Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-18T12:06:57.936Z Has data issue: false hasContentIssue false
  • English
  • Français

Increasing Access to CBT: Stepped Care and CBT Self-Help Models in Practice

Published online by Cambridge University Press:  01 November 2008

Chris Williams  and
Rebeca Martinez
Chris Williams*
Affiliation:
University of Glasgow, UK
Rebeca Martinez
Affiliation:
University of Glasgow, UK
*
Reprint requests to Chris Williams, Senior Lecturer in Psychiatry, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK. E-mail: chris.williams@clinmed.gla.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

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 these beliefs may be incorrect for many. How these new ways of working will be introduced, evaluated and integrated into existing services currently remains a challenge. A helpful way of resolving some of these issues is to view CBT using a learning/teaching paradigm. In this the focus is primarily on how the client wishes to learn to tackle their problems. This provides a helpful way for both introducing different and new ways of working, and also maintaining a focus on the client's needs at the centre of service development. Crucially, phase two CBT working does not replace phase one. How the two approaches complement each other and compare will be two of the interesting questions to be addressed over the next few years.

Keywords

Cognitive behaviour therapyself-helpbibliotherapycomputerized CBTlow intensitystepped care
Type
New and Emerging Areas
Information
Behavioural and Cognitive Psychotherapy , Volume 36 , Issue 6: Developments in the Theory and Practice of Cognitive and Behavioural Therapies , November 2008 , pp. 675 - 683
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2008

