The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science

TY - JOUR

T1 - The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science

AU - Holmes, Emily A.

AU - Ghaderi, Ata

AU - Harmer, Catherine J

AU - Ramchandani, Paul G

AU - Cuijpers, Pim

AU - Morrison, Anthony

AU - Roiser, Jonathan P.

AU - Bockting, Claudi L H

AU - O'Connor, Rory C.

AU - Shafran, Roz

AU - Moulds, Michelle L

AU - Craske, Michelle G.

N1 - Funding Information: How can we ensure that the next generation of research leaders, both clinical and basic, are able to bridge the growing divide between their fields? One priority is to provide extra opportunities for academic training to trainees and qualified practitioners, and to attract those with a strong aptitude for research. In the UK, although competition for places on professional doctoral courses in clinical psychology is intense, and they recruit students who are highly academically able, very few graduates subsequently have a career in clinical research. Funding opportunities for the academic training of qualified clinical psychologists are highly competitive. That said, some major UK research funding bodies, such as the National Institute for Health Research (NIHR) and the Medical Research Council, offer academic training pathways for clinicians. These training pathways offer clinically qualified, non-medical health-care professionals the chance to undertake a PhD, while covering a clinical-level salary, tuition, travel, training costs, and research consumables. This training provides a valuable springboard for a career in clinical research, but there is scope for uptake by more clinical psychologists than at present, in part because they might not be aware of these opportunities or have sufficient support or research experience to develop a strong application. Another way of improving academic training in clinical psychology would be to create longer training programmes specifically for those trainees with a strong aptitude for research. These courses could be similar to the North American PhD model, providing students with sufficient time to complete an extensive research project and teaching relevant scientific material alongside clinical skills. The Psychological Clinical Science Accreditation System model that has been developed in the USA, which emphasises the science of clinical psychology in training and internships, would also be an effective way of increasing opportunities for research training. A similar training model is offered at The University of New South Wales (UNSW), Sydney, Australia, in which students are enrolled in a clinical training programme and a PhD programme concurrently, and they are awarded both degrees at the conclusion of their course (eg, Master of Psychology [Clinical] and PhD). Training pathways also need to be developed for mental health researchers that cultivate an interdisciplinary approach both between clinical psychology and psychiatry, and between disciplines of clinical mental health and a variety of relevant basic research. One possible way to achieve this interdisciplinary approach would be to encourage clinical psychologists to undertake internships or placements in basic-research settings across a range of relevant disciplines, from economics and social science, to neuroscience and genetics. Psychiatrists in the UK already have such an opportunity through the NIHR Academic Clinical Fellowships scheme, but no equivalent programmes seem to be available for clinical psychologists, in either the UK or other European countries. Multiskilled clinical academics, trained in an interdisciplinary environment, would have the advantage of being able to speak the languages of both clinical and basic research. They would also be best placed to develop the metaprofessional skills needed to do truly interdisciplinary translational research, and to use the knowledge derived from basic research to drive innovation in the development of psychological treatments. Funding Information: We see mental health as a substantial global challenge, but at the same time we recognise that nowadays we are faced with an array of pressing priorities that demand global attention and action, including, but in no way limited to: climate change, international conflicts, famine, and the displacement of millions of people from their home countries. Notwithstanding that many such substantial problems exist in the world, in the domain of mental health, we call for increased research efforts to advance psychological treatments, so that more effective interventions will serve as an essential part of our set of approaches that are needed to make an impact upon the burden of mental disorders worldwide and improve lives. We acknowledge that our call for developments in psychological treatments for mental disorders is but one endeavour in the context other similar timely initiatives. For example, Wykes and colleagues 338 have laid out six key priorities for a mental health research agenda for Europe and worldwide. Mental health is increasingly being recognised as an area that needs to move forward on a global scale. Furthermore, psychological inter-ventions can be applied not only