Marinela Congess Centre Lobby + Sofia 1 Exhibition Area

General Mental Health - B

275: Cognitive bias modification for hostile interpretation: An experimental trial in male personality disorder patients and non-patient controls

Martijn van Teffelen, Jill Lobbestael, Maastricht University

The tendency to misinterpret ambiguous information as hostile (i.e., hostile interpretation bias) has been shown to have a causal link with transdiagnostic anger. This, in turn, is observed to be a potent predictor of treatment failure and drop-out across psychopathology. Cognitive bias modification for interpretation (CBM-I) has been found to effectively reduce psychopathology through a learned association between emotional ambiguity and benign interpretation of everyday situations. The present work evaluated the efficacy of CBM-I for hostile interpretation bias in a mixed sample of male personality disorder patients with clinical anger (n=13) and non-patient controls (n=19). We expected an increase in benign interpretation, a decrease in hostile bias, state anger and reactive aggression after 8 sessions of CBM-I, compared to an active control condition. Results confirmed an increase in benign interpretation and a decrease in hostile bias and state anger in the experimental condition. Change in reactive aggression in the experimental condition was not observed. These findings provide a first insight in the promising potential of CBM-I for transdiagnostic anger.

274: Psychometric characteristics of the Bulgarian version of the Anxiety Sensitivity Index

Dimitar Nedelchev, Elena Psederska, Kiril Bozgunov, Georgi Vasilev, Bulgarian Addictions Institute, Sofia, Bulgaria;  Jasmin Vassileva, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond VA, USA

The anxiety sensitivity (AS) firstly called “fear of fear” is a construct well-known in clinical practice, mainly because it is linked to a number of disorders- primarily in the anxiety spectrum and also in substance abuse. The poster evaluates psychometric properties of the Bulgarian version of one of the most widely used measures of Anxiety sensitivity - Anxiety Sensitivity Index (ASI). It is 16-item self-report measure. The Bulgarian translation form of ASI was completed by 514 (males= 363) participants, some of whom were in a protracted abstinence, from amphetamine (N= 87), heroin (N= 106) or polysubstance (N= 123) dependence as well as „pure“ controls (N= 198). The scale showed very good internal consistency (α = .84). Individuals with past history of substance abuse demonstrated higher scores of anxiety sensitivity compared with controls. ASI displayed relationships with both internalizing and externalizing psychopathology spectrums. The properties of the scale showed that it can be used in Bulgarian population as an additional diagnostic tool in treatment of anxiety related problems.

270: Can decentering and compassionate skills buffer the depressogenic effect of the shame feelings?

Trindade, I. A., Ferreira, C., Mendes, A. L., & Marta-Simões, J., Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC)

Evidences have consistently shown that shame feelings are highly associated with several psychological difficulties, namely depressive symptoms. Prior studies suggested that the depressogenic effect of shame depends on the way ones cope with perceptions of inferiority and inadequacy. Decentering and self-compassionate skills are both adaptive emotional processes linked with lower levels of psychological difficulties. Nevertheless, the potential helpful role of adaptive emotion processes to cope with this painful emotion is still not clear. Objective:This study aimed to explore the moderator effect of decentering and self-compassionate skills on the relationship between general feelings of shame and depressive symptomatology.
The current sample comprises 955 adults from the community, with ages ranging from 18 and 60 years. Moderations analyses were conducted, to explore the protective role of decentering and self-compassionate skills in face of shame feelings, through a hierarchical regression analysis.
Results corroborated the moderator effects of these adaptive emotional processes. Current findings revealed that decentering and self-compassionate abilities buffers the impact of shame on depression symptoms, with the tested model accounting for 33% and 31% of the variance of depressive. The visualization of these results allowed to observe that for the same levels of shame, participants who reported higher levels of decentering and self-compassion tend to present lower experience of depression symptoms.
Findings suggest that both the ability to observe and cope with unwanted experiences as subjective and temporary events (i.e., decentering abilities) and self-soothing and compassionate skills are effective emotional processes to consider in well-being programs.

