Publications by year
In Press
Ukoumunne OC, Mann J, Kuyken W, O'Mahen H, Evans A, Ford T (In Press). Manual Development and Pilot Randomised Controlled Trial of Mindfulness-based Cognitive Therapy versus Usual Care for Parents with a History of Depression.
MindfulnessAbstract:
Manual Development and Pilot Randomised Controlled Trial of Mindfulness-based Cognitive Therapy versus Usual Care for Parents with a History of Depression
Parental depression can adversely affect parenting and children's development. We adapted mindfulness-based cognitive therapy (MBCT) for parents (MBCT-P) with a history of depression and describe its development, feasibility, acceptability and preliminary estimates of efficacy. Manual development involved interviews with 12 parents who participated in MBCT groups or pilot MBCT-P groups. We subsequently randomised 38 parents of children aged between 2 and 6 years to MBCT-P plus usual care (n=19) or usual care (n=19). Parents were interviewed to assess the acceptability of MBCT-P. Preliminary estimates of efficacy in relation to parental depression. and children’s behaviour were calculated at 4 and 9 months post-randomisation. Levels of parental stress, mindfulness and self-compassion were measured. Interviews confirmed the acceptability of MBCT-P; 78% attended at least half the sessions. In the pilot RCT, at 9 months, depressive symptoms in the MBCT-P arm were lower than in the usual care arm (adjusted mean difference = -7.0; 95% CI: -12.8 to -1.1; p=0.02) and eleven participants (58%) in the MBCT-P arm remained well compared to six (32%) in the usual care arm (mean difference = 26%; 95% CI: -4% to 57%; p = 0.02). Levels of mindfulness (p=0.01) and self-compassion (p =
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Lynch TR, Hempel RJ, Whalley B, Russell I, Byford S, Clark P, Shearer J, O'Mahen HA, Clarke S, Kingdon D, et al (In Press). Refractory depression – Mechanisms and Evaluation of Radically Open Dialectical Behaviour Therapy (RO-DBT) [REFRAMED]: protocol for randomised trial.
BMJ Open(in press).
Abstract:
Refractory depression – Mechanisms and Evaluation of Radically Open Dialectical Behaviour Therapy (RO-DBT) [REFRAMED]: protocol for randomised trial
Introduction: Only 30% to 40% of depressed patients treated with medication achieve full remission. Studies where medication is switched or augmented by psychotherapy indicate only limited benefits, in part because current treatments are not specifically designed for chronic and complex patients; previous RCTs have tended to exclude high risk patients and those with comorbid personality disorder. Radically Open Dialectical Behaviour Therapy (RO-DBT) is a novel, transdiagnostic treatment for disorders of emotional over-control. The REFRAMED study aims to evaluate the effectiveness and cost-effectiveness of RO-DBT for patients with treatment-resistant depression.
Methods & Analysis: REFRAMED is a multi-centre, randomized controlled trial, comparing seven months of individual and group RO-DBT treatment with treatment as usual (TAU). Our primary outcome is depressive symptoms, measured 12 months after randomisation. The cost effectiveness of RO-DBT will be estimated in terms of cost per quality-adjusted life-years. Novel causal analyses will explore the mechanisms by which RO-DBT may be effective.
Ethics & Dissemination: Ethical approval has been granted: First MREC, 20/06/2011, ref: 11/SC/0146. Trial Registration: http://www.isrctn.com/ISRCTN85784627
Strengths & Limitations of this study: This study tests a novel and promising psychotherapeutic intervention, specifically designed for patients with chronic and hard to treat depression. RO-DBT is manualised, and enjoys increasing adoption as a treatment for over-controlled patients. Our inclusive sample will enable us to generalise our findings, and will add to the limited evidence base on interventions for refractory depression. Our comparator for the effectiveness of RO-DBT is standard clinical practice, including both medication and other psychotherapies. Our mechanisms analyses will estimate the role of mediators including the therapeutic alliance and adherence to treatment, and our design enables us to reduce bias inherent in conventional analyses of mediation.
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O'Mahen HA, Tester-Jones M, Karl A, Watkins E (In Press). Rumination in dysphoric mothers negatively affects mother-infant interactions.
Journal of Child Psychology and Psychiatry Full text.
Taylor AK, O'Mahen HA, Stein A, Evans J, Pearson R (In Press). The association between maternal postnatal depressive symptoms and offspring sleep problems in adolescence.
Psychological Medicine Full text.
2021
Perry RC, Ford TJ, O’Mahen H, Russell AE (2021). Prioritising Targets for School-Based ADHD Interventions: a Delphi Survey.
School Mental HealthAbstract:
Prioritising Targets for School-Based ADHD Interventions: a Delphi Survey
AbstractMany studies have investigated the effectiveness of school-based ADHD interventions at modifying different social, emotional and behavioural target outcomes. However, there is a lack of evidence about which targets stakeholders perceive to be most important. This study sought to obtain consensus on which outcomes are perceived to be most important. A total of 114 people with ADHD, educational professionals, parents of children with ADHD, clinicians and researchers participated in a Delphi survey with 3 rounds. The importance of 52 intervention targets was rated on a scale from 0 to 8 (8 being extremely important). Consensus was reached if >70% of a stakeholder group rated a target as between 6–8 and <15% rated it as 0–2. Targets were dropped from subsequent rounds if more than 50% of stakeholder groups rated it as 0–5. Targets that all four stakeholder groups reached consensus on in any round were automatically included in our final outcome set. Comments were analysed using Thematic Analysis. All four stakeholder groups reached consensus on the importance of seven targets: ability to pay attention, conflict with teachers and peers, executive functioning, global functioning and quality of life, inattention symptoms, organisation skills and self-esteem. Four overarching themes were identified: Complexity of ADHD, Relationships, School Context, and What ADHD means to me. School-based ADHD interventions should target outcomes identified as most important to those who stand to benefit from such interventions. Some outcomes prioritised by our participants have not yet been targeted in school-based ADHD interventions. Implications of our findings for intervention and research design are discussed.
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2020
Halligan S, wilson K, Safazadeh S (2020). Blocking Out Baby’s Crying: Maternal Emotion Regulation, Mood. and Parental Problem Solving.
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Blocking Out Baby’s Crying: Maternal Emotion Regulation, Mood. and Parental Problem Solving.
A mother’s ability to regulate her emotions in childrearing contexts may be key to effective parenting. However, only a small number of correlational studies have explored this dynamic. We aimed to examine experimentally the effects of two key emotion regulation strategies (reappraisal and suppression), when used in a context of infant distress, on postnatal women’s emotional experience, confidence and ability to solve parenting problems. Sixty-six postnatal women were randomly allocated to one of three emotion regulation conditions, where they were asked to reappraise, suppress or do nothing about their emotional responses to an audio recording of a crying baby. The effects of maternal emotion regulation on change in maternal negative and positive affect from before and after the crying task, parental problem-solving and their problem-solving confidence were assessed. Mothers in the suppression condition demonstrated smaller increases in negative mood from baseline to after the crying task, and better problem-solving effectiveness than those in the control condition. There was limited evidence to support reappraisal strategies in the context of infant crying. There were no other significant differences in problem-solving effectiveness or confidence in problem solving.
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Lynch TR, Hempel RJ, Whalley B, Byford S, Chamba R, Clarke P, Clarke S, Kingdon DG, O'Mahen H, Remington B, et al (2020). Refractory depression - mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms.
Br J Psychiatry,
216(4), 204-212.
Abstract:
Refractory depression - mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms.
BACKGROUND: Individuals with depression often do not respond to medication or psychotherapy. Radically open dialectical behaviour therapy (RO DBT) is a new treatment targeting overcontrolled personality, common in refractory depression. AIMS: to compare RO DBT plus treatment as usual (TAU) for refractory depression with TAU alone (trial registration: ISRCTN 85784627). METHOD: RO DBT comprised 29 therapy sessions and 27 skills classes over 6 months. Our completed randomised trial evaluated RO DBT for refractory depression over 18 months in three British secondary care centres. of 250 adult participants, we randomised 162 (65%) to RO DBT. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), assessed masked and analysed by treatment allocated. RESULTS: After 7 months, immediately following therapy, RO DBT had significantly reduced depressive symptoms by 5.40 points on the HRSD relative to TAU (95% CI 0.94-9.85). After 12 months (primary end-point), the difference of 2.15 points on the HRSD in favour of RO DBT was not significant (95% CI -2.28 to 6.59); nor was that of 1.69 points on the HRSD at 18 months (95% CI -2.84 to 6.22). Throughout RO DBT participants reported significantly better psychological flexibility and emotional coping than controls. However, they reported eight possible serious adverse reactions compared with none in the control group. CONCLUSIONS: the RO DBT group reported significantly lower HRSD scores than the control group after 7 months, but not thereafter. The imbalance in serious adverse reactions was probably because of the controls' limited opportunities to report these.
