The analysis of single-case data is a contested area, but the position taken in this text is that both visual and statistical analysis should be conducted. Chapter 5 focuses on how to construct data displays that help the user understand the data. It emphasises the benefits of exploratory data analysis. Examples of unhelpful graphical displays are given and then a series of steps for ensuring good-quality data plots and appropriate data exploration are illustrated. The chapter emphasises ways of exploring changes in the central location, trends and variance within and across phases within a study.
Case formulation is considered important in both the development of the therapeutic relationship and in starting the process of therapeutic change. Cognitive analytic therapy (CAT) describes the developmental origins and maintenance of a client's problems in both written (reformulation letter) and diagrammatic form (sequential diagrammatic reformulation). This study aimed to investigate the effects of these reformulation tools on insight and symptom change. A small-N repeated measures design was employed with quantitative and qualitative measures collected from six therapist/client dyads. Participating therapists kept a record of their delivery of CAT reformulation tools. Participating clients completed the insight subscale of the Self-Reflection and Insight Scale every fourth session and the Clinical Outcomes in Routine Evaluation-10 every session. Qualitative data from client change interviews regarding their experiences of CAT and attributions of change was explored using template analysis. Participants demonstrated improvements (symptom reduction and insight increases) over the course of the intervention. Administration of reformulation tools did not consistently result in significant changes on insight and symptom measures. However, the tools were identified by participants as leading to insight and emotional change within the context of a good therapeutic relationship. These findings suggest that a genuine therapeutic relationship is an important change mechanism operating through, and strengthened by, CAT-specific tools.
Abstract Background and aims: People with hoarding behaviours often struggle to engage in treatment. This study aimed to explore the experiences of a sample of people who identify as engaging in hoarding behaviours and who are seeking support. Exploring motivation to seek help, the barriers those who hoard face in accessing support and what facilitates accepting help, can aid understanding of how best to intervene. Method: Eight individuals who self-identified as seeking help in relation to hoarding behaviours were recruited via social media and support groups. Interviews were conducted by telephone or video call, before being transcribed and analysed using interpretative phenomenological analysis. Results: Participants described complex help-seeking narratives and reported continued ambivalence about addressing their hoarding behaviours. The four group experiential themes identified were Wrestling with identity; Who can I trust?; Services don’t fit; and Being overlooked: ‘they’re too busy looking at the thing, not the person’. Difficulties trusting others and services were identified; services were experienced as rejecting and many participants sought help for problems other than their hoarding. Problems accessing appropriate help for hoarding were predominant in the narratives, although participants who had accessed peer support described this as valuable. Conclusions: There are both internal (e.g. fear of judgement; feeling overwhelmed) and external (e.g. service gaps) barriers that make finding useful help for hoarding behaviours very difficult. Services may facilitate those seeking help by taking a compassionate and person-centred approach to hoarding problems.
Abstract Published research shows small-to-medium effects of Cognitive Behavioral Therapy for Psychosis (CBTp) on reducing psychotic symptoms. Given the on-going development of CBTp interventions, the aim of this systematic review is to examine whether the effectiveness of CBTp has changed across time. MEDLINE, EMBASE, PsycINFO, and CENTRAL were searched for randomized controlled trials examining CBTp interventions targeting positive and/or negative symptoms vs treatment as usual. Four meta-analyses were carried out to examine the effectiveness of CBTp for: positive symptoms; delusions; hallucinations; and negative symptoms. Four meta-regressions examined whether the effectiveness of CBTp changed across time for these groups of symptoms. A total of 28 studies (n = 2698) yielded a pooled g of −0.24 (95% confidence interval [CI] −0.32, −0.16, P < .001) favoring CBTp for positive symptoms, with nonsignificant heterogeneity (Q = 26.87, P = .47; I2 =0%); 13 studies (n = 890) yielded a pooled g of −0.36 (95% CI −0.59, −0.13, P = .002) for delusions, with substantial heterogeneity (Q = 31.99, P = .001; I2 =62%); 16 studies (n = 849) yielded a pooled g of −0.26 (95% CI −0.42, −0.11, P < .001) for hallucinations, with nonsignificant heterogeneity (Q = 18.10, P = .26; I2 =17%); 19 studies (n = 1761) yielded a pooled g of −0.22 (95% CI −0.33, −0.12, P < .001) for negative symptoms, with nonsignificant heterogeneity (Q = 20.32, P = .32, I2 =11%). Meta-regressions indicated a significant effect of year on the effectiveness of CBTp only for delusions (F[1, 11] = 5.99, P = .032; R2 = 0.594); methodological quality did not effect this finding. Findings indicate small-to-medium effects of CBTp for psychotic symptoms, with increasing effectiveness across time for delusions.
This conclusion presents some closing thoughts on the concepts covered in the preceding chapters of this book. The book focuses on single-case designs; an approach to clinical evaluation and research that is suited particularly to investigate individual variability in response to treatment but which, has received insufficient attention. It identifies the single case as a potentially rich source of learning for curious clinicians and endeavours to promote single-case methodology, not only in the development of critical understanding and interpretation of data, but also in the design of clinical interventions. The book introduces the argument for considering single-case methods as a valid research strategy within the context of the dominance of the randomised controlled trial and 'big' data. It discusses the use of standardised measures and highlights the advantages of measures in the study of single cases. The book looks at the concept of validity in measurement and identifies criterion validity as central to the assessment of clinical problems.
Background Extensive research has explored the impact of traumatic births on mothers, capturing enduring adverse outcomes as well as post-traumatic growth. The literature on fathers' experiences of birth trauma is more limited and little is known of the ongoing impact. The present study aimed to investigate the long-term effects of attending a traumatic birth.
The preceding chapters should have provided the reader with some critical acumen in evaluating single-case research, which this chapter further develops. The first part of this chapter considers and illustrates the merits of formal quality rating scales that have been designed to evaluate published reports. Given the problems of applying these scales to clinical practice, the chapter outlines an approach to appraisal of an individual case study. It then describes Elliott's hermeneutic single-case efficacy design, which encourages the thoughtful analysis of multiple sources of evidence. This approach is particularly useful to students when preparing case studies.
This chapter emphasises the value of replication both within individual studies and across studies. The essence of replication is discussed and the basis of science as replication under specified conditions is emphasised. The value of reviews of single-case data in the evaluation and development of treatments is discussed. The chapter ends with examples of meta-analysis of single-case data, but with an emphasis on valid clinical interpretation rather than mere statistical summary.
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