The relationships between quality of life, psychopathology and group cognitive behavioural treatment outcome

Niamh McAlinden (2010). The relationships between quality of life, psychopathology and group cognitive behavioural treatment outcome PhD Thesis, School of Psychology, The University of Queensland.

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Author Niamh McAlinden
Thesis Title The relationships between quality of life, psychopathology and group cognitive behavioural treatment outcome
School, Centre or Institute School of Psychology
Institution The University of Queensland
Publication date 2010-03
Thesis type PhD Thesis
Supervisor Emeritus Professor Tian Oei
Dr Simon Smith
Total pages 195
Total colour pages 6
Total black and white pages 189
Subjects 17 Psychology and Cognitive Sciences
Abstract/Summary The World Health Organization (WHO, 1948) has long advocated the importance of including positive indicators of behaviour and health, such as quality of life (QOL), in clinical assessment and treatment planning. QOL is likely to assist in our understanding and treatment of psychological conditions when assessed in addition to negative clinical symptoms. However, the majority of clinical research studies have focused primarily on the negative symptomatology of psychological disorders. It is suggested in this thesis that this narrow approach to treatment outcome assessment is incomplete without considering the factors that can enable mental health patients to return to an active, meaningful life. Clinicians have only recently begun to incorporate QOL assessment into their treatment protocols and outcome studies, and very little longitudinal data over extended time frames has been reported in the literature. It is clear that further research into the effects of different treatments on QOL, particularly psychotherapeutic techniques, is necessary if QOL instruments are to be accepted as a serious addition to routine outcome measures. Furthermore, the inclusion of QOL as an outcome measure in clinical studies of cognitive behaviour therapy (CBT) may have implications for the cognitive models of psychopathology. However, the mechanisms by which QOL improves during CBT have not been adequately explored. This thesis aims to make an important contribution to the QOL literature, by demonstrating the maintenance of long-term gains in QOL following a group CBT intervention in a naturalistic clinical setting, and by investigating the underlying mechanisms by which QOL improves during CBT. The specific aims of this thesis were to: 1) validate the QOLI for use with anxiety and depression patients; 2) examine the generalisability of the relationships between QOL and the psychopathology of anxiety and depression in an Australian naturalistic clinical sample; 3) examine patient QOL outcomes and the effectiveness of group CBT for anxiety and depression; 4) test a number of models regarding the underlying mechanisms that may explain treatment-related changes in QOL; and 5) assess longitudinal changes in QOL, symptom and cognitive variables over a naturalistic follow-up period of seven years, on average. Chapter 1 provides a review of the existing QOL literature, discussing the utility and importance of QOL assessment with clinical groups, the impact of anxious and depressive psychopathology on QOL, the use of pharmacological and psychotherapeutic interventions to improve QOL, and the way in which QOL can be incorporated into cognitive theories of psychopathology. The results of Chapter 2 highlight the reliability and validity of the Quality of Life Inventory (Frisch, 1994b) for a sample of patients with anxiety and depression. In Chapter 3, it was found that for depressed patients, symptoms of depression were negatively related to QOL, and for anxiety patients, anxiety and depression symptoms were negatively related to QOL. Both groups of patients experienced significant improvements in QOL, symptoms of anxiety and depression, and cognitions, following group CBT, as reported in Chapter 4. Furthermore, between 35% and 40% of therapy completers, reported reliable improvements in their anxiety and depression symptoms. The results of Chapters 3 and 4 were consistent with the QOL literature and demonstrated that the relationships between QOL and psychopathology at baseline and post-treatment each generalized to a real-world clinical sample. Chapter 5 presents findings which suggest that changes in specific cognitions predicted changes in anxiety and depression, which in turn were directly related to changes in QOL. There was no evidence that cognitive change mediated the relationships between change in QOL and changes in anxiety and depression. These results provide some insight into how QOL might be incorporated into CBT models of anxiety and depression. Long-term QOL and symptom outcomes, measured on average seven years after the completion of group CBT, were reported in Chapter 6 such that post-treatment scores for both anxiety and depression patients were maintained at follow-up. Furthermore, for the anxiety group, anxiety symptoms continued to decrease between post-treatment and follow-up assessments. Finally, in Chapter 7, the results of this thesis are integrated and discussed with regard to their implications for cognitive behavioural theories of anxiety and depression, for theories of CBT, for the use of QOL in clinical practice and for future research into QOL, psychopathology, and CBT. It is argued that patients’ QOL is a valid and important outcome to consider in real-world, clinical practice with patients who struggle with anxiety and depressive disorders. Aiming to improve patients’ QOL in addition to reducing their symptoms represents a more holistic approach to treatment and it acknowledges that it important for patients to feel that they are successfully meeting their personal needs and goals. Furthermore, the key to improving QOL appears to be directly linked to reducing psychopathology rather than changing cognitions.
Keyword quality of life
group CBT
mechanisms of change
longitudinal follow-up
Additional Notes Colour pages: 108, 109, 110, 111, 193, 195

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Created: Thu, 07 Apr 2011, 18:03:31 EST by Ms Niamh Mcalinden on behalf of Library - Information Access Service