Past Projects

What can blue do for you?

A research study asking people with bipolar, schizophrenia or psychosis about their experiences of blue space and wellbeing.

What are blue spaces?

‘Blue spaces’ are usually defined as areas with visible bodies of water, for example rivers, lakes and seas.

Some people who participated in the study also connected blue spaces with other ideas such as blue skies or blue glass objects.

What were the aims of the study?

Previous research into blue spaces has focused on the benefits of living near blue spaces, as well as their benefits for people with depression and anxiety.

The study aimed to increase understanding about how accessing blue spaces intentionally can help people who experience, or have experienced, mental ill-health, in particular for those with bipolar disorder, schizophrenia and psychosis.

The study also aimed to find out more about what helps or hinders access to blue spaces.

How was the study run and funded?

Leading the project was Dr Kim Wright and funding was provided by the U.K. Economic and Social Research Council (ESRC) as part of their Closing The Gap scheme, in partnership with the University of York.

Who was involved in the study?

19 participants with bipolar, schizophrenia or psychosis were interviewed about their relationship to blue space. They were then invited to contribute to designing an online resource with the aim of sharing their experiences and our findings.

What were the findings of the project?

The interviews were analysed by researchers and a range of common themes were identified which helped to shed light on the impacts of blue spaces on the participants’ sense of wellbeing.

In particular, blue spaces were described as having the potential to reset the mind, emotions and body. Participants felt this was helped by the way that spending time in blue spaces provides a peaceful break from the more socially stressful aspects of life. This was supported by a sense of connection to familiar blue spaces.

How have the findings been helpful?

The findings of the study, including pictures, poems and comments from the participants, have been used to create online resources to help others find ways to experience the benefits of blue spaces. This can be found at: Home > What blue can do for you (exeter.ac.uk).

The findings of this study and the recommendations of the participants help to provide more information about how access to blue spaces can be best used to support the wellbeing of people with a wide range of mental health difficulties.

The AccEPT clinic is one of three sites in this multi-centre trial evaluating whether a group Mindfulness Based Cognitive Therapy (MBCT) course can help individuals who have previously not responded to current best practice individual psychological therapies (for example, cognitive behavioural therapy) in NHS Talking Therapies for depression and anxiety services. A total of 234 patients across the sites will be randomised to receive treatment as usual or treatment as usual + MBCT and both clinical- and cost- effectiveness will be evaluated. 

The AccEPT clinic co-hosted and co-delivered MBCT for this trial. This project was funded by a National Institute of Health Research (NIHR) grant awarded to Dr Thorsten Barnhofer at the University of Surrey.

This trial is close to recruitment and is currently in follow up. More information about the trial can be found here: RESPOND Trial

 Publications:

-       Barnhofer, T., Dunn, B. D., Strauss, C., Ruths, F., Barrett, B., … & Warren, F. (2023). A randomised controlled trial to investigate the clinical effectiveness and cost effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for depressed non-responders to Increasing Access to Psychological Therapies (IAPT) high-intensity therapies: study protocol. Trials, 24(1), 43. https://doi.org/10.1186/s13063-022-06882-w

The ADepT-FO project is adapting the ADepT wellbeing protocol already used in previous work to focus specifically on the treatment of young adults experiencing their first episode of depression. A multiple randomised baseline case series aims to recruit 15 students from the University wellbeing service who are experiencing depression. This case series is currently recruiting. The AccEPT clinic will host the project and all treatment will be delivered by AccEPT therapists.

The IBER project, funded by NIHR, is a pilot randomised controlled trial evaluating whether an imagery based therapy can help individuals with bipolar disorder manage anxiety symptoms. Participants were recruited at three sites (Devon, Berkshire and Oxford), and half received one-to-one imagery-based therapy on top of their usual care. The therapy consists of up to 12 sessions over four months. This project has now finished recruiting, treatment has been completed and the results are expected in early 2021. The AccEPT clinic hosted the project at the Devon site and one of our therapists delivered the therapy to local participants.
Publications:

• Steel, C., Wright, K., Goodwin, G., Simon, J., Morant, N., Taylor, R., ... & Holmes, E. (2020). The IBER study: study protocol for a feasibility randomised controlled trial of Imagery Based Emotion Regulation for the treatment of anxiety in bipolar disorder. Pilot and feasibility studies, 6(1), 1-9.

