The Counseling Center Assessment of Psychological Symptoms (CCAPS-62): Acceptance, feasibility, and initial psychometric properties in a UK student population.

BACKGROUND: The burden and severity of student mental health continue to increase in parallel with increasing financial pressures on students and services alike. There is a need for a student-specific measure of distress that acknowledges their unique context. This study examined the feasibility, acceptance, and initial psychometric properties of a US measure, the Counseling Center Assessment of Psychological Symptoms (CCAPS), in a UK student sample. METHODS: A sample of 294 UK help-seeking students from two universities completed the CCAPS-62 and Clinical Outcomes in Routine Evaluation (CORE-10) as a comparator. The factor solution and reliability of the CCAPS-62 were examined. Correlations and clinical boundaries were determined between the CCAPS-62 subscales and CORE-10, and comparisons were made with US published norms. RESULTS: The CCAPS-62 demonstrated a strong factor solution that matched the intended subscales. All subscales had good reliability and correlated significantly with the CORE-10. The agreement on caseness between the two measures was 92.8% with 86.3% reaching clinical threshold on both the CCAPS-62 and CORE-10. Severity was most noticeable for academic distress, depression, anxiety, and social anxiety. Compared to US data, UK students showed higher clinical severity for all psychological symptoms. CONCLUSIONS: The CCAPS-62 is a reliable and psychometrically valid assessment measure to use with UK students without revision. The overall distress indicated is similar to that of the CORE-10, but the individual subscales are more informative of specific student concerns including academic distress, social anxiety, and substance abuse. Potential benefits of administering a student-focused assessment measure in student counselling services are discussed. KEY PRACTITIONER MESSAGE: University students attending counselling in the UK demonstrate clinical severity for academic distress, depression, anxiety, and social anxiety. Compared to university students in the US, UK students present with higher clinical severity on all contextual measures of student psychological distress. It is advantageous for university counselling services to administer a student-specific clinical measure over measures intended for the general clinical population. CCAPS-62 is an acceptable, feasible, and psychometrically valid measure of student psychological distress that can be used in the UK without revision. It is important for university counselling services to continue to provide support from therapists that are trained and experienced in the university context over services intended for the general clinical population.

Variability in treatment effects in an English national dataset of psychological therapies: The relationships between severity, treatment duration, and therapy type.

BACKGROUND: Comparisons between bona fide psychological therapies generally report no effects or small effects favoring cognitive behavioral therapy (CBT), suggesting that differences between therapy modalities are of little importance. METHODS: An observational, cohort study of patients (N = 11,116), drawn from the English Talking Therapies program. Patients presented with depression and were treated by CBT or person-centered experiential therapy (PCET), 67 % were female and the age range was 15-94. Multilevel modeling was used to identify variables associated with outcomes and CBT and PCET outcomes were compared dependent on the number of sessions patients attended and the severity of their depression at intake. RESULTS: Although overall a small effect size of 0.14 (0.10, 0.18) favored CBT, we found differing effect sizes depending on patient severity and the number of sessions they had attended at outcome. For non-clinical and moderately depressed patients no significant differences between therapies were found. For moderately-severe and severe patients there was a crossover in effectiveness with PCET more effective up to 5 or 6 sessions and CBT more effective thereafter. However, small effects in favour of PCET were unreliable. The largest effects were found for CBT for patients who were moderately-severe and had >10 sessions (d = 0.30, 0.12, 0.48) or were severe and had >12 sessions (d = 0.26 (0.02, 0.49). LIMITATIONS: No data was available on therapy allocation decisions or therapists and the results may not be generalizable to non-NHS Talking Therapies services. CONCLUSIONS: Small effects can mask important contextual differences between therapies and their study can inform allocation decisions.

Signs of increased cortical hyperexcitability selectively associated with spontaneous anomalous bodily experiences in a nonclinical population.

INTRODUCTION: The current study examined the presence of cortical hyperexcitability, in nonclinical hallucinators, reporting different forms of anomalous bodily experiences (ABEs). Groups reporting visual out-of-body experiences and nonvisual sensed-presence experiences were examined. It was hypothesised that only those hallucinators whose experiences contained visual elements would show increased signs of visual cortical hyperexcitability. METHODS: One hundred and eighty-two participants completed the "Pattern-glare task" (involving the viewing of striped gratings with spatial frequencies irritable to visual cortex)-a task known to reflect degrees of cortical hyperexcitability associated with hallucinatory/aura experiences in neurological samples. Participants also completed questionnaire measures of anomalous "temporal-lobe experience" and predisposition to anomalous visual experiences. RESULTS: Those reporting increased levels of anomalous bodily experiences provided significantly elevated scores on measures of temporal-lobe experience. Only the visual OBE group reported significantly elevated levels of cortical hyperexcitability as assessed by the pattern-glare task. CONCLUSIONS: Collectively, the results are consistent with there being an increased degree of background cortical hyperexcitability in the cortices of individuals predisposed to some ABE-type hallucinations, even in the nonclinical population. The present study also establishes the clinical utility of the pattern-glare task for examining signs of aberrant visual connectivity in relation to visual hallucinations.

