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Field dodder is an obligatory stem and leaf plant parasite that causes significant damage in field and vegetable crops in all agricultural regions of the globe. Selective and effective measures to control the parasite are extremely limited. In recent studies, we have shown that granular formulations of dinitroaniline cell division–inhibiting herbicides applied after crop establishment and before dodder germination fit our dodder control strategy and kill the parasite effectively and selectively. The aim of our study conducted from 2014 to 2018 was to evaluate the efficacy and selectivity of granular pendimethalin for dodder control in chickpea under laboratory, greenhouse, and field conditions. Petri dish experiments revealed that the herbicide reduces dodder seed germination while its main effect is a restriction of shoot elongation. Greenhouse experiments demonstrated that the inhibition and distortion of dodder shoot growth impede shoot twining and prevent attachment to the host plant. In dose–response experiments conducted in the greenhouse, we observed that half the recommended rate of granular pendimethalin provides efficient dodder control with no damage to chickpea seedlings. In 3 yr of chickpea field trials, GPM applied across the seeding bed at the recommended rate resulted in high crop yields that were not significantly different from those observed for the untreated no-dodder control, while half of the recommended dose efficiently controlled dodder and other weeds with no damage to the crop, resulting in significantly increased chickpea yields and profitability. These studies indicate that GPM can provide efficient and selective dodder control in chickpea.
Research suggests that paranoia and social anxiety can be understood as part of the same continuum, having shared processes such as the anticipation of threat, cognitive biases, poor self-concept, worry and safety-seeking behaviours. There is limited research on whether evidence-based interventions for social anxiety could be used with individuals who experience paranoia; however, an existing brief intervention study using techniques taken from cognitive behavioural therapy (CBT) for social anxiety has had promising results.
This paper uses a single-case experimental design to explore whether using a clinical model of the maintenance of paranoia followed by CBT for social anxiety can be an effective formulation and intervention method in cases where social anxiety processes appear to be maintaining paranoid thoughts. This may be an effective formulation and intervention method, resulting in a reduction in anxiety and a reduction in the distress associated with paranoid thoughts. The clinical implications are discussed along with limitations and recommendations for further research.
Key learning aims
(1)To describe shared processes in social anxiety and paranoia.
(2)To identify the benefits and limitations of using a clinical model of paranoia and CBT for social anxiety for formulation and intervention with individuals experiencing paranoia.
(3)To identify areas where further research is warranted in treatment for individuals experiencing paranoia.
Choosing an intervention for a patient experiencing distressing symptoms and/or suffering with a mental disorder is part of routine practice for clinicians. While there are now many effective pharmacological and psychological therapies for mental health problems, syndromes and persistent physical symptoms (e.g. chronic pain), choosing the ‘right’ therapy can sometimes be a challenge. This can certainly be the case when it comes to psychological therapies. There are many different approaches to choose from and many have not been subjected to rigorous study.
In this article, we aim to help inform and guide the busy clinician in choosing a psychological therapy for their patient. We give a brief overview of the major psychotherapy modalities and consider which guidelines to refer to and which psychological therapies have been found to be most effective for the presenting problem(s) seen in clinic. Lastly, we discuss the limitations of the current guidelines in relation to comorbid presentations and consider how this can be best addressed.
•Develop knowledge regarding the major psychotherapy approaches
•Be aware that there is no psychotherapy equivalence
•Learn that there is good evidence that some approaches are more effective than others for specific problems and be better able to choose a psychological therapy
DECLARATION OF INTEREST
D. McC. works on research trials funded by the Guy's and St Thomas’ Charity. T. C. receives salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, and receives several grants for evaluating the efficacy of different cognitive–behavioural approaches. This article received no specific grant from any funding agency, or from the commercial or not-for-profit sectors. The views expressed in this article are those of the authors and not necessarily those of the NIHR or the NHS.
Successful treatment of pediatric disorders has necessitated the development of alternative medication formulations, as children may prefer alternative dosage forms to tablets or capsules. This is especially true for attention-deficit/hyperactivity disorder (ADHD), which is one of the most common chronic pediatric conditions and often involves children with a variety of overlapping physical, psychological, or neurodevelopmental disorders. A special challenge for developing alternative dosage forms for ADHD treatment is the incorporation of a once-daily long-acting formulation. Traditional ADHD medication formulations have been limited, and issues surrounding prescribed dosing regimens—including poor medication adherence, difficulty swallowing, and the lack of dosing titration options—persist in ADHD treatment. In other disease areas, the development of alternative formulations has provided options for patients who have issues with consuming solid dosage forms, particularly children and individuals with developmental disorders. In the light of these new developments, several alternative formulations for ADHD medications are under development or have recently become available. This article reviews the various strategies for developing alternative dosage forms in other disease areas and discusses the application of these strategies in ADHD treatment. Alternative dosage forms may increase medication adherence, compliance, and patient preference and, therefore, improve the overall treatment for ADHD.
