Cognitive behaviour therapy (CBT) for the treatment of co-occurring depression and substance use : current evidence and directions for future research

Issues and Approach: The high rates of co-occurring depression and substance use, and the negative impact of this on illness course and outcomes have been well established. Despite this, few clinical trials have examined the efficacy of cognitive behaviour therapy (CBT). This paper systematically reviews these clinical trials, with an aim of providing recommendations for how future research can develop a more robust evidence base for the treatment of these common comorbidities. Leading electronic databases, including PubMed (ISI) and PsychINFO (CSA), were searched for peer-reviewed journal articles using CBT for the treatment of co-occurring depression and substance use. Of the 55 articles identified, 12 met inclusion criteria and were included in the review. ---------- Key Findings: There is only a limited evidence for the effectiveness of CBT either alone or in combination with antidepressant medication for the treatment of co-occurring depression and substance use. While there is support for the efficacy of CBT over no treatment control conditions, there is little evidence that CBT is more efficacious than other psychotherapies. There is, however, consistent evidence of improvements in both depression and substance use outcomes, regardless of the type of treatment provided and there is growing evidence that that the effects of CBT are durable and increase over time during follow up. ---------- Conclusions. Rather than declaring the ‘dodo bird verdict’ that CBT and all other psychotherapies are equally efficacious, it would be more beneficial to develop more potent forms of CBT by identifying variables that mediate treatment outcomes.

Modelling web search behaviour : a user’s cognitive style perspective [Unpublished]

Many researchers have investigated and modelled aspects of Web searching. A number of studies have explored the relationships between individual differences and Web searching. However, limited studies have explored the role of users’ cognitive styles in determining Web searching behaviour. Current models of Web searching have limited consideration of users’ cognitive styles. The impact of users’ cognitive style on Web searching and their relationships are little understood or represented. Individuals differ in their information processing approaches and the way they represent information, thus affecting their performance. To create better models of Web searching we need to understand more about user’s cognitive style and their Web search behaviour, and the relationship between them. More rigorous research is needed in using more complex and meaningful measures of relevance; across a range of different types of search tasks and different populations of Internet users. The project further explores the relationships between the users’ cognitive style and their Web searching. The project will develop a model depicting the relationships between a user’s cognitive style and their Web searching. The related literature, aims and objectives and research design are discussed.

The effect of track defects on the dynamics of wagons under brake-traction torque

Track defects cause profound effects to the stability of railway wagons; normally such problems are modeled for cases of wagons running at constant speed. Brake/traction torque adversely affect the wheel-rail contact characteristics but they are not explicitly considered in most of the wagon-track interaction simulation packages. This research developed a program that can simulate the longitudinal behaviour of railway wagon dynamics under the actions of braking or traction torques. This paper describes the mathematical formulation of modelling of a full wagon system using a fixed coordinate reference system. The effect of both the lateral and the vertical track geometry defects to the dynamics of wagons is reported; sensitivity of traction/brake state is analysed through a series of numerical examples.

Predicting the consumption of foods low in saturated fats among people diagnosed with Type 2 diabetes and cardiovascular disease. The role of planning in the theory of planned behaviour

The present study tested the utility of an extended version of the theory of planned behaviour that included a measure of planning, in the prediction of eating foods low in saturated fats among adults diagnosed with Type 2 diabetes and/or cardiovascular disease. Participants (N = 184) completed questionnaires assessing standard theory of planned behaviour measures (attitude, subjective norm, and perceived behavioural control) and the additional volitional variable of planning in relation to eating foods low in saturated fats. Self-report consumption of foods low insaturated fats was assessed 1 month later. In partial support of the theory of planned behaviour, results indicated that attitude and subjective norm predicted intentions to eat foods low in saturated fats and intentions and perceived behavioural control predicted the consumption of foods low in saturated fats. As an additional variable, planning predicted the consumption of foods low in saturated fats directly and also mediated the intention–behaviour and perceived behavioural control–behaviour relationships, suggesting an important role for planning as a post-intentional construct determining healthy eating choices. Suggestions are offered for interventions designed to improve adherence to healthy eating recommendations for people diagnosed with these chronic conditions with a specific emphasis on the steps and activities that are required to promote a healthier lifestyle.

