Can cognitive analytic therapy treat hoarding disorder? An adjudicated hermeneutic single‐case efficacy design evaluation

Spence, Claire; Kellett, Stephen; Totterdell, Peter; Parry, Glenys

doi:10.1002/cpp.2390

Cited by 3 publications

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“…In terms of outcome, the ‘task’ subscale on the SIS significantly increased from baseline to treatment phases, indicating that treatment sessions were more task‐focused. This increase in task focus is a feature of the phase change of CAT from reformulation to more active recognition/revision and has been previously illustrated (Spence, Kellett, Totterdell & Parry, 2019). Despite no significant change being recorded in the ‘relationship’ SIS subscale, scores were consistently high, indicating that throughout the therapy the patient felt positively towards the therapist and the course of therapy.…”

Section: Discussionsupporting

confidence: 57%

The effectiveness of cognitive analytic therapy for borderline personality disorder: Utilizing a withdrawal experimental design to improve sensitivity to abandonment

2020

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Objectives A primary methodological weakness of the single‐case experimental design (SCED) outcome studies conducted of the treatment of personality disorder with cognitive analytic therapy (CAT) is that they have failed to employ a withdrawal phase or cross‐over design and so are deemed quasi‐experimental. This study sought to implement a withdrawal design, in order to improve the internal validity of the study to make it a true SCED, and also in order to enable the patient to explore abandonment dynamics. Design The study employed an A1/B1/A2/B2 with extended follow‐up SCED with a female patient treated with CAT meeting diagnostic criteria for borderline personality disorder (BPD). Following the 6‐week baseline period ‘A1’, treatment occurred in two phases (21 sessions ‘B1’ and 24 sessions ‘B2’) sandwiching a 12‐week treatment withdrawal phase (‘A2’) and a 24‐week structured follow‐up phase. Seven idiographic daily measures were collected that created a N = 698 day timeline. Nomothetic outcome measures were collected at baseline and at the end of each phase of the study, and the Session Impact Scale was completed after each treatment session. Results There was a significant increase in the task focus of treatment sessions. Ideographically, CAT was an effective treatment for improving the participant’s self‐to‐self relationship, as their self‐hate reduced and their sense‐of‐self increased. There was a broad pattern of deterioration during the second treatment phase (B2) and follow‐up phase across the ideographic measures, and CAT was ineffective for BPD ideographic emotional or self‐to‐other measures. Reliable change occurred on the primary BPD nomothetic outcome measure from baseline to end of first treatment phase. Conclusions The study suggests that the CAT intervention was partially successful and that it is possible to integrate good research practice with clinical innovation. The methodological strengths and limitations of the design and the clinical implications of the results are discussed. Practitioner points Cognitive analytic therapy was partially effective in the treatment of BPD in a case that had been unresponsive to other psychological interventions. Therapists need to complete lengthy and structured follow‐up to capture any emerging relapse. Therapists need to discuss the patient’s thoughts and feelings about termination regularly in a relationally informed manner.

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Section: Discussionsupporting

confidence: 57%

The effectiveness of cognitive analytic therapy for borderline personality disorder: Utilizing a withdrawal experimental design to improve sensitivity to abandonment

2020

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How to Evaluate a Tailor-made Social Work Intervention? Some Practice-Based Solutions with Single-Case Designs

Landman

Bogaerts

Spreen

2023

Journal of Evidence-Based Social Work

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‘The role of encourager’: Exploring the experiences of mental health professionals working with older adults with hoarding disorder

Tinlin¹

2022

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Hoarding disorder affects 2–5 per cent of the population, with older adults making up a substantial proportion of that due to the chronic nature of hoarding behaviours and consequent clutter. Multiagency hoarding frameworks are being developed all over the UK, with mental health services working alongside other agencies to support an individual with hoarding difficulties holistically. Mental health clinicians have previously reported finding their role in this difficult. Therefore, this study recruited 30 clinicians working in an older adult mental health team and explored their experiences through a questionnaire. Thematic analysis identified six key themes detailing the clinicians experiences of working with hoarding: (1) contextual factors (time constraints, scale of clutter, previous negative experiences influencing current treatment, lack of skills); (2) assessment (risk, life story, beliefs and motives, MDT); (3) formulation (co-creation, motives and beliefs, helping staff understanding); (4) treatment (values based, support systems, discarding, meaningful activity, monitoring progress); (5) therapeutic relationship (trust, making the time, reinforcement); (6) multiagency working (skill profile, differing perspectives, coordination). The data highlighted the need for staff training and support, providing the necessary tools to deliver evidence-based assessment, formulation, and intervention. The challenges described suggest better links between different agencies is required. Meaningful interactions and success stories were linked to developing trusting relationships, introducing values and needs based approaches, and making use of the skill mix with the mental health team. Keywords: Hoarding; Older Adults; Multidisciplinary team; Multiagency working.

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Can cognitive analytic therapy treat hoarding disorder? An adjudicated hermeneutic single‐case efficacy design evaluation

Cited by 3 publications

References 50 publications

The effectiveness of cognitive analytic therapy for borderline personality disorder: Utilizing a withdrawal experimental design to improve sensitivity to abandonment

The effectiveness of cognitive analytic therapy for borderline personality disorder: Utilizing a withdrawal experimental design to improve sensitivity to abandonment

How to Evaluate a Tailor-made Social Work Intervention? Some Practice-Based Solutions with Single-Case Designs

‘The role of encourager’: Exploring the experiences of mental health professionals working with older adults with hoarding disorder

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