269: Psychological flexibility’s role in the association between attachment, shame and depressive symptoms

Ana Laura Mendes, Cláudia Ferreira, Cognitive and Behavioural Centre for Research and Intervention (CINEICC),  Faculty of Psychological and Education Sciences, University of Coimbra, Portugal

Research has emphasized the significant role of attachment interactions on well-being and mental health. For instance, literature suggests that attachment relationships, when associated with empathy, warmth, and security feelings, may associate with later positive social comparison. On the other hand, insecure attachment is reported to be associated with unfavorable social comparisons, depression and anxiety symptoms, and submissive behaviours. Furthermore, negative emotional and affiliative interactions and a lack of a secure base to regulate adverse feelings are associated with the development of different mental health conditions, and with feelings of insecurity, such as shame. Shame is a powerful emotion characterized by the perception that others evaluate the self as weak, defective and unattractive (i.e., external shame). This painful emotion is known to play a significant role in the development and maintenance of psychopathological conditions, namely depressive symptomatology. Previous literature has identified psychological flexibility, defined as the ability to be open, in touch with the present moment, and to modify or persist in behavior according to life experiences and values, as being associated with resilience, mental health and well-being and with a buffer of psychological distress symptoms.
The present study aimed to test whether the association between attachment, external shame and depressive symptoms would be explained by psychological flexibility. This hypothesis was explored through path analysis. 
The study’s sample comprised 114 women from the Portuguese general population, aged between 18 and 61 years old, who completed self-reported measures.
The path model accounted for 23% of external shame, 43% of psychological flexibility and 56% of depressive symptoms, and showed excellent model fit indices. Results seem to demonstrate that a secure attachment style is associated with lower levels of external shame. Additionally, the model suggests that the relationship between external shame and depressive symptomatology is partially carried by lower levels of psychological flexibility. Conclusions:
Overall, findings of the current study support the importance of establishing secure attachment interactions, characterized by acceptance, security and support, to one´s later mental health and well-being. Furthermore, our results appear to have significant clinical implications, by highlighting the importance of targeting maladaptive emotion strategies through the development of psychological flexibility, specifically in prevention and intervention programs for depressed populations.

81: Motivation in the therapist’s speech

De Pascual, R.,  Universidad Europea de Madrid;  Galván, N., Alonso, J., Froxán, M.X.,  Universidad Autónoma de Madrid

Therapists often use their speech as a motivation tool to increase compliance with instructions or simply to create and maintain a better therapeutic alliance. These motivational utterances (verbalisations issued by the therapist that explicitly state the consequences of the client’s actions), however, are not randomly issued; rather, they tend to be grouped with other utterances that might benefit from their closeness. This research explores the relation between motivational utterances and other verbalisations issued by the therapist.
Using a coding system, 98 clinical sessions were analysed, and motivational utterances were coded and classified. Motivational blocks were defined as parts of the therapist’s speech that include one or more motivational utterance and that deal with a particular topic (an instruction, a specific issue…). Motivational blocks throughout the sample were then analysed to find out which verbalisations were more likely to be issued alongside a motivational utterance. There were 808 motivational blocks in the sample.
In the sample, 136 informative utterances, 149 instructional utterances, 10 verbalisations with a reinforcer topography and 2 with a punishment topography were found. These data point to a per-block average for informative, instructional, reinforcing and punishing verbalisations of 0.168, 0.184, 0.012 and 0.002, respectively.
It seems that the therapist is indeed using the motivational utterance as a tool to increase the odds of the client complying with a specific instruction, or, alternatively, to drive home an explanation of their situation.

79: Verbal interaction patters in clinical contexts with severe and persistent mental illnesses diagnosed participants.

