Using Implementation Intentions to Prevent Relapse after Psychological Treatment for Depression – the SMArT Intervention

Lucock, Mike; Bartys, Serena; Cupac, Jade; Delgadillo, Jaime; Denton, Charlotte; Gaines, Sarah M.; McMillan, Dean; Prestwich, Andrew; Stebbings, Rick

doi:10.1017/s1352465818000255

Cited by 5 publications

(9 citation statements)

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“…A major area for improvement is the consistent implementation of evidence‐based relapse prevention support, such as booster sessions (Gearing, Schwalbe, Lee, & Hoagwood, 2013) or mindfulness‐based relapse prevention (Kuyken et al ., 2016). A promising development in this regard concerns telephone‐delivered relapse prevention support which could be implemented at low cost to support IAPT patients to maintain their improvement after the acute phase of therapy (Lucock et al ., 2018) and during the first 6 months after therapy which is known to be the time of highest risk of relapse (Ali et al ., 2017).…”

Section: Discussionmentioning

confidence: 99%

Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence

Wakefield

Kellett

Simmonds‐Buckley

et al. 2020

British J Clinic Psychol

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133

104

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Objectives Improving Access to Psychological Therapies (IAPT) is a national‐level dissemination programme for provision of evidence‐based psychological treatments for anxiety and depression in the United Kingdom. This paper sought to review and meta‐analyse practice‐based evidence arising from the programme. Design A pre‐registered (CRD42018114796) systematic review and meta‐analysis. Methods A random effects meta‐analysis was performed only on the practice‐based IAPT studies (i.e. excluding the clinical trials). Subgroup analyses examined the potential influence of particular methodologies, treatments, populations, and target conditions. Sensitivity analyses investigated potential sources of heterogeneity and bias. Results The systematic review identified N = 60 studies, with N = 47 studies suitable for meta‐analysis. The primary meta‐analysis showed large pre‐post treatment effect sizes for depression (d = 0.87, 95% CI [0.78–0.96], p < .0001) and anxiety (d = 0.88, 95% CI [0.79–0.97], p < .0001), and a moderate effect on functional impairment (d = 0.55, 95% CI [0.48–0.61], p < .0001). The methodological features of studies influenced ESs (e.g., such as whether intention‐to‐treat or completer analyses were employed). Conclusions Current evidence suggests that IAPT enables access to broadly effective evidence‐based psychological therapies for large numbers of patients. The limitations of the review and the clinical and methodological implications are discussed. Practitioner points IAPT interventions are associated with large pre‐post treatment effect sizes in depression and anxiety measures. IAPT interventions are associated with moderate treatment effect sizes with regards to work and social adjustment. A reduction in dropout and also the prevention of post‐treatment relapse via the offer of follow‐up support are important areas for future development.

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Section: Discussionmentioning

confidence: 99%

Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence

Wakefield

Kellett

Simmonds‐Buckley

et al. 2020

British J Clinic Psychol

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133

104

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“…Four studies aimed at improving co-production within already ongoing work processes 48–51. Most of the studies aimed at evaluating outcomes of co-produced information, interventions/services or products 47 48 52–67. Among the studies evaluating outcomes of co-produced interventions/services, the focus was on effectiveness52 61 and on the level of improvement 54.…”

Section: Results Of the Systematic Reviewmentioning

confidence: 99%

Measurement and outcomes of co-production in health and social care: a systematic review of empirical studies

