Publications by category
Journal articles
Warbrick LA, Dunn BD, Moran PA, Campbell J, Kessler D, Marchant K, Farr M, Ryan M, Parkin M, Sharpe R, et al (2023). Non-randomised feasibility study of training workshops for Talking Therapies service high-intensity therapists to optimise depression and anxiety outcomes for individuals with co-morbid personality difficulties: a study protocol.
Pilot and Feasibility Studies,
9(1).
Abstract:
Non-randomised feasibility study of training workshops for Talking Therapies service high-intensity therapists to optimise depression and anxiety outcomes for individuals with co-morbid personality difficulties: a study protocol
Abstract
. Background
. The NHS Talking Therapies for Anxiety and Depression programme (‘TTad’; formerly Improving Access to Psychological Therapies ‘IAPT’) delivers high-intensity cognitive behavioural therapy (CBT) to over 200,000 individuals each year for common mental health problems like depression and anxiety. More than half of these individuals experience comorbid personality difficulties, who show poorer treatment outcomes. TTad therapists report feeling unskilled to work with clients with personality difficulties, and enhancing the training of TTad therapists may lead to improved treatment outcomes for individuals presenting with secondary personality difficulties alongside depression and anxiety.
.
. Methods
. This is a pre-post non-randomised mixed-method feasibility study, exploring the feasibility and acceptability of a 1-day training workshop for high-intensity (HI) CBT therapists. The workshop is focused on understanding and assessing personality difficulties and adapting HICBT treatments for anxiety and depression to accommodate client needs. The feasibility and acceptability of the workshop and the evaluation procedures will be investigated. It will be examined to what extent the workshop provision leads to improvements in therapist skills and confidence and explored to what extent the training has the potential to enhance clinical outcomes for this client group.
.
. Discussion
. This feasibility study will provide data on the acceptability and feasibility of delivering brief therapist training to adapt usual HICBT to optimise care for individuals with secondary personality difficulties seeking treatment in TTad services for a primary problem of depression and/or anxiety. The study will also evaluate proof of concept that such an approach has the potential to improve clinical outcomes for those with secondary personality difficulties and report any possible harms identified. The study will inform the design of a future randomised controlled trial designed to test the effectiveness and cost-effectiveness of the training.
.
. Trial registration
. ISRCTN81104604. Submitted on 6th June 2022. Registration date: 3rd January 2023.
.
Abstract.
Dunn BD, Widnall E, Warbrick L, Warner F, Reed N, Price A, Kock M, Courboin C, Stevens R, Wright K, et al (2023). Preliminary clinical and cost effectiveness of augmented depression therapy versus cognitive behavioural therapy for the treatment of anhedonic depression (ADepT): a single-centre, open-label, parallel-group, pilot, randomised, controlled trial. eClinicalMedicine, 61, 102084-102084.
Publications by year
2023
Warbrick L (2023). Enhancing NHS Talking Therapies treatments for depression & anxiety in the context of personality difficulties: Emerging findings from focused CPD workshops.
Abstract:
Enhancing NHS Talking Therapies treatments for depression & anxiety in the context of personality difficulties: Emerging findings from focused CPD workshops
A set of characteristics known to be prognostically important within IAPT services are difficulties in managing emotions, relationships and sense of self – often experienced in the context of adverse early life experiences. A range of terms have been used to describe these difficulties falling at the milder end of the ICD-11 personality disorder spectrum framework, including ‘personality difficulties’. As many as 80% of IAPT clients meet criteria for personality difficulties, which has been shown to independently predict poorer depression and anxiety outcomes in step 3 samples. A secondary analysis of the prevalence of personality difficulties and their association with outcomes in the Somerset IAPT service will be presented. (Mars et al. 2020). The prognostic importance of personality difficulties within low-intensity IAPT approaches has not been thoroughly examined. Preliminary secondary analysis results exploring the impact of personality difficulties on low-intensity IAPT treatment outcomes will be presented.
Method:
Further, high-intensity (HI) therapists and Psychological Wellbeing Practitioners (PWPs) report feeling unskilled to support these clients, and suggest training in this area should form part of the IAPT core curriculum (Lamph. ). While IAPT treatments are not optimised for clients with personality difficulties, they can and do benefit from IAPT depression and anxiety protocols. Delivering focused Continuing Professional Development (CPD) workshops to clinicians focused on tailoring care to accommodate personality difficulties is one approach which may improve care for these clients.
