Behavioral couples therapy for brain injury: single case methodology with bi-phasic design.

OBJECTIVES: To explore the outcomes of Behavioral Couples Therapy (BCT) for couples with brain injury. BACKGROUND: Brain injury can result in communication, emotional and behavioral disturbances, leading to higher levels of depression, anxiety and relationship distress. Currently, no study has explored the outcomes of BCT in couples impacted by brain injury. METHOD: Four heterosexual couples living with brain injury were seen at a specialist outpatient service, and attended an average of 13 (range 8-25) BCT sessions. Participants with brain injury and their partners completed weekly measures of depression, anxiety, and couple satisfaction throughout baseline, assessment, intervention, and follow-up phases. Data were visually analyzed, and effects examined using reliable change analysis, and between-phase comparison conducted using Tau-U. RESULTS: Tau-U analysis demonstrated that both the patient and partner groups experienced significant overall improvement in relationship satisfaction and anxiety. Partners also reported significant reduction in depression scores overall. Reliable change analysis indicated improvement for some individual patients and partners, with effects maintained at follow-up in some cases. CONCLUSIONS: The results offer promising results regarding the use of BCT for brain injury in increasing relationship satisfaction and reducing psychological distress. Further investigation is warranted.

Couple-based Intervention for Depression: An Effectiveness Study in the National Health Service in England.

This study represents an effectiveness study and service evaluation of a cognitive behavioral, couple-based treatment for depression (BCT-D) provided in London services that are part of the "Improving Access to Psychological Therapies" (IAPT) program in England. Twenty-three therapists in community clinics were trained in BCT-D during a 5-day workshop, followed by monthly group supervision for 1 year. The BCT-D treatment outcome findings are based on 63 couples in which at least one partner was depressed and elected to receive BCT-D. Eighty-five percent of couples also demonstrated relationship distress, and 49% of the nonclient partners also met caseness for depression or anxiety. Findings demonstrated a recovery rate of 57% with BCT-D, compared to 41% for all IAPT treatments for depression in London. Nonclient partners who met caseness demonstrated a 48% recovery rate with BCT-D, although they were not the focus of treatment. BCT-D was equally effective for clients regardless of the clinical status of the nonclient partner, suggesting its effectiveness in assisting both members of the couple simultaneously. Likewise, treatment was equally effective whether or not both partners reported relationship distress. The findings are promising regarding the successful application of BCT-D in routine clinical settings.

Effects of directional exercise on lingual strength.

PURPOSE: To examine the application of known muscle training principles to tongue strengthening exercises and to answer the following research questions: (a) Did lingual strength increase following 9 weeks of training? (b) Did training conducted using an exercise moving the tongue in one direction result in strength changes for tongue movements in other directions? (c) Were differential training effects observed for participants completing exercises sequentially (in isolation) versus concurrently (several exercises in combination)? (d) Were strength gains maintained after exercise was discontinued? Methods Participants were 39 healthy adults assigned to sequential or concurrent lingual strength training. Lingual exercise (elevation, protrusion, and/or lateralization) was conducted for 9 weeks, with lingual strength and cheek strength (control variable) assessed weekly. RESULTS: All lingual strength measures increased with training, but cheek strength remained unchanged. Training effects were not related to training condition (sequential vs. concurrent), nor were specificity effects observed for direction of exercise. Significant decreases in lingual strength were noted 2-4 weeks after exercise was discontinued. CONCLUSIONS: The findings replicate those of earlier studies demonstrating that lingual strength may be increased with a variety of exercise protocols and confirm that detraining effects may be observed when training is discontinued. The findings further suggest that the lingual musculature may demonstrate less dramatic training specificity than what has been reported for skeletal muscles.

Therapists' beliefs about research and the scientist-practitioner model in an evidence-based health care climate: A qualitative study.

The growing emphasis on achieving therapeutic practice that is informed by research evidence or 'evidence-based' has been well documented. However, if therapists are to operate effectively within evidence-based services, it is necessary to develop a better understanding of factors that influence their attitudes towards research in routine clinical work. Within this context, there is a need to re-examine the scientist-practitioner model as potentially complementing or competing with evidence-based practice. This study explores the beliefs about research and the scientist-practitioner model amongst a diverse group of therapists whose work is contextualized by evidence-based practice. In-depth, qualitative interviews were used to elicit significant themes that related to current practices, previous training and contact with other professionals. The findings suggest that the therapists' beliefs were shaped by different levels of influence that range from personal values to organizational and political issues. The results also highlighted how the therapists had constructed more idiosyncratic definitions of the scientist-practitioner model that related to perceptions of its value. Implications for further research, training and practice are discussed.