Objective: There is a high prevalence of complex psychological distress after a traumatic brain i... more Objective: There is a high prevalence of complex psychological distress after a traumatic brain injury but limited evidence of effective interventions. We examined the feasibility of Acceptance and Commitment Therapy after a severe traumatic brain injury using the criteria, investigating a therapeutic effect, and reviewing the acceptability of measures, treatment protocol, and delivery method (in a dyad of two clients and a therapist). Method: Two male outpatients with severe traumatic brain injury and associated psychological distress jointly engaged in a seven session treatment program based on Acceptance and Commitment Therapy principles. Pre-and post-treatment measures of mood, psychological flexibility, and participation were taken in addition to weekly measures. Results: The intervention showed a therapeutic effect with one participant, and appeared to be acceptable for both participants with regard to program content, measures, and delivery mode by in a dyad. One participant showed both significant clinical and reliable change across several outcome measures including measures of mood and psychological flexibility. The second participant did not show a reduction in psychological inflexibility, but did show a significant drop in negative affect. Significant changes pre-to post-treatment for measures of participation were not indicated. Qualitatively, both participants engaged in committed action set in accordance with their values. Conclusions: This study suggests that Acceptance and Commitment Therapy may be feasible to be delivered in a dyad with individuals who have a severe traumatic brain injury. A further test of its potential efficacy in a phase II clinical trial is recommended.
ABSTRACT A program designed to prepare long-stay “hard-to-place” psychiatric inpatients for succe... more ABSTRACT A program designed to prepare long-stay “hard-to-place” psychiatric inpatients for successful community placement was evaluated. Fifteen patients in the Intensive Learning Center (ILC) program were assessed at 5- and 10-month intervals following baseline. In addition, their functioning was compared to a criterion related comparison group of 26 patients who had been transferred to community placements 18 months earlier. Two informant driven measures were used: The Rehabilitation Evaluation of Hall and Baker (REHAB), (Baker & Hall, 1988) and, Adaptive Behavior Scale (ABS), (Nihira, Foster, Shellhaas, & Leland, 1975). The results indicated significant improvement in the ILC patients adaptive functioning after 5 months, but this improvement was not consistently sustained at the 10 month follow-up. Comparisons between the ILC and community groups were made at 10 months and suggested considerable overlap in functioning between the two groups. The implications of the findings for program development and implementation as well as for discharge planning are discussed.
... The bond in the partnership is consistent with the core therapeutic relationship issues descr... more ... The bond in the partnership is consistent with the core therapeutic relationship issues described by Rogers (1957), and Bordin (1994 ... outcome in community psychiatry and case management located five studies assessing the relationship in these contexts (Howgego et al., 2003 ...
Seventy-three men who were currently accessing or had recently accessed mental health services co... more Seventy-three men who were currently accessing or had recently accessed mental health services completed a questionnaire regarding their emotional expression, engagement in therapy, perceptions of treatment helpfulness, and future help-seeking intentions. Perceptions of treatment helpfulness were inversely predicted by alexithymia (mediated by bond) and restrictive emotionality, although these emotional expression variables were unrelated to future help-seeking intentions. Bond was positively related to perceptions of treatment helpfulness and both variables predicted future help-seeking intentions. Contrary to expectations, perceptions of treatment helpfulness did not mediate the relationship between bond and future help-seeking intentions. It was concluded that, once in therapy, bond and perceptions of treatment helpfulness are more important to future help-seeking intentions than a man's difficulty or discomfort with emotional expression.
Http Dx Doi Org 10 1080 09638280902738581, Jun 1, 2009
This study explores the effects of anxiety on driving performance in a sample of 35 individuals w... more This study explores the effects of anxiety on driving performance in a sample of 35 individuals with cognitive impairment who underwent driving reassessment 2 weeks after neuropsychological assessment. Participants completed measures of test, state and driving anxiety prior to the neuropsychological assessment. Measures of state anxiety were re-administered immediately before and after the on-road driving test. Higher anxiety before the on-road test was associated with fewer errors, although regression analyses showed that anxiety was not a unique predictor of driving performance. The results suggest that anxiety has a positive influence on driving performance but does not predict driving assessment outcome. Occupational therapists and driving instructors were better judges of the effects of anxiety on driving performance than were the participants themselves. Implications of these findings for clinical and medico-legal contexts are discussed.
General practitioners (GPs) are in a unique position to detect and manage patients with co-morbid... more General practitioners (GPs) are in a unique position to detect and manage patients with co-morbid mental health and substance use disorders (dual diagnosis). It has been estimated that over 30% of patients presenting to general practice have a diagnosable mental disorder and 12% have dual diagnosis. Unfortunately, between 30 and 50% of these problems go undetected in general practice. Limited GP education and training in mental health may account for this deficit, with a little over 8% of GPs receiving any formal postgraduate training in mental health. Prior to developing an educational resource for GPs, the present study aimed to establish baseline estimates of GP treatment practices with patients who have dual diagnosis. Two GP division-wide surveys of screening, assessment and treatment for dual diagnosis were conducted one year apart. In addition, five GPs conducted a clinical audit of 508 patient consultations. Results indicate that without ongoing targeted interventions, patient management activities such as GP counselling, use of screening devices, referral to specialist services, coordination and use of EPC items are not likely to improve and are at risk of declining. [Marshall KL, Deane FP. General practitioners' detection and management of patients with a dual diagnosis: implications for education and training. Drug Alcohol Rev 2004;23:455 -462]
Overall, respondents reported relatively little prior mental health training. Consistent with thi... more Overall, respondents reported relatively little prior mental health training. Consistent with this were the relatively low levels of confidence for culture specific diagnoses (e.g. sorcery), but significantly higher levels of confidence with modern diagnoses (e.g. depression). The implications of the findings for training and provision of mental health care are discussed.