Alejandra Álvarez-Iglesias, Jesús Alonso-Vega, Imanol Campo and María Xesús Froxán-Parga, Universidad Autónoma de Madrid

Severe and persistent mental illnesses (SPMI) -schizophrenia and other psychotic disorders, bipolar disorders and personality disorders- are associated with different degrees of disability depending on the difficulties for their autonomous development, which requires a large amount of resources not only by the caregivers but also by society. These problems suppose a great economic cost and generate a great suffering not only to the people who present it but also to those who are around him. Psychological interventions have been introduced over the years in health systems to treat these types of problems. However, the learning processes -which occur in the verbal interaction and allow clinical change- have been little studied.
The aim of this study is to analyze the verbal interaction patters that occur in clinical contexts with severe and persistent mental illnesses diagnosed participants. Sixty-six therapy sessions were recorded in care centers of the public network of social care for people with disabilities. Different cases (n=23) were analyzed, all of them were adults with diagnoses of personality disorders, mood disorders, bipolar disorder or schizophrenia. The Verbal Behavior Categorization System for Severe and Persistent Mental Illnesses (VB-CS-SPMI) have been used to register the therapist verbal behavior and the patient verbal behavior. Once the results were obtained, they were analyzed through a sequential analysis. Results:
The results obtained show the reciprocal influence between the behaviors of both parties of the intervention: We have witnessed how the more directive the therapist is with regard to the instructions that he/she gives, the better the response the user emits. Further, we have also noticed that the therapist refrains from using punishment following anti-therapeutic verbalizations. This is especially true after the realization that the user will not – or has not – followed the instructions, as well as after expressions of the so-called positive symptoms. Finally, we have seen a certain lack of consistency in the use of different verbalizations categorized within the different hypothetical levels of reinforcement: The therapist sometimes reinforces with the same level of strength both pro-therapeutic and neutral verbalizations, and sometimes even expresses strong reinforcements following anti-therapeutic verbalizations.
These results may indicate certain similarities between the immediate context in which these problems are maintained, and the therapeutic context. Recalling that these problems may be sustained by avoidance of aversive stimulation and lack of skills to access potent delayed reinforcements, the lack of instructions and the inconsistent use of reinforcement and punishment not only hinders the acquisition of the skills that the person needs, but exposes him/her to an erratic and compassionate context similar to that which keeps problems out of session.

74: Which emotion regulation strategy is mediating the relationship between temperament, marital adjustment and postpartum depression of mothers with a 3-12 months old baby?

Müyesser Fazlıoglu, Özden Yalçınkaya-Alkar, Department Psychology of Ankara Yıldırım Beyazıt University, Ankara, Turkey

Birth and postpartum period can be a great sources of stress for women. It is of great importance to investigate the psychological factors related to this issue and to understand the underlying mechanism of postpartum depression. Thus, the first aim of this study was to examine the relationship between the depression level of mothers with a 3-12 months old baby and their temperament and marital adjustment levels. Secondly, it was aimed to investigate the mediating role of emotion regulation strategies in the relatonship between temperament, perceived marital adjustment and postpartum depression of mothers with a 3-12 months baby.
357 mothers with a 3-12 months baby between the ages of 20-45 participated in the study voluntarily. Mothers filled out the Demographic Form, Emotion Regulation Questionnaire, Adult Temperament Questionnaire, Dyadic Adjustment Scale and Edingburgh Postpartum Depression Scale.
In this study, in addition to multiple regression analyzes, mediation analyzes were used to examine the indirect effects of independent variables, temperament and perceived marital adjustment of mothers, on postpartum depression. Reappraisal and supression as emotion regulation strategies were mediators. Negative affect, effortful control and extraversion/surgency factors of mother temperament features and marital adjustment were independent variables. The indirect effects of negative affect, effortful control and extraversion/surgency factors of temperament and marital adjustment on postpartum depression were significant with the mediating role of reappraisal as an emotion regulation strategy. However, the mediating role of supression was not significant. In addition, according to the result of regression analysis three factors of mother temperament, negative affect, effortful control and extraversion/surgency, marital adjustment,  and reappraisal and suppression factors of emotion regulation strategies explained the 33% of the total variance in postpartum depression. 
The findings of the study showed that the relationship between mother’s negative affect, effortful control, extraversion/surgency and marital adjustment with postpartum depression might be through the reappraisal as an emotion regulation strategy. Moreover, postpartum depression was predicted significantly by negative affect, effortful control, extraversion/surgency factors of mother temperament, marital adjustment and reappraisal and suppression factors of emotion regulation strategies. Results of the study were discussed in the light of the literature.  
Keywords: Postpartum Depression, Emotion Regulation, Temperament, Marital Adjustment.