Caffeine and Bipolar: PhD student Samantha Eden has carried out research into how caffeine interacts with mood and with exercise in people with bipolar. To read more about some of her findings visit the Caffeine and Bipolar research page.

The BA-BD project is evaluating whether Behavioural Activation is an effective treatment for depression in the context of bipolar disorder. Behavioural Activation has been found to be effective in people with unipolar depression; in this study we adapted it for people who have a Bipolar diagnosis. BA-BD is an individual therapy consisting of up to 20 one-to-one sessions. Twelve patients have been offered the treatment, which is being evaluated with a randomised multiple baseline case series design. This project has now finished recruiting and treatment is being completed. The AccEPT clinic hosted the project and all treatment was delivered by AccEPT therapists.

The ThrIVe-B trial adapted a therapy called Dialectical Behaviour Therapy to see if it would help people to cope with and manage frequent Bipolar mood swings. There are few therapy options available currently for people living with dramatic weekly, daily or even hourly mood swings.

This was a small clinical feasibility trial to identify what changes need to be made before conducting a larger trial. It was too small to properly evaluate the benefit of the treatment itself.

The trials took place in Devon and Cumbria. 43 participants were placed randomly into two groups. Participants were interviewed at various stages and asked to complete questionnaires when the study started and 3, 6, 9 and 15 months later. Group Two also had the therapy which consisted of a 16-week course of two hourly group sessions, up to 8 short individual therapy sessions and a mood monitoring app.

Overall it looks like it would be possible to run a larger trial like this one, and our participants told us that there is a need for psychological therapies that can help them to cope with mood swings. Feedback from the trial participants and the research team flagged up two main areas where the design and delivery could be changed to improve a larger trial that could test out the therapy more thoroughly.

Firstly, we need to reduce the amount of information in the therapy whilst delivering it so that people get what is most relevant to them. Secondly, we need to streamline the number of questionnaires in the study and the methods by which people complete them to improve the quality and quantity of the feedback data. Participants, researchers and therapists gave us specific feedback that will help us make these changes.

We will be giving feedback to those involved in the trial and publicising our findings through social media, a short online film, the mainstream and academic media, and conference presentations.

This study was funded by the National Institute for Health Research (NIHR) [Research for Patient Benefit programme, REF: PB-PG-1215-20023]. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Dr Kim Wright discusses the trial

Publications:

• Wright, K., Palmer, G., Javaid, M., Mostazir, M., & Lynch, T. (2020). Psychological therapy for mood instability within bipolar spectrum disorder: a single-arm feasibility study of a dialectical behaviour therapy-informed approach. Pilot and Feasibility Studies, 6, 1-12.
• Wright, K., Dodd, A., Warren, F. C., Medina-Lara, A., Taylor, R., Jones, S., ... & Newbold, A. (2018). The clinical and cost effectiveness of adapted dialectical behaviour therapy (DBT) for bipolar mood instability in primary care (ThrIVe-B programme): a feasibility study. Trials, 19(1), 560.

The ADepT project developed and then evaluated in a case series and pilot trial a novel wellbeing oriented treatment for depression. ADepT is an individual therapy consisting of up to 15 acute sessions and 5 booster sessions. A multiple randomised baseline case series (11 patients) evaluation showed promising evidence of acceptability, feasibility and clinical efficacy and is now published (Dunn et al., 2019a). The pilot trial randomised 80 depressed participants to receive either ADepT or CBT (trial protocol paper; Dunn et al., 2019b). The trial follow up period finished in March 2020 and the results of the pilot trial are currently being written up. The AccEPT clinic hosted the project and all treatment was delivered by AccEPT therapists.

Since the trial ended, the results have been covered by the BBC and other media outlets.

This project was funded by an NIHR Career Development Fellowship awarded to Barney Dunn. 

