Key publications
Sugg HVR, Richards DA, Russell A, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, Doris FE, Hunt HA, Iles‐Smith H, et al (2022). Nurses’ strategies for overcoming barriers to fundamental nursing care in patients with. <scp>COVID</scp>. ‐19 caused by infection with the. <scp>SARS‐COV</scp>. ‐2 virus: Results from the ‘. <scp>COVID‐NURSE</scp>. ’ survey. Journal of Advanced Nursing, 79(3), 1003-1017.
Sugg HVR, Russell A-M, Morgan LM, Iles-Smith H, Richards DA, Morley N, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, et al (2021). Fundamental nursing care in patients with the SARS-CoV-2 virus: results from the ‘COVID-NURSE’ mixed methods survey into nurses’ experiences of missed care and barriers to care.
BMC Nursing,
20(1).
Abstract:
Fundamental nursing care in patients with the SARS-CoV-2 virus: results from the ‘COVID-NURSE’ mixed methods survey into nurses’ experiences of missed care and barriers to care
Abstract
. Background
. Patient experience of nursing care is associated with safety, care quality, treatment outcomes, costs and service use. Effective nursing care includes meeting patients’ fundamental physical, relational and psychosocial needs, which may be compromised by the challenges of SARS-CoV-2. No evidence-based nursing guidelines exist for patients with SARS-CoV-2. We report work to develop such a guideline. Our aim was to identify views and experiences of nursing staff on necessary nursing care for inpatients with SARS-CoV-2 (not invasively ventilated) that is omitted or delayed (missed care) and any barriers to this care.
.
. Methods
. We conducted an online mixed methods survey structured according to the Fundamentals of Care Framework. We recruited a convenience sample of UK-based nursing staff who had nursed inpatients with SARS-CoV-2 not invasively ventilated. We asked respondents to rate how well they were able to meet the needs of SARS-CoV-2 patients, compared to non-SARS-CoV-2 patients, in 15 care categories; select from a list of barriers to care; and describe examples of missed care and barriers to care. We analysed quantitative data descriptively and qualitative data using Framework Analysis, integrating data in side-by-side comparison tables.
.
. Results
. of 1062 respondents, the majority rated mobility, talking and listening, non-verbal communication, communicating with significant others, and emotional wellbeing as worse for patients with SARS-CoV-2. Eight barriers were ranked within the top five in at least one of the three care areas. These were (in rank order): wearing Personal Protective Equipment, the severity of patients’ conditions, inability to take items in and out of isolation rooms without donning and doffing Personal Protective Equipment, lack of time to spend with patients, lack of presence from specialised services e.g. physiotherapists, lack of knowledge about SARS-CoV-2, insufficient stock, and reluctance to spend time with patients for fear of catching SARS-CoV-2.
.
. Conclusions
. Our respondents identified nursing care areas likely to be missed for patients with SARS-CoV-2, and barriers to delivering care. We are currently evaluating a guideline of nursing strategies to address these barriers, which are unlikely to be exclusive to this pandemic or the environments represented by our respondents. Our results should, therefore, be incorporated into global pandemic planning.
.
Abstract.
Wickersham A, Sugg HVR, Epstein S, Stewart R, Ford T, Downs J (2021). Systematic Review and Meta-analysis: the Association Between Child and Adolescent Depression and Later Educational Attainment.
J Am Acad Child Adolesc Psychiatry,
60(1), 105-118.
Abstract:
Systematic Review and Meta-analysis: the Association Between Child and Adolescent Depression and Later Educational Attainment.
OBJECTIVE: the association between depression and educational attainment in young people is unclear. This systematic review and meta-analysis examines the longitudinal association between depression and subsequent attainment, and its potential effect modifiers and mediators. METHOD: We searched Embase, PsycINFO, PubMed, ERIC, and the British Education Index from inception to October 23, 2019, conducted citation searching, and contacted authors for articles. Eligible studies reported on the longitudinal association between depression in children and adolescents 4 to 18 years of age and later educational attainment. Two reviewers independently conducted screening, data extraction, and risk of bias assessment. Correlation coefficients were pooled in meta-analysis, and effect modifiers were explored using meta-regression and stratification. Other evidence on confounders, modifiers, and mediators was narratively synthesized. The PROSPERO record for the study is CRD42019123068. RESULTS: a total of 31 studies were included, of which 22 were pooled in meta-analysis. There was a small but statistically significant association between depression and lower subsequent attainment (pooled Fisher z = -0.19, 95% CI = -0.22 to -0.16, I2 = 62.9%). A total of 15 studies also reported an enduring effect after adjusting for various confounders. No statistically significant effect modifiers were identified. Social and school problems may mediate between depression and low attainment. CONCLUSION: Depression was associated with lower educational attainment, but further research is needed to establish mechanisms. Nonetheless, there is a clear need for mental health and educational support among children and adolescents with depression.