55: Moral injury and occupation: A meta-analysis and systematic review

Victoria Williamson, Sharon Stevelink, Neil Greenberg, Kings College London

Many people may confront potentially morally injurious experiences in the course of their work can which violate deeply held moral values or beliefs, putting them at risk for psychological difficulties (e.g. post-traumatic stress disorder [PTSD], depression, etc.).
To clarify the impact of moral injury on wellbeing, we conducted a systematic review and meta-analysis of 13 studies that investigated the association between work-related moral injury and mental health disorders (total n = 6,373).
Studies were independently assessed for methodological quality and potential moderator variables were also examined.
Moral injury was found to account for 9.4% of the variance in PTSD, 5.2% of the variance in depression, and 2.0% of the variance in suicidality. Moral injury was associated with more symptoms of anxiety and behavioural problems (e.g. hostility), although this relationship was not consistently significant.
Most studies examined occupational moral injury in military samples and additional studies investigating the impact of moral injury on civilians are needed. Given the limited number of high quality studies available, only tentative conclusions about the association between moral injury and mental health disorders can be made.

51: What are the Roles of Individuation, Attachment and Personality on Psychological Adjustment?: Examination of Individuation, Neuroticisim and Insecure Attachment

Orçun Yorulmaz, Department of Psychology, Faculty of Letters, Dokuz Eylul University, Izmir-Turkey

Transition to college life for an individual is a critical stressful life event which can result in troubles in psychological adjustment, functioning and even physical health through cognitive processes. Outcome of this transition depends on many factors, including various socio-economic conditions and psychological variables. Unlike previous research, it is focused on the role of parental attachment, personality characteristics and ways of coping together with individuation factor on the adjustment in this cross-sectional study. Although one of main developmental tasks at that period is healthy individuation which refers functional separateness without negative feelings but connectedness to some degree, the present research question is whether this statement would be verified, as cultural context and some other relevant factors in the light of research findings are taken into account. Self-report instruments on adjustment, attachment, personality, coping and individuation/separation were completed by Turkish 277 freshmen who have attended in prep school. The analyses of correlation and hierarchical regression showed that those students who were high on neuroticism, who tend to use avoidance and superstition more seem to report more problems in adjustment, and they also had insecure attachment pattern with more difficulties in individuation. Furthermore, being inspired by some previous research findings (e.g., Mattanah et al., 2004), we tested mediator role of individuation problems, and confirmed it for the relationships of neuroticism as well as insecure attachment with psychological adjustment. In other words, it appears that neuroticism and insecure attachment contribute to individuation problems, which in turn bring about difficulties in adjustment. In sum, it seems that in addition to cross cultural verification of this process, prevention and counseling programs supporting not only freshman’s adaptation to new life but also healthy disengagement process and adaptive coping strategies would be beneficial particularly for those students having certain personality traits, attachment style with dysfunctional ways of coping.