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Ahuja L (2020). Unpacking the Influence of Culture: Perfectionism, Achievement, Control and Beliefs about Suppression as predisposing factors of Specific Disordered eating behaviours.
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Unpacking the Influence of Culture: Perfectionism, Achievement, Control and Beliefs about Suppression as predisposing factors of Specific Disordered eating behaviours
Disordered eating behaviours are globally prevalent and represent a significant risk for eating disorders. Recent studies conducted in Non-Western countries like India have demonstrated rates of disordered eating behaviours that approximate those reported in Western literature, although these rates are highly variable (range 0.4%-42.73%). Most research examining factors associated with disordered eating behaviours in India has primarily investigated Western correlates such as body image issues, weight/shape dissatisfaction and role of media, using a cross-cultural (etic) perspective. While it is possible that the prevalence of disordered eating behaviours in India is due to Westernizing influences in the country, it is also possible, given the rich complexity of traditional Indian culture, that there are culturally-specific (emic) predisposing factors of these behaviours. Unfortunately, little research has examined and compared these culturally-specific factors with universal factors. Such an investigation could potentially contribute to the current understanding of disordered eating behaviours at a global level. Therefore, the main objective of this thesis was to examine the factors of disordered eating behaviours across India and the UK, combining cross-cultural and culture-specific approaches. A series of four studies were conducted. The first study aimed to highlight the projected prevalence and correlates of disordered eating behaviours in India (systematic review). The second study explored the cultural factors of disordered eating behaviours in India and the UK (qualitative study). These studies led to two cross-sectional quantitative studies that examined universal and culture-specific factors of disordered eating alongside across India and the UK (online survey) and the ways in which cultural perspective may shape and modify a universal factor (experimental study). Overall, this research provided convergent evidence from etic and emic perspectives that cultural contexts may modify the function of universal factors. Psychological control, perfectionism and need for achievement were identified as universal correlates of disordered eating behaviours in India and the UK. In particular, psychological control, which is a robust predisposing factor in Western countries, was significantly related to disordered eating behaviours in India as well; although, this correlate may be experienced differently across cultures. Preliminary evidence on the culture-specific role of suppression of self and collectivistic perspective in disordered eating behaviours was found in India, suggesting that future studies are required to investigate this area further. These studies provide useful information, which if integrated within the current socio-cultural explanations, may expand the international perspective on disordered eating behaviours.
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2019
Dunn BD, O'Mahen H, Wright K (2019). A commentary on research rigour in clinical psychological science: How to avoid throwing out the innovation baby with the research credibility bath water in the depression field.
Behaviour Research and Therapy,
120, 103417-103417.
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Pettman D, O'Mahen H, Skoog Svanberg A, von Essen L, Axfors C, Blomberg O, Woodford J (2019). Effectiveness and acceptability of cognitive–behavioural therapy based interventions for maternal peripartum depression: a systematic review, meta-analysis and thematic synthesis protocol.
BMJ Open,
9(12), e032659-e032659.
Abstract:
Effectiveness and acceptability of cognitive–behavioural therapy based interventions for maternal peripartum depression: a systematic review, meta-analysis and thematic synthesis protocol
IntroductionPeripartum depression is a common mental health difficulty associated with a range of negative impacts for the mother, infant and wider family. This review will examine the effectiveness of cognitive–behavioural therapy (CBT) based interventions for peripartum depression. Secondary aims are to explore the effect of CBT-based interventions targeted at peripartum depression on novel secondary outcomes and moderators potentially associated with effectiveness. To date, there has been little examination of effect on important secondary outcomes (eg, anxiety, stress and parenting), nor clinical and methodological moderators. Further, this review aims to explore the acceptability of CBT-based interventions for women with peripartum depression and examine important adaptations for this population.Methods and analysisElectronic databases (e.g. MEDLINE; ISI Web of Science; CINAHL; CENTRAL; Prospero; EMBASE; ASSIA; PsychINFO; SCOPUS; and Swemed+) will be systematically searched. Database searches will be supplemented by expert contact, reference and citation checking, and grey literature. Primary outcomes of interest will be validated measures of symptoms of depression. A proposed meta-analysis will examine: (1) the overall effectiveness of psychological interventions in improving symptoms of depression (both self-reported and diagnosed major depression) in the peripartum period; (2) the impact of interventions on secondary outcomes (eg, anxiety, stress and parenting); (3) clinical and methodological moderators associated with effectiveness. A thematic synthesis will be conducted on qualitative data exploring the acceptability of CBT-based intervention for postpartum depression including participants’ experience and perspectives of the interventions, satisfaction, barriers and facilitators to intervention use, intervention relevance to mothers’ situations and suggestions for improvements to tailor interventions to the peripartum client group.Ethics and disseminationFormal ethical approval is not required by the National Ethical Review Board in Sweden as primary data will not be collected. The results will be disseminated through a peer-reviewed publication and inform the development of a new psychological intervention for peripartum depression. This study including protocol development will run from March 2019 to March 2020.
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Ingram J, Johnson D, Johnson S, O'Mahen HA, Kessler D, Taylor H, Law R, Round J, Ford J, Hopley R, et al (2019). Protocol for a feasibility randomised trial of low-intensity interventions for antenatal depression: ADAGIO trial comparing interpersonal counselling with cognitive behavioural therapy.
BMJ Open,
9(8).
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Protocol for a feasibility randomised trial of low-intensity interventions for antenatal depression: ADAGIO trial comparing interpersonal counselling with cognitive behavioural therapy.
INTRODUCTION: One in eight women suffer from depression during pregnancy. Currently, low-intensity brief treatment based on cognitive behavioural therapy (CBT) is the only talking treatment widely available in the National Health Service (NHS) for mild and moderate depression. CBT involves identifying and changing unhelpful negative thoughts and behaviours to improve mood. Mothers in our patient advisory groups requested greater treatment choice. Interpersonal counselling (IPC) is a low-intensity version of interpersonal therapy. It may have important advantages during pregnancy over CBT because it targets relationship problems, changes in role and previous losses (eg, miscarriage). We aim to compare CBT and IPC for pregnant women with depression in a feasibility study. METHODS AND ANALYSIS: a two-arm non-blinded randomised feasibility study of 60 women will be conducted in two UK localities. Women with depression will be identified through midwife clinics and ultrasound scanning appointments and randomised to receive six sessions of IPC or CBT. In every other way, these women will receive usual care. Women thought to have severe depression will be referred for more intensive treatment. After 12 weeks, we will measure women's mood, well-being, relationship satisfaction and use of healthcare. Women, their partners and staff providing treatments will be interviewed to understand whether IPC is an acceptable approach and whether changes should be introduced before applying to run a larger trial.Several groups of patients with depression during pregnancy have contributed to our study design. A patient advisory group will meet and advise us during the study. ETHICS AND DISSEMINATION: Study results will inform the design of a larger multicentre randomised controlled trial (RCT). Our findings will be shared through public engagement events, papers and reports to organisations within the NHS. National Research Ethics Service Committee approved the study protocol. TRIAL REGISTRATION NUMBER: ISRCTN11513120.
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Shearer J, Lynch TR, Chamba R, Clarke S, Hempel RJ, Kingdon DG, O'Mahen H, Remington B, Rushbrook SC, Russell IT, et al (2019). Refractory depression-cost-effectiveness of radically open dialectical behaviour therapy: Findings of economic evaluation of RefraMED trial.
BJPsych Open,
5(5).
