Recent Submissions

  • CBT for long-term conditions and medically unexplained symptoms: A practitioner's guide

    Kinsella, Philip (2021)
    CBT for Long-Term Conditions and Medically Unexplained Symptoms describes how cognitive behavioural therapy (CBT) can be used to treat anxiety and depression with a co-morbid long-term physical health condition (LTC) or medically unexplained symptoms (MUS). The book teaches cognitive behavioural therapists and other clinicians to help patients deal with the psychological aspects of physical symptoms, whatever their cause. It is divided into three parts, beginning with core skills for working with people with LTC and MUS. This includes assessment, formulation and goal setting. Part II focuses on CBT for LTC and includes chapters on low intensity interventions, working with depression and anxiety using protocols, and a consideration of an identity and strengths-based approach to working with LTC. The final part provides details of a formulation driven approach to working with MUS, broken down into individual chapters on working with behaviours, cognitions and emotions. With numerous case examples, the book provides accessible and practical guidance for mental health professionals, particularly CBT practitioners, working with anyone with long-term conditions or MUS.
  • The acceptability and usability of digital health interventions for adults with depression, anxiety, and somatoform disorders: Qualitative systematic review and meta-synthesis

    Patel, Shireen; Malins, Samuel; Wright, Nicola; Rowley, Emma; Young, Emma; Sampson, Stephanie; Morriss, Richard K. (2020)
    Background: The prevalence of mental health disorders continues to rise, with almost 4% of the world population having an anxiety disorder and almost 3.5% having depression in 2017. Despite the high prevalence, only one-third of people with depression or anxiety receive treatment. Over the last decade, the use of digital health interventions (DHIs) has risen rapidly as a means of accessing mental health care and continues to increase. Although there is evidence supporting the effectiveness of DHIs for the treatment of mental health conditions, little is known about what aspects are valued by users and how they might be improved. Objective: This systematic review aimed to identify, appraise, and synthesize the qualitative literature available on service users' views and experiences regarding the acceptability and usability of DHIs for depression, anxiety, and somatoform disorders. Methods: A systematic search strategy was developed, and searches were run in 7 electronic databases. Qualitative and mixed methods studies published in English were included. A meta-synthesis was used to interpret and synthesize the findings from the included studies. Results: A total of 24 studies were included in the meta-synthesis, and 3 key themes emerged with descriptive subthemes. The 3 key themes were initial motivations and approaches to DHIs, personalization of treatment, and the value of receiving personal support in DHIs. The meta-synthesis suggests that participants' initial beliefs about DHIs can have an important effect on their engagement with these types of interventions. Personal support was valued very highly as a major component of the success of DHIs. The main reason for this was the way it enabled individual personalization of care. Conclusions: Findings from the systematic review have implications for the design of future DHIs to improve uptake, retention, and outcomes in DHIs for depression, anxiety, and somatoform disorders. DHIs need to be personalized to the specific needs of the individual. Future research should explore whether the findings could be generalized to other health conditions
  • Association between happiness and psychopathology in an elderly regional rural population in Crete

    Christodoulou, Nikos G. (2019)
    Research has shown that socio-demographic profile and psychopathology symptoms are related to levels of happiness in old age. The aims of this cross-sectional study were: 1) to investigate the effect of recent stressful life events and socio-demographic factors on psychopathological symptoms in elderly residents in mountain regions of Crete, Greece and 2) to explore the mechanism which underlies the relationship between socio-demographic factors and psychopathological symptoms, with levels of happiness in old age. To this end, we used the nine psychopathology dimensions of symptoms as defined in the Symptom Checklist-90-R (SCL-90), while the Holmes and Rahe stress inventory was administered to quantify the stressful life events. A sample of 205 elderly men and women (age=77.1+/-6.7 years) living in 10 remote rural and isolated villages participated in this study. Data was collected through questionnaires completed upon individual meetings with each participant, with the interviewer's assistance. Each questionnaire included the two aforesaid scales alongside questions on individual socio-demographic characteristics. Analysis of variance was applied to detect socio-demographic factors that have a significant effect on specific psychopathological symptoms. Then, path analysis was applied to quantify the direct and indirect effect of the selected socio-demographic factors on happiness levels. Stressful life events were found to have no statistically significant effect on the presence of specific symptoms (somatization, psychoticism, anxiety) in elderly adults. Furthermore, certain socio-demographic factors (marital status, smoking, family income and social activity) were found to influence happiness, which varied according to the level of psycho-emotional tension. The results suggest that somatization, psychoticism, and phobic anxiety symptoms are psychic reactions independent of recent stressful life events. Our study,despite its regional character, may contribute in the development of appropriate clinical assessment tools and interventions, helping primary care practitioners to approach elderly people living in remote villages in a more appropriate and holistic manner, improving thereby the effectiveness of their interventions.
  • Assessment and immediate management of patients with medically unexplained symptoms in primary care

