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Individuals with depression often do not respond to medication or psychotherapy. Radically open dialectical behaviour therapy (RO DBT) is a new treatment targeting overcontrolled personality, common in refractory depression.
To compare RO DBT plus treatment as usual (TAU) for refractory depression with TAU alone (trial registration: ISRCTN 85784627).
RO DBT comprised 29 therapy sessions and 27 skills classes over 6 months. Our completed randomised trial evaluated RO DBT for refractory depression over 18 months in three British secondary care centres. Of 250 adult participants, we randomised 162 (65%) to RO DBT. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), assessed masked and analysed by treatment allocated.
After 7 months, immediately following therapy, RO DBT had significantly reduced depressive symptoms by 5.40 points on the HRSD relative to TAU (95% CI 0.94–9.85). After 12 months (primary end-point), the difference of 2.15 points on the HRSD in favour of RO DBT was not significant (95% CI –2.28 to 6.59); nor was that of 1.69 points on the HRSD at 18 months (95% CI –2.84 to 6.22). Throughout RO DBT participants reported significantly better psychological flexibility and emotional coping than controls. However, they reported eight possible serious adverse reactions compared with none in the control group.
The RO DBT group reported significantly lower HRSD scores than the control group after 7 months, but not thereafter. The imbalance in serious adverse reactions was probably because of the controls' limited opportunities to report these.
Declaration of interest
Six of the 16 authors have received royalties or fees for RO DBT. R.J.H. is co-owner and director of Radically Open Ltd, the RO DBT training and dissemination company. D.K. reports grants outside the submitted work from NIHR. T.R.L. receives royalties from New Harbinger Publishing for sales of RO DBT treatment manuals, speaking fees from Radically Open Ltd and a grant outside the submitted work from the Medical Research Council. He was codirector of Radically Open Ltd between November 2014 and May 2015 and is married to Erica Smith-Lynch, the principal shareholder and one of two current directors of Radically Open Ltd. H.O’M. reports personal fees from the Charlie Waller Institute and Improving Access to Psychological Therapy. S.C.R. provides RO DBT supervision through S C Rushbrook Ltd. I.T.R. reports grants outside the submitted work from NIHR and Health & Care Research Wales. M.St. reports personal fees from British Isles DBT Training, Stanton Psychological Services Ltd, and Taylor & Francis Ltd. M.Sw. reports personal fees from British Isles DBT Training, Guilford Press, Oxford University Press and Taylor & Francis Ltd. B.W. was codirector of Radically Open Ltd between November 2014 and February 2015.
Although political scientists have begun to investigate the properties of Internet surveys, much remains to be learned about the utility of the Internet mode for conducting major survey research projects such as national election studies. This paper addresses this topic by presenting the results of an extensive survey comparison experiment conducted as part of the 2005 British Election Study. Analyses show statistically significant, but generally small, differences in distributions of key explanatory variables in models of turnout and party choice. Estimating model parameters reveals that there are few statistically significant differences between coefficients generated using the in-person and Internet data, and the relative explanatory power of rival models is virtually identical for the two types of data. In general, the in-person and Internet data tell very similar stories about what matters for turnout and party preference in Britain. Determining if similar findings obtain in other countries should have high priority on the research agenda for national election studies.
We present results from deep Chandra X-ray observations of the galaxy group NGC 5813. This system shows three pairs of collinear cavities, with each pair associated with an elliptical AGN outburst shock. Due to the relatively regular morphology of this system, and the unique unambiguous detection of three distinct AGN outburst shocks, it is particularly well-suited for the study of AGN feedback and the AGN outburst history. We find that the mean kinetic power is roughly the same for each outburst, and that the total energy associated with the youngest outburst is significantly lower than that of the previous outbursts. This implies that the mean AGN jet power has remained stable for at least 50 Myr, and that the youngest outburst is ongoing. We find that the mean shock heating rate balances the local radiative cooling rate at each shock front, suggesting that AGN outburst shock heating alone is sufficient to offset cooling and establish AGN/ICM feedback within at least the central 30 kpc. Finally, we find non-zero shock front widths that are too large to be explained by particle diffusion, but are instead consistent with arising from broadening of the shock fronts due to propagation through a turbulent ICM with a mean turbulent speed of ~ 70 km s−1.
Public reactions to policy delivery are central to the valence model of electoral choice. Governments that succeed in delivering cherished public goods such as economic prosperity, low crime rates, effective health care and efficient public services can anticipate electoral success. In contrast, governments that fail to deliver satisfactory quantities of these goods can expect negative reactions from disgruntled electorates. Mechanisms linking policy performance with party support are generally left implicit in the valence model, since the assumption is that good performance automatically generates positive reactions from performance-oriented voters. However, it is an interesting question why people should behave in this way. The aim of this chapter is to examine this linkage, advancing the argument that successful policy delivery increases happiness or subjective well-being and failed policies have the opposite effect.
At the outset, it bears emphasis that the importance of subjective well-being is not restricted to the valence model of voting; rather, it also highly relevant for Downsian spatial models of party competition. Like their valence rivals, spatial models assume that voters are motivated by a desire to maximize utility. However, in spatial models well-being will be enhanced by the government implementing policies on position issues that divide electorates. Position issues animate both elite and mass political behaviour, and governments aim to deliver policies that some voters favour and others oppose. If the division of preferences on a particular policy is very close, large minorities of voters will not experience an increase, and may well experience a decrease in subjective well-being. In a ‘spatial world’ of fixed voter preferences and strategic politicians, there is no guarantee that government policy implementation will yield aggregate increases in life satisfaction. Minorities with intense preferences may be sorely disappointed with government policies and suffer sizable decreases in their sense of well-being.
