scholarly journals General practitioner referral of older patients to Improving Access to Psychological Therapies (IAPT): an exploratory qualitative study

2018 ◽  
Vol 42 (3) ◽  
pp. 115-118 ◽  
Author(s):  
Noel Collins ◽  
Laurie Corna
Keyword(s):  
Older Adults ◽  
General Practitioner ◽  
Thematic Analysis ◽  
Older Patients ◽  
Watchful Waiting ◽  
Behavioural Therapy ◽  
Clinical Implications ◽  
Psychological Therapies ◽  
Cognitive Behavioural ◽  
Willingness To Refer

Aims and methodTo understand general practitioner (GP) reticence to refer older patients to a local Improving Access to Psychological Therapies (IAPT) service providing mostly cognitive–behavioural therapy (CBT)-based interventions. Semi-structured, hour-long interviews were conducted with eight GPs and then analysed by modified grounded theory and thematic analysis.ResultsGP views regarding the treatability of older adults with CBT influenced their willingness to refer to a CBT-based IAPT service. Perceptions of local IAPT assessment processes being distressing and onerous to older patients also motivated referral inaction. GPs expressed a preference to treat depressed older patients themselves (with medication and psychological approaches such as watchful waiting).Clinical implicationsAny strategy to increase referral rates of older adults to CBT-based IAPT services should address local GP concerns regarding assessment processes and the effectiveness of offered treatments.Declaration of interestNone.

scholarly journals Practitioners’ experiences of working collaboratively with interpreters to provide CBT and guided self-help (GSH) in IAPT; a thematic analysis

2018 ◽  
Vol 11 ◽  
Author(s):  
Lumka Tutani ◽  
Clare Eldred ◽  
Catherine Sykes
Keyword(s):  
Thematic Analysis ◽  
Behavioural Therapy ◽  
Structured Interviews ◽  
Psychological Therapies ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Communication Difficulties ◽  
Physical Health Problems ◽  
Collaborative Working ◽  
Culture And Language

AbstractWithin IAPT (Improving Access to Psychological Therapies), cognitive behavioural therapy (CBT) is offered to all clients regardless of gender, religion, culture and language. Hence, the demand for working with interpreters to facilitate communication during therapy in IAPT has increased. This study explored the experience of therapists working with interpreters to facilitate communication in psychological therapies with clients with mild to moderate anxiety and depression including those with co-morbid physical health problems. Thirteen participants, including six CBT therapists and seven Psychological Wellbeing Practitioners (PWPs) working in an NHS IAPT service, were interviewed. A qualitative approach, using semi-structured interviews and thematic analysis (Braun and Clarke, 2006), was implemented. The following four major themes were identified from the participants’ accounts: negotiating a three-way communication, difficulties in expressing empathy, a lack of shared understanding and working creatively with interpreters. During this collaborative working new understandings of engaging emerged leading participants to view this work as possible.

scholarly journals A survey of the provision of psychological treatments to older adults in the NHS

2004 ◽  
Vol 28 (11) ◽  
pp. 411-414 ◽  
Author(s):  
Sandra Evans
Keyword(s):  
Older Adults ◽  
Behavioural Therapy ◽  
Psychological Treatments ◽  
Anxiety Management ◽  
Psychological Therapies ◽  
Cognitive Behavioural ◽  
National Service Framework ◽  
Staff Supervision ◽  
Service Framework

Aims and MethodA questionnaire was sent to old age psychiatrists to ascertain their experience, views and clinical practice regarding psychological therapies in their services.ResultsThe provision of psychological treatments of all modalities to older people is widely varied in Britain. The main difficulty seems to be a lack of resources, but it would appear that inexperience with psychological therapies applied to older adults is also a factor. Most mental health teams (95%) provide anxiety management therapy, and cognitive–behavioural therapy is widely available (76% of teams), but areas such as training and staff supervision appear to be poorly provided.Clinical ImplicationsSuggestions are made to increase provision and quality of service within existing resources; improving services to the standards of the National Service Framework would be a bigger challenge.

