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the University of Southampton leading a suite of educational programmes delivering CBT training. He originally trained as a Mental Health Nurse and then as a High Intensity CBT therapist.Ursula Jamesjoined the IAPT programme in NHS England in 2016. She worked as an RMN in acute and community mental health care for many years before training in CBT and moving into IAPT services in 2009. She works on policy developments, and clinical delivery of the IAPT programme nationally.Nicole Kirkland-Davishas worked for the NHS for the past 11 years; she is currently a Clinical Coordinator and Senior CBT Therapist. She is also a Clinical Tutor at UCL on their Low Intensity Cognitive Behavioural Interventions Postgraduate Certificate course.Ken Laidlawis a Professor of Clinical Psychology, Director of Postgraduate Research Programmes, and Director of DClinPsy and CAPs Programme, CEDAR, at the University of Exeter.Katie Lockwoodis a practising Psychological Wellbeing Practitioner (PWP) and Lecturer within CEDAR, at the University of Exeter.Karina Lovellis a Professor of Mental Health (University of Manchester). She is an accredited CBT therapist. She is an NIHR Senior Investigator and a former president of the BABCP. Her programme of research has focused on alternative, accessible and innovative low intensity interventions for common mental health problems.Dr Jeffrey McDonnellis a Clinical Psychologist with experience of working in Primary and Secondary Care services using cognitive behavioural approaches to assess and treat a variety of presenting problems. He currently works as a Teaching Fellow and Clinical Tutor on University College London's Postgraduate Course in Low Intensity Cognitive Behavioural Interventions.Georgina Milesis a Psychological Wellbeing Practitioner (PWP) and tutor with the Clinical Psychology Unit at the University of Sheffield. She teaches on both the PWP and Education Mental Health Practitioner (EMHP) courses.Pamela Myles-Hootonworked in the NHS for 20 years and at the University of Reading for 11 years. From 2019 she has worked on a number of projects including authoring a blended learning training programme in evidence-based low intensity interventions for NHS Education for Scotland.Rachel Newmanis the Joint Director of the London IAPT programme at UCL.Dr Mark Papworthis a consultant clinical psychologist and Course Director of Newcastle University's PGCert in Low Intensity Psychological Therapies (seconded by Tees, Esk and Wear Valleys NHS Trust). He also works in private practice in Newcastle at Psychology Northeast. He is the lead author of ‘Low Intensity Cognitive Behaviour Therapy: A Practitioner's Guide'.Dr Rebecca Pedleyis a research associate within the Division of Nursing, Midwifery and Social Work at the University of Manchester. Her PhD used mixed methods to develop and test a measure of illness perceptions in OCD. She currently leads an RfPB funded study which explores how to better support parents of children with OCD.Professor Steve Pillingis a Professor of Clinical Psychology & Clinical Effectiveness at UCL.Dr Rob Saundersis a Senior Research Associate at UCL, focusing on the use of data to improve healthcare delivery and the measurement of clinical needs in mental health settings.Faye Smallhas been working within the field of IAPT since 2009, with a previous background in mental health and counselling. Faye has also qualified as both a PWP and High Intensity CBT practitioner and is now the Programme Lead on the PGCert Psychological Therapies Practice (LICBT) within CEDAR at the University of Exeter.Dr Zoe Symonsis a Lecturer at Exeter University. She teaches on courses covering evidence-based low intensity treatments for common mental health problems.Dr Alje van Hoornis an Academic Clinical Fellow at the University of Exeter and a Psychiatrist and Mental Health practitioner for the NHS.Dr Earlise C. Wardis a licensed psychologist and Associate Professor at the University of Wisconsin-Madison, School of Nursing. Her main clinical and research interest is in effectiveness of culturally adapted depression treatments. Dr Ward uses her clinical expertise, and research findings to develop culturally adapted depression treatments for African American adults with depression.Alessa Wersonwas formerly a Psychological Wellbeing Practitioner at NHS IAPT Wellbeing Service Welwyn and Hatfield. She is now a Graduate Research Assistant at the University of Exeter.Professor Chris Williamsis an award-winning author, and Emeritus Professor of Psychosocial Psychiatry at the University of Glasgow, Scotland, UK and a Fellow of the Royal College of Psychiatrists and Honorary Fellow of BABCP. He is Director of Five Areas Ltd and author of the popular www.llttf.com website.

