When self-help is no help: Traditional cognitive skills training does not prevent depressive symptoms in people who ruminate

When self-help is no help: Traditional cognitive skills training does not prevent depressive symptoms in people who ruminate, Behaviour Research and Therapy, 2009

Gerald J. Haeffel – aDepartment of Psychology, University of Notre Dame, Haggar Hall, Notre Dame, IN 46556, USA

Abstract:

A randomized trial was conducted to test the efficacy of three self-directed prevention intervention workbooks for depression. Cognitively at-risk college freshmen were randomly assigned to one of three conditions: traditional cognitive, non-traditional cognitive, and academic skills. Consistent with hypotheses, participants who were high in rumination and experienced stress exhibited significantly greater levels of depressive symptoms after completing the traditional cognitive skills workbook than after completing the other two workbooks. This pattern of results held post-intervention and 4 months later. These findings indicate that rumination may hinder ones ability to identify and dispute negative thoughts (at least without the help of a trained professional). The results underscore the importance of identifying individual difference variables that moderate intervention efficacy. They also raise concerns about the potential benefits of self-help books, an industry that generates billions of dollars each year.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Most Read Article – Mental capacity and psychiatric in-patients: implications for the new mental health law in England and Wales

Mental capacity and psychiatric in-patients: implications for the new mental health law in England and Wales, The British Journal of Psychiatry (2009) 195: 257-263

Gareth S. Owen, MRCPsych

Department of Psychological Medicine and Psychiatry

George Szmukler, FRCPsych

Health Service and Research Department, Institute of Psychiatry, King’s College London

Genevra Richardson, LLM

School of Law, King’s College London

Anthony S. David, FRCPsych

Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, King’s College London

Peter Hayward, PhD

Department of Psychology

James Rucker, MRCPsych

Social, Genetic, Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London

Duncan Harding, MRCPsych

Maudsley Hospital, London

Matthew Hotopf, MRCPsych, PhD

Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, King’s College London, UK

Abstract:

Background

In England and Wales mental health services need to take account of the Mental Capacity Act 2005 and the Mental Health Act 1983. The overlap between these two causes dilemmas for clinicians.

Aims

To describe the frequency and characteristics of patients who fall into two potentially anomalous groups: those who are not detained but lack mental capacity; and those who are detained but have mental capacity.

Method

Cross-sectional study of 200 patients admitted to psychiatric wards. We assessed mental capacity using a semi-structured interview, the MacArthur Competence Assessment Tool for Treatment (MacCAT–T).

Results

Of the in-patient sample, 24% were informal but lacked capacity: these patients felt more coerced and had greater levels of treatment refusal than informal participants with capacity. People detained under the Mental Health Act with capacity comprised a small group (6%) that was hard to characterise.

Conclusions

Our data suggest that psychiatrists in England and Wales need to take account of the Mental Capacity Act, and in particular best interests judgments and deprivation of liberty safeguards, more explicitly than is perhaps currently the case.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

 

Different Components of Metacognition and their Relationship to Psychotic-Like Experiences

Different Components of Metacognition and their Relationship to Psychotic-Like Experiences, Behavioural and Cognitive Psychotherapy, 2009

Clare Reedera1 c1, Teuta Rexhepi-Johanssona1 and Til Wykesa1

a1 Institute of Psychiatry, King’s College London, UK

Abstract:

Background: Theories of the development of psychotic symptoms have suggested that metacognitive beliefs might play a part. However, studies offering supporting evidence have failed to distinguish between metacognitive beliefs about the consequences of having certain thoughts, and metacognitive beliefs about one’s own cognitive skills. Aims: To distinguish metacognitive beliefs and investigate the extent of their association with psychotic-like experiences. Method: Participants were 60 healthy adults recruited primarily from two university campuses. Three measures of metacognition were administered: (i) Metacognitions Questionnaire (MCQ-30); (ii) Metacognitive Assessment Inventory; and (iii) Koriat General Questions Test; and two schizotypy questionnaires: O-Life and SPQ-B and data were analysed using an exploratory principal components analysis of the metacognition measures. Results: Three principal components were identified: (i) Beliefs about thoughts; (ii) Cognitive confidence; and (iii) Beliefs about cognitive regulation. Only the “beliefs about thoughts” component was significantly associated with the “psychotic-like experiences” factor, extracted from the measures of schizotypy. Conclusions: The finding supports theories suggesting that psychotic symptoms may be caused in part by negative metacognitive beliefs about thoughts. However, metacognition is a complex construct that is currently poorly understood.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

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