Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-17T19:56:10.189Z Has data issue: false hasContentIssue false
  • English
  • Français

Development and Evaluation of Cognitive Analytic Guided Self-Help (CAT-SH) for Use in IAPT Services

Published online by Cambridge University Press:  22 March 2017

Jo Meadows  and
Stephen Kellett
Jo Meadows
Affiliation:
University of Sheffield
Stephen Kellett*
Affiliation:
Centre for Psychological Services Research, University of Sheffield, UK and Sheffield Health and Social Care NHS Foundation Trust, UK
*
Correspondence to Stephen Kellett, Department of Psychology, University of Sheffield, Sheffield S10 2TN, UK. E-mail: s.kellett@sheffield.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: There is a lack of treatment plurality at step 2 of Improving Access to Psychological Therapies (IAPT) services. This project therefore sought to develop and pilot a cognitive analytic informed guided self-help treatment for mild-to-moderate anxiety for delivery by Psychological Wellbeing Practitioners (PWPs). Method: Medical Research Council treatment development guidelines were used. Phase I included development of the six-session treatment manual using practice guidelines, small-scale modelling (n = 3) and indicated manual iterations. Phase II consisted of a mixed methods case series design (n = 11) to index feasibility, uptake and clinical outcomes. Results: Cognitive analytic guided self-help (CAT-SH) met established quality parameters for guided self-help. A high treatment completion rate was observed, with 10/11 patients who attended the first treatment session subsequently completing full treatment. Six out of ten patients completing full treatment met reliable recovery criteria at follow-up. Effect sizes and recovery rates equate with extant PWP outcome benchmarks. Practitioner feedback indicated that delivery of CAT-SH was feasible. Conclusion: CAT-SH shows promise as a low-intensity treatment for anxiety, and so further, larger and more controlled evaluations are indicated.