Abstract.
Author URL.
Sugg HVR, Frost J, Richards DA (2020). Personalising psychotherapies for depression using a novel mixed methods approach: an example from Morita therapy.
Trials,
21(1).
Abstract:
Personalising psychotherapies for depression using a novel mixed methods approach: an example from Morita therapy.
BACKGROUND: Current quantitative methods for personalising psychotherapies for depression are unlikely to be able to inform clinical decision-making for hundreds of years. Novel alternative methods to generate hypotheses for prospective testing are therefore required, and we showcase mixed methods as one such approach. By exploring patients' perspectives in depth, and integrating qualitative and quantitative data at the level of the individual, we may identify new potential psychosocial predictors of psychotherapy outcomes, potentially informing the personalisation of depression treatment in a shorter timeframe. Using Morita therapy (a Japanese psychotherapy) as an exemplar, we thus explored how Morita therapy recipients' views on treatment acceptability explain their adherence and response to treatment. METHODS: the Morita trial incorporated a pilot randomised controlled trial of Morita therapy versus treatment as usual for depression, and post-treatment qualitative interviews. We recruited trial participants from general practice record searches in Devon, UK, and purposively sampled data from 16 participants for our mixed methods analysis. We developed typologies of participants' views from our qualitative themes, and integrated these with quantitative data on number of sessions attended and whether participants responded to treatment in a joint typologies and statistics display. We enriched our analysis using participant vignettes to demonstrate each typology. RESULTS: We demonstrated that (1) participants who could identify with the principles of Morita therapy typically responded to treatment, regardless of how many sessions they attended, whilst those whose orientation towards treatment was incompatible with Morita therapy did not respond to treatment, again regardless of treatment adherence and (2) participants whose personal circumstances impeded their opportunity to engage in Morita therapy attended the fewest sessions, though still benefitted from treatment if the principles resonated with them. CONCLUSIONS: We identified new potential relationships between "orientation" and outcomes, and "opportunity" and adherence, which could not have been identified using existing non-integrative methods. This mixed methods approach warrants replication in future trials and with other psychotherapies to generate hypotheses, based on typologies (or profiles) of patients for whom a treatment is more or less likely to be suitable, to be tested in prospective trials. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN17544090. Registered on 23 July 2015.
Abstract.
Author URL.
Sugg HVR, Richards DA, Frost J (2020). What is Morita Therapy? the Nature, Origins, and Cross-Cultural Application of a Unique Japanese Psychotherapy.
Journal of Contemporary Psychotherapy,
50(4), 313-322.
Abstract:
What is Morita Therapy? the Nature, Origins, and Cross-Cultural Application of a Unique Japanese Psychotherapy
Morita Therapy is a Japanese psychotherapy which contrasts with established Western approaches in teaching, through behavioural experience, that symptoms are part of the natural ecology of human experience. Morita Therapy has received increasing international interest over the decades, and the first randomized controlled trial of Morita Therapy to be published outside of China has recently demonstrated the promise of the approach in treating Western patients. To respond to the resulting interest in Morita Therapy from patients and practitioners, and facilitate further Morita Therapy research, it is necessary to provide the detailed explanation of Morita Therapy which is currently rare in the West. In this article, we fill this gap with a thorough description of Morita Therapy in terms of the key principles, objectives and processes of the approach; its basis in Eastern philosophy and naturalism; its sociohistorical context and development over a wide range of formats, patient conditions, and countries. To enable Western practitioners to appreciate and capitalize on the potential value of Morita Therapy as a distinct alternative for patients, we illustrate the approach’s unique method and objective compared to Western psychotherapies, and provide recommendations for practitioners applying Morita Therapy across cultures.
Abstract.
Sugg HVR, Frost J, Richards DA (2019). Morita Therapy for depression (Morita Trial): an embedded qualitative study of acceptability.
BMJ Open,
9(5).
Abstract:
Morita Therapy for depression (Morita Trial): an embedded qualitative study of acceptability.
OBJECTIVE: to explore the views of UK-based recipients of Morita Therapy (MT) on the acceptability of MT. DESIGN: Qualitative study nested within a pilot randomised controlled trial of MT (a Japanese psychological therapy largely unknown in the UK) versus treatment as usual, using post-treatment semistructured interviews analysed with a framework approach. SETTING AND PARTICIPANTS: Participants who received MT as part of the Morita Trial, recruited for the trial from General Practice record searches in Devon, UK. Data from 16 participants were purposively sampled for analysis. RESULTS: We identified five themes which, together, form a model of how different participants viewed and experienced MT. Overall, MT was perceived as acceptable by many participants who emphasised the value of the approach, often in comparison to other treatments they had tried. These participants highlighted how accepting and allowing difficulties as natural phenomena and shifting attention from symptoms to external factors had facilitated symptom reduction and a sense of empowerment. We found that how participants understood and related to the principles of MT, in light of their expectations of treatment, was significantly tied to the extent to which MT was perceived as acceptable. Our findings also highlighted the distinction between MT in principle and practice, with participants noting challenges of engaging with the process of therapy such as fear and discomfort around rest, needing sufficient support from the therapist and others, and the commitment of treatment. CONCLUSIONS: People in the UK can accept the premise of MT, and consider the approach beneficial and novel. Therefore, proceeding to a large-scale trial of MT is appropriate with minor modifications to our clinical protocol. Participants' expectations and understandings of treatment play a key role in acceptability, and future research may investigate these potential moderators of acceptability in MT. TRIAL REGISTRATION NUMBERC: ISRCTN17544090; Pre-results.
