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Low-Intensity CBT Skills & Interventions
Contents
About the Editor
About the Contributors
Foreword
Acknowledgements
Online resources
Worksheet Templates
Workbooks and Resources
Introduction: Pedagogic Approach
Cognitive Model of Skills Development
Declarative Knowledge
Procedural Knowledge
Reflection
Closing the Gap between the DPR systems
Assessing Your Understanding
1 Low-Intensity Cognitive Behavioural Therapy: Revolution Not Evolution
Learning Objectives
Background
The IAPT Programme
Key Point
Stepped Care
Key Point
What is Low-Intensity CBT?
Key Point
Evidence Base
Interventions
Delivery and Support
Acceptability
Key Point
Differences between HICBT and LICBT
Clinical Method
Therapeutic Dose
Here and Now v. Longitudinal Cognitive Behavioural Formulation
Specific Factor Skills Employed When Questioning
Single-Strand v. Multi-Strand Interventions
Workforce
Responsibilities
Training and Supervision
Challenges Encountered
Clinical Heterogeneity
Lack of Consensus Regarding Single-Strand Interventions
Therapeutic Drift during Support Sessions
Therapeutic Drift within CBT Self-Help Interventions
Reflection Point
Retention of the LICBT Psychological Therapy Practitioner Workforce
Increased Demands Placed on LICBT Psychological Therapy Practitioners
Key Point
Summary
Assessing Your Understanding. Declarative. Essay Questions
Extended Matching Questions
Procedural. Case Vignette-Based Question
Further Reading and Resources
2 Low-Intensity CBT Assessment: Unlocking the Key to Successful Intervention
Learning Objectives
Background
Key Point
Questioning Skills
Funnelling
Top of the Funnel
Key Point
Moving down the Funnel
Bottom of the Funnel
Problem Formulation Assessment Structure
Introduction to Assessment Session
Introductions
Clinical Example. Introduction
Brief Clear Explanation of LICBT Practitioner Role
Clinical Example. Introducing Role
Overview and Agree Session Agenda
Clinical Example. Overviewing Session
Confidentiality and Informed Consent
Clinical Practice. Confidentiality
Clinical Example. Breaking Confidentiality
Information-Gathering: General Presentation
Key Point
Triggers
Onset and Progress
Medication
Clinical Example. Questions Exploring Medication Use
Impact
Modifying and Maintaining Factors
Employment Status
Previous Treatments
Other Current Treatments
Alcohol Consumption and Drug Use
Administration of Routine Outcome Measures
Clinical Example. Introducing Routine Outcome Measures
Risk Assessment
Reflection Point
Clinical Example. Introducing Risk Assessment
Information-Gathering: Problem Formulation
Clinical Example. Questions to Elicit Symptoms of the Presenting Problem
Information Giving and Shared Decision-Making
Problem Statement
Goal-Setting
Key Point
Barriers to Goals
Psychoeducation
Treatment Options
Ending the Session
Clinical Practice. Areas Addressed
Summary
Assessing Your Understanding. Declarative. Multiple Choice Questions
Procedural. Self-Practice/Self-Reflection
Further Reading and Resources
3 Diagnoses and Problem Descriptors: Labelling Problems, Not People
Learning Objectives
Background
Key Point
Reflection Point
Problem Descriptors
Key Point
Presenting Characteristics of Common Mental Health Disorders (CMDs)
Depression
Key Point
Anxiety Disorders
Key Point
Generalised Anxiety Disorder
Key Point
Panic Disorder
Key Point
Agoraphobia
Key Point
Obsessive Compulsive Disorder (OCD)
Key Point
Specific Phobias
Key Point
Diagnosis of CMDs Not Treated with LICBT
Social Anxiety Disorder
Key Point
Key Point
Health anxiety
Key Point
Post-Traumatic Stress Disorder (PTSD)
Key Point
Mixed Anxiety and Depressive Disorder
Key Point
Validity of Diagnostic Systems
Probable Diagnosis Determining a Problem Statement
Clinical Example. Case Example: Sallyanne
Improving Diagnosis Rates
Summary
Assessing Your Understanding. Declarative. Extended Matching Questions
Procedural. Reaching a Probable Diagnosis
Further Reading and Resources
4 Clinical Decision-Making in Low-Intensity Cognitive Behavioural Therapy: Integrating Patient Choice, the Practitioner and Evidence Base
Learning Objectives
Background
Key Point. Characteristics of Shared-Decision Making (Elwyn et al., 2010)
Key Point. Factors Potentially Causing Drift from the Evidence Base in Decision-Making
Clinical Decision-Making within Stepped Care
Clinical Practice. Principles of the Stepped Care Model Informing Key Decision-Making Stages (Bower & Gilbody, 2005; Richards et al. 2010)
Decision-Making Protocols within Low-Intensity CBT
Clinical Practice. Common Clinical Decisions within the IAPT Programme and Factors to Consider
Decision 1: Is Step 2 or 3 Treatment Suitable for the Patient?