Abstract:
Refractory depression-cost-effectiveness of radically open dialectical behaviour therapy: Findings of economic evaluation of RefraMED trial
Copyright © the Royal College of Psychiatrists 2019Â This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence. Background Refractory depression is a major contributor to the economic burden of depression. Radically open dialectical behaviour therapy (RO DBT) is an unevaluated new treatment targeting overcontrolled personality, common in refractory depression, but it is not yet known whether the additional expense of RO DBT is good value for money.Aims to estimate the cost-effectiveness of RO DBT plus treatment as usual (TAU) compared with TAU alone in people with refractory depression (trial registration: ISRCTN85784627).Method We undertook a cost-effectiveness analysis alongside a randomised trial evaluating RO DBT plus TAU versus TAU alone for refractory depression in three UK secondary care centres. Our economic evaluation, 12 months after randomisation, adopted the perspective of the UK National Health Service (NHS) and personal social services. It evaluated cost-effectiveness by comparing the net cost of RO DBT with the net gain in quality-Adjusted life-years (QALYs), estimated using the EQ-5D-3L measure of health-related quality of life.Results the additional cost of RO DBT plus TAU compared with TAU alone was £7048 and was associated with a difference of 0.032 QALYs, yielding an incremental cost-effectiveness ratio (ICER) of £220 250 per QALY. This ICER was well above the National Institute for Health and Care Excellence (NICE) upper threshold of £30 000 per QALY. A cost-effectiveness acceptability curve indicated that RO DBT had a zero probability of being cost-effective compared with TAU at the NICE £30 000 threshold.Conclusions in its current resource-intensive form, RO DBT is not a cost-effective use of resources in the UK NHS.Declaration of interest R.H. is co-owner and director of Radically Open Ltd, the RO DBT training and dissemination company. D.K. reports grants outside the submitted work from the National Institute for Health Research (NIHR). T.L. receives royalties from New Harbinger Publishing for sales of RO DBT treatment manuals, speaking fees from Radically Open Ltd, and a grant outside the submitted work from the Medical Research Council. He was co-director of Radically Open Ltd between November 2014 and May 2015 and is married to Erica Smith-Lynch, the principal shareholder and one of two directors of Radically Open Ltd. H.O'M. reports personal fees outside the submitted work from the Charlie Waller Institute and Improving Access to Psychological Therapy. S.R. provides RO DBT supervision through her company S C Rushbrook Ltd. I.R. reports grants outside the submitted work from NIHR and Health & Care Research Wales. M. Stanton reports personal fees outside the submitted work from British Isles DBT Training, Stanton Psychological Services Ltd and Taylor & Francis. M. Swales reports personal fees outside the submitted work from British Isles DBT Training, Guilford Press, Oxford University Press and Taylor & Francis. B.W. was co-director of Radically Open Ltd between November 2014 and February 2015.
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O'Mahen HA, Moberly NJ, Wright KA (2019). Trajectories of Change in a Group Behavioral Activation Treatment for Severe, Recurrent Depression.
Behavior Therapy,
50(3), 504-514.
Abstract:
Trajectories of Change in a Group Behavioral Activation Treatment for Severe, Recurrent Depression
© 2018 Depression is a common and costly problem. Behavioral Activation (BA)is an effective treatment for depression when delivered 1:1, but group treatments often do not perform as well as 1:1 treatments. One way to begin to understand how group treatments perform is to assess the process of change during treatment. This study examined trajectories of change across 10-session group BA for individuals with severe, chronic, or recurrent forms of depression. We also tested whether individuals who had associated sudden gains or depression spikes had better outcomes than those who did not have these change patterns. We examined psychological and sociodemographic predictors of the patterns of change. Participants were 104 individuals who met diagnostic criteria for major depressive disorder and participated in one of 10 BA groups, provided over a 2-year period. A linear, but not quadratic or cubic, rate of change fit the data and the effect size for the change in mood symptoms from baseline to posttreatment was large, Cohen's d = 1.25. Although 34% (26 of the 77 who provided outcome data)of individuals had a sudden gain and 10% (7/77)had a depression spike, neither sudden gains nor depression spikes predicted posttreatment outcomes. None of the demographic or psychological factors (rumination, behavioral activation)predicted the pattern of change. These results suggest that although group BA may help to reduce depressive symptoms in individuals with severe, recurrent, and/or chronic forms of depression, the overall linear pattern of change is different from quadratic patterns of change reported for 1:1 BA.
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2018
Pearson RM, Campbell A, Howard LM, Bornstein MH, O'Mahen H, Mars B, Moran P (2018). Impact of dysfunctional maternal personality traits on risk of offspring depression, anxiety and self-harm at age 18 years: a population-based longitudinal study.
Psychol Med,
48(1), 50-60.
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Impact of dysfunctional maternal personality traits on risk of offspring depression, anxiety and self-harm at age 18 years: a population-based longitudinal study.
BACKGROUND: the impact of underlying parental psychological vulnerability on the future mental health of offspring is not fully understood. Using a prospective cohort design, we investigated the association between dysfunctional parental personality traits and risks of offspring self-harm, depression and anxiety. METHODS: the association between dysfunctional parental personality traits (monotony avoidance, impulsivity, anger, suspicion, and detachment), measured in both mothers and fathers when offspring were age 9 years, and risk of offspring depression, anxiety and self-harm at age 18 years, was investigated in a population-based cohort (ALSPAC) from over 8000 parents and children. RESULTS: Higher levels of dysfunctional maternal, but not paternal, personality traits were associated with an increased risk of self-harm, depression, and anxiety in offspring. Maternal associations were best explained by the accumulation of dysfunctional traits. Associations were strongest for offspring depression: Offspring of mothers with three or more dysfunctional personality traits were 2.27 (1.45-3.54, p < 0.001) times as likely to be depressed, compared with offspring of mothers with no dysfunctional personality traits, independently of maternal depression and other variables. CONCLUSIONS: the accumulation of dysfunctional maternal personality traits is associated with the risk of self-harm, depression, anxiety in offspring independently of maternal depression and other confounding variables. The absence of associations for equivalent paternal traits makes a genetic explanation for the findings unlikely. Further research is required to elucidate the underlying mechanism. Mothers with high levels of dysfunctional personality traits may benefit from additional support to reduce the risk of adverse psychological outcomes occurring in their offspring.
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Lynch TR, Hempel RJ, Whalley B, Byford S, Chamba R, Clarke P, Clarke S, Kingdon D, O’Mahen H, Remington B, et al (2018). Radically open dialectical behaviour therapy for refractory depression: the RefraMED RCT.
Efficacy and Mechanism Evaluation,
5(7), 1-112.
Abstract:
Radically open dialectical behaviour therapy for refractory depression: the RefraMED RCT
. Background
. About one-third of patients who are depressed do not respond to antidepressant medication (ADM) and traditional psychotherapy shows limited benefits. However, most randomised trials have excluded the most sick patients, especially with comorbid personality disorder. Radically open dialectical behaviour therapy (RO DBT) is a new treatment targeting emotionally overcontrolled personality, which is common in refractory depression.
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. Objective
. To evaluate the efficacy, cost-effectiveness and therapeutic mechanisms of RO DBT for patients with refractory depression.
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. Design
. The Refractory depression: Mechanisms and Efficacy of RO DBT (RefraMED) trial was a multicentre, parallel-group, randomised trial in which participants were randomised to receive either RO DBT plus treatment as usual (TAU) or TAU alone. Participants were assessed at 7, 12 and 18 months after randomisation. Therapeutic mechanisms were explored in causal analyses.
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. Setting
. Participants were recruited from three secondary care NHS organisations in the UK: Dorset, Hampshire and North Wales.
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. Participants
. Patients were eligible if they were aged ≥ 18 years, had a Hamilton Rating Scale for Depression (HRSD) score of at least 15, had a current diagnosis of major depressive disorder in the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I, were suffering either refractory or chronic depression and, in their current episode, had taken an adequate dose of ADM for at least 6 weeks without relief. Patients who met criteria for dramatic-erratic personality disorder (Cluster B), bipolar disorder or psychosis or who had a primary diagnosis of substance dependence or abuse were excluded.
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. Interventions
. The intervention, RO DBT, comprised 29 weekly individual sessions lasting 1 hour and 27 weekly skills classes lasting 2.5 hours. Participants allocated to TAU could access any treatment offered by the NHS or privately.
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. Main outcome measures
. The reported HRSD score 12 months after randomisation and cost per quality-adjusted life-year (QALY).
