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The benefits of office-based psychotherapies such as cognitive-behaviour therapy (CBT) are well-established in the treatment of common psychiatric disorders but their effectiveness with more severe conditions and when administered in circumstances beyond the reach of conventional services have not been known. Researchers at the University of Liverpool (UoL) have developed, adapted and evaluated CBT as a treatment for patients with schizophrenia, bipolar disorder and eating disorders and are now pioneering the delivery of CBT in rural areas in the developing world. This work has led to changes in treatment guidelines and improved treatment in the UK and in other countries.
Eating disorders (anorexia nervosa, bulimia nervosa and related conditions) are common, often chronic and disabling, and sometimes fatal. Christopher Fairburn and colleagues have engaged in long-term research into the nature and treatment of eating disorders. The impacts are: (1) developing the standard measurement tools for eating disorders; (2) devising the leading and most effective evidence-based therapy for bulimia nervosa (`CBT-BN'); (3) showing that a modified form of the treatment is effective for all eating disorders (`CBT-E'); (4) developing an effective and popular self-help version. These treatments allow, for the first time, a significant chance of complete and sustained recovery from an eating disorder. The treatments are recommended by NICE and international guidelines, and are being disseminated worldwide.
Anxiety disorders are the most common emotional disorders in children, affecting up to 19% of all children and adolescents, and are associated with significant impairment and poor long term outcomes. Research at the University of Reading has highlighted particular parental factors associated with the development and persistence of childhood anxiety disorders. This research led to the development of a brief treatment which has proven effective for a significant sub-group (>70%) of patients. The treatment has been widely implemented in the U.K. and internationally. As a result, the research has increased access to evidence based treatment, which has benefitted affected children, their parents/caregivers and children's mental health services.
While in Oxford, David M. Clark and colleagues developed psychological models of panic disorder and social anxiety disorder, tested the models in experiments, and devised novel psychological treatments (forms of cognitive therapy [CT]) that target the processes in the models. Randomised controlled trials (RCTs) showed that CT was more effective than existing psychological and drug treatments, with 70-80% of people recovering. The therapies are recommended first-line interventions in current NICE guidelines, and are widely available in the NHS through the Improving Access to Psychological Therapies (IAPT) programme, which Clark helped establish and is now evaluating. The treatments are also being used and recommended in many other countries.
Dr Lina Gega's research has been instrumental to the development and take-up of computerised Cognitive Behavioural Therapy (cCBT) and other technology-mediated interventions for common mental health problems in the UK and internationally. Gega's adjunct on-line methods form a key foundation for the training of professionals to support cCBT, and the National Institute for Health and Care Excellence (NICE) guidelines now include cCBT for first line intervention for common mental health problems. These developments have resulted in a greater patient reach for cCBT internationally, with resultant decreases in waiting time for patients (with associated economic benefit) and improved outcomes.
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.
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.
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.
A research programme of randomised controlled trials undertaken at the University of Southampton demonstrating the efficacy of the New Forest Parenting Programme (NFPP) played a crucial role in: (i) influencing the developers of clinical guidelines to recommend parent training in general as a core part of the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) and (ii) establishing the NFPP, in particular, as a widely employed evidence-based treatment for ADHD, a condition estimated to affect up to 400,000 children in the UK alone. As a direct result of the trials, the programme, a novel therapeutic intervention that teaches parents of preschool children with ADHD how to modify their children's behaviour and improve their self-regulation, has been included in the National Institute for Health and Clinical Excellence (NICE) and other clinical guidelines and recommended internationally as an effective alternative to medication, which often brings only short-term benefits and is associated with a range of potentially debilitating side-effects.
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.