scholarly journals Evaluation of a Trauma-Focused CBT Training Programme for IAPT services

2017 ◽  
Vol 45 (5) ◽  
pp. 467-482 ◽  
Author(s):  
Hannah Murray
Keyword(s):  
Training Programme ◽  
Behavioural Therapy ◽  
Routine Practice ◽  
Post Traumatic Stress ◽  
Training Interventions ◽  
Psychological Therapies ◽  
Cognitive Behavioural ◽  
Co Morbidity ◽  
Early Life Trauma ◽  
Post Traumatic

Background: Therapists in Improving Access to Psychological Therapies (IAPT) services are often expected to treat complex presentations of post-traumatic stress disorder (PTSD), such as individuals with multiple, prolonged or early life trauma histories and significant co-morbidity, for which they have received minimal training. Although high recovery rates for PTSD have been demonstrated in randomized controlled trials, these are not always replicated in routine practice, suggesting that training interventions are required to fill the research–practice gap. Aims: This study investigated the outcomes of a therapist training programme on treating PTSD with trauma-focused cognitive behavioural therapy (TF-CBT). Method: Twenty therapists from ten IAPT services participated in the training, which consisted of workshops, webinars and consultation sessions over a 6-month period. Results: Feedback indicated that participants found the training highly acceptable. PTSD knowledge and self- and supervisor-rated competence on TF-CBT measures improved following the training and improvements were maintained a year later. Client outcomes on a PTSD measure improved following the training. Participants reported attempts to disseminate learning from the course back to their teams. Conclusions: The findings indicate that the training programme was successful in improving TF-CBT knowledge, skills and outcomes for IAPT therapists. Tentative support for training ‘trauma experts’ within IAPT services was found, although institutional constraints and staff turnover may limit the sustainability of the model.

scholarly journals Use of cognitive–behavioural therapy skills among trained psychiatrists

2006 ◽  
Vol 30 (2) ◽  
pp. 58-60 ◽  
Author(s):  
Graeme Whitfield ◽  
Moira Connolly ◽  
Alan Davidson ◽  
Chris Williams
Keyword(s):  
Professional Development ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Postal Survey ◽  
Clinical Implications ◽  
Therapeutic Activity ◽  
Protected Time ◽  
Training And Supervision ◽  
Cognitive Behavioural ◽  
The Cost

Aims and MethodPrevious studies have suggested that despite the cost of attendance at postgraduate cognitive–behavioural therapy (CBT) courses, psychiatrists are unable to engage in CBT after qualification. A postal survey of psychiatrists with postgraduate CBT training currently practising in Scotland was performed to assess the levels of training and supervision that they provide, therapeutic CBT activity, and supervision and continued professional development that they receive.ResultsOf the 58 psychiatrists, 51 replied to the survey (88%). Less than half of the respondents supervised other staff. Although 43 (84%) engaged in some therapeutic CBT activity, only 25 (49%) received supervision for their own practice. The main reasons given for not engaging in CBT therapeutic activity were that there was inadequate ‘protected time’ and that CBT had not been included in ‘job plans'.Clinical ImplicationsPsychiatrists can help to disseminate CBT skills. To do this, they require personal supervision, and time for the development and maintenance of therapeutic skills as well as for the training and supervision of others. This survey builds on the results of others and indicates that these requirements are currently being inadequately met.

The acceptability and feasibility of group cognitive behavioural therapy for older adults with generalised anxiety disorder

2020 ◽  
Vol 48 (5) ◽  
pp. 621-625
Author(s):  
Jo Hall ◽  
Stephen Kellett ◽  
Manreesh Kaur Bains ◽  
Heather Stonebank ◽  
Shonagh Scott
Keyword(s):  
Older Adults ◽  
Anxiety Disorder ◽  
Cognitive Behavioural Therapy ◽  
Group Treatment ◽  
Behavioural Therapy ◽  
Generalised Anxiety Disorder ◽  
Group Setting ◽  
Group Cognitive Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Therapy Protocol

