Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units: Working with Clients, Staff and

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The Rosenberg self-esteem scale RSES [ 15 ] was administered to measure general self-concept and consists of ten items using a four-point Likert-type response format. A high score reflects elevated self-esteem.

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The HoNOS is a item clinician-rated scale that is comprehensive in coverage, clinically relevant, and quick to administer. HoNOS was introduced to the clinic in the middle of , and therefore data are not available for one year of the study. The effectiveness of the CBT was evaluated in a variety of ways. The mean difference of Another way to examine the overall effectiveness was to examine the clinical significance of the outcomes.

Calculating a reliable change index [ 19 ] and using the normative data on the BDI described by Robinson et al. Comparing the present results with those of in the depressed outpatient sample [ 9 ], it is apparent that inpatients were more severe at admission than the outpatient population i.

This is consistent with a treatment model within which acutely unwell patients are first stabilised and then gains consolidated in a CBT program. The number of patients who demonstrated a clinically significant improvement from pre- to post-CBT i. These changes in outcome were also observable on other clinician-rated and self-reported measures. Although the changes during the CBT program are comparable to those in published studies, one possible interpretation of the present findings is that the patients would have improved to the same degree due to their hospital stay.

To partly address this concern, the patients who completed the CBT program were compared at admission and discharge to hospital with those who did not begin the CBT program on the one hand and those who withdrew from the program on the other. Thus, despite the absence of differences at admission, those who completed the CBT program were the least depressed at discharge.

To address the concern that the observed improvement may be due to the general effects of hospitalization rather than the specific effects of CBT, the profile of symptom change from admission to pre-CBT and then from pre- to post-CBT was examined. Assuming a degree of symptom specificity of treatments, because CBT is focussed on symptoms of depression and anxiety, the changes in these domains should be greater during CBT, whereas the earlier phase in an inpatient admission will be focussed on acute symptom management.

Thus, the symptoms targeted by CBT change following the treatment, but domains that are not the focus of treatment shift little during the CBT program. Given the data showing that symptoms of depression improved during the time patients were in the CBT program, the effect on outcome of various clinical variables was examined. Thus, there was no strong evidence in the present sample that presentations of major depression that were complicated by other Axis I, II, or III were any more resistant to a CBT program than the less complicated presentations.

However, there was one clinical variable that was strongly related to outcome and that was severity of depression at admission. The present study examined the effectiveness for patients with depression of a CBT program adapted to an inpatient psychiatric clinic. The intensive program brought about reductions in depression ratings compared to those found in the literature more generally, but importantly, it was able to achieve these gains within a two-week period, rather than the more usual 16—20 weeks of treatment.

The speed of the treatment gains is important because patients who require inpatient treatment are often distressed and may represent a threat to their own safety. Therefore, a relatively rapid treatment means that a safer environment can be provided, but the period of time when they are removed from their typical routines and support is minimized.

Acute inpatient care in the UK. Part 1: recovery-oriented wards

Thus, CBT for depression can be adapted to an intensive program suitable for delivery within the model of care found in inpatient settings. However, within inpatient settings, multiple interventions co-occur.

For the present study, this means that it is not possible to use the data to conclude that the CBT program caused the symptom changes. However, this is an empirical issue that has already been answered numerous times in controlled efficacy studies [ 4 ], and the present question is related to the effectiveness of CBT in a particular context.

In particular, it is also clear that packaging a CBT program as part of an inpatient treatment program can deliver comparable treatment outcomes to spaced treatments, but it did not achieve these outcomes at the expense of longevity of treatment gains. The gains observed were stable over the six-week followup, and there was no evidence that the more severe patients were any more likely to return to problematic levels following the termination of the program. In our experience, common reasons given for the lack of generalization include the greater severity of patients outside efficacy studies, the higher occurrence of comorbidity especially substance use and personality disorders since these patients can rarely be prohibited from receiving treatment in the way that they may be appropriately excluded from an efficacy study, and the setting itself.

Therefore, it was curious to see that in the present sample, the only variable that was associated with differential outcomes was symptom severity such that the greatest change was observed in the patients who were most depressed.

Acute inpatient care in the UK. Part 1: recovery-oriented wards

Given that other studies have found that comorbidity and type of depression have an impact on outcome, it is intriguing that the present study failed to find these differences. One possible reason for the lack of a difference is the intensity of the program. There may be greater opportunity for the comorbid conditions to interfere with treatment when an intervention extends to months, whereas in an intense CBT program that fills most of the day, there may be less opportunity for these associated conditions to manifest themselves.

For instance, a person with a substance use problem may be able to maintain harm-free use or abstinence for a couple of weeks while in treatment, whereas over a few months, this might be more difficult. Without random assignment to intensive or spaced treatment sessions, it is not possible to offer any more than this as a speculative suggestion, but the present data would encourage investigation of the benefits and costs of alternative forms of delivery. In considering the results, there are a number of limitations that need to be borne in mind.

