Development and application of criteria to evaluate written CBT self-help interventions adopted by Improving Access to Psychological Therapies services (original) (raw)
Related papers
Increasing Access to CBT: Stepped Care and CBT Self-Help Models in Practice
Behavioural and Cognitive Psychotherapy, 2008
The delivery of cognitive behaviour therapy (CBT) in the UK has moved through two phases. In the first phase specialist practitioners delivered bespoke CBT to individuals often experiencing complex and longer-lasting problems. This phase has been characterized by waiting lists and a high quality service delivered to a few. In the second phase of service delivery CBT has begun to be delivered in all sorts of different formats, including CBT self-help/guided CBT, behavioural activation, computerized CBT and group based CBT that aim to increase access to CBT delivered in these ways. It remains unclear how these varying models – “high intensity” (phase 1) and “low intensity” (phase 2) should relate – and even who does best with each. There are implicit assumptions by practitioners reflected in language such as “stepping up/down” that assumes high intensity working is superior in some way to low intensity. Few studies have however examined this in depth and what studies there are suggest...
BMC Psychiatry
Background: A previously published article in this journal reported the service effects from 103 services within the UK Improving Access to Psychological Therapies (IAPT) initiative and the comparative effectiveness of CBT and Counselling provision. All patients received High-intensity CBT or High-intensity Counselling, but some also received Low-intensity CBT before being stepped-up to High intensity treatments. The report did not distinguish between patients who received low-intensity CBT before being stepped-up. This article clarifies the basis for collapsing low-and high-intensity interventions by analysing the four treatment conditions separately. Method: Data from 33,243 patients included in the second round of the National Audit of Psychological Therapies (NAPT) were re-analysed as four separate conditions: High-intensity CBT only (n = 5975); High-intensity Counselling only (n = 3003); Low-intensity CBT plus High-intensity CBT (n = 17,620); and Low-intensity CBT plus High-intensity Counselling (n = 6645). Analyses considered levels of pre-post therapy effect sizes (ESs), reliable improvement (RI) and reliable and clinically significant improvement (RCSI). Multilevel modelling was used to model predictors of outcome, namely patient pre-post change on PHQ-9 scores at last therapy session. Results: Significant differences obtained on various outcome indices but were so small they carried no clinical significance. Including the four treatment groups in a multilevel model comprising patient intake severity, patient ethnicity and number of sessions attended showed no significant differences between the four treatment groups. Comparisons between the two high-intensity interventions only (N = 8978) indicated Counselling showed more improvement than CBT by 0.3 of a point on PHQ-9 for the mean number of sessions attended. However, this result was moderated by the number of sessions and for 12 or more sessions, the advantage went to CBT. Conclusions: This re-analysis showed no evidence of clinically meaningful differences between the four treatment conditions using standard indices of patient outcomes. However, a differential advantage to high-intensity Counselling for fewer than average sessions attended and high-intensity CBT for more than average sessions attended has important service implications. The finding of equivalent outcomes between high-intensity CBT and Counselling for more severe patients also has important policy implications. Empirically-informed procedures (e.g., predictive modelling) for assigning patients to interventions need to be considered to improve patient outcomes.
PubMed, 2009
Background In response to a research recommendation made by a UK healthcare policy agency (National Institute for Health and Clinical Excellence (NICE)), this study compared the effectiveness of computer-based cognitive behavioural therapy (CBT) with other self-help treatment options for mild to moderate depression and anxiety.Method Comparative, clinical feasibility study of three self-help CBT tools with six-month follow-up. Out of an initial sample of 180 adults referred by their general practitioners, 100 met the inclusion criteria and after consenting to take part were allocated one of three self-help CBT tools: the Beating the Blues® (BtB) computer programme;(1) workbooks on overcoming depression and anxiety; and the Livinglifetothefull free access internet website.(2)Results Only 50 of the 100 consented participants completed the allocated intervention protocols, however, drop-out rates were not significantly different between the groups of participants allocated each of the three self-help CBT tools. Adults aged over 24 years (χ(2) = 14.5; df = 2; P = 0.001) and with symptom duration greater than four years (χ(2) = 3.96; df = 1; P = 0.047) were significantly more likely to complete any of the three interventions. There was a highly significant reduction in mean Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) score at week eight compared to entry in all three groups (t (49) = 9.150; P ≤0.001). Adjusting for entry scores, there was no significant difference between the three groups in CORE-OM score improvement at week eight. There was no significant association between CORE-OM score improvement at week eight and number of general practitioner (GP) consultations at six months. There was no significant association between whether participants completed the programme and number of GP consultations at six months.Conclusions The results demonstrated that within a two-month follow-up period, three different tools delivering self-help CBT all produced significant clinical benefit for adults with mild to moderate depression and anxiety. The study had limited statistical power, but none of the modalities for delivering supported self-help CBT appeared superior to another. There was no evidence to suggest that any of these interventions would be likely to reduce subsequent service uptake. Nevertheless, this pilot study has shown sufficient benefit from each of the self-administered CBT tools to justify larger trials of their use.