Nordin,

Kjellstrom,

Robert

et al. 2023

BMJ Open

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BackgroundCo-production is promoted as an effective way of improving the quality of health and social care but the diversity of measures used in individual studies makes their outcomes difficult to interpret.ObjectiveThe objective is to explore how empirical studies in health and social care have described the outcomes of co-production projects and how those outcomes were measured.Design and methodsA scoping review forms the basis for this systematic review. Search terms for the concepts (co-produc* OR coproduc* OR co-design* OR codesign*) and contexts (health OR ‘public service* OR “public sector”) were used in: CINAHL with Full Text (EBSCOHost), Cochrane Central Register of Controlled trials (Wiley), MEDLINE (EBSCOHost), PsycINFO (ProQuest), PubMed (legacy) and Scopus (Elsevier). There was no date limit. Papers describing the process, original data and outcomes of co-production were included. Protocols, reviews and theoretical, conceptual and psychometric papers were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The Mixed Methods Appraisal Tool underpinned the quality of included papers.Results43 empirical studies were included. They were conducted in 12 countries, with the UK representing >50% of all papers. No paper was excluded due to the Mixed Methods Quality Appraisal screening and 60% of included papers were mixed methods studies. The extensive use of self-developed study-specific measures hampered comparisons and cumulative knowledge-building. Overall, the studies reported positive outcomes. Co-production was reported to be positively experienced and provided important learning.ConclusionsThe lack of common approaches to measuring co-production is more problematic than the plurality of measurements itself. Co-production should be measured from three perspectives: outputs of co-production processes, the experiences of participating in co-production processes and outcomes of co-production. Both self-developed study-specific measures and established measures should be used. The maturity of this research field would benefit from the development and use of reporting guidelines.

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“…It was previously established that the PWP training (a one-year part time Post Graduate Certificate including supervised practice) provided the necessary knowledge and competences in face-to-face and telephone based guided self-help (Lucock et al, 2018). In this study, an additional single workshop was provided which specifically focussed on the SMArT intervention and included demonstration videos and role plays.…”

Section: The Smart Interventionmentioning

confidence: 99%

“…Implementation intentions have been incorporated into a brief relapse prevention intervention called Self-Management after Therapy (SMArT), with encouraging indications of acceptability and effectiveness (Lucock et al, 2018). Specific elements of the design of the SMArT intervention were informed by research, for example, outcomes are improved if participants select their own goals and plans (Koestner et al, 2002); guidance and support increases the quality of the plans (Gallo et al, 2009) and improves outcomes (Luszczynska, 2006;Luszczynska et al, 2007); faceto-face "booster" sessions improve outcomes (Chapman & Armitage, 2010); and framing IMPS as plans that are personally relevant, rather than imposed, leads to better behavioural engagement (Adriaanse et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…Finally, a meta-analysis provides support for monitoring goal progress as an effective self-regulation strategy, which can include the use of diaries (Harkin et al, 2016). The SMArT intervention is therefore based on a theoretical framework, as recommended by the UK Medical Research Council (MRC) guidance on the development, evaluation and implementation of complex interventions (Craig et al, 2008), and designed in collaboration with patients and practitioners (Lucock et al, 2018) but more evidence is required to establish its impact on relapse prevention. The aims of this study were to investigate: 1.…”

Section: Introductionmentioning

confidence: 99%

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Using implementation intentions to prevent relapse after remission from psychological treatment for depression: The SMArT intervention

Lucock

Borthwick

Cupac

et al. 2021

Psychotherapy Research

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Objective: To provide evidence of the effectiveness of a brief relapse prevention intervention using implementation intentions (Self-Management after Therapy, SMArT), following remission from depression and to identify effective relapse prevention strategies. Method: The SMArT intervention was provided to 107 patients who were recovered after psychological therapy for depression. Relapse events were calculated as reliable and clinically significant increases in PHQ-scores. Sixteen patients receiving the intervention and eight practitioners providing it were interviewed. Framework Analysis identified seven themes which highlighted effective relapse prevention strategies and effective implementation of the SMArT intervention. Results: Relapse rates at the final SMArT session (four months after the end of acute stage therapy) were 11%. Seven themes were identified that supported effective self-management: (1) Relationship with the practitioner-feeling supported; (2) Support networks; (3) Setting goals, implementing plans and routine; (4) Changing views of recovery; (5) The SMArT sessions-mode, content, timing, duration; (6) Suitability for the person; and (7) Suitability for the service. Conclusion:The study provides some support for the effectiveness of the SMArT intervention, although a randomized controlled trial is required; and identifies important relapse prevention strategies.

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Using Implementation Intentions to Prevent Relapse after Psychological Treatment for Depression – the SMArT Intervention

Abstract: Implementation intentions are a promising approach to support the self-management of depression.

Cited by 5 publications

References 5 publications

Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence

Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence

Measurement and outcomes of co-production in health and social care: a systematic review of empirical studies

Using implementation intentions to prevent relapse after remission from psychological treatment for depression: The SMArT intervention

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