First, the hospital is a private clinic where the patients are insured, and therefore, the extent of generalization to the public sector is not clear. It is possible that even though comorbid conditions are present, the severity or types of comorbidity that may be present in public hospitals e. Second, by its nature, the present investigation was a retrospective examination of effectiveness and not a randomized controlled trial.

Therefore, there are a variety of issues that make it hard to conclude that the CBT program caused the observed effects. It is possible that the symptom changes that are observed during the CBT program may not be attributable to the program, but due to patient selection and other factors associated with hospital care e.

Also by Isabel Clarke

While these cannot be ruled out, attempts were made to examine the degree to which these variables may have affected the data. In addition, the apparent specificity of the treatment gains that occurred during CBT speaks against arguments about the general effect of being in hospital as causing the reductions in symptoms. However, while it remains possible that the treatment did not cause the observed outcomes, given that CBT has been demonstrated to be an efficacious treatment for depression and the current treatment effects were comparable to those observed in the efficacy studies, it is not unreasonable to presume that the application of an empirically validated treatment, albeit in a modified form, was largely responsible for the observed improvements.

Although the internal validity of the ratings is less than those carried out by a person blind to the treatment, the external validity of the ratings when conducted by clinicians who have spent two weeks with the patient is greater.

4 editions of this work

Nonetheless, there is a possibility for bias as patients may have tried to please therapists, and the staff may have overestimated the change to a greater degree in the CBT program than in the hospital more generally. Finally, it is important to note that in contrast to efficacy studies, in a hospital context, it is not possible to exclude patients from a treatment with a BDI below a cut-off e. This book shows how this challenge can be addressed, along with introducing and evaluating an important advance in the practice of individual CBT for working with crisis, suited to inpatient work and crisis teams.

The book covers a brief cross-diagnosis adaptation of CBT, employing arousal management and mindfulness, developed and evaluated by the editors. It features ways of supporting and developing the therapeutic role of inpatient staff through consultation and reflective practice. The chapters focus on topics such as: Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units will be essential reading for those trained, or those undergoing training in CBT as well as being of interest to a wider public of nurses, health care support workers, occupational therapists, medical staff and managers.

Our customers have not yet reviewed this title. Be the first add your own review for this title. Sign in to My Account. Thompson Anxiety Disorders Centre to collaborate in the research, development and delivery of effective approaches to managing anxiety disorders such as OCD.

I am also excited, in my role as director of Continuing Mental Health Education at Sunnybrook Health Sciences Centre, to expand public education on OCD and anxiety disorders, and to ensure the highest quality training for clinicians in the treatment of these disorders. Staff Psychiatrist Mark Sinyor, M. I completed my medical degree and Masters at the University of Toronto. My research focuses on two areas: Regarding suicide, I have conducted several studies of coroner's records to better understand suicide in Toronto.

Richter's team to examine suicide as it impacts people with OCD spectrum disorders. I currently conduct several research projects including a randomized controlled trial examining how expectations and trial design influence outcomes. Clinically, I treat patients with various anxiety and mood disorders as well as related impulse control disorders such as trichotillomania and chronic skin picking.

I then completed a post-doctoral internship at St. Joseph's Healthcare in Hamilton, Ontario where I specialized in providing assessment and treatment for individuals presenting with a wide range of anxiety disorders, including Obsessive Compulsive Disorder OCD and depression. After that I was a post-doctoral fellow at the Centre for Addiction and Mental Health, with a focus on cognitive behavioural therapy and cognitive mechanisms in depressive disorders.

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I am currently an Assistant Professor within the Department of Psychiatry. Within these roles I have provided a variety of treatment services, including cognitive behavioural therapy, to individuals experiencing acute and severe mental health issues.

In addition, I have led the development and implementation of clinical programming to enhance service delivery and patient care. I have also had the opportunity to provide training to mental health professionals in group facilitation skills and behavioural activation interventions as part of these program development initiatives. My current clinical and research interests include: It is a privilege to be able to work with individuals with severe symptoms of OCD and help them develop skills to fight their OCD and begin the path to wellness and recovery.

Evaluating these services and understanding how treatment can best meet the needs of our clients and families will be an important part of this program. I am also delighted to be a part of our clinical and research training opportunities for incoming trainees. Hospital Foundation Research Education. Team members The Frederick W. Please see members of our team below: Art Therapist Linda Chapman, MCAT I am an art therapist and psychotherapist and have been working in Toronto since , providing first art therapy then art therapy, psychotherapy and counselling in workplaces that ranged from private practice to community agencies, hospital settings and an employee assistance program, as well as teaching at the college level.

Neil Rector I completed my Ph. Psych I completed my Ph.

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