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Research at Edinburgh Napier University regarding psychosocial interventions for trauma has pioneered management of mental health problems. We have developed and tested a number of individual, group and self-help interventions aimed at promoting recovery following psychological childhood and adulthood trauma. We have trained a large number of healthcare professionals on our interventions in the voluntary and statutory sectors. Our research has also informed policy regarding the management of psychological trauma. Self-help materials developed through our research are currently being used by health and social care workers in Scotland and abroad, making an impact on the wellbeing of survivors of trauma.
Research by Anke Ehlers' group at Oxford University has had major impacts on the treatment and outcome of post-traumatic stress disorder (PTSD). The group developed and validated a psychological model of the key factors that lead to PTSD. A novel form of cognitive therapy (CT) that specifically targets these psychological processes was then developed. Randomised controlled trials showed that CT is highly acceptable and highly effective in recent-onset and chronic PTSD, in adults and children. It is one of the recommended first-line interventions in the NICE PTSD guideline. It has been made widely available in the NHS through Improving Access to Psychological Therapies (IAPT), and is being disseminated in other countries. Separate research by Ehlers showed that a previously leading treatment, debriefing, was ineffective, leading to it not being recommended by NICE.
Depression is a major public health problem producing substantial decrements in health and well-being, with 15% lifetime prevalence, affecting 350 million people worldwide. The Mood Disorders Centre (MDC) has improved treatment for depression by (i) understanding psychological mechanisms underpinning depression; (ii) translating this into innovative treatments and prevention interventions, evaluated in clinical trials; (iii) improving dissemination, delivery, and access to treatments. This research has improved patient care and quality of life, influenced national policy (NICE Depression Guidelines), informed national service and training provision (Improving Access to Psychological Therapies IAPT programme, with 680,000 people completing treatment 2008-2011) and achieved international impact on clinical practice.
The pioneering work undertaken at UCL has had a major impact on clinical practice for the treatment of self-harming, suicidal patients with a diagnosis of borderline personality disorder and the techniques have been drawn on in extensions to other common mental disorders including eating disorder, substance misuse, and antisocial personality disorder. This treatment, known as mentalisation based therapy or MBT, has since been applied in a range of clinical settings including inpatient and outpatient work in the UK and internationally. This case study presents two areas in particular where our research has been applied: the treatment of personality disorders, and in work with troubled adolescents.
An estimated one in four people in the UK will experience depression or anxiety at some point in their lives. Cognitive behavioural therapy (CBT) is the most widely recommended non-medication- based treatment for common mental health problems, although access to this treatment is limited because of low numbers of expert practitioners. Self-help CBT resources developed by researchers at the University of Glasgow have been integrated into routine clinical practice delivered by health services and the voluntary sector in the UK, Ireland and Canada. Since 2008, these practical user-friendly resources have provided support to over 200,000 users online and an estimated 250,000 people on a one-to-one basis or within a class.
With one in five of the adult population in the UK living with arthritis, self-management education is a key approach used by occupational therapists (OTs) to support people with arthritis. University of Salford research has improved the tools available to OTs to deliver more effective self-management education, demonstrating the following impact:
Work by Fonagy and Roth at UCL to establish a firm evidence base for psychological therapies has had a profound impact on the delivery of services across the UK. This evidence was used to establish the Improving Access to Psychological Therapies programme. Building on the original research, Roth and Pilling developed a series of competence frameworks which have been used to train thousands of additional therapists to deliver the programme. More than a million patients have now benefitted from the programme, which, along with the clear impacts on individual wellbeing, has also been recognised as having significant economic gains, in terms of NHS savings, reduced welfare spending, and increased return to the workforce.
Research into primary care insomnia by the Community and Health Research Unit (CaHRU) has led to broad improvements in healthcare provision for insomnia, improved patient quality of life, informed national/international policy and practice in insomnia care and impacted directly on health professional practice and insomnia sufferers, initially in Lincolnshire spreading across the UK and internationally from 2008 to 2011. Direct effects on practice include changes in sleep management and reduced hypnotic prescribing through seminars, workshops, conferences and e-learning developed by the team; inclusion in UK policy, practitioner information, training materials and guidance on hypnotics has led to greater professional and public awareness of sleep management internationally.
Recent NHS policy has prioritised improving access to cost-effective psychological interventions for people with mental health problems. Research by Lucock at the Centre for Health and Social Care Research (CHSCR) has contributed to meeting this challenge by developing and evaluating self-help interventions which can be provided by a range of NHS staff without professional psychotherapy or mental health training. This work has resulted in the creation of the Self-Help Access in Routine Primary Care (SHARP) initiative, a programme that gives practitioners materials and training which enable them to deliver brief self-help interventions supported by a dedicated website and a range of leaflets that recognise service users' need for easy-to-understand material. Feedback from practitioners on the website and training has been positive. There is evidence of positive impacts of the training on practitioners' confidence in their ability to deal with anxiety and depression, and in greater use of Cognitive Behaviour Therapy (CBT) approaches with patients. Evidence from testimony demonstrates impact on practice. Research also provides evidence of benefit to patients in terms of reduction of anxiety and depression and goal attainment. The research has also influenced national guidance on best practice.
The discovery of an early Acute Traumatic Coagulopathy (ATC, a syndrome of abnormal clotting after trauma) by Professor Brohi's team in 2000, and subsequent work building on that pivotal discovery, has led to [A] a new understanding of why patients bleed to death after severe injury and resulted in [B] a fundamental change in resuscitation strategy for acute bleeding patients (`Damage Control Resuscitation') that has led to [C] a 250-300 per cent improved survival in massively bleeding trauma patients. Discovering the character and mechanism of ATC has led to [D] new research in diagnostics and therapeutic opportunities to further improve outcomes. These rapid changes have led to [E] new forums for professional education and [F] improved public understanding of science and medicine.