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Title: Individual differences in response to brief psychological interventions : using a mixed methods design to identify the role of user characteristics in the treatment of Obsessive-Compulsive Disorder (OCD)
Author: Knopp, Jasmin
ISNI:       0000 0004 6498 2082
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2017
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Background: OCD is a debilitating mental health condition. Poor access to evidence-based psychological treatment has motivated the implementation of low intensity interventions in UK mental health services for OCD. Around one half of those accessing care remain clinically unwell. Service users, providers, and treatment decision-makers could benefit from understanding users' views of low intensity interventions and knowing which users are more likely to benefit from diverse low intensity approaches in order to match individuals with treatments of known efficacy. Aim and objectives: The primary aim of this research was to determine user characteristics associated with engagement and outcome in low intensity interventions for OCD. The objectives of the study were: 1) to review the published literature on predictors of psychological therapy outcome in OCD, 2) to explore individual variation in intervention acceptability, uptake, and engagement, and 3) to identify user characteristics, which moderate intervention engagement and outcome. Methods: This mixed methods thesis was conducted in three parts. Firstly, a systematic review of published trial data was conducted to identify predictors of therapy outcome. Secondly, primary data were collected as part of a large effectiveness trial: 1) qualitative interviews with 36 trial participants, randomised to one of two low intensity interventions (guided self-help; cCBT); and 2) quantitative trial assessments conducted at baseline and at 3-months follow-up. Data from the systematic review and the qualitative study were used to identify possible moderators of outcome. Confirmatory analyses were then conducted on these variables, using data from the quantitative assessments. Results: Objective 1: The systematic review identified 43 studies, examining predictors of outcome. Robust effects were rare and the applied utility of these findings is limited by methodological weaknesses. Objective 2: Six themes were identified from the qualitative study, three relate to the general acceptability of low intensity interventions: 1) Predisposing concepts of high quality psychological therapies, 2) Engaging with low intensity interventions, and 3) The perceived value of therapist support. Three are specific to individuals with OCD: 4) Positive aspects of OCD, 5) Recognition and accommodation of OCD users' needs, and 6) OCD disclosure. Objective 3: User attachment style, expressed emotion, OCD symptom subtype, and prior help seeking for OCD were examined in confirmatory interaction tests. Symmetry/order/exactness symptoms were associated with a greater likelihood of engagement in guided self-help than cCBT. Contamination/washing symptoms were associated with improved outcome in guided self-help over cCBT. Conclusions: This study has made an original contribution through using a mixed methods design to identify individual differences in response to low intensity interventions in OCD. There is significant individual variation in the acceptability of, and engagement with, low-intensity interventions for OCD, linked to the mode and intensity of therapist support preferable to the individual user. However, few moderators could be identified. Future research should focus on maximising the reliability of stratified medicine research to allow related findings to inform clinical decision-making.
Supervisor: Bower, Peter Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Low Intensity Interventions ; Mixed Methods ; Individual Variation ; Obsessive-Compulsive Disorder ; Moderators