Agoraphobia: nurse therapist-facilitated self-help manual.
by Karina Lovell, Debbie Cox, Rachel Garvey, David Raines, David Richards, Patrick Conroy, Dean Repper.
Journal of Advanced Nursing (2003)
Volume: 43, Issue: 6, Publisher: Blackwell Synergy, Pages: 623-630
PubMed: 12950568
Abstract
BACKGROUND: Agoraphobia is a common and disabling mental health disorder. Substantial evidence supports the use of cognitive behaviour therapy (CBT), in particular the intervention termed exposure therapy, as the treatment of choice. However, although the evidence base for cognitive-behaviour therapy is extensive, the service delivery evidence base is poor, and alternative ways of delivering therapy are required if mental health services are to achieve standards set out by the National Service Framework in the United Kingdom. AIM: The study had two aims: (1) to develop a self-help manual, which could be facilitated by a nurse trained in CBT, for clients suffering from agoraphobia and (2) to pilot the self-help manual and evaluate its effectiveness. METHOD: The self-help manual was piloted with experienced nurses trained in CBT on three clinical sites for 10 weekly sessions of 30 minutes duration. A range of clinical outcome measures was administered by an independent assessor before and after treatment and at 1-month follow-up. RESULTS: A total of 18 clients completed treatment and results showed improvement on all clinical measures; improvement was maintained at 1-month follow-up. Importantly, 89% of clients were clinically significantly improved at post-treatment assessment. Clients were satisfied with their treatment and the self-help manual, and therapists found facilitated self-help an acceptable way to deliver treatment. CONCLUSION: Nurses can deliver effective support to patients using a self-help manual for agoraphobia. Although the results are promising, further work is required with larger numbers, longer follow-up and economic evaluation under controlled conditions. The work could also be adapted to different psychological conditions. Variation in the amount of specialist educational training is necessary to determine how many nurses are needed to support patients using self-help.
Telephone Administered Cognitive Behaviour Therapy for Treatment of Obsessive Compulsive Disorder: Randomised Controlled Non-inferiority Trial
Karina Lovell, Debbie Cox, Gillian Haddock, Christopher Jones, David Raines, Rachel Garvey, Chris Roberts and Sarah Hadley
BMJ 2006; 333 doi: 10.1136/bmj.38940.355602.80 (Published 26 October 2006)
Cite this as: BMJ 2006;333:
Abstract
Objectives To compare the effectiveness of cognitive behaviour therapy delivered by telephone
with the same therapy given face to face in the treatment of obsessive compulsive disorder. Design
Randomised controlled non-inferiority trial. Setting Two psychology outpatient departments in the
United Kingdom. Participants 72 patients with obsessive compulsive disorder. Intervention 10 weekly sessions of exposure therapy and response prevention delivered by telephone or face to face.
Main outcome measures Yale Brown obsessive compulsive disorder scale, Beck depression
inventory, and client satisfaction questionnaire. Results Difference in the Yale Brown obsessive
compulsive disorder checklist score between the two treatments at six months was -0.55 (95%
confidence interval -4.26 to 3.15). Patient satisfaction was high for both forms of treatment.
Conclusion The clinical outcome of cognitive behaviour therapy delivered by telephone was
equivalent to treatment delivered face to face and similar levels of satisfaction were reported
Dynamic hierarchies: a control system paradigm for exposure therapy
Alec Bradya1 c1 and David Rainesa1
The Cognitive Behaviour Therapist: Practice article
a1 Department of Psychology, University of Chester, Chester, UK
Abstract
Exposure therapy is a widely used and well-evidenced treatment for a variety of avoidance behaviours. This paper offers a modest proposal for an improvement in how it is carried out (‘dynamic hierarchies’). The theoretical and practical context is set out, including some thoughts on the role of appraisals and cognitive dissonance, and some advantages of the method are suggested.
(Online publication January 05 2009)
The Cognitive Behaviour Therapist (2010), 2 : pp 51-62 Copyright © British Association for Behavioural and Cognitive Psychotherapies 2009 DOI: 10.1017/S1754470X0800010X (About DOI) Published online: 05 January 2009
