Yesterday evening was the fifth session of this 12 evening training course.  I wrote about the fourth session last week.  As usual, this evening, the material we were due to cover was described in a dozen Powerpoint slides which the participants received as a handout.  See slides 1-6, Powerpoint or slides 1-6, PDF and slides 7-12, Powerpoint or slides 7-12, PDF.

Here are six studies relevant to improving psychotherapy outcomes.  Brewin et al report on using imagery-based interventions to help people with depressioin.  Lydiard et al highlight the importance of sleep-related disturbances as a treatment target in PTSD.  McCrady and colleagues show that working with couples rather than just individuals seems more effective when using behavioural therapy to help women with alcohol use disorders.  Geerts et al describe rather amazing research investigating "The role of parental bonding and nonverbal communication in the short-term treatment response was investigated in 104 depressed outpatients. At baseline patients completed the Parental Bonding Instrument. We registered the nonverbal involvement behaviour of patients and interviewers from video recordings of baseline clinical interviews and calculated the convergence between patient-interviewer behaviour over the interview ... As hypothesized, low maternal care and high paternal overprotection predicted a poor response to an 8-week treatment.  Maternal care was positively correlated with nonverbal convergence. Moreover, convergence moderated the relationship between maternal care and the response to treatment: Lack of convergence between patients and interviewers turned out to annul the positive effects of maternal care on the treatment response.

Here are five papers on lifestyle and the benefits of making healthy choices.  The first by Cohen et al on sleep habits and susceptibility to the common cold, showed increased risk of developing a cold after infection for those with shorter sleep duration.  Interestingly the increased risk was even greater for those with poor sleep efficiency.  Sleep efficiency is calculated by dividing the time spent asleep by the time spent in bed trying to sleep.  The Good Knowledge section of this website contains useful information on assessing and treating sleep difficulties.

Here are two papers on mindfulness and four on sleep.  The Kuyken et al paper is important.  It compares mindfulness-based cognitive therapy (MBCT) with continuation antidepressants in the prevention of relapse in recurrent depression.  The results are great - "Relapse/recurrence rates over 15-month follow-ups in MBCT were 47%, compared with 60% in the m-ADM (maintenance antidepressant) group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04).  MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains."  I have been cautious in my enthusiasm for MBCT (see previous post) but this is exactly the kind of research that we need to help clarify MBCT's potential further.  The second paper on mindfulness is lower key.  It is a mention of its potential in enhancing sexuality.  It makes sense - see last month's posts on the effects of meditation training on experiencing positive emotions - but the relevant research is still in its early stages. 

Here are a collection of handouts, questionnaires and information sheets about sleep, ADHD, and fatigue.  The sleep handouts are mostly based on Colin Espie's excellent self-help book "Overcoming insomnia and sleep problems" and the intention is that the handouts would be used in conjunction with this book - see the bottom of the page for more details. 

Sleep diary and instructions - a key component of Espie's CBT programme is the use of this weekly diary form to both assess the sleep problem initially and then monitor progress.

Sleep diary, measuring progress - this is a form that can be helpful when measuring overall progress using information from the sleep diaries.

Sleep advice - fairly standard general advice about improving sleep. 

Sleep stimulus control - this and sleep restriction (see below) are probably both the most challenging and the most useful components of a CBT approach for insomnia.  

The SIGN draft guideline day on "Non-pharmacological management of mild to moderate depression" last Wednesday continued with two further presentations in this first section on "Lifestyle and Alternative/Complementary Therapies 1".  After the "grade A" recommendations on exercise and St John's Wort given during the first two presentations (covered in the two previous blog posts), the rest of this section felt a bit of an anticlimax.

“ How you do anything is how you do everything. ” - Zen Proverb

This section contains handouts, questionnaires and information sheets about sleep, ADHD, and fatigue.  The sleep handouts are mostly based on Colin Espie's excellent self-help book "Overcoming insomnia and sleep problems" and the intention is that the handouts would be used in conjunction with this book - see the bottom of the page for more details.  

Sleep diary and instructions - a key component of Espie's CBT programme is the use of this weekly diary form to both assess the sleep problem initially and then monitor progress.

Sleep diary, measuring progress - this is a form that can be helpful when measuring overall progress using information from the sleep diaries.

“

Keep on sowing your seed, for you never know which will grow - perhaps it all will.

” - Einstein

Generalized anxiety disorder (GAD)

Manber, R., J. D. Edinger, et al. (2008).