AbstractBackground:Group psychotherapy for older adults with generalised anxiety disorder is an under-researched area.Aim:This report describes a mixed method evaluation of the acceptability and feasibility of an Overcoming Worry Group.Method:The Overcoming Worry Group was a novel adaptation of a cognitive behavioural therapy protocol targeting intolerance-of-uncertainty for generalised anxiety disorder, tailored for delivery to older adults in a group setting (n = 13).Results:The adapted protocol was found to be acceptable and feasible, and treatment outcomes observed were encouraging.Conclusions:This proof-of-concept study provides evidence for an Overcoming Worry Group as an acceptable and feasible group treatment for older adults with generalised anxiety disorder.

Client-led culturally responsive CBT – integrating familism in the treatment of chronic depression: a case study

2020 ◽  
Vol 13 ◽  
Author(s):  
Lilian Skilbeck ◽  
Christopher Spanton ◽  
Ian Roylance
Keyword(s):  
Cultural Adaptation ◽  
Treatment Plan ◽  
Behavioural Therapy ◽  
Cultural Responsiveness ◽  
Chronic Depression ◽  
List Type ◽  
Her Family ◽  
Psychological Therapies ◽  
Cognitive Behavioural

Abstract Britain has increasingly become a multi-cultural society. In order to improve access to primary care psychological therapy including cognitive behavioural therapy (CBT), there has been an increase in focus on cultural adaptation and cultural responsiveness. To date, these adaptations have focused on domains such as language, beliefs and values. In this case, familism was the focus for adaptation. The client was a 22-year-old female from a black African-British background. She presented with severe symptoms of chronic depression as measured on routine standard questionnaires and the interview. She had minimal success from previous interventions and was struggling to make progress. Therapy was guided by the client’s views on what issues had a bearing on her difficulties. The client hypothesised that familism factors with themes around ‘my parents’ culture’ and ‘family comes first’ were interacting with her cognitive behavioural factors to maintain her problem. She requested the involvement of her family in her treatment plan. In line with the Improving Access to Psychological Therapies–Black, Asian and Minority Ethnic service user Positive Practice Guide, this was integrated as part of her formulation. Upon involvement of her father in a single session, the client attained reliable improvement. She attributed her improvement to this involvement. By the end of therapy, she reached recovery, which was maintained at 3-month follow-up. This study was responsive to the client’s own perceived cultural needs through the integration of familism into her CBT formulation. It illustrates a client-led cultural adaptation of CBT to treat chronic depression. Key learning aims It is hoped that the reader will increase their understanding of the following from reading this case study: (1) Creating an environment where clients can freely discuss their perceived cultural factors from the outset. (2) Client-led cultural responsiveness to their expressed cultural needs. (3) Familism as a domain for adapting CBT.

Geographic Inequity in the Availability of Cognitive Behavioural Therapy in England and Wales: A 10-Year Update

2013 ◽  
Vol 42 (4) ◽  
pp. 497-501 ◽  
Author(s):  
Kate Cavanagh
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Geographic Distribution ◽  
Fold Increase ◽  
Behavioural Therapy ◽  
England And Wales ◽  
Psychological Therapies ◽  
Cognitive Behavioural ◽  
Proxy Measure ◽  
Scarcity Of Resources ◽  
Made In

Background: Improving access to psychological therapies, and in particular cognitive behavioural therapy (CBT), has been a health service priority in England and Wales over the past decade. The delivery of CBT has been limited by a scarcity of resources and further limited by the inequitable geographic distribution of CBT therapists. Aims: The current study replicates and extends our previous analysis of the geography of British Association of Behavioural and Cognitive Psychotherapies (BABCP) membership (Shapiro, Cavanagh and Lomas, 2003) 10 years later in order to evaluate the progress made in improving equitable access to CBT. Method: This paper presents the absolute and comparative geographic distribution of current BABCP members, accredited CBT practitioners, and BABCP members who are nurses or clinical psychologists in England and Wales. Results: Efforts to improve the availability of CBT in England and Wales are reflected in the doubling of total membership, and a 4.5 fold increase in accredited membership over the last 10 years. There is evidence that the magnitude of inequity in the geographic availability of CBT therapists has decreased, but that inequity is still evident. Limitations of using BABCP membership data as a proxy measure of CBT availability are acknowledged. Conclusions: A five-fold discrepancy in accredited CBT practitioners between the best and least well-served population decile indicates ongoing “postcode availability” of the best qualified CBT practitioners. Possible strategies to improve the availability of CBT and remedy this inequity are discussed.

