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Background: Given the degenerative nature of the condition, people living with motor neuron disease (MND) experience high levels of psychological distress. The purpose of this research was to investigate the cost‐effectiveness of acceptance and commitment therapy (ACT), adapted for the specific needs of this population, for improving quality of life. Methods: A trial‐based cost–utility analysis over a 9‐month period was conducted comparing ACT plus usual care (n = 97) versus usual care alone (n = 94) from the perspective of the National Health Service. In the primary analysis, quality‐adjusted life years (QALYs) were computed using health utilities generated from the EQ‐5D‐5L questionnaire. Sensitivity analyses and subgroup analyses were also carried out. Results: Difference in costs was statistically significant between the two arms, driven mainly by the intervention costs. Effects measured by EQ‐5D‐5L were not statistically significantly different between the two arms. The incremental cost‐effectiveness was above the £20,000 to £30,000 per QALY gained threshold used in the UK. However, the difference in effects was statistically significant when measured by the McGill Quality of Life‐Revised (MQOL‐R) questionnaire. The intervention was cost‐effective in a subgroup experiencing medium deterioration in motor neuron symptoms. Conclusions: Despite the intervention being cost‐ineffective in the primary analysis, the significant difference in the effects measured by MQOL‐R, the low costs of the intervention, the results in the subgroup analysis, and the fact that ACT was shown to improve the quality of life for people living with MND, suggest that ACT could be incorporated into MND clinical services. [ABSTRACT FROM AUTHOR]

Objective: To understand the feasibility of recruiting people with advanced cancer into a randomised controlled trial of acceptance and commitment therapy (ACT) vs a standardised talking control (TC) and delivering ACT to this population; to explore the acceptability of outcome measures and generate normative data.Methods: This was a feasibility two-arm randomised controlled trial. Participants were attendees with advanced cancer at one of three hospice-based day-therapy units in London, United Kingdom, who demonstrated low scores on the Functional Assessment of Cancer Therapies-General (FACT-G). The primary end point was 3 months.Results: The recruitment target was 54 participants; 42 people were recruited and randomised to up to eight individual sessions of ACT (n = 20) or TC (n = 22). Eighteen out of 42 (43%) of participants completed the primary outcome at 3 months, and at least one follow-up was available in 30/42 (71%) participants. An exploratory analysis revealed a non-significant adjusted mean difference after 3 months in the main outcome FACT-G of -3.41 (CI = -18.61-11.79) with TC having better functioning. Over 6 months, the adjusted mean difference between trial arms was 2.25 (CI = -6.03-10.52) in favour of ACT.Conclusions: It is feasible to recruit people with advanced cancer in a trial of ACT versus TC. Future research should test the effectiveness of ACT in a fully powered trial. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioural therapy (CBT) is commonly used to treat cancer patients with psychological disorders such as depression. There has been little qualitative research exploring the experience of therapists delivering CBT to patients with advanced cancer and long‐term health conditions generally. Therapists' views may help identify difficulties in delivering therapy and how these may be overcome. The aim of this study was to inform practice by qualitatively exploring the experiences of therapists delivering CBT to patients with advanced cancer. Design: Sixteen semi‐structured interviews were conducted with therapists from Increasing Access to Psychological Therapy (IAPT) services in London, UK, who had delivered CBT to patients enrolled on the CanTalk trial. Interviews were recorded, transcribed, and analysed using framework analysis. Results: Therapists reported positive experiences when working with the target population. Flexibility, adaptability, and a consideration of individual needs were identified as important when delivering CBT, but the rigidity of IAPT policies and demand for services were perceived as problematic. Although therapists reported adequate training, specialist supervision was desired when delivering therapy to this complex population. Conclusion: IAPT therapists can deliver CBT to advanced cancer patients, given therapists positive experiences evident in the present study. However, it was concluded that additional service and modifications of therapy may be needed before positive outcomes for both therapists and patients can be achieved. [ABSTRACT FROM AUTHOR]

A commentary on a reintegrative model for old age psychiatry is presented. The management of aging involves the use of developing medications and other technological innovations. In an attempt to work with older people, it is important to understand the nature of adjustment responses to loss. During the work with older people it is apparent that the main human capacities for adjusting loss remain.