Cognitive Behaviour Therapy
Cognitive behavioural therapy (CBT) can effectively treat common mental disorders (CMDs), but access to treatment is insufficient. Guided self-help (GSH) CBT has shown effects comparable to face-toface CBT and may be a resource-efficient treatment alternative. However, not all patients respond to GSH. Learning more about predictors of outcome may increase knowledge regarding which patients respond to GSH. The aim of this study was to investigate predictors of outcome for GSH CBT for patients with CMDs in primary care. Consecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia or stress-related disorders were included. All patients received GSH CBT. Outcomes were remission status, reliable change and post-treatment depression ratings. Predictors investigated were clinical, demographic and therapyrelated variables. Analyses were conducted using logistic and linear regression. Higher educational level predicted remission, higher quality of life ratings predicted remission and decreased depression, and higher age at onset predicted reliable change. Therapy-related variables, i.e. patient adherence to treatment and patients' and clinicians' estimation of treatment response, were all related to outcome. More large-scale studies are needed, but the present study points at the importance of therapy-related variables such as monitoring and supporting treatment adherence for an increased chance of remission.
Psychological Medicine, 2017
Background Common mental disorders (CMDs) cause great individual suffering and high societal costs including long-term sick leave. Cognitive behavioural therapy (CBT) can effectively treat CMDs, but access to treatment is insufficient. Moreover, sick leave is not reduced to the same extent as psychiatric symptoms after CBT. Little is known about predictors of outcome after CBT, especially concerning guided self-help. Aims The aim of the present thesis was to systematically review the effects and evidence of psychological treatments on sick leave and assess the effects in a meta-analysis of published treatment trials (Study I), evaluate the effect of CBT and a novel return-to-work intervention (RTW-I) on sick leave and psychiatric symptoms for patients with CMDs (Study II), test a stepped care CBT model for CMDs in primary care (Study III), and investigate predictors of outcome for guided self-help CBT (Study IV). Methods In Study I, a systematic review and meta-analysis (45 studies) was conducted regarding effects of psychological interventions on sick leave and symptoms. In Study II (N = 211) and III (N = 396) patients from four primary care centres in Stockholm were treated with disorder specific CBT for CMDs. In Study II, patients on sick leave were randomised to CBT, RTW-I, or a combination of the two, and were followed up one year after treatment regarding sick leave and symptoms. In Study III all patients received disorder specific guided self-help CBT for nine weeks. Non-responders were then randomised to face-to-face CBT or continued guided self-help. In Study IV predictors of outcome for guided self-help CBT in Study III were investigated. Results Study I showed that psychological interventions were more effective than care as usual in reducing sick leave and psychiatric symptoms but the effect sizes were small (g = 0.15 and 0.20, respectively). There was no significant difference in effect between work focused interventions, problem solving therapy, CBT or collaborative care. In Study II, there was no significant difference between treatments regarding days on sick leave one year after treatment start; CBT however led to larger reduction of symptoms post-treatment than RTW-I. In Study III, 40% of patients were in remission after nine weeks of guided self-help CBT. After Step II, 39% of the non-remitted patients who had been randomised to face-to-face CBT were in remission compared to 19% of patients who received continued guided self-help (p < 0.05). Study IV showed that patients across all disorders benefitted from guided self-help CBT, but those with social anxiety disorder and depression reached remission to a lower extent. Higher educational level predicted remission, higher quality of life ratings predicted remission and post treatment depression ratings, and higher age at onset predicted reliable change. All investigated therapy related variables, e.g., adherence to treatment and expectancy of outcome, were positively associated to outcome. Conclusions Psychological interventions can reduce sick leave compared to treatment as usual, but effects are small. Adding RTW-I as investigated in the present thesis to CBT seems to have little effect on sick leave. This could be due to lack of power or that CBT also had an effect on sick leave. Disorder specific CBT can effectively treat CMDs in primary care and using stepped care with guided self-help CBT as the initial step seem to be a resource efficient way to treat CMDs. Patients with higher education, higher ratings of quality of life and later age of onset appear to have a better outcome of guided self-help. Patients who rate treatment as credible and actively participate in therapy have a greater chance of recovering. This knowledge can be of value when making treatment recommendations.