Abstract.
Author URL.
Publications by year
2022
Richards DA, Bollen J, Jones B, Melendez-Torres GJ, Hulme C, Cockcroft E, Cook H, Cooper J, Creanor S, Cruickshank S, et al (2022). Evaluation of a COVID-19 Fundamental Nursing Care Guideline (COVID-NURSE) Versus Usual Care: a Cluster Randomised Controlled Trial.
Whear R, Abbott RA, Bethel A, Richards DA, Garside R, Cockcroft E, Iles-Smith H, Logan PA, Rafferty AM, Shepherd M, et al (2022). Impact of COVID-19 and other infectious conditions requiring isolation on the provision of and adaptations to fundamental nursing care in hospital in terms of overall patient experience, care quality, functional ability, and treatment outcomes: systematic review.
J Adv Nurs,
78(1), 78-108.
Abstract:
Impact of COVID-19 and other infectious conditions requiring isolation on the provision of and adaptations to fundamental nursing care in hospital in terms of overall patient experience, care quality, functional ability, and treatment outcomes: systematic review.
AIM: This systematic review identifies, appraises and synthesizes the evidence on the provision of fundamental nursing care to hospitalized patients with a highly infectious virus and the effectiveness of adaptations to overcome barriers to care. DESIGN: Systematic review. DATA SOURCES: in July 2020, we searched Medline, PsycINFO (OvidSP), CINAHL (EBSCOhost), BNI (ProQuest), WHO COVID-19 Database (https://search.bvsalud.org/) MedRxiv (https://www.medrxiv.org/), bioRxiv (https://www.biorxiv.org/) and also Google Scholar, TRIP database and NICE Evidence, forwards citation searching and reference checking of included papers, from 2016 onwards. REVIEW METHODS: We included quantitative and qualitative research reporting (i) the views, perceptions and experiences of patients who have received fundamental nursing care whilst in hospital with COVID-19, MERS, SARS, H1N1 or EVD or (ii) the views, perceptions and experiences of professional nurses and non-professionally registered care workers who have provided that care. We included review articles, commentaries, protocols and guidance documents. One reviewer performed data extraction and quality appraisal and was checked by another person. RESULTS: of 3086 references, we included 64 articles; 19 empirical research and 45 review articles, commentaries, protocols and guidance documents spanning five pandemics. Four main themes (and 11 sub-themes) were identified. Barriers to delivering fundamental care were wearing personal protective equipment, adequate staffing, infection control procedures and emotional challenges of care. These barriers were addressed by multiple adaptations to communication, organization of care, staff support and leadership. CONCLUSION: to prepare for continuation of the COVID-19 pandemic and future pandemics, evaluative studies of adaptations to fundamental healthcare delivery must be prioritized to enable evidence-based care to be provided in future. IMPACT: Our review identifies the barriers nurses experience in providing fundamental care during a pandemic, highlights potential adaptations that address barriers and ensure positive healthcare experiences and draws attention to the need for evaluative research on fundamental care practices during pandemics.
Abstract.
Author URL.
Sugg HVR, Richards DA, Russell A, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, Doris FE, Hunt HA, Iles‐Smith H, et al (2022). Nurses’ strategies for overcoming barriers to fundamental nursing care in patients with. <scp>COVID</scp>. ‐19 caused by infection with the. <scp>SARS‐COV</scp>. ‐2 virus: Results from the ‘. <scp>COVID‐NURSE</scp>. ’ survey. Journal of Advanced Nursing, 79(3), 1003-1017.
2021
Richards DA, Sugg HV, Cockcroft E, Cooper J, Cruickshank S, Doris F, Hulme C, Logan P, Iles-Smith H, Melendez-Torres GJ, et al (2021). COVID-NURSE: evaluation of a fundamental nursing care protocol compared with care as usual on experience of care for noninvasively ventilated patients in hospital with the SARS-CoV-2 virus-protocol for a cluster randomised controlled trial.
BMJ Open,
11(5).
Abstract:
COVID-NURSE: evaluation of a fundamental nursing care protocol compared with care as usual on experience of care for noninvasively ventilated patients in hospital with the SARS-CoV-2 virus-protocol for a cluster randomised controlled trial.
