Peter Fisher | University of Liverpool (original) (raw)

Papers by Peter Fisher

Eye

Uveal melanoma (UM) survivors can experience significant emotional distress, although the factors... more Uveal melanoma (UM) survivors can experience significant emotional distress, although the factors underpinning this are poorly understood. Systematic reviews of distress in UM only include cross-sectional studies, thereby limiting our understanding of causal factors. This review identified prospective clinical, demographic, social and psychological predictors of distress in UM survivors. A systematic search of the literature for English language prospective studies was conducted. Thirteen papers, reporting data from seven unique datasets were included in a narrative synthesis of the results. Younger age (3 studies from 3 datasets), physical health (including visual impairment, ocular symptoms, and other UM-related factors; 3 studies from 3 datasets), and psychological factors (mainly baseline distress; 3 studies from 3 datasets and worry about recurrence; 2 studies from 2 datasets), significantly predicted distress. There was no consistent evidence for other demographic, clinical or...

BMC Medical Research Methodology, 2007

Background The 'Hawthorne Effect' may be an important factor affecting the generalisabili... more Background The 'Hawthorne Effect' may be an important factor affecting the generalisability of clinical research to routine practice, but has been little studied. Hawthorne Effects have been reported in previous clinical trials in dementia but to our knowledge, no attempt has been made to quantify them. Our aim was to compare minimal follow-up to intensive follow-up in participants in a placebo controlled trial of Ginkgo biloba for treating mild-moderate dementia. Methods Participants in a dementia trial were randomised to intensive follow-up (with comprehensive assessment visits at baseline and two, four and six months post randomisation) or minimal follow-up (with an abbreviated assessment at baseline and a full assessment at six months). Our primary outcomes were cognitive functioning (ADAS-Cog) and participant and carer-rated quality of life (QOL-AD). Results We recruited 176 participants, mainly through general practices. The main analysis was based on Intention to trea...

Metacognitive Therapy Metacognitive therapy is based on the principle that worry and rumination a... more Metacognitive Therapy Metacognitive therapy is based on the principle that worry and rumination are universal processes leading to emotional disorder. These processes are linked to erroneous beliefs about thinking and unhelpful self-regulation strategies. Metacognitive Therapy: ...

Medical Education, 2013

This study investigated the applicability of the self-regulatory executive functioning (S-REF) mo... more This study investigated the applicability of the self-regulatory executive functioning (S-REF) model to performance test anxiety (PTA) in objective structured clinical examinations (OSCEs). Specifically, it examined the relative contributions of metacognitive beliefs, trait worry and attentional control to PTA.

Journal of Behavior Therapy and Experimental Psychiatry, 2007

Intrusive sensory memories are a common feature of depression but these are not targeted in stand... more Intrusive sensory memories are a common feature of depression but these are not targeted in standard cognitive treatments. Imagery rescripting of distressing memories has so far been mainly used to treat trauma-related disorders and as a component of the treatment of personality disorders. We propose that this approach might also be effective in treating depression. This paper describes the initial application of imagery rescripting as a stand-alone treatment for two patients with a sole diagnosis of major depressive disorder. The two cases are described in detail and follow-up data are reported. Implications for the cognitive treatment of depression and for our theoretical understanding about the mechanisms of change in cognitive therapy are considered.

International Journal of Cognitive Therapy, 2009

A number of models of Obsessive Compulsive Disorder (OCD) stress the role of beliefs in the devel... more A number of models of Obsessive Compulsive Disorder (OCD) stress the role of beliefs in the development of symptoms. However, they differ as to which beliefs they consider central. These beliefs fall into two categories-cognitive and metacognitive. The current study compared the relative contribution of cognition and metacognition as prospective predictors of obsessive-compulsive symptoms. We used measures of cognitive beliefs derived from cognitive theories of OCD (e.g., Salkovskis, 1985) a measure of metacognition derived from Wells' metacognitive model (Wells, A., 1997), and another metacognitive measure that draws from several models of OCD (e.g., Rachman, 1997). We controlled for worry and beliefs concerning overestimation of threat. Thought-fusion, a metacognitive belief implicated in Wells' model, emerged as an independent prospective predictor of O-C symptoms but other beliefs did not. The results add to a growing database supporting the metacognitive model.