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. Results
. A total of 250 participants were allocated at random: 162 (65%) participants were randomised to RO DBT plus TAU and 88 (35%) were randomised to TAU. The difference between RO DBT and TAU in the primary outcome at 12 months was not statistically significant. Nevertheless, after 7 months, participants randomised to RO DBT had substantially, and significantly, reduced depressive symptoms, relative to TAU, by 5.40 HRSD points [standardised mean difference 1.03 points, 95% confidence interval (CI) 0.94 to 9.85 points; p = 0.02]. Thereafter, RO DBT remained the better treatment with net, but non-significant, reductions of 2.15 HRSD points (standardised mean difference 0.41 points, 95% CI –2.28 to 6.59 points; p = 0.29) after 12 months and 1.69 points (standardised mean difference 0.32 points, 95% CI –2.84 to 6.22 points; p = 0.42) after 18 months. Participants allocated to TAU could access any treatment offered by the NHS or privately. Participants randomised to RO DBT reported significantly better psychological flexibility and emotional coping than TAU participants; these differences increased over time. From the perspective of the NHS and personal social services, RO DBT was not cost-effective; the incremental cost-effectiveness ratio was £220,000 per QALY, which is considerably above the willingness-to-pay threshold of £30,000 set by the National Institute for Health and Care Excellence (NICE). RO DBT participants reported eight possible serious adverse reactions compared with none by TAU participants; however, we believe that this imbalance was a result of major differences in reporting opportunities. The Data Monitoring and Ethics Committee agreed that there was no reason to suspect that RO DBT was harmful.
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. Conclusions
. Although RO DBT achieved the target effect size (Cohen’s d) with a d of 0.4 at the primary end point of 12 months, this was not significant. RO DBT was not cost-effective by NICE criteria. Nevertheless, RO DBT enhanced psychological flexibility and emotional coping, which are potential mechanisms of change.
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. Limitations
. Analysing only 190 participants, instead of the target of 245, reduced the statistical power of the trial.
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. Future work
. Future studies should aim to refine RO DBT, by maintaining clinical effectiveness while reducing costs, and to evaluate it for a wider range of overcontrolled disorders over a longer period.
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. Trial registration
. Current controlled trials ISRCTN85784627.
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. Funding
. This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and NIHR partnership, and will be published in full in Efficacy and Mechanism Evaluation; Vol. 5, No. 7. See the NIHR Journals Library website for further project information.
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2017
Richards DA, Rhodes S, Ekers D, McMillan D, Taylor RS, Byford S, Barrett B, Finning K, Ganguli P, Warren F, et al (2017). Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive-behavioural therapy for depression.
Health Technol Assess,
21(46), 1-366.
Abstract:
Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive-behavioural therapy for depression.
BACKGROUND: Depression is a common, debilitating and costly disorder. The best-evidenced psychological therapy - cognitive-behavioural therapy (CBT) - is complex and costly. A simpler therapy, behavioural activation (BA), may be an effective alternative. OBJECTIVES: to determine the clinical effectiveness and cost-effectiveness of BA compared with CBT for depressed adults at 12 and 18 months' follow-up, and to investigate the processes of treatments. DESIGN: Randomised controlled, non-inferiority trial stratified by depression severity, antidepressant use and recruitment site, with embedded process evaluation; and randomisation by remote computer-generated allocation. SETTING: Three community mental health services in England. PARTICIPANTS: Adults aged ≥ 18 years with major depressive disorder (MDD) recruited from primary care and psychological therapy services. INTERVENTIONS: BA delivered by NHS junior mental health workers (MHWs); CBT by NHS psychological therapists. OUTCOMES: Primary: depression severity (as measured via the Patient Health Questionnaire-9; PHQ-9) at 12 months. Secondary: MDD status; number of depression-free days; anxiety (as measured via the Generalised Anxiety Disorder-7); health-related quality of life (as measured via the Short Form questionnaire-36 items) at 6, 12 and 18 months; and PHQ-9 at 6 and 18 months, all collected by assessors blinded to treatment allocation. Non-inferiority margin was 1.9 PHQ-9 points. We undertook intention-to-treat (ITT) and per protocol (PP) analyses. We explored cost-effectiveness by collecting direct treatment and other health- and social-care costs and calculating quality-adjusted life-years (QALYs) using the EuroQol-5 Dimensions, three-level version, at 18 months. RESULTS: We recruited 440 participants (BA, n = 221; CBT, n = 219); 175 (79%) BA and 189 (86%) CBT participants provided ITT data and 135 (61%) BA and 151 (69%) CBT participants provided PP data. At 12 months we found that BA was non-inferior to CBT {ITT: CBT 8.4 PHQ-9 points [standard deviation (SD) 7.5 PHQ-9 points], BA 8.4 PHQ-9 points (SD 7.0 PHQ-9 points), mean difference 0.1 PHQ-9 points, 95% confidence interval (CI) -1.3 to 1.5 PHQ-9 points, p = 0.89; PP: CBT 7.9 PHQ-9 points (SD 7.3 PHQ-9 points), BA 7.8 PHQ-9 points (SD 6.5 PHQ-9 points), mean difference 0.0 PHQ-9 points, 95% CI -1.5 to 1.6 PHQ-9 points, p = 0.99}. We found no differences in secondary outcomes. We found a significant difference in mean intervention costs (BA, £975; CBT, £1235; p
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Finning K, Richards DA, Moore L, Ekers D, McMillan D, Farrand PA, O'Mahen HA, Watkins ER, Wright KA, Fletcher E, et al (2017). Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation.
BMJ Open,
7(4).
Abstract:
Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation.
OBJECTIVE: to explore participant views on acceptability, mechanisms of change and impact of behavioural activation (BA) delivered by junior mental health workers (MHWs) versus cognitive behavioural therapy (CBT) delivered by professional psychotherapists. DESIGN: Semistructured qualitative interviews analysed using a framework approach. PARTICIPANTS: 36 participants with major depressive disorder purposively sampled from a randomised controlled trial of BA versus CBT (the COBRA trial). SETTING: Primary care psychological therapies services in Devon, Durham and Leeds, UK. RESULTS: Elements of therapy considered to be beneficial included its length and regularity, the opportunity to learn and not dwelling on the past. Homework was an important, although challenging aspect of treatment. Therapists were perceived as experts who played an important role in treatment. For some participants the most important element of therapy was having someone to talk to, but for others the specific factors associated with BA and CBT were crucial, with behavioural change considered important for participants in both treatments, and cognitive change unsurprisingly discussed more by those receiving CBT. Both therapies were considered to have a positive impact on symptoms of depression and other areas of life including feelings about themselves, self-care, work and relationships. Barriers to therapy included work, family life and emotional challenges. A subset (n=2) of BA participants commented that therapy felt too simple, and MHWs could be perceived as inexperienced. Many participants saw therapy as a learning experience, providing them with tools to take away, with work on relapse prevention essential. CONCLUSIONS: Despite barriers for some participants, BA and CBT were perceived to have many benefits, to have brought about cognitive and behavioural change and to produce improvements in many domains of participants' lives. To optimise the delivery of BA, inexperienced junior MHWs should be supported through good quality training and ongoing supervision. TRIAL REGISTRATION NUMBER: ISRCTN27473954, 09/12/2011.
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O'Mahen HA, Wilkinson E, Bagnall K, Richards DA, Swales A (2017). Shape of change in internet based behavioral activation treatment for depression.
Behaviour Research and Therapy,
95, 107-116.
Abstract:
Shape of change in internet based behavioral activation treatment for depression
© 2017 Shape of change, sudden gains and depression spikes were examined in an online 12-session Behavioral Activation (BA) treatment for depression. Client and therapist factors related to sudden gains were examined to investigate processes associated with outcome. Methods: Participants were postpartum Women with Major Depressive Disorder (n=42) who received online BA supported in 30-minute telephone sessions by a mental health worker. Depression symptoms were assessed at each session and number of sessions completed were recorded by the online program. Therapist records were rated for client stressful life event and therapist concrete focus. A quadratic pattern provided the best fit with the data; a cubic pattern was a poor fit. Sudden gains, but not depression spikes, predicted lower depression scores at 17-week outcome. Women who had higher baseline social functioning, did not experience a stressful life event during therapy, and completed more online modules, but not more telephone sessions, were more likely to have a sudden gain. A concrete therapist focus was associated with sudden gains. These results extend research on trajectories of change and sudden gains to an online BA treatment and to postpartum depression, and suggest important client and therapist factors associated with sudden gains.
Abstract.