INTRODUCTION: Patient experience of nursing care is correlated with safety, clinical effectiveness, care quality, treatment outcomes and service use. Effective nursing care includes actions to develop nurse-patient relationships and deliver physical and psychosocial care to patients. The high risk of transmission of the SARS-CoV-2 virus compromises nursing care. No evidence-based nursing guidelines exist for patients infected with SARS-CoV-2, leading to potential variations in patient experience, outcomes, quality and costs. METHODS AND ANALYSIS: we aim to recruit 840 in-patient participants treated for infection with the SARS-CoV-2 virus from 14 UK hospitals, to a cluster randomised controlled trial, with embedded process and economic evaluations, of care as usual and a fundamental nursing care protocol addressing specific areas of physical, relational and psychosocial nursing care where potential variation may occur, compared with care as usual. Our coprimary outcomes are patient-reported experience (Quality from the Patients' Perspective; Relational Aspects of Care Questionnaire); secondary outcomes include care quality (pressure injuries, falls, medication errors); functional ability (Barthell Index); treatment outcomes (WHO Clinical Progression Scale); depression Patient Health Questionnaire-2 (PHQ-2), anxiety General Anxiety Disorder-2 (GAD-2), health utility (EQ5D) and nurse-reported outcomes (Measure of Moral Distress for Health Care Professionals). For our primary analysis, we will use a standard generalised linear mixed-effect model adjusting for ethnicity of the patient sample and research intensity at cluster level. We will also undertake a planned subgroup analysis to compare the impact of patient-level ethnicity on our primary and secondary outcomes and will undertake process and economic evaluations. ETHICS AND DISSEMINATION: Research governance and ethical approvals are from the UK National Health Service Health Research Authority Research Ethics Service. Dissemination will be open access through peer-reviewed scientific journals, study website, press and online media, including free online training materials on the Open University's FutureLearn web platform. TRIAL REGISTRATION NUMBER: ISRCTN13177364; Pre-results.
Abstract.
Author URL.
Sugg HVR, Russell A-M, Morgan LM, Iles-Smith H, Richards DA, Morley N, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, et al (2021). Fundamental nursing care in patients with the SARS-CoV-2 virus: results from the ‘COVID-NURSE’ mixed methods survey into nurses’ experiences of missed care and barriers to care.
BMC Nursing,
20(1).
Abstract:
Fundamental nursing care in patients with the SARS-CoV-2 virus: results from the ‘COVID-NURSE’ mixed methods survey into nurses’ experiences of missed care and barriers to care
Abstract
. Background
. Patient experience of nursing care is associated with safety, care quality, treatment outcomes, costs and service use. Effective nursing care includes meeting patients’ fundamental physical, relational and psychosocial needs, which may be compromised by the challenges of SARS-CoV-2. No evidence-based nursing guidelines exist for patients with SARS-CoV-2. We report work to develop such a guideline. Our aim was to identify views and experiences of nursing staff on necessary nursing care for inpatients with SARS-CoV-2 (not invasively ventilated) that is omitted or delayed (missed care) and any barriers to this care.
.
. Methods
. We conducted an online mixed methods survey structured according to the Fundamentals of Care Framework. We recruited a convenience sample of UK-based nursing staff who had nursed inpatients with SARS-CoV-2 not invasively ventilated. We asked respondents to rate how well they were able to meet the needs of SARS-CoV-2 patients, compared to non-SARS-CoV-2 patients, in 15 care categories; select from a list of barriers to care; and describe examples of missed care and barriers to care. We analysed quantitative data descriptively and qualitative data using Framework Analysis, integrating data in side-by-side comparison tables.
.
. Results
. of 1062 respondents, the majority rated mobility, talking and listening, non-verbal communication, communicating with significant others, and emotional wellbeing as worse for patients with SARS-CoV-2. Eight barriers were ranked within the top five in at least one of the three care areas. These were (in rank order): wearing Personal Protective Equipment, the severity of patients’ conditions, inability to take items in and out of isolation rooms without donning and doffing Personal Protective Equipment, lack of time to spend with patients, lack of presence from specialised services e.g. physiotherapists, lack of knowledge about SARS-CoV-2, insufficient stock, and reluctance to spend time with patients for fear of catching SARS-CoV-2.
.
. Conclusions
. Our respondents identified nursing care areas likely to be missed for patients with SARS-CoV-2, and barriers to delivering care. We are currently evaluating a guideline of nursing strategies to address these barriers, which are unlikely to be exclusive to this pandemic or the environments represented by our respondents. Our results should, therefore, be incorporated into global pandemic planning.
.
Abstract.
Wickersham A, Sugg HVR, Epstein S, Stewart R, Ford T, Downs J (2021). Systematic Review and Meta-analysis: the Association Between Child and Adolescent Depression and Later Educational Attainment.
J Am Acad Child Adolesc Psychiatry,
60(1), 105-118.