Mental health trajectories in university students across the COVID-19 pandemic: findings from the Student Wellbeing at Northern England Universities prospective cohort study.

Introduction: Psychological wellbeing in university students is receiving increased focus. However, to date, few longitudinal studies in this population have been conducted. As such, in 2019, we established the Student Wellbeing At Northern England Universities (SWANS) cohort at the University of York, United Kingdom aiming to measure student mental health and wellbeing every six months. Furthermore, the study period included the COVID-19 pandemic, giving an opportunity to track student wellbeing over time, including over the pandemic. Methods: Eligible participants were invited to participate via email. Data were collected, using Qualtrics, from September 2019 to April 2021, across five waves (W1 to W5). In total, n = 4,622 students participated in at least one wave of the survey. Data collection included sociodemographic, educational, personality measures, and mental health and wellbeing. Latent profile analyses were performed, exploring trajectories of student wellbeing over the study period for those who had completed at least three of the five waves of the survey (n = 765), as measured by the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Results: Five latent profile trajectories of student wellbeing were identified. Of these, the two latent classes with initially higher wellbeing scores had broadly stable wellbeing across time (total n = 505, 66%). Two classes had lower initial scores, which lowered further across time (total n = 227, 30%). Additionally, a fifth class of students was identified who improved substantially over the study period, from a mean WEMWBS of 30.4 at W1, to 49.4 at W5 (n = 33, 4%). Risk factors for having less favourable wellbeing trajectories generally included identifying as LGBT+, self-declaring a disability, or previously being diagnosed with a mental health condition. Conclusion: Our findings suggest a mixed picture of the effect of the COVID-19 pandemic on student wellbeing, with a majority showing broadly consistent levels of wellbeing across time, a smaller but still substantial group showing a worsening of wellbeing, and a small group that showed a very marked improvement in wellbeing. Those from groups traditionally underrepresented in higher education were most at risk of poorer wellbeing. This raises questions as to whether future support for wellbeing should target specific student subpopulations.

What factors facilitate partnerships between higher education and local mental health services for students? A case study collective.

BACKGROUND: Higher education institutions face challenges in providing effective mental health services for diverse student needs. In the UK, discrepancies between healthcare and education service provision create barriers for students and require stronger alignment through partnerships. OBJECTIVES: This study aimed to identify risks, barriers and enablers to developing service partnerships between universities and the National Health Service (NHS) in England. It investigated existing partnerships and strategies that facilitate effective collaborative working. DESIGN AND SETTING: A case study approach was employed, including coproduction and stakeholder involvement with staff and service users, to gather information from eight English universities developing regional student mental health hubs. This research received appropriate ethical approval. PARTICIPANTS: In total, 27 professional staff from counselling, mental health, disability and well-being services participated and represented their respective services. OUTCOME MEASURES: Descriptive information was collected from service websites, handbooks, reports and 11 focus groups using a standardised data collection template. Inter-rater reliability was used to determine the agreement between coders and finalise focus group themes. EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Standards for Reporting Qualitative Research were adopted. RESULTS: Using inductive thematic analysis, five themes were identified for developing partnerships: building blocks, facing barriers, achieving positive outcomes, shaping student services and developing coordinated care. Fleiss' kappa showed strong agreement between raters regarding the partnership factors (k=0.84 (95% CI 0.81 to 0.87), p<0.0005). Effective communication, shared understanding and trust were essential. Barriers included restrictions to information sharing and incompatible data infrastructures between services. CONCLUSIONS: Stronger partnerships between universities and NHS are needed to meet increasing student mental health demands. Addressing barriers and implementing strategies to develop partnerships can enhance student services. PREREGISTRATION: https://osf.io/u54qk/.

Key questions: research priorities for student mental health.