Free surface problems for static Coulomb-Mohr granular solids

This paper is concerned with some plane strain and axially symmetric free surface problems which arise in the study of static granular solids that satisfy the Coulomb-Mohr yield condition. Such problems are inherently nonlinear, and hence difficult to attack analytically. Given a Coulomb friction condition holds on a solid boundary, it is shown that the angle a free surface is allowed to attach to the boundary is dependent only on the angle of wall friction, assuming the stresses are all continuous at the attachment point, and assuming also that the coefficient of cohesion is nonzero. As a model problem, the formation of stable cohesive arches in hoppers is considered. This undesirable phenomena is an obstacle to flow, and occurs when the hopper outlet is too small. Typically, engineers are concerned with predicting the critical outlet size for a given hopper and granular solid, so that for hoppers with outlets larger than this critical value, arching cannot occur. This is a topic of considerable practical interest, with most accepted engineering methods being conservative in nature. Here, the governing equations in two limiting cases (small cohesion and high angle of internal friction) are considered directly. No information on the critical outlet size is found; however solutions for the shape of the free boundary (the arch) are presented, for both plane and axially symmetric geometries.

Optimization problems for controlled mechanical systems : bridging the gap between theory and application

Mechanical control systems have become a part of our everyday life. Systems such as automobiles, robot manipulators, mobile robots, satellites, buildings with active vibration controllers and air conditioning systems, make life easier and safer, as well as help us explore the world we live in and exploit it’s available resources. In this chapter, we examine a specific example of a mechanical control system; the Autonomous Underwater Vehicle (AUV). Our contribution to the advancement of AUV research is in the area of guidance and control. We present innovative techniques to design and implement control strategies that consider the optimization of time and/or energy consumption. Recent advances in robotics, control theory, portable energy sources and automation increase our ability to create more intelligent robots, and allows us to conduct more explorations by use of autonomous vehicles. This facilitates access to higher risk areas, longer time underwater, and more efficient exploration as compared to human occupied vehicles. The use of underwater vehicles is expanding in every area of ocean science. Such vehicles are used by oceanographers, archaeologists, geologists, ocean engineers, and many others. These vehicles are designed to be agile, versatile and robust, and thus, their usage has gone from novelty to necessity for any ocean expedition.

Multitasking information behaviour in public libraries : a survey study

Multitasking information behaviour is the human ability to handle the demands of multiple information tasks concurrently. When we multitask, we work on two or more tasks and switch between those tasks. Multitasking is the way most of us deal with the complex environment we all live in, and recent studies show that people often engage in multitasking information behaviours. Multitasking information behaviours are little understood, however, and an important area for information behaviour research. Our study investigated the multitasking information behaviours of public library users at the Brentwood and Wilkinsburg Public Libraries in Pittsburgh through diary questionnaires. Findings include that some 63.5 percent of library users engaged in multitasking information behaviours, with a mean of 2.5 topic changes and 2.8 topics per library visit. A major finding of our study is that many people in libraries are seeking information on multiple topics and are engaged in multitasking behaviours. The implications of our findings and further research are also discussed. (Contains 7 tables and 2 figures.)

The Behaviour of Young Novice Drivers Scale (BYNDS)

The contribution of risky behaviour to the increased crash and fatality rates of young novice drivers is recognised in the road safety literature around the world. Exploring such risky driver behaviour has led to the development of tools like the Driver Behaviour Questionnaire (DBQ) to examine driving violations, errors, and lapses. Whilst the DBQ has been utilised in young novice driver research, some items within this tool seem specifically designed for the older, more experienced driver, whilst others appear to asses both behaviour and related motives. Therefore there is a need for a risky behaviour measurement tool that can be utilised with young drivers with a provisional (intermediate) driving licence.