Abstract:
Systematic Review and Meta-analysis: the Association Between Child and Adolescent Depression and Later Educational Attainment.
OBJECTIVE: the association between depression and educational attainment in young people is unclear. This systematic review and meta-analysis examines the longitudinal association between depression and subsequent attainment, and its potential effect modifiers and mediators. METHOD: We searched Embase, PsycINFO, PubMed, ERIC, and the British Education Index from inception to October 23, 2019, conducted citation searching, and contacted authors for articles. Eligible studies reported on the longitudinal association between depression in children and adolescents 4 to 18 years of age and later educational attainment. Two reviewers independently conducted screening, data extraction, and risk of bias assessment. Correlation coefficients were pooled in meta-analysis, and effect modifiers were explored using meta-regression and stratification. Other evidence on confounders, modifiers, and mediators was narratively synthesized. The PROSPERO record for the study is CRD42019123068. RESULTS: a total of 31 studies were included, of which 22 were pooled in meta-analysis. There was a small but statistically significant association between depression and lower subsequent attainment (pooled Fisher z = -0.19, 95% CI = -0.22 to -0.16, I2 = 62.9%). A total of 15 studies also reported an enduring effect after adjusting for various confounders. No statistically significant effect modifiers were identified. Social and school problems may mediate between depression and low attainment. CONCLUSION: Depression was associated with lower educational attainment, but further research is needed to establish mechanisms. Nonetheless, there is a clear need for mental health and educational support among children and adolescents with depression.
Abstract.
Author URL.
2020
Pentecost C, Frost J, Sugg HVR, Hilli A, Goodwin VA, Richards DA (2020). Patients' and nurses' experiences of fundamental nursing care: a systematic review and qualitative synthesis.
J Clin Nurs,
29(11-12), 1858-1882.
Abstract:
Patients' and nurses' experiences of fundamental nursing care: a systematic review and qualitative synthesis.
AIMS AND OBJECTIVES: to systematically identify, appraise and synthesise patients', residents' and nurses' experiences of fundamental nursing care for nutrition, elimination, mobility and hygiene. BACKGROUND: the evidence base for effective nursing behaviours to assist people with their fundamental care needs is sparse, hampering the development of effective interventions. Synthesising data on patients' and nurses' experiences of fundamentals of nursing care could contribute to the development of such an intervention. METHODS: Systematic review and synthesis of qualitative data from qualitative studies on patients' and nurses' experiences of fundamental nursing care behaviours addressing peoples' nutrition, elimination, mobility and hygiene needs. We appraised study quality and relevance and used a narrative approach to data synthesis, fulfilling PRISMA criteria (Appendix S2). RESULTS: We identified 22,374 papers, and 47 met our inclusion criteria. Most papers were of low quality. Sixteen papers met our quality and relevance criteria and were included for synthesis. Papers were about nutrition (2) elimination (2), mobility (5), hygiene (5) and multiple care areas (2). We found nurses and patients report that fundamental nursing care practices involve strong leadership, collaborative partnerships with patients and cohesive organisational practices aligned to nursing care objectives and actions. CONCLUSIONS: to improve fundamental care and interventions suitable for testing may require attention to leadership, patient-nurse relationships and organisational coherence plus the fundamentals of care nursing interventions themselves. RELEVANCE TO CLINICAL PRACTICE: More rigorous mixed methods research about fundamental nursing care is needed to inform nursing practice and improve patient's experience. Nursing interventions should include effective nurse leadership and nurse-patient collaboration and a focus on fundamental care by the host organisation.
Abstract.
Author URL.
Sugg HVR, Frost J, Richards DA (2020). Personalising psychotherapies for depression using a novel mixed methods approach: an example from Morita therapy.
Trials,
21(1).
Abstract:
Personalising psychotherapies for depression using a novel mixed methods approach: an example from Morita therapy.
BACKGROUND: Current quantitative methods for personalising psychotherapies for depression are unlikely to be able to inform clinical decision-making for hundreds of years. Novel alternative methods to generate hypotheses for prospective testing are therefore required, and we showcase mixed methods as one such approach. By exploring patients' perspectives in depth, and integrating qualitative and quantitative data at the level of the individual, we may identify new potential psychosocial predictors of psychotherapy outcomes, potentially informing the personalisation of depression treatment in a shorter timeframe. Using Morita therapy (a Japanese psychotherapy) as an exemplar, we thus explored how Morita therapy recipients' views on treatment acceptability explain their adherence and response to treatment. METHODS: the Morita trial incorporated a pilot randomised controlled trial of Morita therapy versus treatment as usual for depression, and post-treatment qualitative interviews. We recruited trial participants from general practice record searches in Devon, UK, and purposively sampled data from 16 participants for our mixed methods analysis. We developed typologies of participants' views from our qualitative themes, and integrated these with quantitative data on number of sessions attended and whether participants responded to treatment in a joint typologies and statistics display. We enriched our analysis using participant vignettes to demonstrate each typology. RESULTS: We demonstrated that (1) participants who could identify with the principles of Morita therapy typically responded to treatment, regardless of how many sessions they attended, whilst those whose orientation towards treatment was incompatible with Morita therapy did not respond to treatment, again regardless of treatment adherence and (2) participants whose personal circumstances impeded their opportunity to engage in Morita therapy attended the fewest sessions, though still benefitted from treatment if the principles resonated with them. CONCLUSIONS: We identified new potential relationships between "orientation" and outcomes, and "opportunity" and adherence, which could not have been identified using existing non-integrative methods. This mixed methods approach warrants replication in future trials and with other psychotherapies to generate hypotheses, based on typologies (or profiles) of patients for whom a treatment is more or less likely to be suitable, to be tested in prospective trials. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN17544090. Registered on 23 July 2015.
