The relationship between expected engagement and talking therapy outcome

Harrison, Phillippa; Hardy, Gillian E.; Barkham, Michael

doi:10.1002/cpp.2369

Cited by 5 publications

(4 citation statements)

References 36 publications

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“…A limitation of the study is the decentralized enrollment process, which may have selected a more motivated cohort than expected in clinical practice, potentially overestimating the efficacy of BT-001. The observation that subjects completing more modules had greater HbA 1c reduction supports the importance of engagement, consistent with in-person CBT (12) and behavioral interventions in general (3). Other limitations include the exclusion of non-English speakers, as the app is currently only available in English, and the exclusion of current smokers, a group comprising 14% of adults with diabetes (1), who might be expected to benefit from improved glycemic control.…”

Section: Discussionsupporting

confidence: 66%

Randomized, Controlled Trial of a Digital Behavioral Therapeutic Application to Improve Glycemic Control in Adults With Type 2 Diabetes

Hsia

Guthrie²,

Lupinacci³

et al. 2022

Diabetes Care

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OBJECTIVE To evaluate the efficacy and safety of a digital therapeutic application (app) delivering cognitive behavioral therapy (CBT) designed to improve glycemic control in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Adults with type 2 diabetes and an HbA1c of 7 to <11% were randomly assigned to receive access to a digital therapeutic app delivering CBT (BT-001) or a control app, both on top of standard of care management. CBT is an established form of psychological treatment that endeavors to identify and change unhelpful thinking patterns. The primary study end point was treatment group difference in mean HbA1c change from baseline to 90 days. RESULTS Among 669 randomly assigned subjects who completed app onboarding, the mean age was 58 years, BMI 35 kg/m2, 54% were female, 28% Black, and 16% Latino. Baseline HbA1c was 8.2 and 8.1% in the BT-001 and control groups, respectively. After 90 days of app access, change in HbA1c was −0.28% (95% CI −0.41, −0.15) in the BT-001 group and +0.11% (95% CI −0.02, 0.23) in the control group (treatment group difference 0.39%; P < 0.0001). HbA1c reduction paralleled exposure to the therapeutic intervention, assessed as the number of modules completed on the app (P for trend <0.0001). No adverse events in either group were attributed to app use and no adverse device effects reported. CONCLUSIONS Patients randomly assigned to the BT-001 arm relative to the control arm had significantly lower HbA1c at 90 days. The digital therapeutic may provide a scalable treatment option for patients with type 2 diabetes.

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Section: Discussionsupporting

confidence: 66%

Randomized, Controlled Trial of a Digital Behavioral Therapeutic Application to Improve Glycemic Control in Adults With Type 2 Diabetes

Hsia

Guthrie²,

Lupinacci³

et al. 2022

Diabetes Care

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“…In relation to successful psychosexual and relationship therapy, the client is required to be able to effectively communicate, be open minded, and trust the therapist (Harrison, Hardy and Barkham, 2019). The shared micro-dosing experiences can enhance feelings of closeness supporting relationship connection (Gabb and Fink, 2015).…”

Section: Discussionmentioning

confidence: 99%

Micro-dosing psychedelics as a plausible adjunct to psychosexual and couple’s therapy: a qualitative insight

Jacobs

Banbury

Lusher

2022

Sexual and Relationship Therapy

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Background: Research has predominated among the therapeutic application of psychedelics for varied psychopathologies and yet remains limited when supporting sexual behaviour and intimacy among couples; particularly those who micro-dose. Method: Using semi-structured interviews, this qualitative study explored the micro-dosing sexual experiences of four partnered men and women aged 20-35 years. Interviews examined the effect of microdosing on confidence, openness, sexuality, inhibition and perceived relationship satisfaction.Results: Thematic analysis identified three key narratives: increased sexual self-efficacy; sexual exploration; and heightened relationship satisfaction. From the participant perspective, the use of micro-dosing psychedelics had a positive effect on sexual and physical well-being by reducing stress and performance-related anxiety. This in turn elevated sexual desire, exploration, communication and enhanced sensory and sexual experience, thus potentially supporting emotional and physical connection. In terms of erectile functioning and orgasm, participants attributed this to being micro-dose and psychedelic choice dependent. Whilst higher doses of ecstasy hindered sexual functioning this did not negatively impact the emotional and sensory experiences. Conclusion: These findings point to micro-dosing psychedelics as offering a potentially beneficial adjunct to psychosexual and couple's therapy; potentiating relationship and sexual satisfaction. Further research might wish to gravitate quantitatively towards a larger and varied micro-dosing populace in supporting sexual self-efficacy and intimacy.

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“…Further, the importance of considering client's preference has been found to be greater for short-term therapies (Swift, Callahan, Ivanovic, & Kominiak, 2013). Finally, clients' positive expectations for the effect of therapy influence the outcome (Constantino, Vîsla ˘, Coyne, & Boswell, 2018) and there is emerging evidence that client's level of acceptance of the theoretical explanation of their problem and the therapeutic actions proposed is important for nurturing such expectation (Harrison, Hardy, & Barkham, 2019). The above findings further support the need for a greater provision of a range of models in IAPT, as they suggest that a model that better fits client's preference and belief system will lead to better outcomes.…”

Section: The Elusiveness Of Cbt Superiority and The Neglected Effecti...mentioning

confidence: 99%

Moving beyond a single-model philosophy: Integrating relational therapies in front-line psychological therapy services in England.

Leonidaki

2021

Journal of Psychotherapy Integration

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This article critically reflects on controversial aspects of the English service model of frontline psychological therapies. The Improving Access to Psychological Therapies (IAPT) program in England has had worldwide influence and embodied core psychotherapy debates between clinical practice, research evidence, and politics. The article initially focuses on the definition of evidence-based therapy in the program and the resulting dominance of protocol-based, specific-disorder, Cognitive Behavioral Therapy (CBT), which has ostracized other treatment models. The medical model, the outcome research paradigm, and the English clinical guidelines, treated as the pillars of the CBT hegemony, are critically examined. Omissions are highlighted, including the therapist's effect, the effectiveness of psychodynamic psychotherapy and integrative practice, and the contribution of client-related factors to treatment outcome, all which contradict key principles of the IAPT philosophy. An innovative initiative to integrate a relational pathway, including brief psychodynamic and relational integrative therapy, into the English service model is then presented. The article discusses the potential remedying effect of injecting relational therapies into the program philosophy. In particular, the IAPT framework has extended beyond a service model to represent a certain paradigm of what psychotherapy should look like, emphasizing diagnosis and technical manuals. On the contrary, a relational pathway places the client, the therapist and an individualized approach to treatment at the heart of therapy. Thus, integrating relational therapies in IAPT would entail renegotiation of core psychotherapy dialectics, including technical knowledge versus clinician's expertise and diagnostic-driven versus individually tailored treatments. The wider implications of such renegotiations are pointed out.

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The relationship between expected engagement and talking therapy outcome

Cited by 5 publications

References 36 publications

Randomized, Controlled Trial of a Digital Behavioral Therapeutic Application to Improve Glycemic Control in Adults With Type 2 Diabetes

Randomized, Controlled Trial of a Digital Behavioral Therapeutic Application to Improve Glycemic Control in Adults With Type 2 Diabetes

Micro-dosing psychedelics as a plausible adjunct to psychosexual and couple’s therapy: a qualitative insight

Moving beyond a single-model philosophy: Integrating relational therapies in front-line psychological therapy services in England.

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