2016
Wilkinson EL, O’Mahen HA, Fearon P, Halligan S, King DX, Greenfield G, Dunkley-Bent J, Ericksen J, Milgrom J, Ramchandani PG, et al (2016). Adapting and testing a brief intervention to reduce maternal anxiety during pregnancy (ACORN): study protocol for a randomised controlled trial.
Trials,
17(1).
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Richards DA, Ekers D, McMillan D, Taylor RS, Byford S, Warren FC, Barrett B, Farrand PA, Gilbody S, Kuyken W, et al (2016). Cost and Outcome of Behavioural Activation versus
Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial.
Lancet Full text.
2015
O'Mahen HW, Buist A, Rooney R (2015). Acceptability, Attitudes and Overcoming Stigma. In Milgrom J, Gemmill A (Eds.) Identifying Perinatal Depression and Anxiety: Evidence Based Practice in Screening, Psychosocial Assessment, and Management, Wiley Blackwell.
Netsi E, Evans J, Wulff K, O'Mahen H, Ramchandani PG (2015). Infant outcomes following treatment of antenatal depression: Findings from a pilot randomized controlled trial.
Journal of Affective Disorders,
188, 252-256.
Abstract:
Infant outcomes following treatment of antenatal depression: Findings from a pilot randomized controlled trial
© 2015 Elsevier B.V. All rights reserved. Introduction Maternal antenatal depression is associated with an increased risk of emotional and behavioural problems in children. More recently antenatal depression has been associated with shorter sleep duration, higher number of awakenings and sleep problems in infants. Examining the effect of treatment of depression on child development is the next step in unravelling the complex association between antenatal depression and offspring development. Methods We used data from a pilot RCT of women with antenatal depression who received either Cognitive Behavioural Therapy (CBT) or Treatment as Usual (TAU), to examine infant sleep duration and temperament two months postpartum. Data was available for n=14 in the CBT group and n=11 in the TAU group. Results No differences by treatment arm were evident. Improvement in depression scores during pregnancy was associated with easier temperament (β=-.45, p=.024) and shorter nocturnal sleep duration (β=-.58, p=.003). The findings were more pronounced in the CBT group compared to the TAU group. Limitations This was a pilot RCT and as such the sample size was small and there was some loss to follow up between the baseline and postnatal assessment. Conclusion Improvement in antenatal depressive symptoms may have beneficial effects for the infant; whether these are directly through effects on foetal development or indirectly through changes in the postnatal mother-infant relationship remains to be determined.
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O'Mahen HA, Boyd A, Gashe C (2015). Rumination decreases parental problem-solving effectiveness in dysphoric postnatal mothers.
Journal of Behavior Therapy and Experimental Psychiatry,
47, 18-18.
Abstract:
Rumination decreases parental problem-solving effectiveness in dysphoric postnatal mothers
Background
Postnatal depression is associated with poorer parenting quality, but there are few studies examining maternal-specific cognitive processes that may impact on parenting quality. In this study, we examined the impact of rumination on parental problem-solving effectiveness in dysphoric and non-dysphoric postnatal mothers.
Methods
Fifty-nine mothers with a infant aged 12 months and under, 20 of whom had a Beck Depression Score II (BDI-II) score ≥ 14, and 39 who scored less than 14 on the BDI-II were randomly assigned to either a rumination or distraction condition. Problem-solving effectiveness was assessed post-induction with the “Postnatal Parental Problem-Solving Task” (PPST), which was adapted from the Means Ends Problem-solving task. Parental problem-solving confidence was also assessed.
Results
Dysphoric ruminating mothers exhibited poorer problem-solving effectiveness and poorer confidence regarding their problem-solving compared to dysphoric distracting, non-dysphoric distracting, and non-dysphoric ruminating mothers.
Limitations
A self-report measure of depressed mood was used.
Conclusions
Rumination may be a key mechanism associated with both depressive mood and maternal parenting quality during the postnatal period.
Abstract.
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Tester-Jones M, O'Mahen HA, Karl A, Watkins ER (2015). The Impact of Maternal Characteristics, Infant Temperament and Contextual Factors on Maternal Responsiveness to Infant.
Infant Behavior and Development(40), 1-11.
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O'Mahen HA, Grieve H, Jones J, Woodford J (2015). Women's experiences of factors affecting treatment engagement and adherence in Internet Delivered Behavioural Activation for Postnatal Depression.
Internet Interventions,
2, 84-84.
Full text.
2014
Rhodes S, Richards DA, Ekers D, McMillan D, Byford S, Farrand PA, Gilbody S, Hollon SD, Kuyken W, Martell C, et al (2014). Cost and outcome of behavioural activation versus cognitive behaviour therapy for depression (COBRA): study protocol for a randomised controlled trial.
Trials,
15Abstract:
Cost and outcome of behavioural activation versus cognitive behaviour therapy for depression (COBRA): study protocol for a randomised controlled trial.
BACKGROUND: Cognitive behaviour therapy (CBT) is an effective treatment for depression. However, CBT is a complex therapy that requires highly trained and qualified practitioners, and its scalability is therefore limited by the costs of training and employing sufficient therapists to meet demand. Behavioural activation (BA) is a psychological treatment for depression that may be an effective alternative to CBT and, because it is simpler, might also be delivered by less highly trained and specialised mental health workers. METHODS/DESIGN: COBRA is a two-arm, non-inferiority, patient-level randomised controlled trial, including clinical, economic, and process evaluations comparing CBT delivered by highly trained professional therapists to BA delivered by junior professional or para-professional mental health workers to establish whether the clinical effectiveness of BA is non-inferior to CBT and if BA is cost effective compared to CBT. Four hundred and forty patients with major depressive disorder will be recruited through screening in primary care. We will analyse for non-inferiority in per-protocol and intention-to-treat populations. Our primary outcome will be severity of depression symptoms (Patient Health Questionnaire-9) at 12 months follow-up. Secondary outcomes will be clinically significant change and severity of depression at 18 months, and anxiety (General Anxiety Disorder-7 questionnaire) and health-related quality of life (Short-Form Health Survey-36) at 12 and 18 months. Our economic evaluation will take the United Kingdom National Health Service/Personal Social Services perspective to include costs of the interventions, health and social care services used, plus productivity losses. Cost-effectiveness will explored in terms of quality-adjusted life years using the EuroQol-5D measure of health-related quality of life. DISCUSSION: the clinical and economic outcomes of this trial will provide the evidence to help policy makers, clinicians and guideline developers decide on the merits of including BA as a first-line treatment of depression. TRIAL REGISTRATION: Current Controlled Trials ISRCTN27473954.
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O'Mahen HA, Richards DA, Woodford J, Wilkinson E, McGinley J, Taylor RS, Warren FC (2014). Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression.
Psychological Medicine,
44, 1675-1689.
Abstract:
Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression.
Background. Despite the high prevalence of postnatal depression (PND), few women seek help. Internet interventions
may overcome many of the barriers to PND treatment use. We report a phase II evaluation of a 12-session, modular,
guided Internet behavioural activation (BA) treatment modified to address postnatal-specific concerns [Netmums
Helping with Depression (NetmumsHWD)].
Method. To assess feasibility, we measured recruitment and attrition to the trial and examined telephone session support
and treatment adherence. We investigated sociodemographic and psychological predictors of treatment adherence.
Effectiveness outcomes were estimated with the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety
Disorder-7, Work and Social Adjustment Scale, Postnatal Bonding Questionnaire, and Social Provisions Scale.
Results. A total of 249 women were recruited via a UK parenting site, Netmums.com. A total of 83 women meeting
DSM-IV criteria for major depressive disorder were randomized to NetmumsHWD (n=41) or treatment-as-usual
(TAU; n=42). of the 83 women, 71 (86%) completed the EPDS at post-treatment, and 71% (59/83) at the 6-month
follow-up. Women completed an average of eight out of 12 telephone support sessions and five out of 12 modules.
Working women and those with less support completed fewer modules. There was a large effect size favouring
women who received NetmumsHWD on depression, work and social impairment, and anxiety scores at post-treatment
compared with women in the TAU group, and a large effect size on depression at 6 months post-treatment. There were
small effect sizes for postnatal bonding and perceived social support.
Conclusions. A supported, modular, Internet BA programme can be feasibly delivered to postpartum women, offering
promise to improve depression, anxiety and functioning.
Abstract.
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O'Mahen, HA, Karl A, Moberly N, Fedock G (2014). The association between childhood maltreatment and emotion regulation: Two different mechanisms contributing to depression?. Journal of Affective Disorders, 174, 287-295.