BACKGROUND: The high prevalence of mental distress among university students is gaining academic, policy and public attention. As the volume of research into student mental health increases, it is important to involve students to ensure that the evidence produced can translate into meaningful improvements. AIMS: For the first time, we consult UK students about their research priorities on student mental health. METHOD: This priority setting exercise involved current UK university students who were asked to submit three research questions relating to student mental health. Responses were aggregated into themes through content analysis and considered in the context of existing research. Students were involved throughout the project, including inception, design, recruitment, analysis and dissemination. RESULTS: UK university students (N = 385) submitted 991 questions, categorised into seven themes: epidemiology, causes and risk factors, academic factors and work-life balance, sense of belonging, intervention and services, mental health literacy and consequences. Across themes, respondents highlighted the importance of understanding the experience of minority groups. CONCLUSIONS: Students are interested in understanding the causes and consequences of poor mental health at university, across academic and social domains. They would like to improve staff and students' knowledge about mental health, and have access to evidence-based support. Future research should take a broad lens to evaluate interventions; considering how services are designed and delivered, and investigating institutional and behavioural barriers to accessibility, including how this varies across different groups within the student population.

Counseling With Guided Use of a Mobile Well-Being App for Students Experiencing Anxiety or Depression: Clinical Outcomes of a Feasibility Trial Embedded in a Student Counseling Service.

BACKGROUND: Anxiety and depression continue to be prominent experiences of students approaching their university counseling service. These services face unique challenges to ensure that they continue to offer quality support with fewer resources to a growing student population. The convenience and availability of mobile phone apps offer innovative solutions to address therapeutic challenges and expand the reach of traditional support. OBJECTIVE: The primary aim of this study was to establish the feasibility of a trial in which guided use of a mobile phone well-being app was introduced into a student counseling service and offered as an adjunct to face-to-face counseling. METHODS: The feasibility trial used a two-arm, parallel nonrandomized design comparing counseling alone (treatment as usual, or TAU) versus counseling supplemented with guided use of a mobile phone well-being app (intervention) for 38 university students experiencing moderate anxiety or depression. Students in both conditions received up to 6 sessions of face-to-face counseling within a 3-month period. Students who approached the counseling service and were accepted for counseling were invited to join the trial. Feasibility factors evaluated include recruitment duration, treatment preference, randomization acceptability, and intervention fidelity. Clinical outcomes and clinical change were assessed with routine clinical outcome measures administered every counseling session and follow-up phases at 3 and 6 months after recruitment. RESULTS: Both groups demonstrated reduced clinical severity by the end of counseling. This was particularly noticeable for depression, social anxiety, and hostility, whereby clients moved from elevated clinical to low clinical or from low clinical to nonclinical by the end of the intervention. By the 6-month follow-up, TAU clients' (n=18) anxiety had increased whereas intervention clients' (n=20) anxiety continued to decrease, and this group difference was significant (Generalized Anxiety Disorder-7: t22=3.46, P=.002). This group difference was not replicated for levels of depression: students in both groups continued to decrease their levels of depression by a similar amount at the 6-month follow-up (Physical Health Questionnaire-9: t22=1.30, P=.21). CONCLUSION: Supplementing face-to-face counseling with guided use of a well-being app is a feasible and acceptable treatment option for university students experiencing moderate anxiety or depression. The feasibility trial was successfully embedded into a university counseling service without denying access to treatment and with minimal disruption to the service. This study provides preliminary evidence for using a well-being app to maintain clinical improvements for anxiety following the completion of counseling. The design of the feasibility trial provides the groundwork for the development of future pilot trials and definitive trials embedded in a student counseling service. TRIAL REGISTRATION: ISRCTN registry ISRCTN55102899; http://www.isrctn.com/ISRCTN55102899.

Comparing counselling alone versus counselling supplemented with guided use of a well-being app for university students experiencing anxiety or depression (CASELOAD): protocol for a feasibility trial.