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

Ashworth, P., Williams, C. J. and Blackburn, I.-M. (1999). What becomes of cognitive therapy trainees? A survey of trainees' opinions and current clinical practice after postgraduate cognitive therapy training. Behavioural and Cognitive Psychotherapy, 27, 267–277.CrossRefGoogle Scholar
BABCP (2008). www.babcp.com and select trainingGoogle Scholar
Bados, A., Balaguer, G. and Saldana, C. (2007). The efficacy of cognitive-behavioral therapy and the problem of drop-out. Journal of Clinical Psychology, 63, 585–592.CrossRefGoogle ScholarPubMed
Bara-Carril, N., Williams, C. J., Pombo-Carril, M. G., Reid, Y., Murray, K., Aubin, S., Harkin, P. J. R., Treasure, J. and Schmidt, U. (2004). A preliminary investigation into the feasibility and efficacy of a CD-ROM based cognitive-behavioural self-help intervention for bulimia nervosa. International Journal of Eating Disorders, 35, 538–548.CrossRefGoogle Scholar
Book Prescription Schemes (2008). www.fiveareas.com/bookprescriptionschemesGoogle Scholar
Bower, P. and Gilbody, S. M. (2005). Getting the biggest bang for your (limited) buck: issues in the implementation and evaluation of stepped care in psychological therapies in the NHS. British Journal of Psychiatry, 186, 11–18.CrossRefGoogle Scholar
Bower, P., Gilbody, S., Richards, D. A., Fletcher, J. and Sutton, A. (2006). Collaborative care for depression in primary care. Making sense of a complex intervention: systematic review and meta regression. British Journal of Psychiatry, 189, 484–493.CrossRefGoogle ScholarPubMed
Brown, J. S. L., Elliott, S. A., Boardman, J., Ferns, J. and Morrison, J. (2004). Meeting the unmet need for depression services with psychoeducational self-confidence workshops: preliminary report. The British Journal of Psychiatry, 185, 511–515.CrossRefGoogle ScholarPubMed
Critics (2008a). www.iapt-cbt.info/Google Scholar
Critics (2008b). http://ipnosis.postle.net/pages/IAPTCBTIpnosisEditorial.htmGoogle Scholar
Critics (2008c). http://ipnosis.postle.net/Google Scholar
CSIP (2008). http://www.mhchoice.csip.org.uk/psychological-therapies.htmlGoogle Scholar
Cuijpers, P., van Straten, A. and Smit, F. (2006). Psychological treatment of late-life depression: a meta-analysis of randomized controlled trials. International Journal of Geriatric Psychiatry, 21, 1139–1149.CrossRefGoogle ScholarPubMed
Department of Health (2001). The Expert Patient: a new approach to chronic disease management for the 21st century. www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4018578.pdf) and chronic disease management.Google Scholar
Department of Health/Mental Health Programme/Improving Access to Psychological Therapies (2008a). IAPT implementation plan: curriculum for high-intensity therapies workers. London: CSIP.Google Scholar
Department of Health/Mental Health Programme/Improving Access to Psychological Therapies (2008b). IAPT Implementation Plan: Implementation Plan: Curriculum for low-intensity therapies workers. London: CSIP.Google Scholar
Farrand, P., Confue, P., Byng, R. and Shaw, S. (2008). Guided self-help supported by paraprofessional mental health workers: an uncontrolled before–after cohort study. Health and Social Care in the Community. Pre-published online.Google Scholar
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.CrossRefGoogle ScholarPubMed
Ghosh, A., Marks, I. M. and Carr, A. C. (1988). Therapist contact and outcome of self-exposure treatment for phobias: a controlled study. British Journal of Psychiatry, 152, 234–238.CrossRefGoogle ScholarPubMed
Graham, C. (2003). Reading about self-help books on obsessive-compulsive and anxiety disorders: a review. Psychiatric Bulletin, 27, 235–237.CrossRefGoogle Scholar
Hopko, D. R., Lejuez, C. W., LePage, J. P., Hopko, S. D. and McNeil, D. W. (2003). A brief behavioral activation treatment for depression: a randomized trial within an inpatient psychiatric hospital. Behavior Modification, 27, 458–469.CrossRefGoogle ScholarPubMed
Johnson, A. (2007). Download, October, at: www.gnn.gov.uk/Content/Detail.asp?ReleaseID=321341andNewsAreaID=2Google Scholar
Keeley, H., Williams, C. J. and Shapiro, D. (2002). A United Kingdom survey of accredited cognitive behaviour therapists' attitudes towards and use of structured self-help materials. Behavioural and Cognitive Psychotherapy, 30, 191–201.CrossRefGoogle Scholar
Keijers, G. P. J., Kampman, M. and Hooduin, C. A. L. (2001). Dropout prediction in cognitive behavior therapy for panic disorder. Behavior Therapy, 32, 739–749.CrossRefGoogle Scholar
Kenwright, M. (2005). Patients' Preferences and Outcomes with Self-help Guided by Computer vs Workbook: a naturalistic study. Presented at the BABCP annual conference.Google Scholar
Lovell, K. and Richards, D. (2000). Multiple Access Points and Levels of Entry (MAPLE): ensuring choice, accessibility and equity for CBT services. Behavioural and Cognitive Psychotherapy, 28, 379–391.CrossRefGoogle Scholar
Martinez, R., Whitfield, G., Dafters, R. and Williams, C. J. (2008). Can people read self-help manuals for depression? A challenge for the stepped care model and book prescription schemes. Behavioural and Cognitive Psychotherapy, 36, 89–97.CrossRefGoogle Scholar
Mitchell, N. and Gordon, P. K. (2007). Attitudes towards computerized CBT for depression amongst a student population. Behavioural and Cognitive Psychotherapy, 35, 421–430.CrossRefGoogle Scholar
NICE (2004). Depression: Management of depression in primary and secondary care. CG23. NICE: London.Google Scholar
NICE (2006). Depression and Anxiety: computerised cognitive behaviour therapy for depression and anxiety (Review of Technology Appraisal 51).Google Scholar
NIMHE (2003). http://www.newwaysofworking.org.ukGoogle Scholar
Rapee, R. M., Abbott, M. J. and Lyneham, H. J. (2006). Bibliotherapy for children with anxiety disorders using written materials for parents: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 436–444.CrossRefGoogle ScholarPubMed
Richards, D. A., Lovell, K., Gilbody, S., Gask, L., Torgerson, D., Barkham, M., Bower, P., Bland, J. M., Lankshear, A., Simpson, A., Fletcher, J., Escott, D., Hennessy, S. and Richardson, R. (2008). Collaborative care for depression in UK primary care: a randomised controlled trial. Psychological Medicine, 38, 279–287.CrossRefGoogle Scholar
SEHD (2006). Doing Well by People with Depression Report. http://www.scotland.gov.uk/Publications/2006/07/12090019/0)Google Scholar
Shapiro, D. L., Cavanagh, K. and Lomas, H. (2003). Geographic inequity in the availability of cognitive behavioural therapy in England and Wales. Behavioural and Cognitive Psychotherapy, 31, 185–192.CrossRefGoogle Scholar
Summerfield, D. and Veale, D. (2008). Proposals for massive expansion of psychological therapies would be counterproductive across society. The British Journal of Psychiatry, 192, 326–330.CrossRefGoogle ScholarPubMed
Turkington, D. and McKenna, P. J. (2003). Is cognitive-behavioural therapy a worthwhile treatment for psychosis? The British Journal of Psychiatry, 182, 477–479.CrossRefGoogle ScholarPubMed
Veale, D. (2008). Behavioural activation for depression. Advances in Psychiatric Treatment, 14, 29–36.CrossRefGoogle Scholar
White, J. (1998). Stresspac: 3 year follow-up of a controlled trial of a self-help package for the anxiety disorders. Behavioural and Cognitive Psychotherapy, 26, 237–245.CrossRefGoogle Scholar
Whitfield, G., Hinshelwood, R., Pashley, A., Campsie, L. and Williams, C. (2006). The impact of a novel computerised CBT CD Rom (Overcoming Depression) offered to patients referred to clinical psychology. Behavioural and Cognitive Psychotherapy, 34, 1–11.CrossRefGoogle Scholar
Williams, C. (2003). New technologies in self-help: another effective way to get better? (Editorial). European Eating Disorders Review, 11, 170–182.CrossRefGoogle Scholar
Williams, C. J. and Garland, A. (2002). A cognitive behavioural therapy assessment model for use in everyday clinical practice. Advances in Psychiatric Treatment, 8, 172–179.CrossRefGoogle Scholar
Williams, C., Dafters, R., Ronald, L., Martinez, R. and Garland, A. (2008). Training practitioners in cognitive behavioural self-help: the SPIRIT (Structured Psychosocial InteRventions in Teams) project. Manuscript submitted.Google Scholar
Submit a response

Comments

No Comments have been published for this article.