Acta Psychiatrica Scandinavica, 2010

Objective: To evaluate CBTp delivered by non-expert therapists, using CBT relevant measures. Meth... more Objective: To evaluate CBTp delivered by non-expert therapists, using CBT relevant measures. Methods: Participants (N=74) were randomised into immediate therapy or waiting list control groups. The therapy group was offered six months of therapy and followed up three months later. The waiting list group received therapy after waiting nine months (becoming the delayed therapy group). Results: Depression improved in the combined therapy group at both the end of therapy and follow-up. Other significant effects were found in only one of the two therapy groups (positive symptoms; cognitive flexibility; uncontrollability of thoughts) or one of the two timepoints (end of therapy: PANSS general symptoms, anxiety, suicidal ideation, social functioning, resistance to voices; follow-up: power beliefs about voices, negative symptoms). There was no difference in costs between the groups. Conclusions: The only robust improvement was in depression. Nevertheless, there were further encouraging but modest improvements in both emotional and cognitive variables, in addition to psychotic symptoms.

Journal of Affective Disorders, 2020

Behaviour Research and Therapy, 2009

Many depressed patients report intrusive and distressing memories of specific events in their liv... more Many depressed patients report intrusive and distressing memories of specific events in their lives. Where present, these memories are believed to act as a maintaining factor. A series of ten patients with major depressive disorder and intrusive memories, many of them reporting severe, chronic, or recurrent episodes of depression, were given an average of 8.1 sessions of imagery rescripting as a stand-alone treatment. Hierarchical linear modelling demonstrated large treatment effects that were well maintained at one year follow-up. Seven patients showed reliable improvement, and six patients clinically significant improvement. These gains were achieved entirely by working through patients' visual imagination and without verbal challenging of negative beliefs. Spontaneous changes in beliefs, rumination, and behaviour were nevertheless observed.

Journal of Psychosomatic Research

Meta-analyses of trials of psychological treatments for emotional distress in breast cancer (BCa)... more Meta-analyses of trials of psychological treatments for emotional distress in breast cancer (BCa) conclude that efficacious treatments exist. Subsequently, their implementation in routine care is widely promoted by health policy. However, the methodological quality of these trials has not been systematically evaluated. The present review investigates this issue. Method A systematic search identified randomised controlled trials of psychological treatments for emotional distress in BCa. The Psychotherapy Outcome Study Methodology Rating Form was used to assess the quality of trials. Generic design elements, including representativeness of sample, control of concomitant treatments, reporting clinical significance outcomes, and design elements specific to psychotherapy trials, including manualisation, therapist training, and therapist adherence and competence were evaluated. Results 91 trials were eligible. Overall, methodological quality was low. Generic design elements were limited in most trials: 15% specified as an inclusion criterion that participants were distressed; 10% controlled for concomitant treatments; and 11% reported the clinical significance of findings. Design elements specific to psychotherapy trials were also implemented poorly: 51% used treatment manuals; 8% used certified trained therapists; and monitoring of adherence and competence occurred in 15% and 4%, respectively. Conclusion

Journal of affective disorders, 2018

procrastination is highly prevalent amongst students and impairs academic performance. The metaco... more procrastination is highly prevalent amongst students and impairs academic performance. The metacognitive model of procrastination explains a significant proportion of unintentional procrastination variance. However, the model has yet to be tested using academic performance as the dependent variable. We tested whether the metacognitive model of procrastination explained self-reported academic performance (AP). a convenience sample of 204 current undergraduate and postgraduate students completed a battery of online questionnaires that measured intentional and unintentional procrastination, metacognitions about procrastination, AP, and depression. We conducted a series of correlation analyses and a path analysis (based on the metacognitive model of procrastination) that specified AP as the dependent variable. the correlation analyses indicated that there are significant, negative associations between AP and depression, AP and negative metacognitions about procrastination, and AP and un...

