such interventions and to better understand the potential for lasting negative effects of the intervention so that these can be minimised