Abstract.
Author URL.
Sugg HVR, Richards DA, Frost J (2020). What is Morita Therapy? the Nature, Origins, and Cross-Cultural Application of a Unique Japanese Psychotherapy.
Journal of Contemporary Psychotherapy,
50(4), 313-322.
Abstract:
What is Morita Therapy? the Nature, Origins, and Cross-Cultural Application of a Unique Japanese Psychotherapy
Morita Therapy is a Japanese psychotherapy which contrasts with established Western approaches in teaching, through behavioural experience, that symptoms are part of the natural ecology of human experience. Morita Therapy has received increasing international interest over the decades, and the first randomized controlled trial of Morita Therapy to be published outside of China has recently demonstrated the promise of the approach in treating Western patients. To respond to the resulting interest in Morita Therapy from patients and practitioners, and facilitate further Morita Therapy research, it is necessary to provide the detailed explanation of Morita Therapy which is currently rare in the West. In this article, we fill this gap with a thorough description of Morita Therapy in terms of the key principles, objectives and processes of the approach; its basis in Eastern philosophy and naturalism; its sociohistorical context and development over a wide range of formats, patient conditions, and countries. To enable Western practitioners to appreciate and capitalize on the potential value of Morita Therapy as a distinct alternative for patients, we illustrate the approach’s unique method and objective compared to Western psychotherapies, and provide recommendations for practitioners applying Morita Therapy across cultures.
Abstract.
2019
Sugg HVR, Frost J, Richards DA (2019). Morita Therapy for depression (Morita Trial): an embedded qualitative study of acceptability.
BMJ Open,
9(5).
Abstract:
Morita Therapy for depression (Morita Trial): an embedded qualitative study of acceptability.
OBJECTIVE: to explore the views of UK-based recipients of Morita Therapy (MT) on the acceptability of MT. DESIGN: Qualitative study nested within a pilot randomised controlled trial of MT (a Japanese psychological therapy largely unknown in the UK) versus treatment as usual, using post-treatment semistructured interviews analysed with a framework approach. SETTING AND PARTICIPANTS: Participants who received MT as part of the Morita Trial, recruited for the trial from General Practice record searches in Devon, UK. Data from 16 participants were purposively sampled for analysis. RESULTS: We identified five themes which, together, form a model of how different participants viewed and experienced MT. Overall, MT was perceived as acceptable by many participants who emphasised the value of the approach, often in comparison to other treatments they had tried. These participants highlighted how accepting and allowing difficulties as natural phenomena and shifting attention from symptoms to external factors had facilitated symptom reduction and a sense of empowerment. We found that how participants understood and related to the principles of MT, in light of their expectations of treatment, was significantly tied to the extent to which MT was perceived as acceptable. Our findings also highlighted the distinction between MT in principle and practice, with participants noting challenges of engaging with the process of therapy such as fear and discomfort around rest, needing sufficient support from the therapist and others, and the commitment of treatment. CONCLUSIONS: People in the UK can accept the premise of MT, and consider the approach beneficial and novel. Therefore, proceeding to a large-scale trial of MT is appropriate with minor modifications to our clinical protocol. Participants' expectations and understandings of treatment play a key role in acceptability, and future research may investigate these potential moderators of acceptability in MT. TRIAL REGISTRATION NUMBERC: ISRCTN17544090; Pre-results.
Abstract.
Author URL.
Wickersham A, Epstein S, Sugg HVR, Stewart R, Ford T, Downs J (2019). The association between depression and later educational attainment in children and adolescents: a systematic review protocol.
BMJ Open,
9(11).
Abstract:
The association between depression and later educational attainment in children and adolescents: a systematic review protocol.