Implementing low intensity CBT in case management of clients with severe mental illness

In a previous chapter (Dean and Kavanagh, Chapter 37), the authors made a case for applying low intensity (LI) cognitive behaviour therapy (CBT) to people with serious mental illness (SMI). As in other populations, LI CBT interventions typically deal with circumscribed problems or behaviours. LI CBT retains an emphasis on self-management, has restricted content and segment length, and does not necessarily require extensive CBT training. In applying these interventions to SMI, adjustments may be needed to address cognitive and symptomatic difficulties often faced by these groups. What may take a single session in a less affected population may require several sessions or a thematic application of the strategy within case management. In some cases, the LI CBT may begin to appear more like a high-intensity (HI) intervention, albeit simple and with many LI CBT characteristics still retained. So, if goal setting were introduced in one or two sessions, it could clearly be seen as an LI intervention. When applied to several different situations and across many sessions, it may be indistinguishable from a simple HI treatment, even if it retains the same format and is effectively applied by a practitioner with limited CBT training. ----- ----- In some ways, LI CBT should be well suited to case management of patients with SMI. treating staff typically have heavy workloads, and find it difficult to apply time-consuming treatments (Singh et al. 2003). LI CBT may allow provision of support to greater numbers of service users, and allow staff to spend more time on those who need intensive and sustained support. However, the introduction of any change in practice has to address significant challenges, and LI CBT is no exception. ----- ----- Many of the issues that we face in applying LI CBT to routine case management in a mnetal health service and their potential solutions are essentially the same as in a range of other problem domains (Turner and Sanders 2006)- and, indeed, are similar to those in any adoption of innovation (Rogers 2003). Over the last 20 years, several commentators have described barriers to implementing evidence-based innovations in mental health services (Corrigan et al. 1992; Deane et al. 2006; Kavanagh et al. 1993). The aim of the current chapter is to present a cognitive behavioural conceptualisation of problems and potential solutions for dissemination of LI CBT.

Adapting low intensity CBT interventions for clients with severe mental illness

Many people with severe mental illness (SMI) such as schizophrenia, whose psychotic symptoms are effectively managed, continue to experience significant functional problems. This chapter argues that low intensity (LI) cognitive behaviour therapy (CBT; e.g. for depression, anxiety, or other issues) is applicable to these clients, and that LI CBT can be consistent with long-term case management. However, adjustments to LI CBT strategies are often necessary and boundaries between LI CBT and high intensity (HI) CBT (with more extensive practitioner contact and complexity) may become blurred. Our focus is on LI CBT's self-management emphasis, its restricted content and segment length, and potential use after limited training. In addition to exploring these issues, it draws on the authors' Collaborative Recovery (CR; Oades et al. 2005) and 'Start Over and Survive' programs (Kavanagh et al. 2004) as examples. ----- ----- Evidence for the effectiveness of LI CBT with severe mental illness is often embedded within multicomponent programs. For example, goal setting and therapeutic homework are common components of such programs, but they can also be used as discrete LI CBT interventions. A review of 40 randomised controlled trials involving recipients with schizophrenia or other sever mental illnesses has identified key components of illness management programs (Mueser et al. 2002). However, it is relatively rare for specific components of these complex interventions to be assessed in isolation. Given these constraints, the evidence for specific LI CBT interventions with severe mental ilnness is relatively limited.

Focus of attention and its impact on movement behaviour

Investigations into the relative effectiveness of either focusing on movement form (internal focus) or movement effects (external focus) have tended to dominate research on instructional constraints. However, rather than adopting a comparative approach to determine which focus of attention is more effective, analysis of the relative efficacy of each specific instruction focus during motor learning could be more relevant for both researchers and practitioners. Theoretical advances in the motor learning literature from a nonlinear dynamics perspective might explain the processes that underlie the effect of different attentional focus instructions. Referencing ideas and concepts from a current motor learning model, differential effects of either internal or external focus of instructions are examined. This paper also highlights some deficiencies in extant theory and research design on focus of attention which require further investigations.