Journal of psychosocial oncology, Jan 3, 2018

Adolescent and young adults who have survived cancer are at an increased risk of psychological di... more Adolescent and young adults who have survived cancer are at an increased risk of psychological distress. This study investigated whether metacognitive beliefs are associated with emotional distress and trauma symptoms in adolescent and young adult (AYA) survivors of cancer independent of known covariates, including current physical health difficulties. Cross-sectional survey using multiple self-report measures. Eighty-seven AYA survivors of cancer were recruited from follow-up appointments at an oncology unit and completed self-report questionnaires measuring emotional distress, posttraumatic stress symptoms, metacognitive beliefs, demographic information, and current physical health difficulties. Data were analysed using correlational and hierarchical multiple regression analyses. Metacognitive beliefs explained an additional 50% and 41% of the variance in emotional distress and posttraumatic stress symptoms, respectively, after controlling for known covariate effects, including cu...

Cognitive Therapy and Research, 2014

Two hundred and six patients, diagnosed with primary breast or prostate cancer completed self-rep... more Two hundred and six patients, diagnosed with primary breast or prostate cancer completed self-report questionnaires on two occasions: before treatment (T1) and 12 months later (T2). The questionnaires included: the Hospital Anxiety and Depression Scale; Impact of Events Scale; the Metacognitions Questionnaire-30 (MCQ-30) and the Illness Perceptions Questionnaire-revised. A series of regression analyses indicated that metacognitive beliefs at T1 predicted between 14 and 19 % of the variance in symptoms of anxiety, depression and trauma at T2 after controlling for age and gender. For all three outcomes, the MCQ-30 subscale 'negative beliefs about worry' made the largest individual contribution with 'cognitive confidence' also contributing in each case. For anxiety, a third metacognitive variable, 'positive beliefs about worry' also predicted variance in T2 symptoms. In addition, hierarchical analyses indicated that metacognitive beliefs explained a small but significant amount of variance in T2 anxiety (2 %) and T2 depression (4 %) over and above that explained by demographic variables, T1 symptoms and T1 illness perceptions. The findings suggest that modifying metacognitive beliefs and processes has the potential to alleviate distress associated with cancer.

British Journal of Psychiatry, 2007

A number of governmental and professional organizations have recommended that cancer patients be ... more A number of governmental and professional organizations have recommended that cancer patients be screened routinely for the presence of heightened psychological distress. For example, the National Comprehensive Cancer Network (NCCN) initially published guidelines in 1999, recommending that all patients be screened for distress at their initial visit and at appropriate intervals thereafter. Several arguments can be made for implementation of routine screening for distress. First, evidence suggests that heightened distress is associated with a number of negative outcomes that include poorer adherence to treatment recommendations, worse satisfaction with care, and worse quality of life. Relationships have also been reported between heightened distress (such as greater depressive symptomatology) and poorer survival in people with cancer. Second, heightened distress is treatable. Numerous randomized controlled trials show that psychological distress, including anxiety and depression, can be alleviated by pharmacologic and nonpharmacologic interventions. Third, heightened distress is common. Prevalence estimates derived from large-scale studies typically exceed 30%. Fourth, and perhaps most important, evidence indicates that heightened distress often goes unrecognized by oncology professionals. In one of the largest studies examining this issue, Fallowfield et al evaluated the ability of 143 physicians to detect heightened distress in 2,297 cancer patients. Only 29% of patients with scores exceeding the cutoff on an established screening measure were identified by their physicians as having heightened distress. Despite evidence that heightened distress is under-recognized, clinicians seem reluctant to use screening tools routinely. The format and length of many existing tools may be a barrier, in that the time required for administering, scoring, and interpreting these measures favors use of more informal methods. To address this issue, several ultrashort screening tools have been developed. The most widely studied of these is the Distress Thermometer, a single-item measure that asks respondents to rate their distress during the last week on an 11-point scale ranging from “no distress” (0) to “extreme distress” (10). Although they possess greater potential for routine clinical use than longer measures, the accuracy of these ultrashort tools in detecting heightened distress could be too low to recommend them. The article by Mitchell in the this issue of the Journal of Clinical Oncology represents the first comprehensive evaluation of the accuracy of ultrashort methods in detecting heightened distress in people with cancer. The study is notable for the use of systematic search and pooled analysis methods, similar to those used in a comprehensive evaluation of the results of randomized controlled trials. That is, the investigator used replicable methods to identify all relevant studies and then used quantitative methods to summarize findings across studies. The results of these efforts indicate that ultrashort methods possess both strengths and weaknesses that need to be considered when they are used in the clinic. The principal strength of these methods is their accuracy in ruling out the presence of heightened distress relative to longer methods; the principal weakness is their generally poor accuracy in confirming the presence of heightened distress. An example provided by the author illustrates these qualities. Findings summarized across studies suggest that if 100 people were screened for heightened distress using the Distress Thermometer and the cutoff currently recommended by NCCN, distress would be correctly ruled out (ie, patients identified as not distressed would be classified accurately) in 51 of 60 patients, but correctly confirmed (ie, patients identified as distressed would be classified accurately) in just 22 of 40 patients. Based on these findings, should ultrashort methods be recommended as screening tools? Their poor accuracy in ruling in heightened distress is a liability. If used consistent with NCCN guidelines to decide whether patients should be referred for mental health, social work, or pastoral services, implementation of ultrashort screening measures is likely to result in many patients who are not distressed receiving inappropriate referrals. The primary consequence of this would be the needless use of generally scarce resources available for psychosocial care. The mislabeling of some patients as distressed might also have the unintended consequence of causing distress where it was not present previously. Conversely, the generally good accuracy of ultrashort methods in ruling out heightened distress can be viewed as a major asset that outweighs the previously identified liability. As noted by Mitchell, this feature means that “. . . one simple screen could be used to exclude most cases of distress and mood disorder.” Given that ultrashort methods are unlikely to possess the same accuracy…