Clinical Practice. IAPT Inclusion and Exclusion Criteria
Clinical Practice. To Determine the Suitability of Step 2 and 3 Treatments consider:
Provisional Diagnosis
Severity
Clinical Practice. Wider Information to Consider Alongside ROM Severity (NICE, 2011b, para. 1.4.1)
Risk
Alcohol and Drug Use
Clinical Practice. Indicators of Unsuitability of Step 2/3 Treatment for Patients Using Alcohol or Drugs
Decision 2: Which LICBT Intervention Do I Offer?
Clinical Practice. NICE (2011b) Recommended LICBT Interventions
Co-morbidity
Signposting
Decision 3: How Should the Intervention Be Delivered?
Decision 4: Should I Discharge or Step up?
Clinical Practice. Clinical Decision-Making Informed by Number of Treatment Sessions
Summary
Assessing Your Understanding
Declarative. Multiple Choice Questions
Procedural
Reflection Point
Further Reading and Resources
5 Common and Specific Factors: The Importance of What You Do and How You Do It
Learning Objectives
Common and Specific Factors. Common Factors
Key Point. Examples of Common Factors
Specific Factors
The Importance of Common and Specific Factors
Evidence Base
Common Factors in LICBT
Practitioner Characteristics
Warmth
Genuineness
Empathy
Clinical Example. Clinical Demonstration of the Importance of Empathy
Nonverbal Skills
Clinical Practice. SOLER (Egan, 2002)
Listening Skills
Verbal Skills
Expressing Therapeutic Empathy
Key Point. Elements Associated with Therapeutic Empathy (Thwaites and Bennett-Levy, 2007)
Clinical Example. Use of Empathy in Response to Patient Distress
What Empathy is Not!
Clinical Example. Verbal Expressions to Avoid
Reflection
Clinical Example. Example of Reflection
Summarising
Key Point. Functions of Summaries
Key Point. Types of Summary
Working Together
Challenges to Good Common Factor Skills
Reflection Point
Summary
Assessing Your Understanding. Declarative. Extended Matching Question
Procedural. Practising Common Factor Skills
Further Reading and Resources
6 Supporting Low-Intensity Cognitive Behavioural Therapy Interventions: Teach Me, Don't Tell Me
Learning Objectives
Background
Key Point. Levels of Practitioner Support Provided for LICBT Interventions
Evidence Base
Structuring a Course of Treatment
Focus of Support Sessions
Key Point. Types of Support in the LICBT Clinical Method
Structure of Individual Support Sessions
Clinical Practice. Support Session Structure
Stage 1: Introduction
Clinical Practice. Introduction to Support Session
Stage 2: Information-Gathering: General
Clinical Practice. General Information-Gathering Areas
Review the Problem Statement
Clinical Practice. Structure When Reviewing Problem Statement
Review Engagement with Other Interventions or Treatments
Routine Outcome Measures
Risk Review
Clinical Practice. Essential Areas of Risk to Review at Every Support Session
Clinical Example. Example 1: A Section of a Risk Review Undertaken during a Support Session
Stage 3: Information-Gathering: Intervention
Clinical Example. Example 2: Identifying Barriers Engaging with the Home Practice Plan
Stage 4: Information-Giving
Clinical Example. Example 3: Bridging Statement
Key Point. Information-Giving Clinical Competencies
Structuring Information-Giving
Checking Understanding and Giving Information
Clinical Example. Example 4: Checking Understanding and Giving Information during Stage 4 of a Behavioural Activation Session
Addressing Difficulties
Clinical Example. Example 5: Support Provided to Address Patient Difficulties with Specific Factors associated with Behavioural Activation
Stage 5: Shared Decision-Making
Reflection Point
Stage 6: Ending
Relapse Prevention
Clinical Practice. Steps within a Relapse Prevention Technique
Common Challenges
Summary
Assessing Your Understanding. Declarative. Extended Matching Questions
Procedural
Further Reading and Resources
7 Identifying the Best Match between Delivery Modality and Learning Style: Change is the End Result of All True Learning