BACKGROUND: University counselling services face a unique challenge to offer short-term therapeutic support to students presenting with complex mental health needs and in a setting which suits the academic timetable. The recent availability of mobile phone applications (apps) offers an opportunity to supplement face-to-face therapy and has the potential to reach a wider audience, maintain engagement between therapy sessions, and enhance therapeutic outcomes. The present study, entitled Counselling plus Apps for Students Experiencing Levels of Anxiety or Depression (CASELOAD), aims to explore the feasibility of supplementing counselling with guided use of a well-being app. METHODS/DESIGN: Forty help-seeking university students (aged 18 years and over) with symptoms of moderate anxiety or depression will be recruited from a University Counselling Service (UCS) in the United Kingdom (UK). Participants will be recruited via counsellors who provide the initial clinical assessment and who determine treatment allocation to one of two treatments on the basis of client-treatment fit. The two conditions comprise (1) counselling alone (treatment as usual/TAU) or (2) counselling supplemented with guided use of a well-being app (enhanced intervention). Trained counsellors will deliver up to six counselling sessions in each treatment arm across a 6-month period, and the session frequency will be decided by client-counsellor discussion. Assessments will occur at baseline, every counselling session, post-intervention (3 months after consent) and follow-up (6 months after consent). Assessments will include clinical measures of anxiety, depression, psychological functioning, specific mental health concerns (e.g. academic distress and substance misuse), resilience and therapeutic alliance. The usage, acceptability, feasibility and potential implications of combining counselling with guided use of the well-being app will be assessed through audio recordings of counselling sessions, telephone interviews with participants, focus groups with counsellors and counsellor notes. DISCUSSION: This study will inform the design of a randomised pilot trial and a definitive trial which aim to improve therapy engagement, reduce dropout and enhance clinical outcomes of student counselling. TRIAL REGISTRATION: ISRCTN55102899.

Autonomic emotional responses to the induction of the rubber-hand illusion in those that report anomalous bodily experiences: evidence for specific psychophysiological components associated with illusory body representations.

We present the first study to examine indicators of autonomic arousal associated with shifts in body image and as a function of predisposition to report spontaneous anomalous bodily experiences (ABEs) from nonclinical samples. Participants completed the Temporal-Lobe Experience subscale of the Cardiff Anomalous Perception scale-a measure associated with anomalous experiences resulting from temporal lobe dysfunction (Bell, Halligan, & Ellis, 2006) followed by a rubber-hand illusion experiment. We examined: (a) the time taken to induce the illusion, (b) effects on the tonic skin conductance level, and (c) phasic skin conductance responses in the form of nonspecific skin conductance responses (NS-SCRs) in the period leading up to the declaration of the illusion. The illusion took significantly longer to induce in those reporting high levels of ABEs, relative to those reporting low levels of such experiences. A significant increase in the tonic skin conductance level and the frequency of NS-SCRs occurred in the period leading directly up to the declaration of the illusion. Both measures were significantly increased for those reporting higher-levels of ABEs. The data question generic notions of "weak" body representations subserving increasing malleability in body image. Instead, they lend general support for a "dysconnection" account of anomalous bodily experiences-at least for some nonclinical hallucinators. Theoretical considerations are discussed.

Associations between specific technologies and adolescent sleep quantity, sleep quality, and parasomnias.

OBJECTIVE: We tested the hypothesis that weekday bedtime use of six technologies would be significantly associated with eight sleep parameters studied relating to sleep quantity, sleep quality, and parasomnias. METHODS: In our cross-sectional study, we previously administered validated age-appropriate questionnaires (School Sleep Habits Survey, Technology Use Questionnaire). Participating adolescents (n=738; 54.5% boys) were aged 11-13 years and were from the Midlands region of the United Kingdom in 2010. RESULTS: Frequent use of all technology types was significantly inversely associated with weekday sleep duration (hours). Frequent music listeners and video gamers had significantly prolonged sleep onset (ß=7.03 [standard error {SE}, 2.66]; P<.01 and ß=6.17 [SE, 2.42]; P<.05, respectively). Frequent early awakening was significantly associated with frequent use of all technology types. The greatest effect was observed in frequent television viewers (odds ratio [OR], 4.05 [95% confidence interval {CI}, 2.06-7.98]). Difficulty falling asleep was significantly associated with frequent mobile telephone use, video gaming, and social networking, with music listeners demonstrating the greatest effect (OR, 2.85 [95%CI, 1.58-5.13]). Music listeners were at increased risk for frequent nightmares (OR, 2.02 [95% CI, 1.22-3.45]). Frequent use of all technologies except for music and mobile telephones was significantly associated with greater cognitive difficulty in shutting off. Frequent television viewers were almost four times more likely to report higher sleepwalking frequency (OR, 3.70 [95% CI, 1.89-7.27]). CONCLUSIONS: Frequent weekday technology use at bedtime was associated with significant adverse effects on multiple sleep parameters. If confirmed in other samples and longitudinally, improving sleep hygiene through better management of technology could enhance the health and well-being of adolescent populations.

An investigation into the strength of the association and agreement levels between subjective and objective sleep duration in adolescents.