2013
Burns AJ, O'Mahen HA, Baxter HA, Bennert K, Wiles NJ, Sharp DJ, Turner KM, Thorn JC, Noble SM, Evans JM, et al (2013). A pilot randomised controlled trial of Cognitive Behavioural Therapy for antenatal depression.
BMC Psychiatry(33).
Abstract:
A pilot randomised controlled trial of Cognitive Behavioural Therapy for antenatal depression
Background
Few trials have evaluated the effectiveness of psychological treatment in improving depression by the end of pregnancy. This is the first pilot randomised controlled trial (RCT) of individual cognitive behavioural therapy (CBT) looking at treating depression by the end of pregnancy. Our aim was to assess the feasibility of delivering a CBT intervention modified for antenatal depression during pregnancy.
Methods
Women in North Bristol, UK between 8–18 weeks pregnant were recruited through routine contact with midwives and randomised to receive up to 12 sessions of individual CBT in addition to usual care or to continue with usual care only. Women were eligible for randomisation if they screened positive on a 3-question depression screen used routinely by midwives and met ICD-10 criteria for depression assessed using the clinical interview schedule – revised version (CIS-R). Two CBT therapists delivered the intervention. Follow-up was at 15 and 33 weeks post-randomisation when assessments of mental health were made using measures which included the CIS-R.
Results
Of the 50 women assessed for the trial, 36 met ICD-10 depression criteria and were randomised: 18 to the intervention and 18 to usual care. Thirteen of the 18 (72%) women who were allocated to receive the intervention completed 9 or more sessions of CBT before the end of pregnancy. Follow-up rates at 15 and 33 weeks post-randomisation were higher in the group who received the intervention (89% vs. 72% at 15 weeks and 89% vs. 61% at 33 weeks post-randomisation). At 15 weeks post-randomisation (the end of pregnancy), there were more women in the intervention group (11/16; 68.7%) who recovered (i.e. no longer met ICD-10 criteria for depression), than those receiving only usual care (5/13; 38.5%).
Conclusions
This pilot trial shows the feasibility of conducting a large RCT to assess the effectiveness of CBT for treating antenatal depression before the end of pregnancy. The intervention could be delivered during the antenatal period and there was some evidence to suggest that it could be effective.
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O'Mahen H, Himle JA, Fedock G, Henshaw E, Flynn H (2013). A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression adapted for women with low incomes.
Depression and Anxiety,
30(7), 679-687.
Abstract:
A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression adapted for women with low incomes
Background: Perinatal women with identified depression in prenatal care settings have low rates of engagement and adherence with depression-specific psychotherapy. We report the feasibility and symptom outcomes of Cognitive Behavioral Therapy (CBT) modified (mCBT) to address the needs of perinatal, low-income women with Major Depressive Disorder (MDD).
Methods: Pregnant women (n = 1421) were screened for depressive symptoms in obstetrics clinics
in conjunction with prenatal care visits. A total of 59 women met diagnostic criteria for MDD; 55 women were randomly assigned to mCBT or Treatment as Usual (TAU). The mCBT intervention included an initial engagement session, outreach, specific perinatal content and interpersonal components. Measures were gathered at pre-treatment, 16 week post-randomization, and 3-month followup.
Results: Most participants attended at least one CBT session and met study criteria for treatment adherence. Active research staff outreach promoted engagement and retention in the trial. Treatment satisfaction was rated as very good.
In both observed and multiple imputation results, women who received mCBT demonstrated greater improvement in depressed mood than those in TAU at
16-week post-randomization and 3-month follow-up, Cohen’s d = –0.71 (95% CI –4.93, –5.70). Conclusions: Modified CBT offers promise as a feasible and acceptable treatment for perinatal women with low-incomes in prenatal care
settings. Targeted delivery and content modifications are needed to engage populations
tailored to setting and psychosocial challenges specific to the perinatal period.
Abstract.
Kingston REF, Watkins ER, O'Mahen HA (2013). An Integrated Examination of Risk Factors for Repetitive Negative Thought.
JOURNAL OF EXPERIMENTAL PSYCHOPATHOLOGY,
4(2), 161-181.
Author URL.
O'Mahen HA, Woodford J, McGinley J, Warren FC, Richards DA, Lynch TR, Taylor RS (2013). Internet-based behavioral activation-Treatment for postnatal depression (Netmums): a randomized controlled trial.
Journal of Affective Disorders,
150(3), 814-822.
Abstract:
Internet-based behavioral activation-Treatment for postnatal depression (Netmums): a randomized controlled trial
Background: Despite the high prevalence of postnatal depression (PND), few women seek help. The internet may increase timely access to treatment. We report a randomized controlled trial of a minimal intervention internet Behavioral Activation (iBA) treatment modified to address postnatal specific concerns (Postnatal-iBA). Methods: Women (n=910) recruited via a popular UK parenting site, Netmums.com, scoring above 12 on the Edinburgh Postnatal Depression Scale (EPDS) were randomly assigned to receive either Postnatal-iBA delivered or treatment-as-usual (TAU). We investigated the feasibility (recruitment, trial and treatment adherence) and effectiveness (depression status EPDS > 12) of the intervention. Results: Recruitment was excellent; 1261 women, 961 of whom met inclusion criteria, signed up to the trial within two 2-week recruitment periods. Thirty-eight percent (343/910) of women completed the 15-week outcome assessment. of those who completed 15-week assessment, fewer exceeded the depression cutoff in the Postnatal-iBA group (n = 66/181) compared to TAU (n=91/162). Assuming all non-respondents remained depressed, the Postnatal-iBA effect was reduced. Limitations: the study suffered from high attrition and future trials need to consider strategies for improving outcome completion. Some women reported struggles "keeping up" with the treatment. Conclusions: a minimal support, widely accessible internet Behavioral Activation program for PND is feasible to deliver to community populations when embedded within popular parenting sites. For women who provide outcome data, postnatal-iBA offers promise as an effective treatment for PND. The addition of support may reduce women's struggles to keep pace with the treatment. © 2013 Elsevier B.V. All rights reserved.
Abstract.
Lynch TR, Gray KLH, Hempel RJ, Titley M, Chen EY, O'Mahen HA (2013). Radically Open-Dialectical Behavior Therapy for adult Anorexia Nervosa: Feasibility and outcomes from an inpatient program.
BMC Psychiatry,
293(13).
Abstract:
Radically Open-Dialectical Behavior Therapy for adult Anorexia Nervosa: Feasibility and outcomes from an inpatient program
Background
Anorexia Nervosa (AN) is a highly life-threatening disorder that is extremely difficult to treat. There is evidence that family-based therapies are effective for adolescent AN, but no treatment has been proven to be clearly effective for adult AN. The methodological challenges associated with studying the disorder have resulted in recommendations that new treatments undergo preliminary testing prior to being evaluated in a randomized clinical trial. The aim of this study was to provide preliminary evidence on the effectiveness of a treatment program based on a novel adaptation of Dialectical Behavior Therapy (DBT) for adult Anorexia Nervosa (Radically Open-DBT; RO-DBT) that conceptualizes AN as a disorder of overcontrol.
Methods
Forty-seven individuals diagnosed with Anorexia Nervosa-restrictive type (AN-R; mean admission body mass index = 14.43) received the adapted DBT inpatient program (mean length of treatment = 21.7 weeks).
Results
Seventy-two percent completed the treatment program demonstrating substantial increases in body mass index (BMI; mean change in BMI = 3.57) corresponding to a large effect size (d = 1.91). Thirty-five percent of treatment completers were in full remission, and an additional 55% were in partial remission resulting in an overall response rate of 90%. These same individuals demonstrated significant and large improvements in eating-disorder related psychopathology symptoms (d = 1.17), eating disorder-related quality of life (d = 1.03), and reductions in psychological distress (d = 1.34).
Conclusions
RO-DBT was associated with significant improvements in weight gain, reductions in eating disorder symptoms, decreases in eating-disorder related psychopathology and increases in eating disorder-related quality of life in a severely underweight sample. These findings provide preliminary support for RO-DBT in treating AN-R suggesting the importance of further evaluation examining long-term outcomes using randomized controlled trial methodology.
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Pearson RM, O'Mahen H, Burns A, Bennert K, Shepherd C, Baxter H, Chauhan D, Evans J (2013). The normalisation of disrupted attentional processing of infant distress in depressed pregnant women following Cognitive Behavioural Therapy.
