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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.
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.
Research at Sheffield has changed UK and international clinical guidelines for the treatment of post-traumatic stress disorder and has ensured that more appropriate treatments target people who have been traumatised. The Sheffield studies revealed the limitations and ineffectiveness of a commonly adopted clinical approach reliant on psycho-education and self-help. These studies concluded, on the basis of three randomised control trials of self-help provision, that despite the provision of information being valued by patients, it had no direct effect on relieving symptoms or enhancing quality of life or functioning. These research findings have directly contributed to good practice guidance for public health, disaster management and relief, and responding to terrorism and conflict.
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.
Over the last 20 years Imperial College research on the assessment and treatment of personality disorder has led to important changes in healthcare policy and the provision of services for people with these mental disorders. Our introduction of the first reliable assessment of the severity of personality disorder made it a much better understood and accepted diagnosis and led to current plans for changing the World Health Organisation (WHO) international classification of this disorder. Our research highlighting the impact of personality disorder contributed to the development of new services and our evaluation of these services led to them becoming more widely available throughout the NHS. In contrast, our evaluation of an intensive assessment and treatment programme for a select group of offenders with personality disorder showed that it was not cost effective. This programme has now been stopped and resources have been diverted to help treat a far wider group of people with personality disorder and offending behaviour.
This case study describes how Prof Cecilia Essau's research into emotional and behavioural problems in children and adolescents has been of benefit to children and has helped parents and schools to provide them with better support. Essau has worked with a children's charity to use her externally funded research to contribute to public understanding through providing presentations and skills training and to underpin the development and implementation of an anxiety prevention programme, Super Skills for Life (SSL), which has had a demonstrable benefit on children's wellbeing. In addition, Essau's research has been of value in informing the development of DSM-5, in introducing a specifier to the diagnosis of conduct disorder using callous-unemotional traits, and in refining the diagnosis of somatic symptom disorder. It has also contributed to policies and interventions internationally.
Impact: Health and welfare and public healthcare policy; demonstrating that community-directed treatment of onchocerciasis with doxycycline is effective where ivermectin is contra-indicated.
Significance: 12,936 onchocerciasis patients were treated safely and protected for at least 4 years. The treatment regime has been adopted by the US Centers for Disease Control and Prevention, the World Health Organization and governments.
Beneficiaries: Patients with onchocerciasis; governments and policy-makers.
Attribution: Studies performed by a long-standing African-European partnership formed and led by Taylor (UoE).
Reach: International; up to 8 million people in the Congo basin; onchocerciasis patients in Africa where ivermectin is not appropriate plus those in South America participating in focal eradication campaigns.
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.
Trachoma, caused by ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness. Research by Professors David Mabey and Robin Bailey, LSHTM, has shown that a single oral dose of azithromycin is an effective, feasible mass treatment and could eliminate trachoma from affected communities. As a result, the manufacturer Pfizer agreed to donate azithromycin to trachoma control programmes for as long as necessary and WHO established an Alliance for the Global Elimination of Blinding Trachoma by 2020. Since 2008, 205m azithromycin doses have been donated, and WHO elimination targets have been achieved in nine 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.