Learning Objectives
Background
Teaching Resources
Modality Supporting the Delivery of Low-Intensity CBT
Written CBT Self-Help Interventions
Computerised/Internet CBT Self-Help Interventions
Limitations of cCBT
Audio CBT Self-Help Interventions and Resources
Key Point. Advantages of Audiobooks and Downloads
Key Point. Examples of online and audio resources
Matching Learning Style to LICBT Modality
Reflection Point
Clinical Example. Useful Initial Questions to Match Learning Style to Modality
Clinical Example. Example Dialogue to Introduce LICBT Modality
Choosing Written LICBT Intervention
Key Point. Different Ways Written Materials Are Presented
Summary
Assessing Your Understanding. Declarative. Multiple Choice Questions
Procedural
Further Reading and Resources
8 Using Behaviour Change Models to Support Low-Intensity Cognitive Behavioural Therapy Interventions: Enabling Patients to Engage and Make Lasting Change
Learning Objectives
Introduction
Models, Theories and Frameworks of Behaviour Change
Key Point. Necessary Conditions for Behaviour
Reflection Point
Application of COM-B to Support LICBT Interventions
Clinical Practice. Intervention Stages
Step 1: Identifying Targets for Behaviour Change
Clinical Practice. Common Difficulties Faced Engaging with LICBT
Step 2: Understanding What Needs to Change – Behavioural Diagnosis
Using COM-B to develop a behavioural diagnosis
Step 3: Designing and Delivering Interventions to Modify Influences on a Behaviour
Using BCW Intervention Functions to Modify Influences on Behaviour
Key Point. Intervention Functions Associated with Behavioural Activation (BA)
Clinical Example. Case Study: Behavioural Activation
Working with Multiple Influences on Behaviour
Clinical Example. Case Study: Exposure Therapy
Summary
Assessing Your Understanding. Declarative
Procedural
Further Reading and Resources
9 Supervision in Low-Intensity CBT: Fundamental to the Clinical Method
Learning Objectives
Background
Key Point. Supervision Objectives
Supervision in Low-Intensity CBT
Key Point. LICBT Supervision Objectives (Turpin and Wheeler, 2011)
Case Management
Key Point. Characteristics of CM Supervision Implemented within the IAPT Programme (Turpin and Wheeler, 2011)
Clinical Skills
Key Point. Characteristics of CS supervision implemented within the IAPT programme (Turpin and Wheeler, 2011)
Enhancing the Delivery of Clinical Skills Supervision
Specific Factors. Case Management Supervision
Reflection Question
Clinical Practice. Patient Selection Criteria for Case Management Supervision
Clinical Practice. Stages Involved in CM Supervision
Stage 1: Check for Burnout
Stage 2: Introduce Caseload
Stage 3: Individual Case Discussion
Stage 4: Summary and Action Planning
Clinical Skills Supervision
Case Presentation
Supervision Questions
Agenda Items
Enhancing the Reflective System
Clinical Practice. Using a Reflection Record to Support CS Supervision for the LICBT Workforce
Consideration of Supervision for the LICBT Workforce
Summary
Assessing Your Understanding. Declarative. Extended Matching Question
Procedural
Patient 1 – Scheduled Review
Patient 2 – High Score
Further Reading and Resources
10 Medication for Common Mental Health Problems: Extending the Evidence-Based Treatment Toolkit
Learning Objectives
Background
Reflection Point
NICE Guidance on Medication for Depression and Anxiety
Depression
Key Point. Specific recommendations for depression
Anxiety
Key Point. Specific recommendations for anxiety disorders
Addressing Medication in LICBT
Assessment and Subsequent Contacts
Recognising Concerns with Medication Taking
Depression and Antidepressants
Types of Antidepressant
Key Point. Common Classes of Antidepressants Involved in Treating Depression
Key Point. Common Types of SSRI
Duration of Treatment
Effectiveness
Combined with CBT
How Do Antidepressants Work?