Publications:

• Dunn, B. D., Widnall E, Reed, N., Owens, C., Campbell, J., Kuyken, W. (2019) Bringing light into darkness: A randomised multiple baseline mixed methods case series evaluation of Augmented Depression Therapy (ADepT). Behaviour Research & Therapy, 120, 103418.
• Dunn, B. D., Widnall, E., Reed, N., Taylor, R., Owens, C. et al (2019) Evaluating Augmented Depression Therapy (ADepT): Study protocol for a pilot randomised controlled trial. Pilot and Feasibility Studies, 5: 63.
• Dunn, B. D. et al (2023). A comparison of Augmented Depression Therapy (ADepT) versus Cognitive Behavioural Therapy (CBT) for the treatment of anhedonic depression: Results of a pilot randomized controlled trial. Lancet eClinicalMedicine.

The Morita Trial developed and tested the feasibility and acceptability of Morita Therapy for depression. Morita Therapy is a Japanese psychological therapy previously untested in the UK, which contrasts with established Western approaches in teaching that symptoms are part of the natural ecology of human experience. The Morita Trial consisted of a pilot randomised controlled trial, post-treatment qualitative interviews and integrative mixed methods analysis, which showed promising evidence of acceptability, feasibility and treatment benefits (Sugg et al., 2018; Sugg et al., 2019; Sugg et al., 2020a). The pilot trial randomised 68 depressed participants to receive either 8-12 individual sessions of Morita Therapy according to the UK Morita Therapy protocol (Sugg et al., 2017) or treatment as usual. 94% of participants were retained at four month follow-up; 70.6% of Morita Therapy participants adhered to the minimum treatment dose, and 66.7% achieved remission in depressive symptoms (compared to 30.0% in TAU). Qualitative and mixed methods findings indicated that Morita Therapy was broadly acceptable to therapists and participants, and highlighted potential moderators of acceptability, treatment adherence and outcomes.  The AccEPT clinic hosted the project and all treatment was delivered by AccEPT therapists.  This project was funded by a University of Exeter Medical School PhD awarded to Holly Sugg.

 Publications:

• 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, pp.1-10, doi: 10.1007/s10879-020-09464-6.
• Sugg HVR, Frost J, Richards DA. 2020. Personalising psychotherapies for depression using a novel mixed methods approach: an example from Morita therapy. Trials, 21(41), pp.1-12.
• Sugg HVR, Frost J, Richards DA. 2019. Morita Therapy for depression (Morita Trial): an embedded qualitative study of acceptability. BMJ Open, 9, e023873.
• Sugg HVR, Richards DA, Frost J. 2018. Morita Therapy for depression (Morita Trial): a pilot randomised controlled trial. BMJ Open, 8(8), e021605.
• 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 and Feasibility Studies, 3(1), 37.
• Sugg HVR, Richards DA, Frost J. 2016. Morita therapy for depression and anxiety (Morita Trial): study protocol for a pilot randomised controlled trial. Trials, 17(1), 161. 

The ACORN trial examined the acceptability and feasibility of a new brief psychological intervention for maternal prenatal anxiety within maternity services in London and Exeter. A total of 114 pregnant individuals with elevated anxiety were randomly assigned to receive the ACORN intervention or to continue their treatment as usual. The new ACORN intervention was found to be acceptable to pregnant individuals and their partners in reducing anxiety. https://pubmed.ncbi.nlm.nih.gov/35177019/

Publications:

O’Mahen HA, Ramchandani PG, King DX, Lee-Carbon L, Wilkinson EL, Thompson-Booth C, Ericksen J, Milgrom J, Dunkley-Bent J, Halligan SL, et al (2022). Adapting and testing a brief intervention to reduce maternal anxiety during pregnancy (ACORN): report of a feasibility randomized controlled trial. BMC Psychiatry, 22(1).

Wilkinson EL, O’Mahen HA, Fearon P, Halligan S, King DX, Greenfield G, Dunkley-Bent J, Ericksen J, Milgrom J, Ramchandani PG, et al (2016). Adapting and testing a brief intervention to reduce maternal anxiety during pregnancy (ACORN): study protocol for a randomised controlled trial. Trials, 17(1).

The HeLM project developed an adapted version of MBCT for supporting patients with depression and cardiovascular disease and compared it in a three arm pilot trial to Mindfulness Based Stress Reduction (MBSR) or treatment as usual (TAU). The project is now completed, with the main results having been published (Alsubaie et al., 2020). The project was funded through a Saudi Arabian government PhD award to Modi Alsubaie and some additional support from PenCLARHC.