Formulation is widely considered a critical component of psychological therapies, and is thought to have a number of benefits both for the therapeutic process and the client directly. However, the evidence base supporting formulation and its possible interventive capacity is limited, and there is little empirical evidence exploring how clients perceive formulation as part of therapy. Work with the client described in this single case report provided an opportunity to explore the use of formulation as intervention and evaluate ways in which it may or may not prove helpful by interviewing the client directly about her experience of the process. Implications for further research on the use and outcomes of formulation are discussed.
A survey of psychiatrists with a special interest in CBT was conducted by email correspondence to answer two main questions: ‘What are the uses and the usefulness of the cognitive behavioural model within the day-to-day practice of psychiatrists?’ and ‘What are the most important roles of the consultant medical psychotherapist who has specialized in CBT?’ Despite the constraints of a low response rate the results still reflected the views of 46 psychiatrists who were particularly experienced in the area of CBT. They reported that the cognitive behavioural model was useful in general psychiatric settings, in particular in the engagement of patients, improving client's insight, adherence to medications, and for trainee supervision. The responders reaffirmed previously held views about the role of the consultant medical psychotherapist (CBT), in particular the roles of the assessment and management of complex cases, of taking responsibility for patients with a combination of medical and psychological issues and of teaching CBT to psychiatrists and other mental health professionals. The challenges of translating CBT competencies into generic non-CBT psychiatric settings are discussed, with the important potential role of the medical psychotherapist in this respect. The key skill of formulating cases in secondary care is emphasized.
The aim of this study was to identify and develop entomopathogenic fungi as biopesticides for management of Maruca vitrata (Fabricius). Fourteen isolates of Metarhizium anisopliae (Metchnikoff) Sorokin and six of Beauveria bassiana (Bals.-Criv.) Vuill. were screened against first instar larvae of M. vitrata. The two most virulent isolates were selected and further tested for production in four liquid media. Different formulations of one isolate were evaluated against different developmental stages. Metarhizium anisopliae ICIPE 18 and ICIPE 69 caused highest larval mortality of 91 and 81%, with lethal time to 50% mortality (LT50) values of 1.8 and 1.7 days and LC50 of 1.07 × 107 and 3.01 × 106conidia/ml, respectively. ICIPE 69 yielded more biomass and propagules in two liquid media than ICIPE 18. All developmental stages and adult moths were susceptible to fungal infection and horizontal transmission caused a significant reduction in fecundity. Isolate ICIPE 69 was identified as the most potent isolate for managing M. vitrata based on demonstrated efficacy against different developmental stages and amenability to production in liquid media and could be utilized as an alternative to pesticides in cowpea IPM.
While clinicians have described the benefits of using formulations within therapy, little is understood about the client's experience of the formulation process. Cognitive behaviour therapy (CBT) is currently the treatment of choice for many adult mental health difficulties. However, research exploring clients’ experiences of CBT formulation is very limited. The present study set out to explore experiences of CBT formulation in clients with depression. Seven participants were interviewed and the data analysed using Thematic Analysis. The analysis identified key themes such as: ‘Feeling trapped or restricted by depression’, ‘The development of the formulation – from coming to my own conclusions to something the therapist developed’, ‘From negative to mixed feelings: emotional reactions to the formulation during the therapeutic process’ and ‘A new journey: towards making a new sense of oneself’. The results of the study highlight the personal and emotional challenge of the formulation process for clients.
Anorexia nervosa (AN) and obsessive compulsive disorder (OCD) have been shown to have a number of commonalities, such as genetics, neurobiology, and symptoms. Approaches to treatment of AN have recently been described that take such findings into account, extending interventions recommended for obsessive compulsive and anxiety disorders to AN. The current paper aims to outline a formulation model of AN in adults, derived from the literature on OCD, and introduce this topic as a fruitful area to build on existing treatment techniques, and to prompt further discussion of such techniques. A formulation model is described, followed by a discussion of how this might be applied to AN, using examples from clinical practice. Potential benefits and difficulties are discussed. A formulation model is suggested that can easily be adapted to AN, complementing existing models in eating disorders.