In Affluence, Austerity and Electoral Change in Britain we have investigated factors affecting electoral choice and change in modern Britain. Beginning with the landslide 1997 general election that brought Tony Blair's New Labour Party to power, analyses show that the valence politics model that emphasizes party performance judgments, party leader images and flexible partisan attachments does much to account for voting decisions and patterns of party support in inter-election periods. Spatial models of party competition that focus on distances between parties and voters on positional issues dividing the electorate are relevant, but their effects are secondary. Sociological models featuring social class or other sociodemographic characteristics have much weaker effects. As discussed in Chapters 2 and 3, the valence politics model dominated throughout the Blair years and its explanatory power continued unabated during Gordon's Brown's premiership.
Chapters 4 and 5 demonstrate that valence politics considerations also did much to shape the choices voters made in the 2010 general election – the contest that ended the New Labour era and set the stage for a Conservative–Liberal Democrat Coalition Government. The impact of leader images was dramatically illustrated by the first-ever leaders’ debate when voters’ highly favourable reactions to Nick Clegg's performance boosted the Liberal Democrats’ standing in the polls and reconfigured the election campaign. Analyses show that both the Air War – the national campaign in the media – and the Ground War – local campaigns across the country – were important for understanding voting behaviour in 2010.
The design of surveys conducted in the 2010 British Election Study is displayed in Figure A.1. The figure shows there are three distinct components: the in-person pre-campaign and post-election panel survey, the multiwave rolling campaign panel study (RCPS) and the monthly Continuous Monitoring Surveys (CMS). The first of these surveys repeated the classic in-person probability sample which has been the staple of the BES since the first study was conducted by Butler and Stokes in 1963. Although the BES originally included inter-election panel components, this design was replaced in the 1980s by a single post-election survey with no pre-campaign component. The latter design was changed in 2001 when the Essex team assumed responsibility for the study. For the first time the in-person survey consisted of a pre-campaign and a post-election panel survey.
In 2010, fieldwork for the in-person survey was performed by BMRB, under supervision of Study Director, Nick Howat. As Figure A.1 shows, the 2010 pre-campaign survey consisted of slightly less than 2000 respondents. These respondents were approached again immediately after the election, and the post-election sample was increased by a top-up survey giving a total of 3075 respondents. The top-up component was included to increase the representative quality of the survey given that a panel design was employed.
Understanding party choice is a central concern for students of voting and elections. In previous chapters of this book and in earlier studies (Clarke et al., 2004b; 2009b) we have estimated various models of voting with the aim of determining which one provides the best account of the electoral choices people make. These statistical comparisons favour a composite model since no single theoretical account captures all of the factors which influence party choice. However, it bears emphasis that the valence model exhibits the strongest explanatory power. The valence politics model proved itself in the 2001 and 2005 general elections in Britain as the best single model for explaining why people vote as they do (Clarke et al., 2004b, 2009b). The valence model also consistently performs very well in analyses of voting in national elections in Canada and the United States (Clarke et al., 2009a; Clarke et al., 2012) and there is evidence to suggest that it works well in other mature and emerging democracies (Clarke and Whitten, 2013; Ho et al., 2013; Lewis-Beck et al., 2012). In all these cases, statistical analyses indicate that the valence model dominates rival models of voting behaviour, although it does not formally encompass them in the sense of completely accounting for competitors’ contributions to explaining why individuals vote as they do (Charemza and Deadman, 1997). As a result, a composite specification generally provides marginally greater explanatory purchase than a pure valence model.
The timing of the 2010 British general election had a high degree of predictability. When Gordon Brown announced that he would not seek a new mandate in October 2007 following widespread speculation that there would be an early election call, this had two effects. First, it precipitated a rapid erosion of his personal popularity and an end to the public opinion honeymoon which he had enjoyed since taking residence in Number 10 in June 2007. These dynamics were discussed in Chapter 3. But the decision to postpone had a second effect – it informed everyone that the next general election would be delayed until spring 2009 at the earliest and quite likely even longer. In fact, by early 2009, some four years after the previous election, Labour was too far behind in the polls to win, so from that point on it was clear that the next election would be put off until the last possible date – the spring of 2010. This meant that although the official 2010 campaign was a month long as usual, the unofficial ‘long’ campaign which preceded it lasted the best part of a year. From late spring 2009 knowledge that the election would take place a year later permitted the parties to start campaigning early without fear that their efforts would be wasted. As a result, the run-up to the official ‘short’ campaign involved an unusually long unofficial campaign and this helped to shape the outcome.
With this point in mind, the present chapter is divided into four sections. In the first section we describe the official or ‘short’ campaign which lasted from the date the election writs were issued on 6 April to polling day on 6 May. The analysis begins by placing the official campaign in context by describing events earlier in the year which preceded it. Public opinion dynamics during the official campaign are examined using the daily ‘replicate’ surveys conducted in the BES Rolling Campaign Panel Study (RCPS) described in Chapter 1.