Journal of Affective Disorders,
145(2), 208-213.
Abstract:
The normalisation of disrupted attentional processing of infant distress in depressed pregnant women following Cognitive Behavioural Therapy
Background: Maternal depression is associated with abnormal processing of infant distress. This may explain why depression disrupts maternal behaviour and ultimately child outcomes. Understanding and improving such processing, in depressed mothers as early as possible is thus important. Aim: the focus of the current study was to investigate whether Cognitive Behavioural Therapy (CBT) normalises depressed pregnant women's abnormal attentional processing of infant distress. Method: Depressed pregnant women participating in a randomised control trial completed a measure of attentional bias for infant distress before and after intervention. Women received either CBT (n=12) or usual care [UC] (n=12) between their first and last trimesters of pregnancy. Results: at baseline, depressed women in both arms showed a diminished attentional bias for infant distress compared to a non-depressed comparison group (n=51). Following intervention attentional biases of women who received CBT increased becoming comparable to non-depressed women. In contrast there was no improvement in the UC arm. Conclusions: If replicated, the findings may suggest that CBT during pregnancy improves mother's basic processing of infant stimuli before their child is born. Limitations: the sample size was relatively small and there was some loss to follow up between the pre and post intervention sessions. © 2012 Elsevier B.V. All rights reserved.
Abstract.
Pearson RM, O'Mahen H, Burns A, Bennert K, Shepherd C, Baxter H, Chauhan D, Evans J (2013). The normalisation of disrupted attentional processing of infant distress in depressed pregnant women following Cognitive Behavioural Therapy.
J Affect Disord,
145(2), 208-213.
Abstract:
The normalisation of disrupted attentional processing of infant distress in depressed pregnant women following Cognitive Behavioural Therapy.
BACKGROUND: Maternal depression is associated with abnormal processing of infant distress. This may explain why depression disrupts maternal behaviour and ultimately child outcomes. Understanding and improving such processing, in depressed mothers as early as possible is thus important. AIM: the focus of the current study was to investigate whether Cognitive Behavioural Therapy (CBT) normalises depressed pregnant women's abnormal attentional processing of infant distress. METHOD: Depressed pregnant women participating in a randomised control trial completed a measure of attentional bias for infant distress before and after intervention. Women received either CBT (n=12) or usual care [UC] (n=12) between their first and last trimesters of pregnancy. RESULTS: at baseline, depressed women in both arms showed a diminished attentional bias for infant distress compared to a non-depressed comparison group (n=51). Following intervention attentional biases of women who received CBT increased becoming comparable to non-depressed women. In contrast there was no improvement in the UC arm. CONCLUSIONS: If replicated, the findings may suggest that CBT during pregnancy improves mother's basic processing of infant stimuli before their child is born. LIMITATIONS: the sample size was relatively small and there was some loss to follow up between the pre and post intervention sessions.
Abstract.
Author URL.
Mann J, Henley W, O'Mahen H, Ford T (2013). The reliability and validity of the Everyday Feelings Questionnaire in a clinical population.
Journal of Affective Disorders,
148(2-3), 406-410.
Abstract:
The reliability and validity of the Everyday Feelings Questionnaire in a clinical population
Background: Depression could be considered to be on a continuum with well-being and some have argued that it is important to measure well-being as well as distress. The Everyday Feelings Questionnaire was designed to measure both these aspects. Its validity has been assessed in a nonclinical population. This project aims to assess the validity and reliability of the EFQ in a clinical population. Methods: the EFQ was completed by 105 clients within a mental health clinical setting. The following aspects of the EFQ were explored: its internal structure, concurrent validity, re-test reliability and internal consistency. Results: the EFQ had good internal consistency and correlated highly with other measures of anxiety and depression. The correlation between total EFQ scores on the two occasions was reasonable and there was no effect of time during completion. A Bland-Altman plot showed no obvious pattern between the difference between EFQ scores and the mean score. A one factor model showed a moderate fit to the data. Limitations: This study does not explore the acceptability or sensitivity to change of the EFQ, and a larger sample size would be needed to extend the analysis conducted. Conclusions: the EFQ is a valid and reliable measure when used in this clinical population. © 2012 Elsevier B.V.
Abstract.
2012
Farmer C, Farrand P, O'Mahen H (2012). 'I am not a depressed person': how identity conflict affects help-seeking rates for major depressive disorder.
BMC Psychiatry,
12Abstract:
'I am not a depressed person': how identity conflict affects help-seeking rates for major depressive disorder.
BACKGROUND: There is a significant treatment gap for patients with depression. A third of sufferers never seek help, and the vast majority of those who do only do so after considerable delay. Little is understood regarding poor help-seeking rates amongst people with depression, with existing research mainly focussed on the impact of barriers to treatment. The current study explored psychological factors affecting help-seeking behaviour in clinically depressed individuals. METHODS: Semi-structured interviews were conducted with 20 current or previously clinically depressed participants who either had or had not sought professional help. Thematic analysis was used to analyse results. RESULTS: the onset of depressive symptoms created conflict with participants' identity and personal goals. Delays in seeking help were primarily attributed to the desire to protect identity and goals from the threat of depressive symptoms. Participants used avoidance strategies to reduce the perceived threat of depressive symptoms on identity. These strategies interfered with help-seeking. Help-seeking was only undertaken once participants reached a point of acceptance and began to make concessions in their identity and goals, at which time they reduced their use of avoidance. CONCLUSIONS: Difficulties resolving conflict between identity and depressive symptoms may account for significant delays in seeking help for depression. The results have implications for predicting health behaviour and improving treatment uptake for depression, and may inform existing help-seeking models.
Abstract.
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O'Mahen H, Fedock G, Henshaw E, Himle J, Forman J, Flynn H (2012). Modifying CBT for perinatal depression: What do women want? a qualitative study.
Cognitive and Behavioral PracticeAbstract:
Modifying CBT for perinatal depression: What do women want? a qualitative study.
The evidence for the efficacy of CBT for depression during the perinatal period is mixed. This was a qualitative study that aimed to understand the perinatal-specific needs of depressed women in an effort to inform treatment modifications that may increase the relevance and acceptability of CBT during this period. Stratified purposeful sampling resulted in 23 participants selected by pregnancy, socioeconomic, and depression status. Participants completed semistructured interviews exploring their experiences of pregnancy and the postpartum period and its relationship to mood, and perspectives on ideal treatment content. Thematic analysis revealed a number of perinatal-specific themes that were relevant to CBT in three key domains: self, motherhood, and interpersonal. Mothers particularly struggled with: internalization of “motherhood myths,” self-sacrifice, and managing social support during this period. Shifts in women's themes across the perinatal period, and between racial and socioeconomic groups are discussed as are implications for modification of CBT to improve relevance for perinatal depression.
Abstract.
2011
Henshaw EJ, Flynn HA, Himle JA, O'Mahen HA, Forman J, Fedock G (2011). Patient preferences for clinician interactional style in treatment of perinatal depression.
Qualitative Health Research,
21(7), 936-951.
Abstract:
Patient preferences for clinician interactional style in treatment of perinatal depression
Most women with depression around the time of childbearing are not treated adequately, or at all. Clinical practice guidelines focus primarily on provision of information rather than on interaction factors. In this study, we explored clinician interactional style characteristics contributing to patient response to perinatal depression referral and treatment. Stratified purposeful sampling resulted in 23 participants selected by pregnancy, socioeconomic, and depression status. Participants completed semistructured interviews exploring their experiences with and preferences for clinician interactional style characteristics in the context of obstetrics-setting referral and delivery of depression treatment. Thematic analysis revealed a central theme related to interactional cues that influence women's reactions to clinical encounters, summarized by the question, "Can this person help me?" Women evaluated this question in four domains: feeling heard, developing trust in the clinician, perceiving technical competence in the clinician, and feeling that the intervention focus is effectively chosen and communicated. Our results imply that, in addition to informational factors, the way in which clinicians interact with patients about depression might strongly influence patient responses. © the Author(s) 2011.
Abstract.
O'Mahen HA, Henshaw E, Jones JM, Flynn HA (2011). Stigma and depression during pregnancy: Does race matter?.
Journal of Nervous and Mental Disease,
199(4), 257-262.
Abstract:
Stigma and depression during pregnancy: Does race matter?
