Optimising the acceptability and feasibility of novel complex interventions: an iterative, person-based approach to developing the UK Morita therapy outpatient protocol

Sugg, Holly Victoria Rose; Richards, David; Frost, Julia

doi:10.1186/s40814-017-0181-4

Cited by 16 publications

(28 citation statements)

References 16 publications

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“…Other development teams using intervention mapping guidance have carried out extensive data gathering to elicit the views of patients, carers and different groups of health professionals but reported that the overall process was time-consuming and resource-intensive [66,67]. One development team carried out in-depth interviews and qualitative thematic analysis to influence intervention development [68]. It is unclear how much data might be considered sufficient and whether more data and extensive input from multiple stakeholders, as undertaken by such teams, ultimately equates to more effective interventions.…”

Section: Contact Voluntary Transport Servicesmentioning

confidence: 99%

Co-production of “nature walks for wellbeing” public health intervention for people with severe mental illness: use of theory and practical know-how

et al. 2020

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Background: Interventions need to be developed in a timely and relatively low-cost manner in order to respond to, and quickly address, major public health concerns. We aimed to quickly develop an intervention to support people with severe mental ill-health, that is systematic, well founded both in theory and evidence, without the support of significant funding or resource. In this article we aim to open and elucidate the contents of the 'black box' of intervention development. Methods: A multidisciplinary team of seven academics and health practitioners, together with service user input, developed an intervention in 2018 by scoping the literature, face-to-face meetings, email and telephone. Researcher fieldnotes were analysed to describe how the intervention was developed in four iterative steps. Results: In step 1 and 2, scoping the literature showed that, a) people with severe mental illness have high mortality risk in part due to high levels of sedentary behaviour and low levels of exercise; b) barriers to being active include mood, stress, body weight, money, lack of programmes and facilities and stigma c) 'nature walks' has potential as an intervention to address the problem. In Step 3, the team agreed what needed to be included in the intervention so it addressed the "five ways to mental wellbeing" i.e., help people to connect, be active, take notice, keep learning and give. The intervention was mapped to key behavioural change concepts such as, personal relevance, relapse prevention, self-efficacy. In Step 4, the team worked out how best to implement the intervention. The intervention would be delivered over 12 weeks by members of the hospital team and community walk volunteers. Participants would receive a nature walks booklet and text messages. Conclusions: We developed a theoretically-informed, evidence-based nature walks programme in a timely and relatively low-cost manner relevant in an era of growing mental illness and funding austerity. Further research is required to test if the intervention is effective and if this approach to intervention development works.

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Section: Contact Voluntary Transport Servicesmentioning

confidence: 99%

Co-production of “nature walks for wellbeing” public health intervention for people with severe mental illness: use of theory and practical know-how

et al. 2020

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“…Therapists, in an effort to shift patients' attention away from symptom preoccupation and combat, will not focus on discussion or analysis of patients' symptoms or their causes, but will "steer" the conversation towards action-taking and the external environment Action-taking with symptoms Patients learn to undertake purposeful and necessary action, with or without their symptoms; action which is driven by "desire for life" rather than a desire to change internal states. MT thus aims to improve everyday functioning in spite of symptoms, with symptoms reducing as a by-product of moving from a mood-oriented to purpose-oriented and action-based lifestyle and randomised them to receive TAU or TAU plus 8-12 sessions of MT delivered by trained therapists at the University of Exeter's AccEPT clinic following our MT clinical protocol [38]. With the participant's consent, we audio-recorded all therapy sessions.…”

Section: Setting Recruitment and Data Collectionmentioning

confidence: 99%

“…For MT participants, we recorded the number of therapy sessions attended and reason for ending treatment. We completed post-treatment semi-structured interviews with consenting MT participants (n = 28) to explore their views of MT using a topic guide based on recent mental health trials addressing similar questions [13,52,53], MT literature and our MT optimisation study findings [38]. With participants' permission, interviews were audio-recorded and transcribed verbatim.…”

Section: Setting Recruitment and Data Collectionmentioning

confidence: 99%

“…Using Morita therapy (MT) as an exemplar, we utilised this novel mixed methods approach in the Morita trial. The trial follows on from an iterative programme of work conducted to develop our MT clinical protocol, whereby we optimised MT according to the views of stakeholders [38]. MT [39] is a Japanese psychotherapy, informed by Zen Buddhist principles, with a holistic approach aiming to improve everyday functioning rather than targeting specific symptoms [40,41].…”

Section: Introductionmentioning

confidence: 99%

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Personalising psychotherapies for depression using a novel mixed methods approach: an example from Morita therapy