to mental disorders, but have been increasingly of use across a range of areas—eg, in changing health behaviour, managing the psycho-logical aspects and effects of physical health problems (ie, pain management and somatic concerns, psycho-oncology), and instituting organisational change. Clinicians, researchers, patients, carers, funders, commissioners, managers, policy planners, change experts, and the general public all have a part to play in innovating psychological therapies, and a focus on any one of the ideas presented in this Commission has the potential to bring about substantial and much-needed improvements. More ideas will be needed than just those included here. This Commission is not a specific roadmap, all relevant areas of research and mental health science need to be considered to gain traction in this endeavour. Innovations arising from thoughtful effort have genuine potential to transform the science and practice of psychological therapies, and the lives of all of those who are affected by mental disorders. For the Headspace initiative see https://www.headspace.org.au For COMET website see http://www.comet-initiative.org/about/overview For more on the UK National Institute for Health Research fellowship for research see https://www.nihr.ac.uk/funding-and-support/funding-for-training-and-career-development/training-programmes/nihr-hee-ica-programme/nihr-hee-ica-programme-cdrf.htm For more on the UK Medical Research Council Clinical Research Training Fellowship see http://www.mrc.ac.uk/skills-careers/fellowships/clinical-fellowships/clinical-research-training-fellowship-crtf/ For the German Association for Psychiatry, Psychotherapy and Psychosomatics website see https://www.dgppn.de/ For Society for a Science of Clinical Psychology website see http://www.sscpweb.org/ For the Science in Transition website see http://scienceintransition.nl/ For Beacon website see https://beacon.anu.edu.au For the James Lind Alliance website see http://www.jla.nihr.ac.uk/ Contributors All authors contributed equally. Declaration of interests EAH reports her primary affiliation is the Division of Psychology, Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. She is an Honorary Professor of Clinical Psychology at the University of Oxford, Oxford, UK, in the Department of Psychiatry, and holds an honorary position at the Medical Research Council's (MRC's) Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK, and receives no renumeration for these roles. She serves on the board of the charity MQ: Transforming Mental Health and receives no remuneration for this role. She is on the board of overseers for the charity Children and War Foundation, Oslo, Norway, and receives no remuneration for this role. She is an associate editor for Behaviour Research and Therapy , for which she receives an honorarium, and was a founding associate editor for Clinical Psychological Science . She is on the editorial board of Psychological Science and Cognitive Behaviour Therapy and receives no remuneration for these roles. She has presented keynote addresses at conferences, such as European Association for Behavioural and Cognitive Therapies (EABCT), and received an honorarium for this. She has presented clinical training workshops, some of which include a fee. She receives royalties from her co-authored book Oxford Guide to Imagery in Cognitive Therapy . AG is a Professor of Clinical Psychology at the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. He is on the editorial board of Behaviour Research and Therapy and receives no remuneration for this role. He has presented clinical training workshops and provided supervision to clinicians at eating disorder treatment units, most of which include a fee, but are not related to the current contribution. He also receives royalties from his co-authored books on eating disorders and body image. CJH has received consultancy fees from P1vital, Lundbeck, and Servier. She has grant incomes from Johnson & Johnson, UCB Pharma, Lundbeck, and Sunovion. She is employed by the University Department of Psychiatry at Oxford University, Oxford, UK, and holds an associate Professorship at the Department of Psychology, University of Oslo, Oslo, Norway. She is an associate editor for Psychological Medicine , for which she receives an honorarium. PGR reports grants from the UK National Institute for Health Research (NIHR) outside the submitted work. He is employed by Imperial College London, London, UK, and Central and North West London Foundation National Health Service (NHS) Trust. He has been involved in the development and adaption of psychological interventions, but receives no payments from these. PC is Head of the Department of Clinical, Neuro and Developmental Psychology at the Vrije Universiteit, Amsterdam, for which he receives his annual salary. He is deputy editor of Depression and Anxiety , for which his university receives a fee. He is also leader of the Mental Health Program of the EMGO Institute for Health and Care Research at the Vrije Universiteit and Vrije Universiteit Medical Center in Amsterdam, Honorary President of the Canadian Psychological Association (until June, 2017), coordinator of the