Monoamine Theory of Depression
Effects of Antidepressants on Cognition
Cognitive Neuropsychological Model of Depression
Clinical Considerations. Suicide Risk with SSRI and SNRI
Overdose
Anxiety on Initiation
Sexual Dysfunction
Discontinuation Syndrome
Key Point. Common Physical Symptoms Associated with Antidepressant Discontinuation
Clinical Example. In the Session
Bleeding
Anxiety and Anxiolytics
Types of Anxiolytic
Benzodiazepines
Key Point. Common Types of Benzodiazepines for Treating Anxiety
Clinical Considerations. Dependence
Withdrawal Effects
Impact on Exposure-Based LICBT Interventions
Clinical Practice. Reducing Anxiolytic Medication During Exposure Therapy
Overdose
Summary
Assessing Your Understanding. Declarative. Multiple Choice Questions
Procedural. Self-Practice/Self-Reflection
Further Reading and Resources
11 Behavioural Activation: Working Outside In, Rather Than Inside Out
Learning Objectives
Intervention Description
Evidence Base
Theoretical Rationale
Application of Behavioural Activation
Specific Factors: Supporting Behavioural Activation
Clinical Practice. Intervention Stages
Stage 1: Explain BA
Clinical Example. In Session
Reflection Point
Step 1a: Keeping a BA Diary
Stage 2: Identify Routine, Pleasurable and Necessary Activities
Key Point
Unhelpful Activities Being Engaged in or Necessary Activities Not Completed
Stage 3: Grade Activities in Terms of How Difficult They Are to Achieve at Present
Stage 4: Schedule Activities into the Behavioural Activation Schedule
Stage 5: Patient Follows Schedule
Stage 6: Review Progress
Summary
Assessing Your Understanding. Declarative. Multiple Choice Questions
Procedural. Self-Practice/Self-Reflection
Further Reading and Resources
12 Cognitive Interventions: A Thought is Just a Thought
Learning Objectives
Intervention Description
Key Point. Differences between Cognitive Interventions
Evidence Base
Theoretical Rationale
Key Point. Examples of Verbal Techniques Adopted in LICBT CR (Clark, 2013)
Application of the LICBT Cognitive Intervention
Key Point. Common LICBT Cognitive Interventions
Specific Factors: Supporting Cognitive Interventions. Key Point. Intervention Stages
Stage 1: Explain the Rationale and Gain Patient ‘Buy-in'
Clinical Example. Presenting Rationale of the LICBT Cognitive Intervention Combining CR Progressing to BE
Stage 2: Identify Unhelpful NATs
Clinical Practice. Supporting the Thought Diary within the Session
Clinical Example. Reframing a ‘What if’ Statement
Stage 3: Examine Thoughts and Search for Evidence
Clinical Practice. Helpful Questions to Separate Fact from Opinion
Stage 4: Using Gathered Evidence to Reconsider Thoughts
Stage 5: Review Progress Using CR
Clinical Practice. Decision-Making Following the Use of CR
Stage 6: Plan
Clinical Practice. Supporting the BE within the Session
Stage 7: Do
Stage 8: Review
Reflection Point
Challenges with LICBT Cognitive Intervention
Key Point. Common Challenges
Difficulties Challenging Thoughts with High Initial Belief Ratings
Small and Limited Improvement
Difficulty Supporting the BE between sessions
Summary
Assessing Your Understanding. Declarative. Multiple Choice Questions
Procedural. Self-Practice/Self-Reflection
Further Reading and Resources
13 Graded Exposure Therapy
Learning Objectives
Intervention Description
Exposure Approaches
Key Point. Modalities of Exposure Therapy
Key Point. Characteristics of GET That Make It Consistent with LICBT
Exposure Format
Evidence Base
Theoretical Rationale
Key Point. Additional Factors Considered Relevant to the Development of Phobias
Application of Graded Exposure
Specific Factors: Supporting Graded Exposure
Clinical Practice. Intervention Stages
Stage 1: Explain Exposure Principles and Obtain Consent
Key Point. Content of Exposure Psychoeducation (Bourne, 1998; Rosqvist, 2005)
Stage 2: Identify Fear/Anxiety Provoking Stimuli
Clinical Example. Questions to Elicit Feared/Anxiety-Provoking Stimuli
Stage 3: Grade Stimuli and Create an Exposure Hierarchy
Reflection Point
Clinical Example. Questions to Help Prepare for an Exposure Task Relating to a Dog Phobia
Stage 4: Set-up Conditions for Habituation
Clinical Practice. Necessary Conditions for Exposure in GET
Graded
Prolonged
Repeated
Without Distraction
Clinical Example. Case Study and Problem Statement: June
Stage 5: Patient Follows Exposure Hierarchy