Keywords

Cognitive analytic therapypsychoeducationIAPToutcomefeasibility
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 45 , Issue 3 , May 2017 , pp. 266 - 284
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abbass, A. A., Hancock, J. T., Henderson, J. and Kisely, S. (2006). Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Systematic Reviews, 4.Google Scholar
Abbas, S., Ihle, P., Köster, I. and Schubert, I. (2012). Estimation of disease incidence in claims data dependent on length of follow-up: a methodological approach. Health Services Research, 47, 746–755.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision). Washington, DC.Google Scholar
Barkham, M. and Parry, G. (2008). Balancing rigour and relevance in guideline development for depression: The case for comprehensive cohort studies. Psychology and Psychotherapy: Theory, Research and Practice, 81, 399–417.CrossRefGoogle ScholarPubMed
Barlow, D. H. and Hersen, M. (1984). Single Case Experimental Designs: Strategies for Studying Behaviour Change (2nd edn). Oxford: Pergamon Press.Google Scholar
Bennett, D. and Parry, G. (2004). A measure of psychotherapeutic competence derived from cognitive analytic therapy. Psychotherapy Research, 14, 176–192.Google Scholar
Bower, P. and Gilbody, S. (2005). Stepped care in psychological therapies: access, effectiveness and efficiency. British Journal of Psychiatry, 186, 11–17.Google Scholar
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.Google Scholar
Cahill, J., Barkham, M., Hardy, G., Rees, A., Shapiro, D. A., Stiles, W. B. and Macaskill, N. (2003). Outcomes of patients completing and not completing cognitive therapy for depression. British Journal of Clinical Psychology, 42, 133–143.CrossRefGoogle Scholar
Calvert, R. and Kellett, S. (2014). Cognitive analytic therapy: A review of the outcome evidence base for treatment. Psychology and Psychotherapy: Theory, Research and Practice, 87, 253–277.Google Scholar
Cape, J. (2015) Guide to evaluating self-help guidance materials for anxiety disorders and depression. UCL document, PWP training review.Google Scholar
Care Services and Improvement Partnership Choice and Access Team (2008). Improving Access to Psychological Therapies (IAPT) Commissioning Toolkit. London: Department of Health.Google Scholar
Carter, S. L. (2007). Review of recent treatment acceptability research. Education and Training in Developmental Disabilities, 42, 301–316.Google Scholar
Chan, S. W. Y. and Adams, M. (2014). Service use, dropout rate and clinical outcomes: A comparison between high and low intensity treatments in an IAPT service. Cognitive and Behavioural Psychotherapy, 42, 747–759.Google Scholar
Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience. International Review of Psychiatry, 23, 318–327.Google Scholar
Clark, D. M., Layard, R., Smithies, R., Richards, D. A., Suckling, R. and Wright, B. (2009). Improving access to psychological therapy: Initial evaluation of two UK demonstration sites. Behaviour Research and Therapy, 47, 910–920.Google Scholar
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.CrossRefGoogle ScholarPubMed
Coull, G. and Morris, P. G. (2011). The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: a systematic review. Psychological Medicine, 41, 2239–2252.Google Scholar
Cuijpers, P., Donker, T., Van Straten, A., Li, J. and Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine, 40, 1943–1957.CrossRefGoogle ScholarPubMed
Firth, N., Barkham, M. and Kellett, S. (2015a). The clinical effectiveness of stepped care systems for depression in working age adults: A systematic review. Journal of Affective Disorders, 170, 119–130.Google Scholar
Firth, N., Barkham, M., Kellett, S. and Saxon, D. (2015b). Therapist effects and moderators of effectiveness and efficiency in psychological wellbeing practitioners: A multilevel modelling analysis. Behaviour Research and Therapy, 69, 54–62.CrossRefGoogle ScholarPubMed
Gellatly, J., Bower, P., Hennessy, S., Richards, D., Gilbody, S. and Lovell, K. (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine, 37, 1217–1228.Google Scholar
Green, H. Barkham, M. Kellett, S. and Saxon, D. (2014). Therapist effects and IAPT Psychological Wellbeing Practitioners (PWPs): a multilevel modelling and mixed methods analysis. Behaviour Research and Therapy, 63, 43–54.Google Scholar
Gregory, R., Canning, S., Lee, T. and Wise, J. (2004). Cognitive bibliotherapy for depression: a meta-analysis. Professional Psychology, Research and Practice, 35, 275–280.Google Scholar
Hague, J., Hughes, L., Kellett, S., Millington, J., Simmonds-Buckley, M., Siviter, R. and Stonebank, H. (2015). PWP assessment and treatment competency scales. University of Sheffield.Google Scholar
Hammond, G. C., Croudace, T. J., Radhakrishnan, M., Lafortune, L., Watson, A., McMillan-Shields, F. and Jones, P. B. (2013). Comparative effectiveness of cognitive therapies delivered face-to-face or over the telephone: An observational study using propensity methods. PLoS ONE, 7, e42916.Google Scholar
Harai, M. and Clum, G. A. (2006). A meta-analytic study of self-help interventions for anxiety problems. Behaviour Therapy, 37, 99–111.Google Scholar
Howard, L. and Thornicroft, G. (2006). Patient preference randomised controlled trials in mental health research. British Journal of Psychiatry, 188, 303–304.Google Scholar
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The Psychological Health Questionnaire-9. Journal of General Internal Medicine, 16, 606–613.Google Scholar
Lemma, A. and Fonagy, P. (2013). Feasibility study of a psychodynamic online group intervention for depression. Psychoanalytic Psychology, 30, 367–380.Google Scholar
Lewis, C., Pearce, J. and Bisson, J. I. (2012). Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review. British Journal of Psychiatry, 200, 15–21.CrossRefGoogle ScholarPubMed
Menchola, M., Arkowitz, H. S. and Burke, B. L. (2007). Efficacy of self-administered treatments for depression and anxiety. Professional Psychology, Research and Practice, 38, 421–429.Google Scholar
Michel, L., Drapeau, M. and Despland, J. N. (2003). A four session format to work with university students: The brief psychodynamic investigation. Journal of College Student Psychotherapy, 18, 3–14.Google Scholar
Milosevic, I., Levy, H. C., Alcolado, G. M. and Radomsky, A. S. (2015). The treatment acceptability/adherence scale: moving beyond the assessment of treatment effectiveness. Cognitive Behaviour Therapist, 44, 456–469.Google Scholar
