The July BABCP Article of the Month is from the Cognitive Behaviour Therapist and is entitled “IAPT CBT treatment for PTSD following COVID-19-related intensive care admission – a case study” by Lilian Skilbeck and Suzanne Byrne.

Over a year ago, our IAPT service started seeing the first COVID-19-ICU-PTSD clients. There were no unitary guidelines on working with these clients or whether they could be seen in IAPT. I reviewed this client with my case manager, especially as there was a presence of ‘hallucinations’. I trawled through the literature and came across the paper by Murray et al. 2020 (doi:10.1017/S1754470X2000015X). This was the inspiration that guided this work. At the same time, I was embarking on the HEE CBT top-up training program for complex PTSD. I decided to make the most of the training to support this client. Therapy was agreed with a shared understanding that psychological interventions for post COVID-19-ICU-PTSD were not yet well established. I remember the look on my training supervisor’s face when I mentioned the ‘hallucinations’. Upon discussion, we theorised that the ‘hallucinations’ were congruent with the trauma content and could be conceptualised as part of the PTSD symptoms. Collaboration, theoretical integration and strong supervision are what shaped this paper which illustrates that Covid-19-ICU-PTSD cases can be treated in IAPT.

I am intrigued by responsiveness, topical issues and shared-learning in clinical practice. This is what drives my motivation to read or write papers. Discussions with clients and colleagues is the best way to bounce-off ideas. For example, in responding to the pandemic era, I have co-written a review article in addition to the current paper.¹ I have co-written two papers in response to client preferences and topical issues in the treatment of PTSD.^2,3 I have also co-written two papers in response to working with complexity in depression.^4,5  

I strongly believe that if we take a moment to step back and reflect on what we do in our clinical practice, we can realise ideas for shared learning. More often than not, when you are asking a particular clinical question, another clinician is on it too. You may not have the opportunity to discuss this question, but you can share a clinical story. Understandably, working as a clinician in IAPT is fast paced and busy. This means that many IAPT clinicians may not have the time or know where to start. Everybody’s working day is different! I personally find that managing my time to include a routine debrief (self or peer) and reading at least one topical paper each week helps me stay on track with trends in clinical practice. IAPT is a rich and diverse cosmos with a wide scope for extensive clinical practice and shared learning. Therefore, it is hoped that this paper will encourage more IAPT clinicians to share their clinical stories.

Author Bio

Lilian is a clinician working as a CBT therapist in an NHS IAPT service.

l.skilbeck@nhs.net

References

• Skilbeck, L., Spanton, C., & Roylance, I. (2020). Beyond the COVID-19 pandemic: “Learning the hard way” – adapting long-term IAPT service provision using lessons from past outbreaks. The Cognitive Behaviour Therapist, 13. https://doi.org/10.1017/s1754470x20000379

• Skilbeck, L., & Spanton, C. (2022). Delivery of a trauma-focused CBT group for heterogeneous single-incident traumas in adult primary care: a follow-on case study. The Cognitive Behaviour Therapist, 15. https://doi.org/10.1017/s1754470x22000149

• Skilbeck, L., & Spanton, C. (2020). Primary care community engagement – delivery of an enhanced and brief homogeneous group TF-CBT intervention for trauma from a single-incident road traffic accident: a case study. The Cognitive Behaviour Therapist, 13. https://doi.org/10.1017/s1754470x20000227

• Skilbeck, L., Spanton, C., & Roylance, I. (2020). Client-led culturally responsive CBT – integrating familism in the treatment of chronic depression: a case study. The Cognitive Behaviour Therapist, 13. https://doi.org/10.1017/s1754470x20000471

• Skilbeck, L., Spanton, C., & Roylance, I. (2020). Helping clients “restart their engine” – use of in-session cognitive behavioural therapy behavioural experiments for engagement and treatment in persistent depression: a case study. The Cognitive Behaviour Therapist, 13. https://doi.org/10.1017/s1754470x20000070

From Richard Thwaites, the Editor-in-Chief of the Cognitive Behaviour Therapist: Why I chose this article 

This paper has been chosen to be BABCP Article of the Month because it is one of the first published case studies for CBT treatment for PTSD following COVID-19-related intensive care admission and is of interest to the many clinicians working in this area. It is also intriguing because it is the fifth paper in recent years by the same author who keeps producing interesting and clinically relevant papers whilst working within a busy IAPT service. This blog helps inspire us all to combine our clinical roles with a scientist-practitioner stance and both consume and integrate new research and then share our learning with colleagues in a publishable fashion! Thank you Lilian!