PLoS ONE, 2013
Background: Access to Cognitive behavioural therapy (CBT) for depression is limited. One solution is CBT self-help books. Trial Objectives: To assess the impact of a guided self-help CBT book (GSH-CBT) on mood, compared to treatment as usual (TAU). Hypotheses: 1. GSH-CBT will have improved mood and knowledge of the causes and treatment of depression compared to the control receiving TAU 2. Guided self-help will be acceptable to patients and staff. Methods and Findings: Participants: Adults attending seven general practices in Glasgow, UK with a BDI-II score of $14. 141 randomised to GSH-CBT and 140 to TAU. Interventions: RCT comparing 'Overcoming Depression: A Five Areas Approach' book plus 3-4 short face to face support appointments totalling up to 2 hours of guided support, compared with general practitioner TAU. Primary outcome: The BDI (II) score at 4 months. Numbers analysed: 281 at baseline, 203 at 4 months (primary outcome), 117 at 12 months. Outcome: Mean BDI-II scores were lower in the GSH-CBT group at 4 months by 5.3 points (2.6 to 7.9, p,0.001). At 4 and 12 months there were also significantly higher proportions of participants achieving a 50% reduction in BDI-II in the GSH-CBT arm. The mean support was 2 sessions with 42.7 minutes for session 1, 41.4 minutes for session 2 and 40.2 minutes of support for session 3. Adverse effects/Harms: Significantly less deterioration in mood in GSH-CBT (2.0% compared to 9.8% in the TAU group for BDI-II category change). Limitations: Weaknesses: Our follow-up rate of 72.2% at 4 months is better than predicted but is poorer at 12 months (41.6%). In the GSH-CBT arm, around 50% of people attended 2 or fewer sessions. 22% failed to take up treatment. Conclusions: GSH-CBT is substantially more effective than TAU.
IJEDO, 2022
Few tools to encourage therapists to implement evidence based psychological treatments as designed exist. Assessing therapist "competence" (implementing therapeutic procedures well) by evaluating the quality of their treatment sessions is problematic for multiple reasons. Therapist self-rated measures of "adherence" (using the correct therapeutic procedures) may offer a viable alternative. We describe (i) the development of a CBT-E Components Checklist (CBT-E CC) for therapists, as well as (ii) how to use the CBT-E CC and where to access it. The CBT-E CC is an adherence checklist for enhanced cognitive behavior therapy for eating disorders (CBT-E). It is intended as a formative tool for therapists to assess, and improve as needed, their own adherence. Future research on the validity of the checklist to accurately measure adherence is needed.
The Cognitive Behaviour Therapist, 2020
Access to cognitive behaviour therapy for those with psychosis (CBTp) remains poor. The most frequently endorsed barrier to implementation is a lack of resources. To improve access to CBTp, we developed a brief form of CBTp that specifically targets voice-related distress. The results of our pilot trial of guided self-help CBT for voices (GiVE) suggest that the therapy is both acceptable and beneficial. The present study aims to explore the subjective patient experience of accessing GiVE in the context of a trial. We interviewed nine trial participants using the Change Interview and a mixed methods approach. Most participants reported at least one positive change that they attributed to GiVE. We extracted five themes: (1) changes that I have noticed; (2) I am not alone; (3) positive therapy experiences; (4) I want more therapy; and (5) helping myself. The themes indicate that participating in the GiVE trial was generally a positive experience. The main areas in which participants ex...