One hundred and ten people in an university population responded to emailed eating disorder questionnaires. Ninty-seven fulfilling criteria for eating disorders (bulimia nervosa (BN), binge eating disorder (BED), EDNOS) were randomised to therapist administered email bulimia therapy (eBT), unsupported Self directed writing (SDW) or Waiting list control (WLC). Measures were repeated at 3 months. Diagnosis, Beck depression inventory (BDI) and Bulimia investigatory test (BITE) scores were recorded. Follow-up rate was 63% and results must be interpreted cautiously. However significantly fewer participants who had received eBT or SDW fulfilled criteria for eating disorders at follow up compared to WLC. There was no significant difference between eBT and SDW in the analysis of variance (ANOVA), although in separate analyses, eBT was significantly superior to WLC (p < 0.02) and the difference for SDW approached significance (p = 0.06). BDI and BITE scores showed no significant change. For eBT participants there was a significant positive correlation between words written and improvement in BITE severity score. BN, BED and EDNOS can be treated via email. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Background Disturbance of sleep is common in individuals with dementia where there may be reversal of the sleep-wake cycle. People with dementia of the Alzheimer's type have melatonin secretion rhythm disorders. There is some evidence that treatment with exogenous melatonin is an effective treatment for sleep disturbance associated with dementia. A randomised double blind placebo controlled cross over trial was undertaken to test the hypothesis that slow release exogenous melatonin 6 mg improves sleep for people with dementia. Methods Forty-four participants with DSM-IV diagnoses of dementia with sleep disturbance were selected for a seven week randomised double blind cross over trial of slow release melatonin 6 mg versus placebo. Sleep parameters were objectively measured using wrist actigraphy. Results Twenty-five out of 44 completed the trial. Sleep was significantly disturbed in the sample population. Melatonin had no effect on median total time asleep (n =25, z =1.35, p =0.18), number of awakenings (n =25, z =0.32, p =0.75) or sleep efficiency (n =25, z =0.17, p =0.24). Nor were there any carry over effects from melatonin. Conclusions Contrary to previous findings, we found no evidence that two weeks of exogenous melatonin is effective in improving sleep in people with dementia, although possible benefits of melatonin following longer periods of administration cannot be discounted. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Despite the great potential of new technologies, no systematic study of e-mail therapy for subjects with eating disorders has been published. We recruited, using a single announcement made via e-mail, from all 20 000 staff and students of a large college of the University of London, 23 individuals (all female) who appeared to fulfil diagnostic criteria for Bulimia Nervosa or Binge Eating Disorder (DSM IV). These women were offered on-line therapy by one of two clinicians experienced in the treatment of eating disorders. At 3-month follow-up, 19 returned questionnaires and showed significant reductions in outcome scores. Significant correlations were found between word count, a measure of engagement with treatment, and outcomes. This pilot study suggests that the Internet may be a useful way to recruit and treat those with eating disorders. A randomized controlled trial is indicated. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective Cognitive therapy (CT) has been used in anorexia nervosa, but little is known about its effectiveness. A randomized controlled trial was undertaken comparing dietary advice (DA) with cognitive therapy in the outpatient treatment of AN. Method Thirty-five patients were randomly allocated to either cognitive therapy (n =25) or dietary advice (n =10). There were no significant differences in the groups pre-treatment. Twenty sessions of cognitive therapy or dietary advice were offered. Results At 6 months 23 cognitive therapy patients remained engaged whereas all the dietary advice controls dropped out. Cognitive therapy patients showed significant changes in Body Mass Index (p =0.001), Eating Disorder Inventory Scores (p =0.035), Beck Depression Inventory Scores (p <0.0001) and Locus of Control of Behaviour Scores (p =0.017). Conclusions Significant improvements were observed in patients allocated to cognitive therapy, but not in those allocated to dietary advice on an intention to treat analysis. Cognitive therapy has advantages of promoting engagement and facilitating recovery. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Clinicians may experience ethical and legal dilemmas in the management of patients with severe anorexia nervosa. It has been suggested that weight gain through compulsory treatment is counterproductive and adversely affects the therapeutic relationship. Because of the ethical problems of withholding treatment in patients who may be at significant risk of dying, there is a dearth of outcome studies determining the effects of compulsory treatment. This study considers the legal implications, psychotherapeutic management and follow-up of 11 severely ill patients with a DSM IV diagnosis of Anorexia Nervosa. Preliminary findings suggest that if intervention is pursued in a structured and caring manner, compulsory treatment and/or nasogastric feeding may not adversely affect the therapeutic relationship. The assumption that compulsory treatment is necessarily detrimental is therefore questionable and requires further evaluation. © 1998 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]