BIGSPD Annual Conference Manchester 2012 Effectiveness of CAT for borderline PD delivered in routine practice in the NHS. Research team. Stephen Kellett University of Sheffield & Sheffield Health and Social Care NHS Foundation Trust, UK Dawn Bennett
University of Sheffield & Sheffield Health and Social Care NHS Foundation Trust, UK
Clinical Psychology Service, Lancashire Foundation NHS Trust, UK
Schaar, University of Sheffield
All treatments were carried out by 10 accredited CAT therapists
All worked in NHS mental health service Trust sites
All therapists had completed the 2-year CAT practitioner training
Five of the ten therapists were qualified to supervisor level and all therapists were required to be in receipt of regular clinical supervision.
One therapist treated 6 patients, one therapist 3 patients and one therapist 2 patients (one of whom was lost to follow-up due to emigration); the remaining therapists all treated a single patient.
As this was a study of routine practice, the establishment of a BPD diagnosis was made according to normal diagnostic practice of participating services.
Patients had to meet DSM-IV (APA, 1994) BPD criteria and to score 28 or more on the Personality Structure Questionnaire (PSQ; Pollock, Broadbent, Clarke, Dorrian & Ryle, 2001).
A researcher carried out interview after the 3rd follow-up session.
The interview essentially involves engaging the patient in a skeptical enquiry of the degree and origin of change (Elliott, 2002).
Outcome graphs of CORE-OM, DES and PSQ scores were available for the interviewer to stimulate reflection on change by the patient.
Audiotapes of each interview were then rated by two separate researchers who had not completed the research interview and who were blind to the outcome.
Ratings were made of (1) the degree of change reported (likert scale ranging from 1 ‘definite overall improvement’ to 5 ‘considerably worse’) and (2) of the attribution for change to the therapy (likert scale ranging from 1 ‘change would not have occurred without therapy’ to 5 ‘no effect of therapy’).
Change interviews were available for 12 of the 17 patients in the study (70.58 %) and the ICC for the degree and attribution of change ratings were 0.91 (p < 0.001). This indicates a very high level of agreement and consistency between the raters (Landis & Koch, 1977).
6 of the 7 (85. 71 %) therapists routinely delivered competent CAT.
The overall session CCAT mean was 34.35 (SD = 6.39)
Of the 70 sessions sampled 65 (92.85 %) met the CCAT criteria (CCAT > 20) for competently delivered CAT.
The five out of the six CAT therapists’ scoring over 20 on the CCAT showed highly consistent and competent levels of CAT delivery with a mean score of 35.90 (SD = 2.79).
Therefore, 41.16 % of the total BPD sample benefitted symptomatically from receiving CAT.
So what do the trends means? Slatick & Urman, 2001)
There was a statistically significant trend over the course of the sessions of:-
reduced psychological distressF(1,26) = 28.56, p < 0.00
risk F(1,27) = 9.20, p < 0.005
reduced dissociationF(1,12) = 30.11, p < 0.001
increased personality integrationF(1,12) = 9.67, p < 0.01).
Do CAT patients keep on Slatick & Urman, 2001)
progressing in the follow-up sessions?
Comparisons between treatment and follow-up phase scores
showed that BPD patients continued to experience:-
Degree and attribution Slatick & Urman, 2001)
of change to CAT by BPD patients
Benchmarking across PBE and EBP Slatick & Urman, 2001)
evidence for CAT with BPD
Conclusions … Slatick & Urman, 2001)
after treatment completed in distress and dissociation. Risks reduced.
relief before engaging in more challenging integration work - the shape of change differs.
what are the training and supervision implications of this?