The role of mother-centered factors influencing the complex social behaviour of breastfeeding : social support and self-efficacy

This research investigated the role of mother-centred issues that influence breastfeeding behaviours. The need for social marketing research for breastfeeding is indicated by the fact that despite evidence of the health benefits to both the infant and mother of longer breastfeeding duration, rates in developed countries have failed to increase in recent decades. Breastfeeding is a complex behaviour that for many women involves barriers that influence their commitment to continue breastfeeding. Structural equation modelling was used on a sample of 405 respondents to an online survey. The analysis revealed that personal social support had a significant impact on breastfeeding self-efficacy, which in turn had a significant impact on breastfeeding behaviour. The findings and implications for both social marketing theory and practice are discussed.

Effect of spacing of reinforcement on the behaviour of partially grouted masonry shear walls

Partially Grouted Reinforced Masonry (PGRM) shear walls perform well in places where the cyclonic wind pressure dominates the design. Their out-of-plane flexural performance is better understood than their inplane shear behaviour; in particular, it is not clear whether the PGRM shear walls act as unreinforced masonry (URM) walls embedded with discrete reinforced grouted cores or as integral systems of reinforced masonry (RM) with wider spacing of reinforcement. With a view to understanding the inplane response of PGRM shear walls, ten full scale single leaf, clay block walls were constructed and tested under monotonic and cyclic inplane loading cases. It has been shown that where the spacing of the vertical reinforcement is less than 2000mm, the walls behave as an integral system of RM; for spacing greater than 2000mm, the walls behave similar to URM with no significant benefit from the reinforced cores based on the displacement ductility and stiffness degradation factors derived from the complete lateral load – lateral displacement curves.

Predicting mothers’ decisions to introduce complementary feeding at 6 months : an investigation using an extended theory of planned behaviour

In Australia and other developed countries there is poor adherence to guidelines recommending the introduction of complementary feeding to infants at 6 months of age. We aimed to investigate, via adopting a theory of planned behaviour framework and incorporating additional normative and demographic influences, mothers’ complementary feeding intentions and behaviour. Participants were 375 primiparas who completed an initial questionnaire (infant age 13±3weeks) that assessed the theory of planned behaviour constructs of attitude, subjective norm, and perceived behavioural control, as well as group norm and additional maternal and infant variables of mothers’ age, education level, weight status perception, current maternal feeding practices, and infant birth weight. Approximately, 3 months after completion of the main questionnaire, mothers completed a follow-up questionnaire that assessed the age in months at which the infant was first introduced to solids. The theory of planned behaviour variables of attitude and subjective norm, along with group norm, predicted intentions, with intention, mothers’ age (older more likely), and weight status perception (overweight less likely) predicting behaviour. Overall, the results highlight the importance of attitudes, normative influences, and individual characteristics in complementary feeding decision-making which should be considered when designing interventions aimed at improving adherence to current maternal feeding guidelines.

Ecological leadership : a new perspective on leadership

Given today's focus on the state of the environment and the developing role of corporate social leadership in could be argued that there is a need for the development of successful business leaders who have a positive relationship to the natural world. Gifford (2007) argued that any real change in sustainable practice will most likely happen at an individual level, through changes in attitudes and everyday behaviour. For this change to happen, an individual will need to feel connected to the natural world (Dunbar, 2004; Schroll, 2007). Roszak (1992) developed the notion of ecopsychology specifically to explore this relationship and suggest new ways to generate greater environmental awareness as well as ameliorate psychological problems caused or exacerbated by widespread alienation from nature. From this perspective it seems imperative that we develop people centred leader’s who feel connected to the natural world whilst demonstrating solid performance, as measured by organisational and social indicators. This paper presents information from an International research project that might add further insights into the role outdoor education plays in the development of generic leaders who have a positive relationship to the natural world. Three questionnaires, an established measurement of generic transformational leadership (MLQ) and two established measurement of attitudes to and feelings about the natural world (the New Ecological Paradigm Scale and the Connectedness to Nature Scale), were administered to 214 (males, n=138 and females, n=76) International outdoor leaders with the implicit aim of assessing the nexus of transformational leadership theory and adventure based leadership development. The large and diverse cohort of participants has provided ground-breaking insights into transformational and ecological leadership styles. This paper outlines a descriptive analysis of findings and offers valuable information for those involved in training leaders. Throughout this presentation participants will be encouraged to contextualise the information for their specific circumstance.