Global Consortium for Depression Prevention, a member of the Guideline Development Panel for Depressive Disorders of the American Psychological Association, Chair of the Sir Henry Wellcome Building for Mood Disorders Research Expert Advisory Board in Exeter, UK, adviser for several national and international research projects, and a member of the editorial board of several scientific journals; he receives no remuneration for any of these positions. He does receive expense allowances for his membership of the Board of Directors of the Fonds Psychische Gezondheid and Korrelatie, and for being Chair of the Parliamentary Assistance Coordination Office Committee of the Raad voor Civiel-militaire Zorg en Onderzoek of the Dutch Ministry of Defence. He also receives royalties for books he has authored or co-authored and for occasional workshops and invited lectures. APM's primary affiliation is the School of Psychological Sciences, University of Manchester, Manchester, UK. He is also Director of the Psychosis Research Unit, Greater Manchester West NHS Trust, Manchester, UK. He serves on several editorial boards and receives no remuneration for these roles. He has presented keynote addresses at conferences and given clinical training workshops, some of which have included a fee. He receives royalties from several co-authored and edited books. He delivers cognitive behavioural therapy within the UK NHS and has received funding from both the MRC and UK NIHR to do evaluative research into the efficacy of psychological therapies. JPR is a consultant for Cambridge Cognition and Takeda. He is an associate editor for Neuroimage: Clinical and receives an honorarium for this role. He is a handling editor at Royal Society Open Science and is on the Editorial Board of Computational Psychiatry ; he receives no renumeration for these roles. He has received the British Psychological Society's Spearman Medal, the British Association for Psychopharmacology's Senior Award, and a Philip Leverhulme Prize in Psychology. He has received renumeration for acting as a panel member for the Research Council of Norway. None of these positions or awards have any direct relation to this Commission. CLHB is Professor of Clinical Psychology at the Department of Psychiatry at the Academic Medical Center at the University of Amsterdam, Amsterdam, Netherlands, and at the University of Groningen, Groningen, Netherlands. She also has a Guest Professorship at the Faculty of Psychology and Pedagogy at Ghent University, Ghent, Belgium. She is co-editor of PLoS ONE, and receives no honorarium for this role. She serves on the board of the section for Affective Disorders at Dutch Cognitive Behavioural Association and is a boardmember of the Dutch multidisciplinary guideline for anxiety and depression; she receives no remuneration for this role. She is an adviser for the minister on National Health Care in the Netherlands on issues of care for inclusion in the statutory insured package (Advies Pakket Commissie, ZIN); she receives an honorarium for this role and it has no direct relation to the current contribution. She has received a fellowship at the Netherlands Institute of Advanced Sciences, supported by the Royal Netherlands Academy of Arts and Sciences and this is not directly related to the current contribution. She has given keynote addresses at conferences such as EABCT 2014 and the European Conference of Psychology and received an honorarium. She has given clinical training workshops, some of which included a fee. She receives royalties from her books and co-edited books. RCO'C's primary affiliation is the Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK, where he heads the Mental Health and Wellbeing Research Group. He is also Director of the Suicidal Behaviour Research Laboratory at the University of Glasgow. He is joint chief editor for Archives of Suicide Research and associate editor for Suicide and Life-Threatening Behavior and Behavior Therapy . He also serves on several editorial boards and is a current Vice President of the International Association for Suicide Prevention and past President of the International Academy of Sucide Research. He receives an honorarium for his role at Behavior Therapy , but does not receive a remuneration for any of the other roles. He was a member of the National Institute of Health and Care Excellence's guideline development group for the longer-term management of self-harm and he is a member of Health Education England's Self-Harm & Suicide Prevention Competence Framework Expert Reference Group. He sits on the Scottish Government's Suicide Prevention and Implementation Monitoring Group. He receives royalties from one co-authored and several co-edited books, occasional workshops, and invited addresses. RS served as a Senior Adviser for the MQ: PsyImpact programme from February, 2015, to February, 2016. She was a consultant for Big Health. She also receives royalties for books she has authored or co-authored (American Psychological Association Books, Elsevier Press) and occasional workshops and invited addresses. MLM's primary affiliation is the School of Psychology, UNSW, Sydney, NSW, Australia, where she is a Professor