Faculty of Health and Behavioural Sciences Papers, 2009
Mental illness affects one in five Australians in any given year and depression, anxiety and subs... more Mental illness affects one in five Australians in any given year and depression, anxiety and substance abuse are the most prevalent of the mental health problems. Mental illness is traditionally managed with medication and psychological intervention but exercise and diet have also been shown to be related to mental illness and are associated with improvements in mental health. The present article aims to describe the background and practical issues arising from the establishment of diet and exercise assessments and intervention for people receiving treatment for depression and anxiety in general practice settings. Patients were referred by their general practitioners, and attended sessions either in rooms at their practitioner's surgery or at a central clinic location. The program involved an initial assessment, four individual consultations with a dually qualified dietitian and exercise physiologist, and a final assessment. Issues in the process of assessing mental health, diet quality, physical fitness and physical activity behaviours are described as are key components of the tailored treatment programs. Strategies for improving motivation and adherence such as adjusting frequency of sessions, use of homework and means of communication are highlighted.
Faculty of Health and Behavioural Sciences Papers, Mar 1, 2007
This Open Forum examines research on case management that draws on consumer perspectives. It clar... more This Open Forum examines research on case management that draws on consumer perspectives. It clarifies the extent of consumer involvement and whether evaluations were informed by recovery perspectives. Searches of three databases revealed 13 studies that sought to investigate consumer perspectives. Only one study asked consumers about experiences of recovery. Most evaluations did not adequately assess consumers' views, and active consumer participation in research was rare. Supporting an individual's recovery requires commitment to a recovery paradigm that incorporates traditional symptom reduction and improved functioning, with broader recovery principles, and a shift in focus from illness to well-being. It also requires greater involvement of consumers in the implementation of case management and ownership of their own recovery process, not just in research that evaluates the practice.
Objective: There is a high prevalence of complex psychological distress after a traumatic brain i... more Objective: There is a high prevalence of complex psychological distress after a traumatic brain injury but limited evidence of effective interventions. We examined the feasibility of Acceptance and Commitment Therapy after a severe traumatic brain injury using the criteria, investigating a therapeutic effect, and reviewing the acceptability of measures, treatment protocol, and delivery method (in a dyad of two clients and a therapist). Method: Two male outpatients with severe traumatic brain injury and associated psychological distress jointly engaged in a seven session treatment program based on Acceptance and Commitment Therapy principles. Pre-and post-treatment measures of mood, psychological flexibility, and participation were taken in addition to weekly measures. Results: The intervention showed a therapeutic effect with one participant, and appeared to be acceptable for both participants with regard to program content, measures, and delivery mode by in a dyad. One participant showed both significant clinical and reliable change across several outcome measures including measures of mood and psychological flexibility. The second participant did not show a reduction in psychological inflexibility, but did show a significant drop in negative affect. Significant changes pre-to post-treatment for measures of participation were not indicated. Qualitatively, both participants engaged in committed action set in accordance with their values. Conclusions: This study suggests that Acceptance and Commitment Therapy may be feasible to be delivered in a dyad with individuals who have a severe traumatic brain injury. A further test of its potential efficacy in a phase II clinical trial is recommended.
ABSTRACT A program designed to prepare long-stay “hard-to-place” psychiatric inpatients for succe... more ABSTRACT A program designed to prepare long-stay “hard-to-place” psychiatric inpatients for successful community placement was evaluated. Fifteen patients in the Intensive Learning Center (ILC) program were assessed at 5- and 10-month intervals following baseline. In addition, their functioning was compared to a criterion related comparison group of 26 patients who had been transferred to community placements 18 months earlier. Two informant driven measures were used: The Rehabilitation Evaluation of Hall and Baker (REHAB), (Baker & Hall, 1988) and, Adaptive Behavior Scale (ABS), (Nihira, Foster, Shellhaas, & Leland, 1975). The results indicated significant improvement in the ILC patients adaptive functioning after 5 months, but this improvement was not consistently sustained at the 10 month follow-up. Comparisons between the ILC and community groups were made at 10 months and suggested considerable overlap in functioning between the two groups. The implications of the findings for program development and implementation as well as for discharge planning are discussed.
... The bond in the partnership is consistent with the core therapeutic relationship issues descr... more ... The bond in the partnership is consistent with the core therapeutic relationship issues described by Rogers (1957), and Bordin (1994 ... outcome in community psychiatry and case management located five studies assessing the relationship in these contexts (Howgego et al., 2003 ...