STUDY OBJECTIVES: The majority of adolescent sleep research has utilized self-reported sleep duration and some have based information on a solitary question. Whilst some have claimed to have validated sleep survey data with objective actigraphy measures in adolescents, the statistical approach applied only demonstrates the strength of the association between subjective and objective sleep duration data and does not reflect if these different methods actually agree. METHODS: Data were collected as part of the Midlands Adolescents Schools Sleep Education Study (MASSES). Adolescents (n=225) aged 11-13 years provided estimates for weekday, weekend and combined sleep duration based on self-reported survey data, a 7-day sleep diary, and wrist-worn actigraphy. RESULTS: We assessed the strength of the relationship as well as agreement levels between subjective and objectively determined sleep duration (weekday, weekend and combined). Subjective diary sleep duration was significantly correlated with actigraphy estimates for weekday and weekend sleep duration r=0.30, p ≤ 0.001 and r=0.31, p ≤ 0.001 respectively. Pitman's test demonstrated no significant difference in the variance between weekend sleep duration (r=0.09, p=0.16) and combined sleep duration (r=0.12, p=0.08) indicating acceptable agreement between actigraphy and sleep diary sleep duration only. Self-reported sleep duration estimates (weekday, weekend and combined) did not agree with actigraphy determined sleep duration. CONCLUSIONS: Sleep diaries are a cost-effective alternative to survey/questionnaire data. Self-reported measures of sleep duration in adolescents do not agree with actigraphy measures and should be avoided where possible. Previous adolescent sleep studies that have utilized self-reported survey data may not provide a complete representation of sleep on the outcome measure of interest.

Evidence for elevated cortical hyperexcitability and its association with out-of-body experiences in the non-clinical population: new findings from a pattern-glare task.

Individuals with no history of neurological or psychiatric illness can report hallucinatory Out-of-Body Experiences (OBEs) and display elevated scores on measures of temporal-lobe dysfunction (Braithwaite et al., 2011). However, all previous investigations of such biases in non-clinical populations are based on indirect questionnaire measures. Here we present the first empirical investigation that a non-clinical OBE group is subject to pattern-glare, possibly as a result of cortical hyperexcitability (Wilkins et al., 1984). Fifty-nine students at the University of Birmingham viewed a series of square-wave gratings with spatial frequencies of approximately .7, 3 and 11 cycles-per-degree, both black/white and of contrasting colours. The illusions and discomfort reported when viewing gratings with mid-range spatial frequency have been hypothesized to reflect cortical hyperexcitability (Wilkins, 1995; Huang et al., 2003). Participants also completed the Cardiff Anomalous Perception Scale (CAPS: Bell et al., 2006) which included experiential measures of disruptions in 'Temporal-lobe Experience'. Participants who reported OBEs also reported significantly more visual illusions/distortions and significantly greater discomfort as a result of viewing the mid-frequency gratings. There were no such differences with respect to gratings with relatively lower or higher spatial frequency. The OBE group also produced significantly elevated scores on the CAPS measures of Temporal-lobe Experience, relative to controls. Collectively, the results are consistent with there being a neural 'vulnerability' in the cortices of individuals pre-disposed to some hallucinations, even in the non-clinical population.

Cognitive correlates of the spontaneous out-of-body experience (OBE) in the psychologically normal population: evidence for an increased role of temporal-lobe instability, body-distortion processing, and impairments in own-body transformations.

Recent findings from studies of epileptic patients and schizotypes have suggested that disruptions in multi-sensory integration processes may underlie a predisposition to report out-of-body experiences (OBEs: Blanke et al., 2004; Mohr et al., 2006). It has been argued that these disruptions lead to a breakdown in own-body processing and embodiment. Here we present two studies which provide the first investigation of predisposition to OBEs in the normal population as measured primarily by the recently devised Cardiff anomalous perception scale (CAPS; Bell et al., 2006). The Launay-Slade Hallucination scale (LSHS) was also employed to provide a measure of general hallucination proneness. In Study 1, 63 University students participated in the study, 17 of whom (26%) claimed to have experienced at least one OBE in their lifetime. OBEers reported significantly more perceptually anomalies (elevated CAPS scores) but these were primarily associated with specific measures of temporal-lobe instability and body-distortion processing. Study 2 demonstrated that OBEers and those scoring high on measures of temporal-lobe instability/body-distortion processing were significantly impaired, relative to controls, at a task requiring mental own-body transformations (OBTs) (Blanke et al., 2005). These results extend the findings from epileptic patient studies to the psychologically normal population and are consistent with there being a disruption in temporal-lobe and body-based processing underlying OBE-type experiences.