Sugg

Frost

Richards

2020

Trials

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Background: Current quantitative methods for personalising psychotherapies for depression are unlikely to be able to inform clinical decision-making for hundreds of years. Novel alternative methods to generate hypotheses for prospective testing are therefore required, and we showcase mixed methods as one such approach. By exploring patients' perspectives in depth, and integrating qualitative and quantitative data at the level of the individual, we may identify new potential psychosocial predictors of psychotherapy outcomes, potentially informing the personalisation of depression treatment in a shorter timeframe. Using Morita therapy (a Japanese psychotherapy) as an exemplar, we thus explored how Morita therapy recipients' views on treatment acceptability explain their adherence and response to treatment. Methods: The Morita trial incorporated a pilot randomised controlled trial of Morita therapy versus treatment as usual for depression, and post-treatment qualitative interviews. We recruited trial participants from general practice record searches in Devon, UK, and purposively sampled data from 16 participants for our mixed methods analysis. We developed typologies of participants' views from our qualitative themes, and integrated these with quantitative data on number of sessions attended and whether participants responded to treatment in a joint typologies and statistics display. We enriched our analysis using participant vignettes to demonstrate each typology. Results: We demonstrated that (1) participants who could identify with the principles of Morita therapy typically responded to treatment, regardless of how many sessions they attended, whilst those whose orientation towards treatment was incompatible with Morita therapy did not respond to treatment, again regardless of treatment adherence and (2) participants whose personal circumstances impeded their opportunity to engage in Morita therapy attended the fewest sessions, though still benefitted from treatment if the principles resonated with them. Conclusions: We identified new potential relationships between "orientation" and outcomes, and "opportunity" and adherence, which could not have been identified using existing non-integrative methods. This mixed methods approach warrants replication in future trials and with other psychotherapies to generate hypotheses, based on typologies (or profiles) of patients for whom a treatment is more or less likely to be suitable, to be tested in prospective trials.

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“…It follows on from a programme of work conducted with patients and therapists to develop our Morita Therapy clinical protocol. 40 Findings from qualitative and mixed-methods work undertaken alongside the trial, to explore the acceptability of Morita Therapy and how this relates to treatment adherence, are reported elsewhere.…”

Section: Introduction and Objectivesmentioning

confidence: 99%

Morita Therapy for depression (Morita Trial): a pilot randomised controlled trial

2018

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ObjectiveTo address uncertainties prior to conducting a fully powered randomised controlled trial of Morita Therapy plus treatment as usual (TAU) versus TAU alone, or to determine that such a trial is not appropriate and/or feasible.DesignPilot parallel group randomised controlled feasibility trial.Setting and participantsParticipants aged ≥18 years with Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV major depressive disorder, with or without DSM-IV anxiety disorder(s), recruited from general practice record searches in Devon, UK.InterventionsWe randomised participants on a 1:1 basis stratified by symptom severity, concealing allocation using a secure independent web-based system, to receive TAU (control) or 8–12 sessions of Morita Therapy, a Japanese psychological therapy, plus TAU (intervention).OutcomesRates of recruitment, retention and treatment adherence; variance and estimated between-group differences in follow-up scores (on the Patient Health Questionnaire 9 (PHQ-9) (depressive symptoms); Generalised Anxiety Disorder Questionnaire 7 (anxiety symptoms); Short Form 36 Health Survey Questionnaire/Work and Social Adjustment Scale (quality of life); Morita Attitudinal Scale for Arugamama (attitudes)) and their correlation with baseline scores.ResultsWe recruited 68 participants, 5.1% (95% CI 3.4% to 6.6%) of those invited (34 control; 34 intervention); 64/68 (94%; 95% CI 88.3% to 99.7%) provided 4-month follow-up data. Participants had a mean age of 49 years and mean PHQ-9 score of 16.8; 61% were female. Twenty-four of 34 (70.6%) adhered to the minimum treatment dose. The follow-up PHQ-9 (future primary outcome measure) pooled SD was 6.4 (95% CI 5.5 to 7.8); the magnitude of correlation between baseline and follow-up PHQ-9 scores was 0.42 (95% CI 0.19 to 0.61). Of the participants, 66.7% and 30.0% recovered in the intervention and control groups, respectively; 66.7% and 13.3% responded to treatment in the intervention and control groups, respectively.ConclusionsA large-scale trial of Morita Therapy would require 133 participants per group and is feasible with minor modifications to the pilot trial protocol. Morita Therapy shows promise in treating depression and may provide patients with a distinct alternative to current treatments.Trial registration numberISRCTN17544090; Pre-results.

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Optimising the acceptability and feasibility of novel complex interventions: an iterative, person-based approach to developing the UK Morita therapy outpatient protocol

Cited by 16 publications

References 16 publications

Co-production of “nature walks for wellbeing” public health intervention for people with severe mental illness: use of theory and practical know-how

Co-production of “nature walks for wellbeing” public health intervention for people with severe mental illness: use of theory and practical know-how

Personalising psychotherapies for depression using a novel mixed methods approach: an example from Morita therapy

Morita Therapy for depression (Morita Trial): a pilot randomised controlled trial

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