Publications:

• Alsubaie M., Dickens C., Dunn B. D., Gibson A., Ukoummunne O., Evans A, et al. (2020). Feasibility and Acceptability of Mindfulness-Based Cognitive Therapy Compared with Mindfulness-Based Stress Reduction and Treatment as Usual in People with Depression and Cardiovascular Disorders: a three-arm Randomised Controlled Trial. Mindfulness, 11, 30-50. 
• Alsubaie, M., Abbot, R., Dunn, B. D., Dickens, C., Keil, T.F. et al. (2017). Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review. Clinical Psychology Review, 55, 74-91.

The COBRA trial compared the clinical and cost effectiveness of behavioural activation (BA) to cognitive behavioural therapy (CBT) for adults with depression. BA is a simpler psychological treatment than CBT and can be delivered by junior mental health workers with less intensive and costly training. The trial recruited a total of 440 individuals across three sites in England, and found that BA is as clinically as effective in treating adult depression as CBT, but is more cost effective. 

Richards DA, Ekers D, McMillan D, Taylor RS, Byford S, Warren FC, Barrett B, Farrand PA, Gilbody S, Kuyken W, et al (2016). Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet.

PREVENT was a large scale multicentre definitive trial comparing MBCT to maintenance anti-depressant medication (ADM) in preventing relapse in those vulnerable to depression. The main trial paper was published in 2015, showing that MBCT (with an invitation to stop making meds) was equivalently effective to continuing with meds. This is one part of the evidence that has led to MBCT now starting to be rolled out nationally as part of the Improving Access to Psychological Therapies Programme. The trial was led from the Mood Disorders Centre and AccEPT clinic staff contributed to delivery of the mindfulness groups run at the Exeter site. The trial was funded by an NIHR HTA grant.

Publications

• Kuyken, W., Hayes, R., Barrett, B., Byng, R, Dalgleish, T., Kessler, D. et al (2015). Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT). The Lancet, 386, 63-73.

The treatment combines elements of trauma-focussed therapy with interpersonal therapy and a compassion-informed emotion regulation component. It is run over 18 weeks. The AccEPT clinic supported this treatment development project. Altogether, 28 clients successfully completed the group. At three months after the treatment, we found overall large reductions in PTSD and medium size reductions in depression and dysfunctional self-organisation a key feature of complex PTSD. A manuscript is currently finalised for publication (Karl et al., 2020) and funding is sought for the evaluation of its effectiveness and cost-effectiveness (an NIHR grant application been submitted recently).

Related to research around self-compassion as one hypothesised key mechanism of addressing negative self bias as it is key vulnerability factor for both PTSD and depression, PhD student Hans Kirschner conducted a psychophysiological study in individuals with recurrent depression who engaged in the clinic’s MBCT program (Kirschner et al., 2020).

Publications

• Kirschner, H., Kuyken, W, & Karl, A. (2020). A biobehavioural approach to understand how mindfulness-based cognitive therapy reduces dispositional negative self-bias. Manuscript under review.
• Karl, A., Shepstone, L., Gilmore, L., Gerdes, S., Drake, A., Handley, V., Haslam, A., Haslam, C. & O'Mahen, H. (2020). Boosting trauma-focused therapy for individuals with PTSD subsequent to interpersonal trauma – development of a new group therapy for more resilient self, emotion regulation and interpersonal learning. Manuscript in preparation.

Working with Netmums.com and mothers who had suffered from postnatal depression an online intervention for postnatal depression was developed and tested. The intervention was tested both in a self-help and guided self-help format and helped formed the 2014 NICE Antenatal and Postnatal Mental Health recommendations for guided self-help. The intervention is freely available to the public and health care professionals at this link: http://www.netmums.com/parenting-support/depression-and-anxiety/netmums-helping-with-depression-course.

Publications:

O'Mahen HA, Woodford J, McGinley J, Warren FC, Richards DA, Lynch TR, Taylor RS (2013). Internet-based behavioral activation-Treatment for postnatal depression (Netmums): a randomized controlled trial. Journal of Affective Disorders, 150(3), 814-822.

O'Mahen HA, Richards DA, Woodford J, Wilkinson E, McGinley J, Taylor RS, Warren FC (2014). Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychological Medicine, 44, 1675-1689.