49: Blended E-health in Schema Therapy; the use of SecureNest some early results and future plans

Sally Skewes, Joseph Skewes, Michiel van Vreeswijk, Secure Nest

Mental health is confronted with ever-shrinking resources while waiting lists become longer and longer and less therapy sessions are avaiable for patients. Specifically patients with chronically clinical syndroms and personality disorders need a sufficient amount of therapy time which unfortunately can more oftenly no longer be offered. This poster describes a new development in the treatment of patients with personality disorders and chronic clinical syndromes. The possibility of giving blended Schema Therapy using Secure Nest. This blended form has the potential to:  complement individual and group Schema Therapy. to provide high intensity treatment without over-taxing therapists. facilitates the availability and equitable delivery of treatment according to patient need. to add significant value to face-to-face Schema Therapy at a minimal cost. to reduce the number (&/or demands on therapist) of face-to-face sessions.Patients and therapists reported in preliminary results several potential benefits of Secure Nest. Part one of the poster describes: What is Secure Nest? Show how Secure Nest works, Part two: Some early results, Part three: future developments; making it suitable for blended group ST and self-help module.

Schema Therapy: Can We Work With The Schema Domains?

Peter Vassilev, Lubomira Tsvetkova, Institute of Ecology of Cognition, Bulgaria

With this study, we have the goal to make first steps in one bigger and deeper researching of the deficient behaviors, which arerepresentative for every one of the five Schema Domains. In a most concise form, this article presents the resultsreceived from а research, which focus was on the schemas from domain “Other-Directedness” – “Subjugation”; “Self-Sacrifice”; “Approval-Seeking/ Recognition – Seeking”. We have made thematic analysis of the data and we found out stable patterns. These behavioral patterns show that people with active Early Maladaptive Schema or Schemas from the domain “Other-Directedness” have hard difficulties to express an anger in their lives, in the sense of self-determination, expression of their natural inclinations, initiating activity etc. Instead of expressing and caring of their needs, we can note a trend, in which these people react through self - aggression or over - subjugation. In our work we will discuss how some of the Neo-Reichian psychotherapeutical techniques can be used to change these blocked behaviors for the Schema Domain “Other-Directedness” and also for each Schema from this domain. We will also discuss the opportunities and the sense of continuing this research to a full size, covering all five Schema Domains.

333: Examination of obsessive-compulsive disorder symptoms in terms of mental contamination and related variables: Structural Equation Modeling with Muslim University Students
Ilgun Bilekli, Mujgan Inozu, Hacettepe University Department of Psychology

Introduction Fear of contamination and washing compulsions are one of the most frequent symptom subtype of OCD (Calamari et al., 2004; Rasmussen & Eisen, 1992). Despite growing recognition that several affective and cognitive vulnerability factors may be critical to the development and maintenance of pathological mental contamination and OCD symptoms, specifically washing urges, there has been a relative dearth of empirical research examining serial associations among these factors that may further increase our understanding of this area. The aim of this study was to examine the associations among religiosity, contamination related thought action fusion, mental contamination and guilt to produce more severe OCD symptoms. The present study hypothesized that religiosity would predict contamination related TAF, which in turn would predict mental contamination, which in turn would predict feelings of guilt, and finally guilt would predict obsessive-compulsive symptoms. Method The study was composed 475 university students. The majority of participants (86.1%, n = 409) were female and Muslim (82.3%, n =391). The ages of participants range from 17 to 33 with a mean of 20.26 (1.84). Participants completed the questionnaires including Religious Fundamentalism Scale, Vancouver Obsessive Compulsive Inventory Mental Contamination Scale, Contamination Thought Action Fusion Scale, Guilt Inventory and Obsessive Compulsive Inventory-Revised. The roles of these variables are examined by Structural Equation Modeling. Results The hypothesized model yielded acceptable (degree of) fit to data: χ2 (df = 2, N = 475) = 2.79, p = .248, RMSEA = 0.03, CFI = 0.99, NFI = 0.99, IFI = 0.99. As seen in Figure (will be added), religiosity positively predicted contamination related TAF (β = 0.13, p = 0.005) and explained 2% of the variance. Religiosity also positively predicted feelings of guilt (β = 0.29, p < 0.001). Contamination related TAF positively predicted the mental contamination feelings (β = 0.45, p <0.001) and explained 20% of the variance. Mental contamination feelings predicted positively feeling of guilt (β = 0.38, p <0.001) and obsessive compulsive symptoms (β = 0.42, p <0.001). Guilt predicted obsessive compulsive symptoms (β = 0.18, p <0.001). All the variables predicted obsessive compulsive symptom level together and accounted 36% of variance. Discussion The results indicated that religiosity is an important variable that explains mental contamination with the mediation of contamination related thought action fusion (TAF). Furthermore, not only mental contamination feelings but also feelings of guilt predict OC symptom level. Clinicians should pay attention to these variables when evaluating the symptoms and try to understand these feelings and beliefs in therapy. Conclusion The findings are discussed as support for the conceptualization of mental contamination offered by Rachman (1994). The results suggest that strict religious codes may create a suitable ground for the increased mental contamination with misinterpretations related contamination related thoughts. Future studies should examine other internal and external negative emotions with different samples.