Preliminary data on the acceptability and feasibility of a HI therapist workshop focused on tailoring usual protocols for clients with personality difficulties will be presented. PWP workshop development procedures and preliminary feedback from PWPs will also be presented.
Ongoing work to evaluate how delivering the HI workshop may impact service level clinical outcomes will be discussed.
Abstract.
Warbrick LA, Dunn BD, Moran PA, Campbell J, Kessler D, Marchant K, Farr M, Ryan M, Parkin M, Sharpe R, et al (2023). Non-randomised feasibility study of training workshops for Talking Therapies service high-intensity therapists to optimise depression and anxiety outcomes for individuals with co-morbid personality difficulties: a study protocol.
Pilot and Feasibility Studies,
9(1).
Abstract:
Non-randomised feasibility study of training workshops for Talking Therapies service high-intensity therapists to optimise depression and anxiety outcomes for individuals with co-morbid personality difficulties: a study protocol
Abstract
. Background
. The NHS Talking Therapies for Anxiety and Depression programme (‘TTad’; formerly Improving Access to Psychological Therapies ‘IAPT’) delivers high-intensity cognitive behavioural therapy (CBT) to over 200,000 individuals each year for common mental health problems like depression and anxiety. More than half of these individuals experience comorbid personality difficulties, who show poorer treatment outcomes. TTad therapists report feeling unskilled to work with clients with personality difficulties, and enhancing the training of TTad therapists may lead to improved treatment outcomes for individuals presenting with secondary personality difficulties alongside depression and anxiety.
.
. Methods
. This is a pre-post non-randomised mixed-method feasibility study, exploring the feasibility and acceptability of a 1-day training workshop for high-intensity (HI) CBT therapists. The workshop is focused on understanding and assessing personality difficulties and adapting HICBT treatments for anxiety and depression to accommodate client needs. The feasibility and acceptability of the workshop and the evaluation procedures will be investigated. It will be examined to what extent the workshop provision leads to improvements in therapist skills and confidence and explored to what extent the training has the potential to enhance clinical outcomes for this client group.
.
. Discussion
. This feasibility study will provide data on the acceptability and feasibility of delivering brief therapist training to adapt usual HICBT to optimise care for individuals with secondary personality difficulties seeking treatment in TTad services for a primary problem of depression and/or anxiety. The study will also evaluate proof of concept that such an approach has the potential to improve clinical outcomes for those with secondary personality difficulties and report any possible harms identified. The study will inform the design of a future randomised controlled trial designed to test the effectiveness and cost-effectiveness of the training.
.
. Trial registration
. ISRCTN81104604. Submitted on 6th June 2022. Registration date: 3rd January 2023.
.
Abstract.
Dunn BD, Widnall E, Warbrick L, Warner F, Reed N, Price A, Kock M, Courboin C, Stevens R, Wright K, et al (2023). Preliminary clinical and cost effectiveness of augmented depression therapy versus cognitive behavioural therapy for the treatment of anhedonic depression (ADepT): a single-centre, open-label, parallel-group, pilot, randomised, controlled trial. eClinicalMedicine, 61, 102084-102084.
2022
Warbrick L (2022). Preliminary evaluation of a training pathway for Augmented Depression Therapy for high intensity therapists in IAPT settings.
Abstract:
Preliminary evaluation of a training pathway for Augmented Depression Therapy for high intensity therapists in IAPT settings
A critical issue in novel treatment development is ensuring they cross a key translational gap from innovation and evaluation into dissemination and adoption into routine care. It is sensible to explore this before treatments are evaluated in a definitive trial. Augmented Depression Therapy (ADepT) is a novel wellbeing-focused depression therapy which has been preliminarily evaluated in a pilot and feasibility trial, and we have now run a small pilot to evaluate a possible training pipeline to train IAPT therapists to deliver it within routine care.
The training programme could be implemented in IAPT, therapists found the training and treatment acceptable and could deliver ADepT competently. Some found the training stressful, but most felt it supported their workplace wellbeing. The pilot evaluation suggests a definitive trial in IAPT could be viable, but there are remaining uncertainties about embedding ADepT within ongoing practice in the longer term.