and PLuS Alliance Fellow. She is a consulting editor of the Journal of Experimental Psychology: Applied and Clinical Psychological Science , and a member of four additional editorial boards; she receives no remuneration for these roles. She has given keynote addresses at conferences and for some of these she has received honoraria. MGC's primary affiliation is the Department of Psychology, University of California, Los Angeles (UCLA), CA, USA, where she is Vice Chair, which provides her annual salary, supplemented by summer funds from grants from the US National Institute of Mental Health or the Defense Advanced Research Projects Agency. She is editor-in-chief of Behaviour Research and Therapy and associate editor of Psychological Bulletin , for which she receives remuneration. She is director of the UCLA Anxiety and Depression Center; co-director of the UCLA Staglin Family Music for Behavioral and Brain Health; former President of the Association for Behavior and Cognitive Therapy; co-chair of the Human Studies Section of the UCLA Grand Challenge for Depression; member of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Steering Committee for the American Psychiatric Association; member of the Scientific Advisory Board for the Center of Excellence on Generalization Research at the University of Leuven, Leuven, Belgium; Honorary Member of the Experimental Psychopathology Group (Dutch-Flemish Postgraduate School for Research and Education); and Honorary Fellow of the Department of Psychiatry at Oxford University, Oxford, UK. She receives no remuneration for any of these positions. She received remuneration for her awards as Eleonore Trefftz Guest Professorship (Technical University of Dresden, Dresden Germany) and the International Francqui Professor (Univeristy of Leuven). She also receives royalties for books she has authored or co-authored (American Psychological Association Books, Elsevier Press) and occasional workshops and invited addresses. Acknowledgments Additional contributors who also attended The Lancet Psychiatry meeting in London, UK, in December, 2015 include: E Barley, N Balmer, S E Blackwell, M Browning, K Carroll, S Cartwright-Hatton, C Creswell, T Dalgleish, M Di Simplicio, S Dix, B Dunn, P Fearon, C Hirsch, J M Hooley, L Iyadurai, S Jones, S Kamboj, A Milton, A Reinecke, U Schmidt, and M Van Ommeren. We also thank C Fairburn and G Goodwin for helpful discussions. We thank R Emsley for his consultancy regarding clinical trial methodology, and we thank L Iyadurai and E L James for help preparing the manuscript. We are grateful for support from MQ: Transforming Mental Health for travel expenses to the Commission meeting held by The Lancet Psychiatry . EAH is supported by the Karolinska Institutet and the Lupina Foundation of Toronto. She has received support from the MRC intramural programme (MRC-A060–5PR50) and the NIHR Oxford Biomedical Research Centre Programme. AG is supported by the Swedish Foundation for Humanities and Social Sciences (Riksbankens Jubileumsfond). CJH has research funding from the Wellcome Trust, MRC, and the NIHR Oxford Health Biomedical Research Centre. PGR has funding from the NIHR to develop and evaluate early interventions in randomised controlled trials, and receives support from the Imperial NIHR Biomedical Research Centre. PC has funding from the European Union (FP7 and H2020 programmes), ZonMw (Dutch Health Research Council), and the Protestants Fonds Geestelijke Volksgezondheid (Protestant Foundation for Mental Health). APM has received funding from the NIHR. JPR is funded by the Wellcome Trust. CLHB is supported by the Department of Psychiatry at the Academic Medical Center of the University of Amsterdam, and the Netherlands Institute of Advanced Sciences (2017), which is supported by the Royal Netherlands Academy of Arts and Sciences. RCOC has received funding from the US Department of Defense, NIHR, NHS, NHS Greater Glasgow and Clyde, NHS Health Scotland, MRC, MQ: Transforming Mental Health Research, the Chief Scientist Office, and the Scottish Government. RS's research at Great Ormond Street Hospital, NHS Foundation Trust and Univeristy College London Great Ormond Street Institute of Child Health, London, UK, is supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre. MLM is supported by the Australian National Health and Medical Research Council. She also receives support from the PLuS Alliance Fellows Funding Scheme (UNSW, Sydney, Australia). MGC is funded by the US National Institutes of Mental Health (R01 MH1001171, R01 MH1014531, R34 MH101359, R01 MH102274), the US Defense Advanced Research Projects Agency (R21 MH1010336), and the US National Aeronautics and Space Administration (NNX15AP57G). The views expressed in this Commission are those of the authors and are not necessarily those of any of the funding bodies or agencies.

PY - 2018/3

Y1 - 2018/3

KW - Journal Article

KW - Review

UR - http://www.scopus.com/inward/record.url?scp=85042499691&partnerID=8YFLogxK

U2 - 10.1016/S2215-0366(17)30513-8

DO - 10.1016/S2215-0366(17)30513-8

M3 - Review article

C2 - 29482764

SN - 0140-6736

VL - 5

SP - 237

EP - 286

JO - The Lancet

JF - The Lancet

IS - 3

ER -