Seventy-three men who were currently accessing or had recently accessed mental health services co... more Seventy-three men who were currently accessing or had recently accessed mental health services completed a questionnaire regarding their emotional expression, engagement in therapy, perceptions of treatment helpfulness, and future help-seeking intentions. Perceptions of treatment helpfulness were inversely predicted by alexithymia (mediated by bond) and restrictive emotionality, although these emotional expression variables were unrelated to future help-seeking intentions. Bond was positively related to perceptions of treatment helpfulness and both variables predicted future help-seeking intentions. Contrary to expectations, perceptions of treatment helpfulness did not mediate the relationship between bond and future help-seeking intentions. It was concluded that, once in therapy, bond and perceptions of treatment helpfulness are more important to future help-seeking intentions than a man's difficulty or discomfort with emotional expression.
Http Dx Doi Org 10 1080 09638280902738581, Jun 1, 2009
This study explores the effects of anxiety on driving performance in a sample of 35 individuals w... more This study explores the effects of anxiety on driving performance in a sample of 35 individuals with cognitive impairment who underwent driving reassessment 2 weeks after neuropsychological assessment. Participants completed measures of test, state and driving anxiety prior to the neuropsychological assessment. Measures of state anxiety were re-administered immediately before and after the on-road driving test. Higher anxiety before the on-road test was associated with fewer errors, although regression analyses showed that anxiety was not a unique predictor of driving performance. The results suggest that anxiety has a positive influence on driving performance but does not predict driving assessment outcome. Occupational therapists and driving instructors were better judges of the effects of anxiety on driving performance than were the participants themselves. Implications of these findings for clinical and medico-legal contexts are discussed.
General practitioners (GPs) are in a unique position to detect and manage patients with co-morbid... more General practitioners (GPs) are in a unique position to detect and manage patients with co-morbid mental health and substance use disorders (dual diagnosis). It has been estimated that over 30% of patients presenting to general practice have a diagnosable mental disorder and 12% have dual diagnosis. Unfortunately, between 30 and 50% of these problems go undetected in general practice. Limited GP education and training in mental health may account for this deficit, with a little over 8% of GPs receiving any formal postgraduate training in mental health. Prior to developing an educational resource for GPs, the present study aimed to establish baseline estimates of GP treatment practices with patients who have dual diagnosis. Two GP division-wide surveys of screening, assessment and treatment for dual diagnosis were conducted one year apart. In addition, five GPs conducted a clinical audit of 508 patient consultations. Results indicate that without ongoing targeted interventions, patient management activities such as GP counselling, use of screening devices, referral to specialist services, coordination and use of EPC items are not likely to improve and are at risk of declining. [Marshall KL, Deane FP. General practitioners' detection and management of patients with a dual diagnosis: implications for education and training. Drug Alcohol Rev 2004;23:455 -462]
Overall, respondents reported relatively little prior mental health training. Consistent with thi... more Overall, respondents reported relatively little prior mental health training. Consistent with this were the relatively low levels of confidence for culture specific diagnoses (e.g. sorcery), but significantly higher levels of confidence with modern diagnoses (e.g. depression). The implications of the findings for training and provision of mental health care are discussed.
Faculty of Health and Behavioural Sciences Papers, 2009
Mental illness affects one in five Australians in any given year and depression, anxiety and subs... more Mental illness affects one in five Australians in any given year and depression, anxiety and substance abuse are the most prevalent of the mental health problems. Mental illness is traditionally managed with medication and psychological intervention but exercise and diet have also been shown to be related to mental illness and are associated with improvements in mental health. The present article aims to describe the background and practical issues arising from the establishment of diet and exercise assessments and intervention for people receiving treatment for depression and anxiety in general practice settings. Patients were referred by their general practitioners, and attended sessions either in rooms at their practitioner's surgery or at a central clinic location. The program involved an initial assessment, four individual consultations with a dually qualified dietitian and exercise physiologist, and a final assessment. Issues in the process of assessing mental health, diet quality, physical fitness and physical activity behaviours are described as are key components of the tailored treatment programs. Strategies for improving motivation and adherence such as adjusting frequency of sessions, use of homework and means of communication are highlighted.
Faculty of Health and Behavioural Sciences Papers, Mar 1, 2007
This Open Forum examines research on case management that draws on consumer perspectives. It clar... more This Open Forum examines research on case management that draws on consumer perspectives. It clarifies the extent of consumer involvement and whether evaluations were informed by recovery perspectives. Searches of three databases revealed 13 studies that sought to investigate consumer perspectives. Only one study asked consumers about experiences of recovery. Most evaluations did not adequately assess consumers' views, and active consumer participation in research was rare. Supporting an individual's recovery requires commitment to a recovery paradigm that incorporates traditional symptom reduction and improved functioning, with broader recovery principles, and a shift in focus from illness to well-being. It also requires greater involvement of consumers in the implementation of case management and ownership of their own recovery process, not just in research that evaluates the practice.
Uploads
Papers by Frank Deane