Cognitive behavioural therapy (CBT) is an empirically grounded approach which typically relies on formulation to guide the shape and course of therapy. Cognitive formulation is widely advocated but poorly understood at an empirical level. This study aimed to characterize how clinicians understand the structure and uses of formulation and how they report on using it in their clinical practice relative to an expert reference group. A total of 124 clinicians in routine clinical practice completed a questionnaire, which assessed their clinical use and understanding of formulation. For some aspects of the questionnaire a comparison with a reference group, 15 highly specialist CBT therapists, was used. High levels of self-rated expertise were noted and at levels comparable to that of the highly specialist group. Participants rated themselves as less capable in terms of their formulation skills relative to their self-rating in CBT overall. Formulation is typically rated as important by those with some professional commitment to CBT. There may be some gaps in the way formulation is applied in clinical practice that should be addressed at the level of training and supervision.
A medication's pharmacokinetic properties can be as important as its efficacy in determining how successful a treatment is. Formulation plays a critical role in absorption, distribution, and elimination of a drug, which in turn can influence the clinical profile of a medication, including onset and duration of action, consistency of plasma levels, ability to cross the blood-brain barrier, and other factors. Advances in drug delivery technology mean that formulation is now an integral component in the development of a drug. Likewise, formulation is one of the factors that may influence selection of a medication to suit the needs of a particular patient. This article briefly reviews the technologies commonly applied in the development of psychotropic medications, with emphasis on the various oral modified-release formulations, and discusses how formulation can be used to optimize the efficacy and tolerability of psychotropic drugs.
There is a wide array of factors, of which feed formulation is one, that can drastically affect both the quality of the feed produced as well as the parameters associated with the production of the feed in the mill. It has long been the practice in commercial broiler production to pellet the feed. It has been accepted at this point that feeding a diet with high quality pellets leads to better performance compared to the same diet with low quality pellets or in mash form. On the other hand, producing a high quality pellet is not the typical result in a large feed mill. In large mills, great quantities of feed must be produced in a short time frame and this is usually accomplished by running the mill at a high production rate and pelleting the diet through a relatively thin die. This usually results in decreased conditioning time and contact with the die for the diet, and consequently a lower quality pellet results, mainly because these are the two primary locations for the physiochemical reactions such as starch gelatinisation and protein denaturation that cause pellet binding. In this review we will discuss research pertaining to the use of different grains, by-products, minerals, pellet binders and most notably feedstuff constituents and their effects on both physical pellet quality as well as feed manufacturing variables such as energy usage and production rate when the data is available. The main focus will be given to research performed within the last decade. However, we have placed no restrictions on the research referenced based on publication date as there is always quality research with pertinent findings that have stood the test of time.
Mental health policy places a requirement on clinicians to address matters of religion and belief, yet practice falls far behind. This paper summarizes a Panel Discussion at the 2008 BABCP Annual Conference attended by over 50 people. The five speakers each presented their experience of working with particular faith groups (Orthodox Jewish, Christian, Muslim) and from an agnostic viewpoint. Common themes are given, as well as practical advice to therapists who find themselves working with people who hold strong faith beliefs they may not share.
Can a cognitive behavioural approach offer a fresh understanding of the maintaining processes in burnout? This paper considers the enduring nature of burnout symptoms over time. It examines the hypothesis that some of the actions associated with ‘coping’ in burnout may conversely serve to perpetuate burnout symptoms. This model is considered in the context of mental-health workers and is discussed in the light of current research. It implies the need to adopt an approach to burnout that incorporates the challenging of burnout-related cognitions and the elimination of safety behaviours, rather than having a sole focus on self-care strategies.
Background: A key process in Cognitive Therapy (CT) is the development and sharing of a formulation. How clinicians develop formulations is under-researched, particularly in working with people with psychosis. Aims: This study investigated agreement between clinicians, when conceptualizing an individual's psychotic beliefs. It also explored whether agreement was dependent on qualifications and experience. Method: Eighty-two clinicians watched a video of an individual with delusional beliefs, and were asked to provide formulations using a CT template. These were compared with a “benchmark” formulation provided by three experts. Results: There was good agreement for overt behaviours, emotions, and some aspects of early experience. However, identification of theory driven components such as core beliefs or assumptions was poorer. Greater clinical experience improved the agreement with the benchmark formulation overall, and greater CT specific experience improved formulation of the theory driven items. The more experience a clinician had of working with people with psychosis the lower the rate of agreement with the expert formulation. Conclusions: Formulation of delusional beliefs from a cognitive perspective is dependant on overall experience in cognitive therapy and not knowledge of psychosis, which may hinder performance. The implications for training in CT and psycho-social interventions are considered.