scholarly journals Management of insomnia in older adults

2007 ◽  
Vol 190 (4) ◽  
pp. 285-286 ◽  
Author(s):  
Børge Sivertsen ◽  
Inger Hilde Nordhus
Keyword(s):  
Older Adults ◽  
Behavioural Therapy ◽  
Societal Burden ◽  
Cognitive Behavioural ◽  
Physical Disorders ◽  
Short And Long Term ◽  
Low Threshold ◽  
The Individual ◽  
Term Management

SummaryComplaints of insomnia are very common, especially in older adults. Although pharmacotherapy is the most common form of treatment, recent evidence shows cognitive–behavioural therapy to be superior in the short- and long-term management of insomnia. Low-threshold intervention programmes may reduce both the individual and societal burden of insomnia, coexisting with or without other mental or physical disorders.

scholarly journals A Pragmatic Pilot Study Of Cognitive Behavioural Therapy For Insomnia Among People Living With HIV

2021 ◽  
Author(s):  
Tyler Gordon Tulloch
Keyword(s):  
Pilot Study ◽  
Sleep Disturbance ◽  
Cognitive Behavioural Therapy ◽  
Thematic Analysis ◽  
Behavioural Therapy ◽  
Future Research ◽  
People Living With Hiv ◽  
Cognitive Behavioural ◽  
Living With Hiv ◽  
Insomnia Severity

The prevalence of insomnia among people living with HIV (PWH) is considerably higher than in the general population. Cognitive, behavioural, and biopsychosocial explanations for this elevated prevalence have been proposed, but there is a lack of consensus in the literature. Sleep disturbance is associated with disrupted immune functioning at the cellular level and increased risk of contracting infectious diseases; therefore, insomnia may be particularly problematic for PWH. Cognitive behavioural therapy for insomnia (CBT-I) is the first-line treatment for insomnia, and is effective at treating insomnia among individuals with comorbid medical disorders. Surprisingly, no study has examined its efficacy among PWH. This pragmatic pilot study examined features of insomnia among 48 PWH and was the first study to examine sleep disturbance among PWH using American Academy of Sleep Medicine guidelines for evaluating chronic insomnia. On average, insomnia chronicity was 8.2 years and was of moderate severity. Psychiatric comorbidity was common, as were comorbid sleep disorders. Insomnia severity was associated with psychosocial variables including sleep effort, self-efficacy for sleep, depression, anxiety, stress, and social functioning-related quality of life. This study was also the first to examine safety, feasibility, acceptability, and intervention effects of CBT-I. These were examined among a subsample of 10 PWH using single-case interrupted time-series design. Thematic analysis was used to explore participant perceptions of CBT-I. Large effect sizes were observed for improvement in insomnia severity, sleep efficiency, and total wake time. Reliable and clinically significant reduction in insomnia severity was observed for all but one participant, and half met criteria for insomnia remission. Overall, CBT-I was an efficacious treatment for insomnia, and participant feedback was consistent with quantitative results. Participants viewed CBT-I as a safe and acceptable treatment for insomnia. Participant feedback identified preexisting needs, positive impacts and challenges of CBT-I, perceived mechanisms of change, and suggested modifications to tailor CBT-I for PWH. Given this preliminary support for the efficacy of CBT-I among PWH, future research should seek to demonstrate generalizability of these effects. Partnering with HIV community organizations may be important next step in conducting future research and increasing accessibility of CBT-I to PWH. Keywords: HIV, insomnia, cognitive behavioural therapy, pilot study, pragmatic trial, thematic analysis

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