      Foreword

      David M. Clark

      Low-intensity CBT interventions have had a profound impact on the provision of psychological therapy for common mental health problems in the UK and in many other countries. It has long been recognised that cognitive-behaviour therapy is effective in the treatment of depression and anxiety related problems. However, public provision was held back by the high cost of traditional face-to-face CBT. Starting in 2004, the National Institute of Health and Social Care Excellence (NICE) issued a series of clinical guidelines that suggested a way forward. Emerging research suggested that many people with mild to moderate depression and/or anxiety might benefit from interventions that involved less therapist input (hence ‘low intensity') but still faithfully imparted the CBT skills that patients would find helpful for managing their emotional difficulties. This opened up the concept of a cost effective ‘stepped care’ system in which a substantial proportion of people would start treatment with a low-intensity intervention. Many should find that the low-intensity intervention alone met their needs. Some would find that, although helpful, low-intensity intervention alone was insufficient and subsequent ‘stepping up’ to a more traditionally delivered high-intensity CBT or other therapy would be required.

      In 2006 the UK Department of Health funded two pilots to examine whether: low-intensity interventions could be offered at scale in routine services; could achieve the outcomes achieved in previously published randomised controlled trials; and could be incorporated within an integrated stepped care system. The pilots (which were in Doncaster and Newham) were a resounding success (Clark, Layard, Smithies, Richards, Suckling, and Wright, 2009). Overall outcomes were in line with what one might expect for CBT and large numbers of people were treated, with the provision of low-intensity interventions being critical to helping large numbers of people.

      Building on the success of the Doncaster and Newham pilots, the UK government announced the creation of a national stepped care therapy programme called Improving Access to Psychological Therapy (IAPT). From small beginnings in 2008, IAPT has now grown to a point where it provides a course of treatment to around 605,000 people a year, with the government committed to expanding to almost 1 million people each year by 2024. A unique session by session outcome monitoring system tracks patients’ progress throughout low- and high-intensity therapy. Outcomes are in line with expectation. Approximately five in every ten treated patients recover and seven in every ten show substantial and worthwhile improvement. Low-intensity CBT continues to be at the heart of the programme and has shown its worth year in and year out.

      Of course, low-intensity CBT can only achieve excellent clinical outcomes if its practitioners are well-trained, have acquired the necessary clinical skills, are well-supported by regular supervision, and work in services that pay attention to the well-being of their staff as well as that of their clients. This is where the excellent Low-intensity CBT Skills and Interventions: A Practitioner's Manual so wonderfully hits the spot. Paul Farrand, one of the leading originators of low-intensity work, has assembled an outstanding group of authors, all of whom are LICBT experts. Together they have produced a comprehensive series of chapters that take students, experienced practitioners and teachers through all aspects of the LICBT practitioner role. The key concepts underpinning low-intensity work and how it differs from more traditional delivery of CBT are clearly articulated. It is a different and important way of working and this is made very clear. The manual then provides invaluable guidance on how to conduct low-intensity assessments and to support patients through the full range of NICE recommended low-intensity therapies. The social context in which interventions are delivered is crucial and suitable adaptions for particular populations are clearly described. An invaluable practitioner manual.David M. ClarkNational Clinical and Informatics Advisor for IAPT; Professor of Experimental Psychology, University of Oxford.

      David M. Clark

      National Clinical and Informatics Advisor for IAPT; Professor of Experimental Psychology, University of Oxford

      Acknowledgements

      Several people are always in the background when taking on the huge endeavour of editing such a substantial text. Paula, my wife, for keeping things running when I locked myself

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