335: The Roles of Mental Contamination and Negative Emotions in the Relationship between Disgust Propensity and Washing Urges: Serial Mediation Analysis with Female University Students

Ilgun Bilekli, Mujgan Inozu, Hacettepe University Department of Psychology

Introduction Fear of contamination and washing compulsions are one of the most frequent symptom subtypes of OCD. However, in mental contamination phenomena these feelings of dirtiness can be triggered without any direct contact with a dirty object. A person can feel dirty as a result of images, thoughts, memories, immoral acts or assaults, physical or psychological violation (Rachman, 1994). Previous research has shown that heightened disgust propensity, as opposed to disgust sensitivity, may have greater relevance for obsessive compulsive disorders (OCD), especially contamination fears, because it reflects individual differences in reactivity to disgust stimuli. However, little evidence documents the specific role of disgust in mental contamination (Badour, Ojserkis, Mckay, & Felder, 2015). Therefore, the current study examined the association of disgust propensity with washing urges triggered by mental contamination within the context of mediating role of internal and external negative emotions. It was hypothesized that disgust propensity would increase mental contamination feeling evoked by non-consensual kiss paradigm, which in turn increases internal and external negative emotions and these increased internal and external negative emotions would evoke cleaning impulses. Method As a part of larger study, this study was composed 92 female university students who attended experimental part of this study. The mean age of participants was 20.29 (SD = 1.68). Participants listened either consensual or non-consensual scenario condition and filled a set of questionnaires included Baseline Ratings Form, Mental Contamination Report, Disgust Propensity and Sensitivity Scale-Revised. The roles of these variables are examined by serial mediation model (Model 6) proposed by Hayes (2012). Results The direct effect of disgust propensity on urges to wash positive but not statistically significant c’ = 3.873, t (88) = 1.082, p = .282, 95%CI -3.241 to 10.987. The results revealed only one significant indirect path that mediated the association between disgust propensity and washing urges. The significant indirect is the specific effect of disgust propensity on urges to wash through mental contamination feelings (feelings of dirtiness) and internal negative emotions, b = 2.285, 95% CI 0.578 to 5.087 in a serial manner. Discussion The positive significant indirect effect indicated that increased disgust propensity was associated with increased feeling of dirtiness that reported after listening scenario, which in turn resulted in stronger internal and external negative emotions. These negative emotions evoked a greater urge to wash body to relief these negative feelings and dirtiness. The results indicated accelerating influence of disgust propensity on mental contamination and washing urges. Conclusion The results indicated a more robust understanding of reciprocal relationships among affective and cognitive mechanisms underlying mental contamination, as well as washing urges felt after mental contamination. Disgust propensity and its association with other negative emotions seems play an important role in the etiology of mental contamination.