Next steps include further refinement of both the treatment and training pipeline, and qualitative feedback from this pilot will help inform this.
Abstract.
2020
Warbrick L (2020). Sudden gains in symptoms and wellbeing during treatment for depression: Are wellbeing and depression sudden gains distinct, and how do they relate to outcomes in CBT compared to a novel wellbeing-focused therapy?.
Abstract:
Sudden gains in symptoms and wellbeing during treatment for depression: Are wellbeing and depression sudden gains distinct, and how do they relate to outcomes in CBT compared to a novel wellbeing-focused therapy?
To recover from depression, clients describe that both reducing depressive symptoms and enhancing broader wellbeing is essential. It is increasingly proposed that these may be orthogonal parts of recovery. Existing treatments, such as Cognitive Behavioural Therapy (CBT) have largely focused on symptom relieve and neglected wellbeing, which may explain sub-optimal outcomes. In response, recent treatments have been developed which target both depression and wellbeing. To further test the orthogonality account of depression and wellbeing the pattern of change during treatment can be studied. A ‘Sudden gain’ (SG; rapid improvement between two consecutive sessions) is one pattern of symptom change known to be prognostically important. This study is an exploratory secondary analysis of a pilot Randomised controlled trial (RCT) where 82 depressed participants were randomised to receive CBT or a novel wellbeing-focused therapy (Augmented Depression Therapy, ADepT). The analysis explores whether SGs in depression and wellbeing are dissociable, and if they differentially predict treatment outcomes. Results indicated that SGs in depression and wellbeing were distinct, with a majority of those experiencing SGs having either a depression or a wellbeing SG, rather than both; and fewer still experiencing both between the same sessions. ANCOVA models found depression SGs predicted superior post-treatment outcomes in both depression and anxiety. However, wellbeing SGs predicted superior post treatment depression, but appeared only to predict superior post-treatment wellbeing in CBT and had no significant effect in ADepT. These results suggest that wellbeing and depression SGs are at least partially distinct, and their relationship with outcome is at least partially orthogonal. These results may further indicate that the relationship between wellbeing and depression is variable, and are more orthogonal in some contexts, and less so in others.
Abstract.
2019
Warbrick L, Dunn B, Widnall E (2019). Do Psychological and Pharmacological Treatments of Depression do a Better Job at Repairing Negative Affect than Enhancing Positive Affect? Evaluating Evidence from Randomised Controlled Trials and Routine Outcome Data.
Abstract:
Do Psychological and Pharmacological Treatments of Depression do a Better Job at Repairing Negative Affect than Enhancing Positive Affect? Evaluating Evidence from Randomised Controlled Trials and Routine Outcome Data
Background:
Research into depression has to date primarily focused on understanding and ameliorating elevations in the negative valence system (i.e. sad and anxious mood). It is now recognised that reductions in the positive valence system (i.e. anhedonia and broader wellbeing) are prominent features of depression that are particularly distressing to clients. To move the field forwards, it is necessary to evaluate how well existing treatments repair anhedonia/wellbeing and to examine if this relates to long term depression outcomes.
Method:
This talk will present a series of secondary analyses of RCTs and routine registry data to make the case that existing treatments do not adequately repair positive affect and if they did so this might lead to enhanced long term depression outcomes.
Results:
We will present secondary analyses of the CPT-2 and CPT-3 trials (DeRubeis et al. 2005; Hollon et al. 2014) showing CBT, anti-depressant medication and combined treatment do a better job of repairing negative affect than positive affect, and that changes in both positive and negative affect are both independently associated with depression outcomes. We will present a secondary analysis of the COBRA trial (Richards et al. 2016), showing that CBT and BA do not adequately repair anhedonia symptoms. We will report routine CBT outcomes from UK Improving Access to Psychology Therapy Services, showing that CBT does a better job at reducing symptoms of anxiety and depression than building wellbeing. We will analyse the PREVENT mindfulness trial (Kuyken et al. 2016), exploring if post-treatment levels of positive affect predict long term recovery from depression and if the extent of change in positive affect mediates any superiority of mindfulness over treatment as usual.
Discussion:
Current treatments fail to repair positive affect satisfactorily. If they did so, this would be of value in its own right (given clients emphasise feeling positive is central to recovery) and may also enhance overall depression outcomes
Abstract.
