Nick Midgley | University College London (original) (raw)

Papers by Nick Midgley

European Child & Adolescent Psychiatry, Jan 11, 2021

Adults with major depressive disorder (MDD) with psychotic features (delusions and/or hallucinati... more Adults with major depressive disorder (MDD) with psychotic features (delusions and/or hallucinations) have more severe symptoms and a worse prognosis. Subclinical psychotic symptoms are more common in adolescents than adults. However, the effects of psychotic symptoms on outcome of depressive symptoms have not been well studied in adolescents. Depressed adolescents aged 11-17 with and without psychotic symptoms were compared on depression severity scores at baseline and at 28-or 42-week follow-up in two large UK cohorts. Psychotic symptoms were weakly associated with more severe depression at baseline in both cohorts. At follow-up, baseline psychotic symptoms were only associated with depressive symptoms in one sample; in the other, the effect size was close to zero. This supports the DSM5 system of psychotic symptoms being a separate code to severity rather than the ICD10 system which only allows the diagnosis of psychotic depression with severe depression. There was no clear support for psychotic symptoms being a baseline marker of treatment response.

European Child & Adolescent Psychiatry, Apr 22, 2021

Reviews around interventions to improve shared decision making (SDM) for child and youth mental h... more Reviews around interventions to improve shared decision making (SDM) for child and youth mental health have produced inconclusive findings on what approaches increase participation. Importantly, the previous reviews did not explore the use of theory, as well as mechanisms of change (intervention functions) and active units of change (behaviour change techniques). The aim of this review was to explore these factors and ascertain how, if at all, these contribute to SDM. Five databases were searched up until April 2020. Studies met inclusion criteria if they were: (a) an intervention to facilitate SDM; (b) aimed at children, adolescence, or young people aged up to 25, with a mental health difficulty, or their parents/guardians; and (c) included a control group. Data were extracted on patient characteristics, study design, intervention, theoretical background, intervention functions, behaviour change techniques, and SDM. Quality assessment of the studies was undertaken using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Eight different interventions met inclusion criteria. The role of theory to increase SDM remains unclear. Specific intervention functions, such as 'education' on SDM and treatment options and 'environmental restructuring' using decision aids, are being used in SDM interventions, as well as 'training' for clinicians. Similarly, behaviour change techniques linked to these, such as 'adding objects to the environment', 'discussing pros/cons', and clinicians engaging in 'behavioural practice/rehearsal'. However, as most studies scored low on the quality assessment criteria, as well as a small number of studies included and a low number of behaviour change techniques utilised, links between behaviour change techniques, intervention functions and increased participation remain tentative. Intervention developers and clinicians may wish to consider specific intervention functions and behaviour change techniques to facilitate SDM.

Journal of Children's Services

Purpose The purpose of this study is to describe the development of the 14-item reflective foster... more Purpose The purpose of this study is to describe the development of the 14-item reflective fostering fidelity rating (RFFR), an observational rating system to evaluate model fidelity of group facilitators in the Reflective Fostering Programme (RFP), a mentalisation-based psychoeducation programme to support foster carers. The authors assess usability, dimensionality, inter-rater reliability and discriminative ability of the RFFR. Design/methodology/approach Eighty video clip extracts documenting 20 RFP sessions were independently rated by four raters using the RFFR. The dimensionality of the RFFR was assessed using principal components analysis. Inter-rater agreement was assessed using the intra-class correlation coefficient. Findings The proportion of missing ratings was low at 2.8%. A single principal component summarised over 90% of the variation in ratings for each rater. The inter-rater reliability of individual item ratings was poor-to-moderate, but a summary score had accepta...