INTRODUCTION: Depression represents a major public health concern for children and adolescents, and is thought to negatively impact subsequent educational attainment. However, the extent to which depression and educational attainment are directly associated, and whether other factors play a role, is uncertain. Therefore, we aim to systematically review the literature to provide an up-to-date estimate on the strength of this association, and to summarise potential mediators and moderators on the pathway between the two. METHODS AND ANALYSIS: to identify relevant studies, we will systematically search Embase, PsycINFO, PubMed, Education Resources Information Centre and British Education Index, manually search reference lists and contact experts in the field. Studies will be included if they investigate and report on the association between major depression diagnosis or depressive symptoms in children and adolescents aged 4-18 years (exposure) and later educational attainment (outcome). Two independent reviewers will screen titles, abstracts and full texts according to eligibility criteria, perform data extraction and assess study quality according to a modified version of the Newcastle-Ottawa Scale. If sufficiently homogeneous studies are identified, summary effect estimates will be pooled in meta-analysis, with further tests for study heterogeneity, publication bias and the effects of moderators using meta-regression. ETHICS AND DISSEMINATION: Because this review will make use of already published data, ethical approval will not be sought. The review will be submitted for publication in a peer-reviewed journal, presented at practitioner-facing conferences, and a lay summary will be written for non-scientific audiences such as parents, young people and teachers. The work will inform upcoming investigations on the association between child and adolescent mental health and educational attainment. PROSPERO REGISTRATION NUMBER: CRD42019123068.
Abstract.
Author URL.
2018
Sugg HVR, Richards DA, Frost J (2018). Morita Therapy for depression (Morita Trial): a pilot randomised controlled trial.
BMJ Open,
8(8).
Abstract:
Morita Therapy for depression (Morita Trial): a pilot randomised controlled trial.
OBJECTIVE: to address uncertainties prior to conducting a fully powered randomised controlled trial of Morita Therapy plus treatment as usual (TAU) versus TAU alone, or to determine that such a trial is not appropriate and/or feasible. DESIGN: Pilot parallel group randomised controlled feasibility trial. SETTING AND PARTICIPANTS: Participants aged ≥18 years with Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV major depressive disorder, with or without DSM-IV anxiety disorder(s), recruited from general practice record searches in Devon, UK. INTERVENTIONS: We randomised participants on a 1:1 basis stratified by symptom severity, concealing allocation using a secure independent web-based system, to receive TAU (control) or 8-12 sessions of Morita Therapy, a Japanese psychological therapy, plus TAU (intervention). OUTCOMES: Rates of recruitment, retention and treatment adherence; variance and estimated between-group differences in follow-up scores (on the Patient Health Questionnaire 9 (PHQ-9) (depressive symptoms); Generalised Anxiety Disorder Questionnaire 7 (anxiety symptoms); Short Form 36 Health Survey Questionnaire/Work and Social Adjustment Scale (quality of life); Morita Attitudinal Scale for Arugamama (attitudes)) and their correlation with baseline scores. RESULTS: We recruited 68 participants, 5.1% (95% CI 3.4% to 6.6%) of those invited (34 control; 34 intervention); 64/68 (94%; 95% CI 88.3% to 99.7%) provided 4-month follow-up data. Participants had a mean age of 49 years and mean PHQ-9 score of 16.8; 61% were female. Twenty-four of 34 (70.6%) adhered to the minimum treatment dose. The follow-up PHQ-9 (future primary outcome measure) pooled SD was 6.4 (95% CI 5.5 to 7.8); the magnitude of correlation between baseline and follow-up PHQ-9 scores was 0.42 (95% CI 0.19 to 0.61). of the participants, 66.7% and 30.0% recovered in the intervention and control groups, respectively; 66.7% and 13.3% responded to treatment in the intervention and control groups, respectively. CONCLUSIONS: a large-scale trial of Morita Therapy would require 133 participants per group and is feasible with minor modifications to the pilot trial protocol. Morita Therapy shows promise in treating depression and may provide patients with a distinct alternative to current treatments. TRIAL REGISTRATION NUMBER: ISRCTN17544090; Pre-results.
Abstract.
Author URL.
2017
Sugg HVR, Richards DA, Frost J (2017). Optimising the acceptability and feasibility of novel complex interventions: an iterative, person-based approach to developing the UK Morita therapy outpatient protocol.
Pilot Feasibility Stud,
3Abstract:
Optimising the acceptability and feasibility of novel complex interventions: an iterative, person-based approach to developing the UK Morita therapy outpatient protocol.