    Morriss, Richard K. (2009)
    Medically unexplained symptoms (MUS) are physical symptoms that doctors cannot explain by organic pathology, which distress or impair the functioning of the patient. Patients with MUS account for around 50% more visits to primary care doctors, one-third more secondary care contacts than patients without MUS. MUS are often precipitated or exacerbated by psychosocial stress, depression and anxiety. Primary care consultations can take the form of a contest between the patient with MUS and the doctors: the doctor tries to reassure the patient, the patient provides more evidence of their distress or information that challenges the authority of the doctor, and the consultation often ends in collusion with an investigation, prescription, or referral that neither patient nor doctor is content with. Patients with MUS seek doctors who take their concerns seriously and legitimize their complaints. They do not necessarily expect a cure, but they seek an alliance to help them understand their health problems. Provision of emotional support, modification of symptom beliefs, explanations linking physical problems to psychosocial issues when they are relevant, antidepressants, and graded exercise for some types of MUS seem to be worth trying by doctors for patients with MUS. A four-stage model to help doctors manage MUS is provided. Some patients with chronic MUS and high consultation behaviour will require regular consultations with a single doctor who restricts the use of investigations, prescriptions, and referrals. Cognitive behavioural therapy may be helpful for patients with MUS who are willing to seek further psychological help. © 2009 Elsevier Ltd. All rights reserved.
  • Estimating the prevalence of medically unexplained symptoms from primary care records

    Morriss, Richard K.; Lindson, N. (2012)
    OBJECTIVES: To develop models to estimate the likely prevalence of medically unexplained symptoms (MUS) and severe MUS in a primary care practice from existing patient electronic records collected in the previous 2 years for secondary prevention and commissioning of psychological treatment.
  • A multidisciplinary approach to conversion disorder with nonepileptic seizures: A case study

    Tickle, Anna C. (2011)
    There are several treatment options for conversion disorder, but none have emerged as a treatment of choice. This case report describes one woman's experiences of conversion disorder and the multidisciplinary and multi-agency care plan developed to meet her needs. It offers reflections from the perspective of staff and the patient herself about which aspects of the treatment were most effective. The study aims to give insight into the benefits and the gaps of the programme. This is a descriptive case study arising from collaboration between client and professionals throughout the period of the care plan. It concludes that the multidisciplinary and multi-agency approach has much to offer in the treatment of conversion disorder.
  • "Reattribution for medically unexplained symptoms": Authors' reply

    Morriss, Richard K. (2008)
    Reply to the commentary Reattribution for medically unexplained symptoms by Hiske J. van Ravesteijn, Peter L. B. J. Lucassen, and Tim C. olde Hartman, (see record 2008-05194-021) on the current authors' original article Randomised controlled trial of training practices in reattribution for medically unexplained symptoms (2007). First, we conducted a 6-hour training intervention in reattribution because, on the basis of a series of studies of training in primary care, this is the length of training that most general practitioners (GPs) are prepared to attend in the UK and also in many other healthcare systems in the world. Second, the paper describing the reattribution model, which was written by one of our team and subsequent descriptions of reattribution written by members of our team, have always promoted a model in which doctors provide the 'making the link' explanation although they should do this through negotiation with the patient. Third, we agree that an instrumental task-oriented consultation such as reattribution might be perceived as less empathic by patients with medically unexplained symptoms than treatment as usual. However, in our trial the data from the patient satisfaction questionnaire suggests that compared with treatment as usual, after reattribution training twice as many patients were very satisfied with how well the GP understood the nature of their problems and their worries. Finally, we agree that certain subgroups of patients with medically unexplained symptoms may benefit from reattribution. However, our trial was not powered to examine this issue. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Role of mental health professionals in the management of functional somatic symptoms in primary care

    Morriss, Richard K. (2012)
    Functional somatic symptoms associated with persistent frequent attendance is emotionally demanding, costly and intractable to treat. Such patients are hard to engage in practice and research by mental health professionals, whose main role may be indirect training, supporting and advising primary care professionals rather than direct patient care.
  • Persistent frequent attenders in primary care: Costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention

    Malins, Samuel (2012)
    Background: The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context. Methods/design: A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (>= 30 appointments with general practitioner [ GP] over 2 years) with 100 normal attenders (6-22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined. Discussion: The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention.
  • Resource implications of Munchausen's syndrome

    Black, William (1993)
    Comments on R. Powell and N. Boast's (see record 1993-45402-001) description of a man with Munchausen's syndrome (MCS) and the resource implications of his case. Black discusses Powell and Boast's proposed treatment of this S using provisions of the Mental Health Act of 1983 and concludes that compulsory treatment of patients with MCS cannot be legally, ethically, clinically, or financially justified. (PsycINFO Database Record (c) 2016 APA, all rights reserved)