There is a long history of literature concerning integrative practice and how a systemic practice can fit with other models of therapy. Much of this literature has focused on establishing a space for systemic therapy within the dominant medical paradigm, and exploring how the medical model can be enhanced by systemic ideas. The outcome has been better practice, especially in child and adolescent mental health. Interestingly, however, there has been less discussion of the converse: the family therapy literature has rarely considered whether or not systemic practice itself can be enhanced by ideas from the dominant medical model. This article proposes that a biopsychosocial formulation can enhance systemic practice by: (1) holding clinicians accountable for their thinking; (2) facilitating a rigour and attention to detail that may prove useful when therapy falters; (3) opening up other possibilities for intervention; and (4) providing a way to engage with the dominant medical paradigm and support clients in negotiating their way through this system. Potential problems nevertheless arise when integrating a biopsychosocial formulation into a systemic framework. This article identifies these problems and presents ideas for how they can be managed in practice.
Background: Cognitive behavioural models of anxiety disorders often include visual representations of feedback loops that maintain the disorder. Cognitive therapy for depression is the prototype for therapy for many other disorders, and there is now good evidence for factors that maintain depression, yet there is still no accepted diagrammatic form of the maintenance model. Aims: To develop a simple, clinically acceptable and empirically based version of the “vicious flower” for depression. Method: Current theoretical developments in depression (Differential activation and Beck's concept of modes) and empirical findings on maintenance factors were reviewed. A model was developed based on clinical utility and current knowledge of the processes and maintenance factors in depression. This model was tested for its usefulness with a small sample of IAPT trainees. Results: The model contained 6 cycles comprising 2 cognitive cycles (automatic negative thinking and rumination/self-attacking), 2 behavioural cycles (withdrawal/avoidance and unhelpful behaviour), a mood/emotion cycle, and a motivation/physical symptoms cycle. Students found it a very useful tool for understanding maintenance factors. Conclusions: This diagrammatic maintenance model of depression, like similar “vicious flowers” for anxiety, may be helpful in conceptualization, socialization and treatment planning as well as teaching CBT.
Method of Levels (MOL) is a form of cognitive therapy based on Perceptual Control Theory (PCT). This paper presents the initial steps towards four methods of establishing the validity of MOL. First, the session was rated by two independent experts for its adherence to MOL using a newly developed 6-item scale based on the Cognitive Therapy Rating Scale. Second, each therapist utterance within a session of MOL was coded and categorized in terms of the therapist's goal to test for adherence to the two specified goals of MOL. Third, a macroanalysis of a MOL session utilizing interpretative phenomenological analysis hypothesized the control hierarchies involved in a client's presenting problem and their zones of conflict. Fourth, a microanalysis of a brief interchange between the therapist and client explored its adherence to PCT. These methods of establishing validity are introduced and explored for later use in larger scale studies. The limitations of the present study and suggestions for future research are discussed.
There is a paucity of research exploring the validity, reliability and impact on clinical outcome of Cognitive Behavioural Psychotherapy (CBP) case formulations. This review considers a variety of literature that relates to formulations and their use, it also draws on other types of psychotherapy where there appears to be a more established and robust research base. The literature review explores the research that has taken place within CBP and considers the themes that emerge from this research. Several themes were identified and these relate to decision-making and experience, specific guidelines to aid quality of formulations and a significant lack of understanding of clients' views on the formulation process and its outcome. It is unclear whether formulations do influence the successfulness of therapy. Recommendations are made as to what further research is needed and the form this should take.
Background: A key component of cognitive therapy for psychosis is the development of a meaningful and shared formulation of the onset of the psychosis. Therapists bring an understanding of the development of psychotic symptoms based on theoretical models and try to marry these with the person's own experience and explanations. However, an important question is whether this understanding is compatible with the explanations held by the client. Aims: This study investigated what factors people believed led to the onset of their psychosis. Method: A Q set of potential causes for psychosis was identified from a literature search and interviews with people with differing experiences of psychosis. From this, 58 potential causes of psychosis were identified. Twenty-one people who had experienced a psychotic breakdown then ranked these explanations as possible causes. Results: Using Principle Components Analysis four main factors were identified as perceived causal factors for the onset of psychosis. These factors were described as: a) drug usage; b) traumatic experiences in adulthood; c) personal sensitivity; and d) developmental vulnerabilities. Conclusions: This study revealed that people with psychosis have different explanatory frameworks for the onset of their difficulties. This work is helpful as this effort to understand the person's own understanding of their problems is a first stepping stone towards a collaboratively generated formulation that may be helpful in building a therapeutic alliance, engagement in treatment, and ultimately in improved outcome. It is likely that these different explanatory frameworks could lend themselves to different treatment approaches.