Stage 6: Review Progress
Challenges Implementing Exposure Therapy
Key Point. Common Challenges
Medication and Alcohol
Lack of Success
Clinical Practice. Solutions to Lack of Success
Motivation
Co-morbid Depression
Summary
Assessing Your Understanding. Declarative. Multiple Choice Questions
Procedural. Self-Practice/Self-Reflection
Further Reading and Resources
14 Exposure Therapy and Response Prevention for Obsessive-Compulsive Disorder: Taking on the Challenge
Learning Objectives
What is OCD?
Key Point. Characteristics of Obsessions and Compulsions
Intervention Description
Key Point. Exposure and Response Prevention
Evidence Base
Theoretical Rationale
Key Point. ERP Implementation Criteria for OCD (Abramowitz, 2006; Foa and Kozak, 1986)
Application of Exposure and Response Prevention
Specific Factors: Supporting Exposure and Response Prevention
Key Point. Intervention Stages
Stage 1: Assessment
Clinical Example. Case Study: Laura
Stage 2: Explaining Exposure and Response Prevention
Key Point. Using the Patient ABC Model to Help Patient to Understand OCD
Reflection Point
Clinical Practice. Useful Information to Patients when Adopting ERP
Stage 3: Conducting ERP
Key Point
Figure 14.3 Graded hierarchy ranging from easiest to hardest exposure situations
Step 4: Continuing to Conduct ERP
Clinical Practice. Specific Support for Patients to Engage with ERP
Summary
Assessing Your Understanding. Declarative. Multiple Choice Questions
Procedural. Self-Practice/Self-Reflection
Further Reading and Resources
15 Worry Management: A Practical Solution to a Problem of Hypotheticals
Learning Objectives
Intervention Description
Key Point. Adopted techniques from HICBT Interventions
Evidence Base
Theoretical Rationale
Application of Worry Management
Specific Factors: Supporting Worry Management
Clinical Practice. Intervention Stages
Stage 1: Explain Worry Management. Stage 1a: Collaboratively Discuss the ‘Vicious Cycle'
Clinical Example. Explaining GAD
Stage 1b: Present the LICBT Treatment Rationale
Clinical Example. Worry Management
Stage 1c: Important Life Areas
Stage 2: Identify and Record Worries
Clinical Practice. Information to Collect Associated with Worry
Reflection Point
Stage 3: Classify Worries
Key Point. Worry Classification
Stage 4: Worry Time
Clinical Example. Worry Time
Step 4a: Schedule Worry Time
Clinical Example. Rules of Scheduling Worry Time
Step 4b: Continue to Record Your Worries
Step 4c: Refocus on the Present
Clinical Practice. Specific Factors Supporting the Patient to Refocus and Let Go
Step 4d: Engage with Worry Time
Clinical Practice. Simple Rules
Step 4e: Review
Clinical Practice. Common Learning from Worry Time
Challenges with Worry Management
Summary
Assessing Your Understanding. Declarative. Multiple Choice Questions
Procedural. Self-Practice/Self-Reflection
Further Reading and Resources
16 Problem-Solving: Doing What It Says on the Tin
Learning Objectives
Intervention Description
Evidence Base
Key Point. Main Types of Problem-Solving Therapy
Theoretical Rationale
Application of Problem-Solving
Clinical Practice. Clinical Decision-Making Informing Problem-Solving
Specific Factors: Supporting Problem-Solving
Clinical Practice. Intervention Stages
Stage 1: Explain Problem-Solving
Stage 2: Identify Problem to Be Worked on
Clinical Practice. Support to Get the Patient Started
Stage 3: Generate a Variety of Potential Solutions to the Problem
Key Point. Useful Tips to Generate Potential Solutions
Stage 4: Complete a Pros and Cons Analysis of the Generated Ideas
Stage 5: Select the Most Appropriate Solution to Put into Action
Stage 6: Plan Implementation
Key Point. The four Ws:
Stage 7: Carry out the Plan
Stage 8: Review
Reflection Point
Problem-Solving Challenges
Clinical Practice. Common Challenges
Plan Considered Too Overwhelming to Complete
Clinical Practice. Supporting the ‘Overwhelmed’ Patient
Solution Has Not Worked
LICBT Practitioner Does Not Believe Patient Solution Will Work
Summary
Assessing Your Understanding. Declarative. Multiple Choice Questions
Procedural. Self-Practice/Self-Reflection
Further Reading and Resources
17 Sleep Managemen: Steps to a Good Night's Sleept
Learning Objectives
What Is Insomnia?
Intervention Description
Evidence Base
Key Point. Characteristics of CBT-I consistent with LICBT:
Theoretical Rationale
Key Point. Mechanisms Regulating Sleep
Application of LICBT Sleep Management
Clinical Practice. Intervention Stages
Stage 1: Psychoeducation
Clinical Example. Explaining the Mechanisms Regulating Sleep
Clinical Example. Debunking Sleep Myths
Sleep Hygiene
Key Point. Differences between Tiredness and Sleepiness
Stage 2: Support the Patient to Begin a Sleep Diary
Stage 3: Establish Appropriate Behaviour Modification Route
Theoretical Rationale for SCT and SRT
Stage 4: Implement Behaviour Modification. Stage 4a: Stimulus Control Therapy
Stage 4b: Sleep Restriction Therapy
Clinical Practice. Steps Associated with SRT
Step 1: Calculate Total Sleep Time
Clinical Example. Calculating TST and TIB
Step 2: Calculate Initial TIB Prescription
Clinical Example. Calculating TIB Prescription
Step 3: Support Patient Apply TIB Prescription
Clinical Example. Calculating Bed and Wake Times
Step 4: Calculate Sleep Efficiency
Clinical Example. Calculating Sleep Efficiency
Step 5: Use Sleep Efficiency to Create New TIB Prescription
Stage 5: Review
Stage 6: If Necessary, Consider Alternatives
Challenges with Sleep Management
Reluctance to Engage
Clinical Practice. Specific Factors Addressing Reluctance to Change
Contraindications
Key Point. Contraindications for Specific Populations
Potential to Increase Risk Undertaking Regular Activities
Summary
Assessing Your Understanding. Declarative. Multiple Choice Questions
Procedural
Reflection Point
Further Reading and Resources
18. Adapting Low-Intensity CBT to Accommodate Black, Asian and Minority Ethnic Patients Supporting BAME!
Learning Objectives
Background
Common Mental Health Problems Experienced by People from BAME Backgrounds
Adapting Psychological Therapy to Accommodate BAME Patients
Key Point. Common Changes to Culturally Adapt Treatments and Interventions
Best Practices
Developing Local Care Pathways
Workforce, Education and Training
Reflection Point
Key Point. Commissioners and Services
Adapting Treatments and Delivery for Specific BAME Populations
Clinical Practice. Adaptations to Enhance Acceptability
Culturally Adapting an Intervention for Black American Adults: Oh Happy Day Class
Key Point. Disparities Affecting Black Americans
Cultural Frameworks Guiding Adaptation of CwD to Create OHDC
Framework to Adapt CwD for Black Americans. Afrocentric Paradigm
Key Point. Nguzo Saba Principles
Ecological Validity and Culturally Sensitive Framework
Key Point. Elements
Cultural Adaptation Process
Key Point. Method Adopted to Culturally Adapt OHDC (Ward et al., 2015)
Key Point. Recommended Cultural Adaptations
Application of Cultural Frameworks
Key Point. Enhancing Engagement with the OHDC LICBT Intervention
Summary
Assessing Your Understanding. Declarative. Multiple Choice Questions
Procedural. Self-Practice/Self-Reflection
Further Reading and Resources
19 Adapting Low-Intensity CBT for Older People: Don't Let Misconceptions Get in the Way of Evidence-Based Treatment
Learning Objectives
Background
