Low-intensity CBT Skills and Interventions - Группа авторов

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       Critically evaluate several challenges with low-intensity CBT and propose potential solutions with reference to the literature.

      Extended Matching Questions

      1 Each answer is worth one mark.

      2 There are 15 answers.

      3 The question is worth 15 marks.

      4 There is negative marking.

      5 Answer by clearly writing the capital letter associated with each option in the response boxes provided after each question.

      6 More response boxes are provided than answers, so you are not required to put an answer in each response box.

      7 For each question, only those answers supplied within the appropriate spaces will be marked as correct. If you make an error, put a cross through the space with the answer in it and add a new space with the answer on the appropriate line.

       Table 1.2 Table 1.2

      Lead in: Select the 15 most commonly identified characteristics associated with Low-Intensity CBT. Each option can be used once, more than once, or not at all.

Table

      Procedural

      Case Vignette-Based Question

      Identify eight examples in the case vignette where the low-intensity CBT psychological therapy practitioner is not working in a manner consistent with low-intensity CBT. (Question worth 16 marks; 2 marks per answer.)

      Ellis, a low-intensity CBT psychological therapy practitioner, has recently assessed Ms Lashmay. At the start of the assessment session Ellis introduced herself and her role as a therapist in the Horizon Mental Health Service. Ellis began the assessment by asking Ms Lashmay what brought her to the service for an assessment and soon recognised that Ms Lashmay was possibly struggling with ‘social anxiety'. To confirm this possibility, Ellis said, ‘People with social anxiety may worry about saying something stupid. Can I ask what would be so bad about that?’ The answer confirmed to Ellis that Ms Lashmay was indeed struggling with social anxiety and introduced the required outcome measures. Ellis fed the outcome measures back and said that because Ms Lashmay only had mild social anxiety, she would work with her delivering evidence-based CBT self-help interventions face to face, usually taking about eight to ten sessions of 60 minutes. Ellis indicated that given that this was based around CBT self-help materials, the time Ms Lashmay would engage with treatment would be less than if Ms Lashmay was to use high-intensity CBT. Ellis recommended a CBT self-help workbook called Be at Ease with Yourself and Others. She highlighted the fact that she had used this with other patients who reported finding it really helpful, especially liking the behavioural activation and cognitive restructuring intervention alongside the compassion-focused approach.

Table 1

      Answers to Assessing Your Understanding questions can be found in the appendix on p. 333

      Further Reading and Resources

      Bennett-Levy, J., Richards, D.A., Farrand, P., Christensen, H., Griffiths, K.M., Kavanagh, D.J. et al. (eds) (2010) Oxford Guide to Low Intensity CBT Interventions. Oxford: Oxford University Press.

      Bower, P. and Gilbody, S. (2005) Stepped care in psychological therapies: access, effectiveness and efficiency: narrative literature review. British Journal of Psychiatry, 186, 11–17.

      Cuijpers, P., Donker, T., van Straten, A. 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, 1943–57.

      National Collaborating Centre for Mental Health (NCCMH) (2018) The Improving Access to Psychological Therapies Manual. Available at www.england.nhs.uk/publication/the-improving-access-to-psychological-therapies-manual (accessed 6 October 2019).

      To access the online resources accompanying this chapter, please visit: https://study.sagepub.com/farrand

Part I Low-Intensity Clinical Method

      2 Low-Intensity CBT Assessment: Unlocking the Key to Successful Intervention

      Pamela Myles-Hooton

      Learning Objectives

      By the end of this chapter you should be able to:

       Structure a low-intensity CBT assessment session

       Gather information in a patient-centred way to collaboratively reach a brief and accurate understanding of the patient's main mental health difficulties and impacts

       Undertake an accurate risk assessment

       Apply standardised assessment tools including symptom and other psychometric instruments to inform a problem formulation

       Summarise patient difficulties within a problem statement

       Negotiate SMART end of treatment goals

      Background

      Before effective delivery of any low-intensity CBT (LICBT) intervention, a comprehensive assessment is required to gain a full understanding of the presenting patient problem and impact. A competent assessment will not only lead to a thorough and accurate understanding of a patient's presenting difficulties and provide a clear indication as to what treatment interventions are appropriate, but also help establish a strong therapeutic relationship. Consistent with the LICBT clinical method, assessments can be undertaken face-to-face, over a media platform, or over the telephone (Chapter 1). There are two main types of overall assessments a practitioner may undertake (NCCMH, 2018).

      Key Point

      Main types of LICBT assessment:

       Problem formulation: Derive an initial shared understanding of the presenting problems captured in a problem statement and used to inform decision-making and treatment planning.

       Screening/Triage: Undertaken to determine if a person is suitable for a service and if so the appropriate step in the stepped care service delivery model (Chapter 4) and determine if urgency is required during allocation due to elevated levels of risk.

      Whilst practitioners may be expected to conduct either of these forms of assessment within service, there is debate surrounding the consistency of screening/triage assessment within LICBT working. Working within the stepped care model of service delivery (Bower and Gilbody, 2005) the assumption is that in the absence of any information suggesting otherwise, patients should undertake an LICBT problem formulation assessment. Following assessment, the patient should continue with treatment at Step 2 where appropriate or be referred to another step consistent with NICE Guidance (NCCMH, 2018). Given service efficiency and cost-benefits associated with this way of working (Chapter 1) resulting in reduced waiting times within the Improving Access to Psychological Therapies programme (IAPT; NCCMH, 2018), it is unclear what additional benefits arise from the LICBT practitioner workforce undertaking screening/triage assessments. Benefits are further questioned given that screening/triage assessments adopted within Stratified Care service delivery models result in patients receiving a greater number of treatment sessions but similar outcomes to stepped care (van Straten et al., 2006).

      Questioning Skills

      During

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