Rates of depression treatment are low in pregnant women, particularly Black women. Stigma is an important barrier to treatment, but little research has examined how depression stigma differs in Blacks and Whites; a key purpose of this study. Participants were 532 pregnant women recruited in obstetrics settings, who responded to measures of stigma and mood. Black women reported more depression stigma than White women, regardless of their depression status, and were more likely to endorse the view that depression should be kept secret, than White women. In White women, stigma increased as a function of depression status (current, past, never). White women's perceptions of depression stigma were positively correlated with their beliefs about keeping depression secret. Secrecy and depression stigma were uncorrelated in Black women. There are important racial differences in the way depression stigma functions in pregnant women. Implications for engaging women in mental health treatment are discussed. Copyright © 2011 by Lippincott Williams & Wilkins.
Abstract.
2010
Flynn HA, Henshaw E, O'Mahen H, Forman J (2010). Patient perspectives on improving the depression referral processes in obstetrics settings: a qualitative study.
Gen Hosp Psychiatry,
32(1), 9-16.
Abstract:
Patient perspectives on improving the depression referral processes in obstetrics settings: a qualitative study.
OBJECTIVES: Although depression screening in obstetrics settings has been recommended, little research exists to guide strategies for screening follow up and depression referral. The purpose of this qualitative study was to inform recommendations for depression screening follow up and referral in obstetrics settings based on responses from a key sample of women about influences on depression treatment use and engagement. METHODS: a stratified purposeful sampling based on pregnancy, socioeconomic status and depression severity was used to identify 23 women who completed semistructured interviews that centered on their beliefs about what would prevent or facilitate entry into depression treatment in the context of obstetrical care. We conducted a thematic analysis through an iterative process of expert transcript review, creation of and refining codes and identifying themes. RESULTS: Two broad themes influencing depression treatment usage emerged including practical and psychological factors. Among practical factors, women reported a strong preference for treatment provided in the obstetric clinic or in the home with a desire for a proactive referral process and flexible options for receiving treatment. Psychological factors included differing conceptualizations of depression, knowledge about severity and treatment and issues of stigma. CONCLUSIONS: This study suggests that the current standard practice of depression screening and referral to specialty treatment does not match with perceived influences on treatment use among our sample of perinatal women. Recommendations derived from the results for improving follow up with screening and depression referral in obstetrics settings are provided as a platform for further research.
Abstract.
Author URL.
O'Mahen HA, Flynn HA, Nolen-Hoeksema S (2010). Rumination and interpersonal functioning in perinatal depression.
Journal of Social and Clinical Psychology,
29(6), 646-667.
Abstract:
Rumination and interpersonal functioning in perinatal depression
Identifying vulnerability factors for antenatal depression is an important step in reducing depression rates. To date, research has focused on demographic and interpersonal risk factors for antenatal depression rather than cognitive factors. This study investigated the moderating role of social functioning on rumination and silencing the self in predicting prospective increases in depressive mood in a sample of pregnant women. Pregnant women at high risk for depression (n = 110) were assessed at baseline for symptoms of depressive mood, rumination, functioning aspects of perceived social support, and silencing the self. Depressive mood was measured again three months later. Social functioning moderated the effects of rumination and silencing the self on depression. For women low in social functioning, rumination was related to increases in depression while silencing the self was unrelated to rumination and depressive mood. High social functioning buffered the impact of rumination on prospective depressive mood; women who endorsed silencing beliefs that they should sacrifice their needs for others' had increases in rumination and depressive symptoms. The findings suggest that interpersonal and cognitive factors interact to predict vulnerability to depressive mood during pregnancy, and highlight the need to understand social functioning as well as beliefs about utilizing available social support.
Abstract.
2009
O'Mahen HA, Flynn HA, Chermack S, Marcus S (2009). Illness perceptions associated with perinatal depression treatment use.
Archives of Women's Mental Health,
12(6), 447-450.
Abstract:
Illness perceptions associated with perinatal depression treatment use
The relationship between psychological beliefs about depression and depression treatment use was examined in depressed pregnant and postpartum women using the Common Sense Model as a framework (CSM; Leventhal H, Nerenz DR, Steele DF (1984) a handbook of psychology and health illness representations and coping with health threats. Hillsdale, NJ: Erlbaum.). Pregnant women who screened >/ 10 on the Edinburgh Postnatal Depression Scale (EPDS; Cox et al. Br J Psychiatry 150:782-786, 1987) completed measures of depression symptoms, perceptions and treatment at three time points through 6 weeks postpartum. Understanding modifiable beliefs may be useful in improving low rates of perinatal depression treatment use.
Abstract.
2008
O'Mahen HA, Flynn HA (2008). Preferences and perceived barriers to treatment for depression during the perinatal period.
Journal of Women's Health,
17(8), 1301-1309.
Abstract:
Preferences and perceived barriers to treatment for depression during the perinatal period
BACKGROUND AND METHODS: Little is understood about why few women during the perinatal period will use depression treatment. In particular, beliefs and barriers related to depression treatment use have not been studied. In this study, African American and white pregnant women (n = 108) who screened > or =10 on the Edinburgh Postnatal Depression Scale (EPDS) were asked about recent formal and informal treatment use in prenatal care settings. Confidence in the helpfulness of treatment, providers, and settings and perceived barriers to treatment were assessed and compared between African American and white women. RESULTS: Pregnant women overall reported low rates of formal treatment use but frequently sought help from informal sources, such as friends, family, and printed materials. All women expressed greatest confidence in psychosocial treatments and lowest confidence in antidepressants. African American women reported less confidence in advice from family and friends and in antidepressants than did white women. Women expressed greatest confidence in treatments delivered by mental health professionals and religious leaders. African American women sought help more frequently and had significantly more confidence in religious leaders as treatment deliverers than white women. Women had greatest confidence in treatments delivered in professional and home settings, with African American women expressing greater confidence in religious settings than white women. All women reported greatest concern with structural barriers, compared with attitudinal and knowledge barriers. CONCLUSIONS: Understanding patterns of treatment use, beliefs, and barriers to depression treatment provides important information for tailoring and improving appropriate use of mental health treatment in women during the perinatal period.
Abstract.
2006
Flynn HA, Cain SA, O'Mahen HA, Davis MM (2006). Detection of maternal alcohol abuse problems in the pediatric emergency department. Alcoholism Clinical and Experimental Research, 30(7), 1160-1164.
O'Mahen HA, Sloan P (2006). Looking ahead: Preparing psychologists for administrative roles in medical settings. Professional Psychology Research and Practice, 37(3), 278-282.
Flynn HA, O'Mahen HA, Marcus S, Massey L (2006). The impact of a brief obstetrics clinic-based intervention on treatment use for perinatal depression. Journal of Women s Health, 15(10), 1195-1204.
2004
Beach, S.R.H. (2004). Understanding dysfunctional behaviors in romantic relationships: a performance ecology perspective. In Leiberman L (Ed) Advances in Psychology, New York: Nova Press.
2002
Whitaker, D. O’Mahen, H.A. Jones, D. (2002). Competition in romantic relationships: Do partners build niches?. In Noller P, Feeney JA (Eds.) Understanding marriage: Developments in the study of couple interaction, Cambridge: Cambridge University Press.
O’Mahen, H.A. Beach, S.R.H. Jackson, M.H. (2002). The empirical underpinnings of marital therapy for depression. In Harvey J, Wenzel A (Eds.) Maintaining and enhancing close relationships: a clinician’s guide, Mahwah, NJ: Lawrence Erlbaum Associates.
2001
Beach, S.R.H. Banawan, S.F. (2001). Depression in marriage. In Harvey J, Wenzel A (Eds.) Maintenance and enhancement of close relationships, Mahwah, NJ: Lawrence Erlbaum Associates, 299-320.
2000
O’Mahen, H.A. (2000). Depression in close relationships. In Hendrick C, Hendrick SS (Eds.) Close relationships: a sourcebook, Thousand Oaks, CA: Sage Publications.
O'Mahen HA, Beach SRH, Tesser A (2000). Relationship ecology and negative communications in romantic relationships: a self-evaluation maintenance perspective. Personality and Social Psychology Bulletin, 26, 1343-1352.
Pyszczynski, T. Greenberg, J. O’Mahen, H.A. (2000). Running from the shadow: Psychological distancing from others to deny characteristics people fear in themselves. Journal of Personality and Social Psychology, 78, 446-462.
