Dr. Thomas Richardson Clinical Psychologist (1,2)
Dr. Lorraine Bell Consultant Clinical Psychologist (1)
1. Mental Health Recovery Teams, Solent NHS Trust, Portsmouth, UK
2. School of Psychology, University of Southampton, UK
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National Health Service (NHS)
Community Mental Health Recovery Team for Adults
Secondary Care: Severe and Enduring problems
Service covers whole of Portsmouth
Wide range of problems: psychosis, bipolar disorder,
personality disorders etc.
Comorbidity the norm
Most band 6 staff (nurses, occupational therapists and
social workers) required to train in a therapy: DBT, CBT for
psychosis or ACT
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Psychological therapies service offers CBT, DBT, Schema
Focused Therapy, CAT, EMDR, Mindfulness and
Psychoeducation Groups
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6 pathways: Emotional Dysregulation, Psychosis,
Depression, Trauma, Anxiety, Trans-Diagnostic
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ACT placed on transdiagnostic pathway (alongside CAT) and
depression pathway (alongside CBT)
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Between Oct 2013 – Feb 2014, over 5 days
n=9 psychological therapists (2 from Eating Disorders)
n=11 non-psychologist staff (psychiatric nurses, OTs and
SWs)
Training delivered by two Consultant Clinical Psychologists:
experienced in using ACT in secondary mental health
Dr. Helen Bolderston and Prof. Sue Clarke, Bournemouth
University Department of Mental Health
Fortnightly supervision
12-16 sessions of individual ACT
Attempted to identify patients who were less complex but
didn’t find many!
At present ACT currently delivered by:
 5/11 of non-psychologist staff originally trained
(2 maternity leave, 1 retired, 1 left service, 2 opted out)
6/9 psychologist staff originally trained
(2 maternity, 1 adoption leave)
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Five remaining staff committed: agreed to attend
regular supervision and take on two cases (with support
from managers)
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Aims: Determine if evaluation effective and whether
differences in psychologists versus non-psychologist staff
Case series: measures given pre and post therapy, 3-month
follow up.
CORE: A 34 item measure of global mental health (e.g. I
have felt OK about myself)
PHQ-9: A 9 item measure of depression (e.g. Little pleasure
in doing things)
Valued Living Questionnaire: how important values such as
family are, how much currently living in line with values
Cognitive Fusion Questionnaire: 7 item measure of
‘Cognitive Fusion’ (e.g. I struggle with my thoughts)
Statistical analysis
 General Linear Model (Mixed Factorial ANOVA)
 Time X Clinician
 All subscales analysed
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Intent to Treat Analysis
For Follow-Up: Last Observation Carried Forward
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18 participants in service evaluation so far
14 women, 4 men
Recurrent depression most common primary diagnosis (one
bipolar disorder)
Most had co-morbidity: PTSD, Anxiety Disorder, Personality
Disorder Traits, Physical Health problems, Alcohol Problems,
Transient Psychotic Disorder.
A number had attempted suicide in past
One Anorexia and Two Bulimia cases
Majority had had other therapies in past
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Statistically significant improvement for:
◦ CORE Total: F=10.2, p<.01
◦ CORE Total (-Risk): F=12.9, p<.01
◦ CORE Functioning: F=14.7, p<.001
◦ CORE Problems and Symptoms: F=18.5, p<.001
◦ CORE Well-Being: F=18.9, p<.001
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PHQ (Depression): F=18.8, p<.001
Valued Living: Importance: F=7.6 p<.05
Valued Living: Action: F=7.7, p<.05
Cognitive fusion: Valued: F=14.6, p<.01
No improvement for:
◦ CORE Risk: F=.08, p>.05
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Statistically significant improvement for:
◦ CORE Problems and Symptoms: F=7.9, p<.05
◦ CORE Total (-Risk) F=14.9, p<.01
◦ PHQ (Depression): F=7.0, p<.05
◦ Cognitive fusion: F=7.7, p<.05
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Trend for:
◦ CORE Total: F=4.2, p<.10
◦ CORE Functioning: F=3.7, p<.10
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No improvement for:
◦ CORE Risk: F=0.0, p>.05
◦ CORE WellBeing F=3.0, p>.05
◦ Valued Living: Importance: F=1.1, p>.05 or Action: F=0.2, p>.05
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Post-Treatment, no significant interaction between
changes over time and clinician (8 psychologists, 10 nonpsychologists):
◦ Wilks Lambda: F(10,7)=1.8, p>.05
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Drop out higher:
◦ non-psychologists: 36.4% (n=4) dropped out
◦ Psychologists: 12.5% (n=1) dropped out
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Psychologists also took on the more complex cases: high
risk, co-morbid personality disorder, physical health
problems etc.
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At three months (7 psychologists, 8 non-psychologists)
◦ Trend for outcomes on CORE Total (-Risk) better for
psychologists than non-psychologists: F=3.6, p<.10
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ACT effective as a component of depression and transdiagnostic pathways for complex secondary care
population
Improvements in global mental health, depression,
cognitive fusion and values post-treatment
Partially maintained at follow- up (data collection ongoing)
High rates of therapist attrition for non-psychologist staff
Higher drop out for non-psychologist staff
non-psychologist staff who stay committed to delivering
ACT have good outcomes similar to psychologists
Possibility that longer-term outcomes better for
psychologists