334: Attachment anxiety as a mediator between parental overprotection and obsessive beliefs in a Turkish sample
Ezgi Trak, Hacettepe University,Turkey

Introduction: Previous studies indicated that parenting rearing style characterized with high parental overprotection might be partly responsible for the occurrence of obsessive-compulsive symptoms. In addition, it has been suggested that attachment anxiety may be linked to the emergence of obsessive beliefs. The aim of this study was to examine the role of anxious attachment as a mediator in the relationship between recalled parental overprotection and obsessive-compulsive symptoms. Method: The sample of the study consisted of 538 Turkish adults. Participants completed self-report measures including Parental Bonding Instrument, Experiences in Close Relationships-Revised and Obsessive Beliefs Questionnaire-TRIP. We used Model 4 of PROCESS macro for SPSS (Hayes, 2013) to conduct a test of indirect effect. Results: Results of path modeling analysis revealed that anxious attachment mediated the relationship between high maternal overprotection and obsessive beliefs. Similarly, anxious attachment mediated the relationship between high paternal overprotection and obsessive beliefs. Discussion: To our knowledge, this was the first study to evaluate the mediator role of attachment anxiety in the relationship between relationship between parental overprotection and obsessive beliefs. Conclusion: Findings supported the link between childhood interpersonal problems and vulnerability to obsessional thinking in adulthood. However, findings are preliminary and further support is needed to establish generalizability of the findings.

125: Psychotherapy in Saudi Arabia: Its History and Cultural Context

Haifa Algahtani, Arabian Gulf University, Manama, Bahrain
Yasmine Buraik, Saudi Aramco Health Organization, Dhahran 31311, Saudi Arabia
Yasser Ad-Dab’bagh, Department of Mental Health, Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia & Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada

The introduction of modern mental healthcare standards and services in the Kingdom of Saudi Arabia (KSA), has resulted in a gradual shift towards a more positive perspective on mental health issues and related services, and has increased the demand for qualified mental health professionals and psychological interventions (WHO 2016). Despite recent advances in mental healthcare services, psychopharmacology remains the main treatment modality for the majority of mental health issues in KSA. Psychotherapy has had a rather slow developmental trajectory in KSA, and its provision requires an understanding of many specific aspects of Saudi culture (Dubovsky 1983). This paper will shed light on the historical development and current challenges of psychiatric and psychological services and the availability of psychotherapy in KSA. By offering an explication of a selection of local social phenomena, this paper will attempt to explain how unique Saudi cultural constructs and social contexts influence the training, perception, and practice of psychotherapy in the country, outlining existing challenges as well as some expected future directions.



339: PRotect after depression: a randomised pilot study of a brief wellbeing intervention
Katherine Clarke, University College London

Depression is a common mental health problem with several effective treatment options, but with high rates of relapse following recovery. To target and reduce this risk of relapse we designed a brief supplement to acute treatment, the PRotect intervention. It focusses on wellbeing and encourages self-efficacy, and includes a self-help booklet, guided workshop and review call. The purpose of this randomised pilot study was to test its feasibility, and potential for efficacy, in an ecologically valid setting.
Participants were recruited from NHS ‘Improving Access to Psychological Therapies’ (IAPT) services following successful depression treatment and randomly allocated to the PRotect intervention (n=41) or to be discharged (n=42). Participants were interviewed at study entry and at 3- and 6-month follow-up; and completed measures of depression symptoms, anxiety symptoms, functional impairment, and use of the intervention. The primary efficacy outcome was ‘relapse’, defined as meeting DSM-V criteria for an episode of major depression, using the Longitudinal Interval Follow-up Evaluation (LIFE).
There were half as many relapses in the intervention arm by 6-months. Overall, relapse rates were low. Mean symptom scores remained steady in the intervention arm but deteriorated in the control arm at 3 and 6 months. Most participants reported finding the intervention useful and introducing new wellbeing activities into everyday life, some of which were maintained.
The PRotect intervention was feasible to offer routinely after acute treatment. It has the potential to reduce risk of relapse and maintain wellbeing.

The trial is registered with the ISRCTN (ISRCTN17371456) and has ethical approval from an NHS REC (Camden and King’s Cross NHS Ethics Committee 14/06/2016, ref: 16/LO/0652). A manuscript is under review at the moment.