PloS one, 2014

The Metacognitions Questionnaire 30 assesses metacognitive beliefs and processes which are centra... more The Metacognitions Questionnaire 30 assesses metacognitive beliefs and processes which are central to the metacognitive model of emotional disorder. As recent studies have begun to explore the utility of this model for understanding emotional distress after cancer diagnosis, it is important also to assess the validity of the Metacognitions Questionnaire 30 for use in cancer populations. 229 patients with primary breast or prostate cancer completed the Metacognitions Questionnaire 30 and the Hospital Anxiety and Depression Scale pre-treatment and again 12 months later. The structure and validity of the Metacognitions Questionnaire 30 were assessed using factor analyses and structural equation modelling. Confirmatory and exploratory factor analyses provided evidence supporting the validity of the previously published 5-factor structure of the Metacognitions Questionnaire 30. Specifically, both pre-treatment and 12 months later, this solution provided the best fit to the data and all i...

Frontiers in Psychology

Background: Adult cancer survivors often experience substantial psychological morbidity following... more Background: Adult cancer survivors often experience substantial psychological morbidity following the completion of acute cancer treatment. Unfortunately, current psychological interventions are of limited efficacy. This study explored if metacognitive therapy (MCT); a brief transdiagnostic psychological intervention was potentially efficacious and could be delivered effectively to adult cancer survivors with psychological morbidity. Methods: An open trial with 3-and 6-month follow-up evaluated the treatment effects of MCT in 27 consecutively referred individuals to a clinical psychology health service specializing in psycho-oncology. Each participant received a maximum of six 1-hour sessions of MCT. Levels of anxiety, depression, fear of cancer recurrence, post-traumatic stress symptoms, health related quality of life, and metacognitive beliefs and processes were assessed using self-report questionnaires. Results: MCT was associated with statistically significant reductions across all outcome measures which were maintained through to 6-month follow-up. In the ITT sample on the primary treatment outcome measure, the Hospital Anxiety and Depression Scale-Total, 59% of participants met recovery criteria at post-treatment and 52% at 6-month follow-up, respectively. No participants significantly deteriorated. In the completer sample (N = 20), 80% recovered at post-treatment and 70% at 6-month follow-up. MCT was acceptable to patients with approximately 75% of patients completing all treatment sessions. Conclusion: MCT, a brief transdiagnostic psychological intervention can be delivered effectively to a heterogenous group of cancer survivors with promising treatment effects. Examining the efficacy of brief MCT against the current gold standard psychological intervention would be a valuable advance toward improving the quality of life of cancer survivors.

Eye