Reflection Point
Misconceptions of Ageing
Key Point. Common Misconceptions
Gerontology Informing Clinical Practice
Impact on Clinical Practice
Key Point
Evidence Base
NICE Depression Clinical Practice Guideline (90) and late life depression
Group CBT
Benefits of Psychological Therapies for Older Adults
Key Point. Benefits of CBT for Older People
Adapting Practice
Appreciating the Older Person's Perspective
The Five Cs
Key Point. The Five Cs
Problem Statements
Capability, Opportunity, Motivation – Behaviour (COM-B)
Selection, Optimisation with Compensation (SOC)
Key Point. Components of the SOC Model
Lifeskills: A Valuable Resource
Supporting Home Practice Plans
Rationale to Support Home Practice Plans
Clinical Example. Using A Home Practice Plan to Inform Support for Behavioural Activation
Summary
Assessing Your Understanding. Declarative. Multiple Choice Questions
Procedural. Self-Practice/Self-Reflection
Further Reading and Resources
20 Low-Intensity CBT: New Horizon or False Dawn?
Learning Objectives
Background
The Value of Data
Key Point. Operation of the IAPT Programme in 2018–19
Recovery
High Performing Services
Key Point. High-Performing IAPT Services
Reflection Point
Challenges
Practitioner Attrition
Key Point. Challenges Arising from High Attrition
Solutions
Key Point. Solutions to Address Attrition
Resiliency
Research-Informed Developments
Criteria to Inform Recommendations for LICBT Interventions
Key Point. Criteria to Evaluate LICBT Interventions
Key Point. Criteria Informing LICBT Intervention Recommendations
Adapting LICBT To Accommodate Diversity
Accommodating Armed Forces Veterans
Peer Support to Enhance Opportunity and Accommodate Challenges with Capability
LICBT for Informal Caregivers
Important Caveat
Conclusions
Assessing Your Understanding. Declarative. Multiple Choice Questions
Essay Questions
Procedural. Self-Practice/Self-Reflection
Further Reading and Resources
Appendix. Answers to Assessing Your Understanding. Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
References
Index
a practitioner's manual
Edited by
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Challenges encountered with LICBT:
For many years, service delivery has evolved to meet large increases in demand for mental health treatment. However, simply evolving mental health services has resulted in excessive waiting times, lack of choice and poor connection to the evidence base. Revolution in mental health service delivery based on the implementation of LICBT within Step 2 of a stepped care model has provided a solution to these challenges. This chapter has highlighted that whilst based on a CBT model, key characteristics associated with the LICBT clinical method and workforce serve to distinguish low- from high-intensity CBT with these characteristics addressed more extensively in other chapters. As can be common with revolution however, several new challenges to be addressed have emerged.
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