Log in
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.
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.
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.
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.
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.
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.
Chronic Fatigue Syndrome or CFS (also known as CFS/ME) affects two percent of the population. Michael Sharpe and colleagues in Oxford developed a cognitive behavioural treatment (CBT) for CFS. In 1996 they published the first randomised controlled trial finding that CBT was substantially more effective than standard care, with patients three times more likely to improve. This was the first treatment ever to be shown to be effective for CFS in a clinical trial. The finding was subsequently confirmed in other trials. Sharpe's research has benefitted people with CFS by: [a] challenging the prevailing view of the illness as untreatable, [b] informing current NICE treatment guidance, [c] providing the leading evidence-based treatment. In England alone, the treatment is implemented in 46 NHS specialist CFS centres, to over 7000 patients per year.
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.
Schizophrenia, a severe and disabling mental disorder, affects about 285,000 people in the UK. It is associated with a progressive course, poor social and occupational functioning, a high suicide rate, premature death from physical illness and high use of health services including in-patient beds. Medication is the preferred treatment but response is limited. Prior to the publication of research carried out by Professor Stephen Pilling and colleagues at UCL there was uncertainty about the effectiveness of psychological interventions. This work established the case for psychological interventions in NICE guidelines and psychological interventions for schizophrenia are now widely available and used in the NHS.