The Lancet Digital Health

Journal of Counseling Psychology

Although the theory of epistemic trust has started informing research in clinical populations and... more Although the theory of epistemic trust has started informing research in clinical populations and in psychotherapy, no study has yet explored the phenomenon of epistemic trust and mistrust in depressed adolescents receiving psychotherapy. The present study aims to address this gap by creating a typology of depressed adolescents' experiences regarding their different journeys through the course of psychotherapy in relation to issues of epistemic trust and mistrust over a 2-year period. This study is based on a post-hoc analysis of interview data collected for a broader purpose. A total of 45 semi-structured interviews at 3 time points were conducted with 15 adolescents (80% female; M age = 15.28, SD = 1.79) who entered treatment with indications of epistemic mistrust or hypervigilance. These interviews were qualitatively analysed using Ideal Type Analysis. Three distinct journeys of adolescents' experiences were identified. Some experienced a shift from epistemic mistrust to epistemic trust which seemed to be associated with the experience of therapy; other adolescents also showed a shift but did not consider it as an outcome of therapy; and finally, some adolescents reported continued mistrust over the 2-year period. An interpersonal component within or beyond therapy may be the key to breaking the vicious cycle of epistemic mistrust and generating epistemic trust; but not all depressed adolescents in therapy achieve this. Particular attention should be drawn to depressed adolescents who have difficulty making use of therapy and/or their broader social environment. Psychological interventions may need to openly address their issues of mistrust in early sessions as epistemic mistrust or hypervigilance may hinder paths to learning both within and beyond therapy. Treatments that intervene at the level of the wider social system are encouraged.

Trial registration at https://doi.org/10.1186/ISRCTN90349442This document provides details regard... more Trial registration at https://doi.org/10.1186/ISRCTN90349442This document provides details regarding the setting up of, conduct, and analysis of the National Institute for Health Research (NIHR), Research for Patient Benefit (RfPB) funded study, “Evaluating the effectiveness of Mentalization-Based Treatment (MBT) as an intervention for children in foster care with emotional or behavioural problems: a phase II (feasibility) randomised controlled trial” (Short title: 'The Herts and Minds Study: Supporting the Emotional Wellbeing of Children ‘Looked After’ in Hertfordshire'). The Anna Freud Centre (AFC), a child mental health charity based in London, is the sponsor for this study. The AFC will be in partnership with the Hertfordshire Partnership University NHS Foundation Trust (HPFT), and The University of Hertfordshire (UH). As such, collaboration agreements will be established and exchanged between the three partner organisations. These agreements outline responsibilities and...

Journal of Child Psychotherapy, 2022

ABSTRACT The role of patients’ questions in psychoanalytic psychotherapy is a neglected topic in ... more ABSTRACT The role of patients’ questions in psychoanalytic psychotherapy is a neglected topic in the clinical and research literature. This qualitative study aims to bridge this gap by exploring the role of patients’ questions in Short-Term Psychoanalytic Psychotherapy (STPP) with adolescents suffering from depression. This is a single case study, focusing on the interaction between the patient and his therapist when questions were asked by the patient, using conversation analysis methodology. Data was taken from the IMPACT study, a randomised controlled trial, investigating three types of therapy in the treatment of adolescent depression. The findings identify some typical ways in which the therapist responded to the patient’s questions, and show that ‘surprising behaviours’ that seem associated with heightened affect appeared when the patient asked a question, leading to an enlivening of the therapeutic interaction. The study examines the significance of these findings within the context of the therapeutic relationship and discusses the implication of these findings for technique.

American Psychiatric Association Publishing eBooks, 2019

Psychotherapy Research, 2022

Internet based psychodynamic psychotherapy (iPDT) for adolescents has been found to be effective ... more Internet based psychodynamic psychotherapy (iPDT) for adolescents has been found to be effective for treating depression, but not much is known about its active ingredients. Objective to explore the techniques used in chat sessions in an iPDT program for depressed adolescents, and to investigate whether they predicted improvement in depression symptoms. Method The study uses data collected from a pilot study. The iPDT consisted of 8 modules delivered over 10 weeks that included text, video, exercises, and a weekly text-based chat session with a therapeutic support worker (TSW). The participants were 23 adolescents meeting criteria for depression. The TSWs were 9 psychology master's students. A depression inventory QIDS-A17-SR was filled weekly by the participants, and a self-rated techniques inventory (MULTI-30) was filled by the TSWs after each chat session. Results Common factor techniques were the most widely used techniques in the chat sessions. Both common factors and psychodynamic techniques predicted improvement in depression, with psychodynamic techniques predicting improvement at the following week. CBT techniques were also used but did not predict improvement in depression. Conclusion iPDT seem to work in line with theory, where the mechanisms thought to be important for change in treatment were predictive of outcome.

Mentalization-based treatment for children: A time-limited approach.

Qualitative Research in Psychology, 2022