Medical Research Council (2008). Developing and evaluating complex interventions: new guidance. Available at: http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC004871 (accessed 12 March 2014).Google Scholar
Morley, S. (1994). Single-case methodology in psychological therapy. In Lindsey, S. J. E. and Powell, G. E. (eds), The Handbook of Clinical Adult Psychology (2nd edn). Hove: Bruner-Routledge.Google Scholar
Mundt, J. C., Marks, I. M., Shear, M. K. and Greist, J. M. (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461–464.Google Scholar
National Institute of Health and Clinical Excellence (2004). Clinical Guidance CG9. Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Available at: https://www.nice.org.uk/guidance/cg9/evidence/full-guideline-243824221 (accessed 8 August 2014).Google Scholar
National Institute of Health and Clinical Excellence (2009). Clinical Guideline 90. Depression: The treatment and management of depression in adults. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22132433 (accessed 6 February 2014).Google Scholar
National Institute of Health and Clinical Excellence (2011). Guideline 113. Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: Management in primary, secondary and community care. Available at: https://www.nice.org.uk/guidance/cg113/chapter/1-guidance (accessed 6 February 2014).Google Scholar
National Institute of Health and Clinical Excellence (2011). Guideline 123. Common mental health disorders Identification and pathways to care. Available at: https://www.ncbi.nlm.nih.gov/books/NBK92254/ (accessed 6 February 2014).Google Scholar
National Institute for Health Research (2006). Patient and public involvement in health and social care research: A handbook for researchers. Available at: http://www.rds.nihr.ac.uk/wp-content/uploads/RDS-PPI-Handbook-2014-v8-FINAL.pdf Google Scholar
Office for National Statistics (2007). Adult psychiatric morbidity in England: results of a household survey. Available at: http://www.esds.ac.uk/doc/6379/mrdoc/pdf/6379research_report.pdf (accessed 7 August 2014).Google Scholar
Poeria, J., Barkham, M., Saxon, D. and Kellett, S. (2016). The role of practitioner resilience and mindfulness in effective practice: A practice-based feasibility study. Administration and Policy in Mental Health and Mental Health Services Research. In press; doi: 10.1007/s10488-016-0747-0.Google Scholar
Pollock, P.H., Broadbent, M., Clarke, S., Dorrian, A. and Ryle, A. (2001). The personality structure questionnaire (PSQ); a measure of multiple self-states model of identity confusion in cognitive analytic therapy. Clinical Psychology and Psychotherapy, 8, 59–72.CrossRefGoogle Scholar
Radhakrishnan, M., Hammond, G., Jones, P. B., Watson, A., McMillan-Shields, F. and Lafortune, L. (2013). Cost of Improving Access to Psychological Therapies (IAPT) programme: An analysis of cost of session, treatment and recovery in selected Primary Care Trusts in the East of England region. Behaviour Research and Therapy, 51, 37–45.Google Scholar
Richards, D. and Whyte, M. (2009). Reach Out: National Programme Educator Materials to support the Delivery of Training for Practitioners Delivering Low Intensity Interventions, 2nd edn. London: Rethink. Available at: http://www.iapt.nhs.uk/silo/files/reach-out-educator-manual.pdf.Google Scholar
Royal College of Psychiatrists (2009). Mental Health and the Economic Downturn: National priorities and NHS solutions. Available at: http://www.rcpsych.ac.uk/pdf/economicdow.pdf (accessed 17 April 2014).Google Scholar
Ryle, A. (1995). Cognitive Analytic Therapy: Developments in Theory and Practice. Chichester, UK: Wiley.Google Scholar
Ryle, A. (2004). The contribution of cognitive analytic therapy to the treatment of borderline personality disorder. Journal of Personality Disorders, 18, 3–35.Google Scholar
Ryle, A., Kellett, S., Hepple, J. and Calvert, R. (2014). Cognitive analytic therapy at thirty. Advances in Psychiatric Treatment, 20, 258–268.Google Scholar
Ryle, A. and Kerr, I. (2002). Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester, UK: Wiley.Google Scholar
Shepherd, M. and Rosairo, M. (2008). Low-intensity workers: lessons learned from supervising primary care mental health workers and dilemmas associated with such roles. Mental Health in Family Medicine, 5, 237–245.Google Scholar
Spek, V., Cuijpers, P., Nyklíček, I., Riper, H., Keyzer, J. and Pop, V. (2007). Internet-based cognitive behavior therapy for mood and anxiety disorders: a meta-analysis. Psychological Medicine, 37, 319–328.Google Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. and Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.Google Scholar
Stockton, C. (2012). Do letters in cognitive analytic therapy help? D Clin Psy Thesis, University of Sheffield.Google Scholar
Thompson, A. R., Donnison, J., Warnock‐Parkes, E., Turpin, G., Turner, J. and Kerr, I. B. (2008). Multidisciplinary community mental health team staff's experience of a ‘skills level’ training course in cognitive analytic therapy. International Journal of Mental Health Nursing, 17, 131–137.Google Scholar
Torgerson, D. J., Klaber-Moffett, J. and Russell, I. T. (1996). Patient preferences in randomised trials: threat or opportunity? Journal of Health Services Research and Policy, 1, 194–197.Google Scholar
Turpin, G. (2010). Good practice guidelines on the use of self-help materials within IAPT services. Available at: http://www.iapt.nhs.uk/silo/files/good-practice-guidance-on-the-use-of-selfhelp-materials-within-iapt-services.pdf.Google Scholar
van Boeijen, C. A., van Balkom, A. J., van Oppen, P., Blankenstein, N., Cherpanath, A. and van Dyck, R. (2005). Efficacy of self-help manuals for anxiety disorders in primary care: a systematic review. Family Practice, 22, 192–196.Google Scholar
van Straten, A., Hill, K., Richards, D. A. and Cuijpers, P. (2015). Stepped care treatment delivery for depression: a systematic review and meta-analysis. Psychological Medicine, 45, 231–246.Google Scholar
Wright, D. and Abrahams, D. (2015). An investigation into the effectiveness of dynamic interpersonal therapy (DIT) as a treatment for depression and anxiety in IAPT. Psychoanalytic Psychotherapy, 29, 160–170.Google Scholar
Submit a response

Comments

No Comments have been published for this article.