BACKGROUND: the aim of this paper is to showcase best practice in intervention development by illustrating a systematic, iterative, person-based approach to optimising intervention acceptability and feasibility, as applied to the cross-cultural adaptation of Morita therapy for depression and anxiety. METHODS: We developed the UK Morita therapy outpatient protocol over four stages integrating literature synthesis and qualitative research. Firstly, we conducted in-depth interviews combining qualitative and cognitive interviewing techniques, utilising vignettes of Morita therapy being delivered and analysed using Framework analysis to investigate potential patients and therapists' perceptions of Morita therapy. Secondly, we developed qualitative themes into recommendations for optimising Morita therapy and synthesised Morita therapy literature in line with these to develop a draft protocol. Thirdly, we conducted repeat interviews with therapists to investigate their views of the protocol. Finally, we responded to these qualitative themes through protocol modification and tailoring our therapist training programme. RESULTS: As a consequence of literature describing Morita therapy and participants' perceptions of the approach, we developed both a therapy protocol and therapist training programme which were fit for purpose in proceeding to a UK-based Morita therapy feasibility study. As per our key qualitative findings and resulting recommendations, we structured our protocol according to the four-phased model of Morita therapy, included detailed guidance and warning points, and supported therapists in managing patients' expectations of the approach. CONCLUSIONS: Our systematic approach towards optimising intervention acceptability and feasibility prioritises the perspectives of those who will deliver and receive the intervention. Thus, we both showcase best practice in intervention development and demonstrate the application of this process to the careful cross-cultural adaptation of an intervention in which balancing both optimisation of and adherence to the approach are key. This presentation of a generalisable process in a transparent and replicable manner will be of interest to those both developing and evaluating complex interventions in the future.
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2016
Sugg HVR, Richards DA, Frost J (2016). Morita therapy for depression and anxiety (Morita Trial): study protocol for a pilot randomised controlled trial.
Trials,
17Abstract:
Morita therapy for depression and anxiety (Morita Trial): study protocol for a pilot randomised controlled trial.
BACKGROUND: Morita Therapy, a psychological therapy for common mental health problems, is in sharp contrast to established western psychotherapeutic approaches in teaching that undesired symptoms are natural features of human emotion rather than something to control or eliminate. The approach is widely practiced in Japan, but untested and little known in the UK. A clinical trial of Morita Therapy is required to establish the effectiveness of Morita Therapy for a UK population. However, a number of methodological, procedural and clinical uncertainties associated with such a trial first require addressing. METHODS/DESIGN: the Morita Trial is a mixed methods study addressing the uncertainties associated with an evaluation of Morita Therapy compared with treatment as usual for depression and anxiety. We will undertake a pilot randomised controlled trial with embedded qualitative study. Sixty participants with major depressive disorder, with or without anxiety disorders, will be recruited predominantly from General Practice record searches and randomised to receive Morita Therapy plus treatment as usual or treatment as usual alone. Morita Therapy will be delivered by accredited psychological therapists. We will collect quantitative data on depressive symptoms, general anxiety, attitudes and quality of life at baseline and four month follow-up to inform future sample size calculations; and rates of recruitment, retention and treatment adherence to assess feasibility. We will undertake qualitative interviews in parallel with the trial, to explore people's views of Morita Therapy. We will conduct separate and integrated analyses on the quantitative and qualitative data. DISCUSSION: the outcomes of this study will prepare the ground for the design and conduct of a fully-powered evaluation of Morita Therapy plus treatment as usual versus treatment as usual alone, or inform a conclusion that such a trial is not feasible and/or appropriate. We will obtain a more comprehensive understanding of these issues than would be possible from either a quantitative or qualitative approach alone. TRIAL REGISTRATION: Current Controlled Trials ISRCTN17544090 registered on 23 July 2015.
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2014
Jenkinson CE, Winder RE, Sugg HVR, Roberts MJ, Ridgway N, Kuyken W, Wiles N, Kessler D, Campbell J (2014). Why do GPs exclude patients from participating in research? an exploration of adherence to and divergence from trial criteria.
Fam Pract,
31(3), 364-370.
Abstract:
Why do GPs exclude patients from participating in research? an exploration of adherence to and divergence from trial criteria.
BACKGROUND: the role of GPs in recruiting or excluding participants critically underpins the feasibility, external validity and generalizability of primary care research. A better understanding of this role is needed. AIM: to investigate why GPs excluded potentially eligible participants from a large scale randomized controlled trial (RCT), to determine the proportion of patients excluded on account of trial eligibility compared with other reasons, and to explore the impact of such exclusions on the management and generalizability of RCTs. DESIGN AND SETTING: Secondary analysis of data from the CoBalT study, a multi-centre general-practice-based RCT investigating cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression. METHOD: GPs were asked to screen patient lists generated from computerized record searches for trial eligibility and to provide narrative reasons for excluding patients. These reasons were coded independently by two researchers, with a third researcher resolving discrepancies. RESULTS: Thirty-one percent (4750/15,379) of patients were excluded at the GP screening stage, including 663 on patient lists that remained unscreened. of the 4087 actively excluded patients, 67% were excluded on account of trial exclusion criteria, 20% for other criteria (half of which were comorbid conditions) and 13% without reason. CONCLUSION: Clear, comprehensive criteria, particularly with regards to comorbidities, are required for GPs to confidently screen patients for potential participation in research. Future studies should promote inclusivity and encourage GPs to adopt a liberal approach when screening patient lists. This would enhance the validity and generalizability of primary care research and encourage greater patient autonomy.
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