Randomized controlled trial of parent-enhanced CBT compared with individual CBT for obsessive-compulsive disorder in young people

Objective: Obsessive-compulsive disorder (OCD) in young people can be effectively treated with Cognitive Behavior Therapy (CBT). Practice guidelines in the United Kingdom recommend that CBT be delivered with parental or family involvement; however, there is no evidence from randomized trials that this enhances effectiveness. The aim of this trial was to assess if CBT with high parental involvement was more effective than CBT with low parental involvement (individual CBT) in reducing symptoms of OCD. Method: Fifty young people ages 12–17 years with OCD were randomly allocated to individual CBT or parent-enhanced CBT. In parent-enhanced CBT parents attended all treatment sessions; in individual CBT, parents attended only Sessions 1, 7, and the final session. Participants received up to 14 sessions of CBT. Data were analyzed using intent-to-treat and per-protocol methods. The primary outcome measure was the Children’s Yale-Brown Obsessive Compulsion Scale (Scahill et al., 1997). Results: Both forms of CBT significantly reduced symptoms of OCD and anxiety. Change in OCD symptoms was maintained at 6 months. Per-protocol analysis suggested that parent-enhanced CBT may be associated with significantly larger reductions in anxiety symptoms. Conclusions: High and low parental involvement in CBT for OCD in young people were both effective, and there was no evidence that 1 method of delivery was superior on the primary outcome measure. However, this study was small. Future trials should be adequately powered and examine interactions with the age of the young person and comorbid anxiety disorders.

Investigating the relationship between competence and patient outcome with CBT

Little is understood about the relationship between therapist competence and the outcome of patients treated for common mental health disorders. Understanding the relationship between competence and patient outcome is of fundamental importance to the dissemination and implementation of Cognitive Behavioural Therapy (CBT). The current study extends existing literature by exploring the relationship between CBT competence and patient outcome in routine clinical practice within the framework of the British Government’s Improving Access to Psychological Therapies (IAPT) programme. Participants comprised 43 therapists treating 1247 patients over a training period of one year. Results found little support of a general association between CBT competence and patient outcome; however significantly more patients of the most competent therapists demonstrated a reliable improvement in their symptoms of anxiety than would be expected by chance alone, and fewer experienced no reliable change. Conversely, significantly more patients treated by the least competent therapists experienced a reliable deterioration in their symptoms than would be expected. The implications of these results for the dissemination and implementation of CBT are discussed.

Cognitive behaviour therapy (CBT) for depression by computer vs. therapist: patient experiences and therapeutic processes

This case series compares patient experiences and therapeutic processes between two modalities of cognitive behaviour therapy (CBT) for depression: computerized CBT (cCBT) and therapist-delivered CBT (tCBT). In a mixed-methods repeated-measures case series, six participants were offered cCBT and tCBT in sequence, with the order of delivery randomized across participants. Questionnaires about patient experiences were administered after each session and a semi-structured interview was completed with each participant at the end of each therapy modality. Therapy expectations, patient experiences and session impact ratings in this study generally favoured tCBT. Participants typically experienced cCBT sessions as less meaningful, less positive and less helpful compared to tCBT sessions in terms of developing understanding, facilitating problem-solving and building a therapeutic relationship.

Overcoming your child’s fears and worries: guided parent delivered CBT treatment manual for therapists

This manual for therapists accompanies ‘Overcoming your child’s fears and worries’ (Creswell & Willetts, 2007), a guide for parents to help their children overcome difficulties with anxiety

Innovative use of e-portfolio for personal development

iLearn is a quasi-Web 2.0 tool developed in Blackboard to help users with Personal Development Planning (PDP). This paper describes a case study on how the innovative use of mobile digital technology in iLearn e-Portfolio for developing reflective portfolios for PDP benefits the users, who are training to be professionals in construction management and surveying, The e-Portfolio tool benefits users as it enables them to create and share portfolios, record achievements and reflections that support future job applications and promotion. Users find it beneficial because they can make use of iLearn e-Portfolio to keep academic records and achievements, activities and interests, work experience, reflective practice, employer information and some other useful resources, and also to tailor their CV and covering letters including evidence to support their CV, transferable skills and selling points. Useful information for preparing for an interview, reflecting after an event and any thoughts and evaluation can be kept in iLearn e-Portfolio. Keeping assessment and feedback records in iLearn e-Portfolio enables learners to know their progress, to identify any gaps they need to fill to develop their study practices and areas for development. The key points from the feedback on the assignments and assessments are beneficial for future improvement. The reflections on the tasks and how they make use of the advice are particularly useful to improve their overall performance. In terms of pedagogical benefits, the “Individual Learner Profile” records and reviews evidence in verbal communication, basic and higher academic skills, time management, numeracy skill and IT skills, learners become increasingly aware of their own strengths and any weaker areas that may require development. The e-Portfolio also provides opportunity for them to reflect on the experience and skills they have gained whilst participating in activities outside their studies. As the iLearn e-Portfolio is a reflective practice tool, it is consistent with the principle of Schon's reflective practitioner to reframe problems and to explore the consequences of actions. From the users’ feedback, for those who engage regularly in iLearn, they are better able to set agendas for their supervision meetings and provide their supervisor with a unique record of their achievements, skills and attributes which help them writing effective references for them. They make the most of their learning experience in general. They also enhance their transferable skills and employability overall. The iLearn e-Portfolio prepares them for the workplace including continuing professional development. Users are aware of their transferable skills, evidence of the skills and skill level, including award or accreditation, and their personal reflection on their transferable skills. It is beneficial for them to be aware of their transferable skills, to produce evidence of the skills and skills level such as award and accreditation, and to record their personal reflection on their transferable skills. Finally, the innovative use of mobile digital technology in iLearn e-Portfolio for developing reflective portfolios for PDP will improve their employability.