Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-17T17:40:49.171Z Has data issue: false hasContentIssue false
  • English
  • Français

Brief psychological interventions for anxiety and depression in a secondary care adult mental health service: an evaluation

Published online by Cambridge University Press:  08 October 2021

Kate Roberts ,
Emma Travers-Hill ,
Siân Coker ,
Jordan Troup ,
Stephanie Casey ,
Katherine Parkin  and
Youngsuk Kim
Kate Roberts*
Affiliation:
Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, NorwichNR4 7TJ, UK
Emma Travers-Hill*
Affiliation:
Cambridge Adult Locality Mental Health Team, Cambridgeshire and Peterborough NHS Foundation Trust, 37 Union House, Union Lane, CambridgeCB4 1PR, UK School of Psychology, University of Kent, CanterburyCT2 7FS, UK
Siân Coker
Affiliation:
Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, NorwichNR4 7TJ, UK
Jordan Troup
Affiliation:
Cambridge Adult Locality Mental Health Team, Cambridgeshire and Peterborough NHS Foundation Trust, 37 Union House, Union Lane, CambridgeCB4 1PR, UK
Stephanie Casey
Affiliation:
Cambridge Adult Locality Mental Health Team, Cambridgeshire and Peterborough NHS Foundation Trust, 37 Union House, Union Lane, CambridgeCB4 1PR, UK
Katherine Parkin
Affiliation:
Cambridge Adult Locality Mental Health Team, Cambridgeshire and Peterborough NHS Foundation Trust, 37 Union House, Union Lane, CambridgeCB4 1PR, UK
Youngsuk Kim
Affiliation:
Cambridge Adult Locality Mental Health Team, Cambridgeshire and Peterborough NHS Foundation Trust, 37 Union House, Union Lane, CambridgeCB4 1PR, UK
*
*Corresponding author. Email: kate.roberts24@nhs.net; e.l.travers-hill@kent.ac.uk
*Corresponding author. Email: kate.roberts24@nhs.net; e.l.travers-hill@kent.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Due to continuing pressures on the UK National Health Service’s mental health services, there has been increased interest in the development of brief psychological interventions (BPIs). These interventions are usually defined as including selected components of established psychological interventions, delivered over fewer sessions, and by staff with less specialised training (paraprofessionals). Cognitive behavioural therapy (CBT)-based BPIs for anxiety and depression have been found to be helpful for clients with mild to moderate mental health problems. This project evaluates the introduction of BPIs for anxiety and depression in a secondary care adult mental health service, with clients experiencing moderate to severe mental health difficulties. The service developed CBT-based manuals for anxiety (anxiety management) and depression (behavioural activation) BPIs. The BPIs were delivered by mental health workers without core therapeutic training, who were offered training and group supervision by psychologists in the team. Measures of anxiety (GAD-7), depression (PHQ-9), wellbeing (SWEMWBS) and functioning (WSAS) were completed at the start and end of treatment. The data reported from a 2-year period suggest that BPIs are associated with reductions in symptoms of anxiety and low mood, and improvements in wellbeing and functioning. Whilst this is a small-scale initial evaluation, the results are promising for the potential benefit of BPIs for clients in secondary care settings. Given that this new way of working has possible additional benefits such as improving access to psychological treatment and cost-effectiveness, further research in the area is warranted and encouraged.

Key learning aims

  1. (1) To overview the current evidence for BPIs.

  2. (2) To outline a possible model for offering BPIs in secondary care.

  3. (3) To illustrate the potential positive effects of BPIs within a secondary care population.

  4. (4) To consider the need for future research and development of BPIs.

Keywords

anxietybehavioural activationbrief psychological interventionCBTdepression
Type
Service Models, Forms of Delivery and Cultural Adaptations of CBT
Information
the Cognitive Behaviour Therapist , Volume 14 , 2021 , e29
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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

Further reading

Armstrong, G., Blashki, G., Lynette, J., Gunn, J., Moulding, R., Bland, R., & Naccarella, L. (2009). Optimising allied health psychological treatments in primary health care: piloting a randomized control trial of social worker training in focused psychological strategies (the SW-fps study). ANU Australian Primary Health Care Research Institute. Published online: November 2009. http://hdl.handle.net/1885/119235 Google Scholar
Cape, J., Whittington, C., Buszewicz, M., Wallace, P., & Underwood, L. (2010). Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Medicine, 8, 38.CrossRefGoogle ScholarPubMed
Richards, D. A., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Warren, F. C., … & O’Mahen, H. (2016). Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. The Lancet, 388, 871–880.CrossRefGoogle ScholarPubMed

References

Armstrong, G., Blashki, G., Lynette, J., Gunn, J., Moulding, R., Bland, R., & Naccarella, L. (2009). Optimising allied health psychological treatments in primary health care: piloting a randomized control trial of social worker training in focused psychological strategies (the SW-fps study). ANU Australian Primary Health Care Research Institute. Published online: November 2009. http://hdl.handle.net/1885/119235 Google Scholar
Bartram, D. J., Sinclair, J. M., & Baldwin, D. S. (2013). Further validation of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) in the UK veterinary profession: Rasch analysis. Quality of Life Research, 22, 379–391.CrossRefGoogle ScholarPubMed
Cameron, I. M., Crawford, J. R., Lawton, K., & Reid, I. C. (2008). Psychometric comparison of the PHQ-9 and HADS for measuring depression severity in primary care. British Journal of General Practice, 58, 32–36.10.3399/bjgp08X263794CrossRefGoogle ScholarPubMed
Cape, J., Whittington, C., Buszewicz, M., Wallace, P., & Underwood, L. (2010). Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Medicine, 8, 38.CrossRefGoogle ScholarPubMed
Clark, D. M., Layard, R., Smithies, R., Richards, D. A., Suckling, R., & Wright, B. (2009). Improving access to psychological therapy: initial evaluation of two UK demonstration sites. Behaviour Research and Therapy, 47, 910–920.10.1016/j.brat.2009.07.010CrossRefGoogle ScholarPubMed
Clark, D., & Oates, M. (2014, June). Improving Access to Psychological Therapies: Measuring Improvement and Recovery Adult Services (v2.0). Retrieved from: http://webarchive.nationalarchives.gov.uk/20160302155408/http://www.iapt.nhs.uk/silo/files/measuring-recovery-2014.pdf Google Scholar
Cuijpers, P., Cristea, I. A., Karyotaki, E., Reijnders, M., & Huibers, M. J. (2016). How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry, 15, 245–258.CrossRefGoogle Scholar
Dell’Osso, L., Carmassi, C., Corsi, M., Pergentini, I., Socci, C., Maremmani, A. G., & Perugi, G. (2011). Adult separation anxiety in patients with complicated grief versus healthy control subjects: relationships with lifetime depressive and hypomanic symptoms. Annals of General Psychiatry, 10, 29–35.CrossRefGoogle ScholarPubMed
Farrand, P., Taylor, A., Greaves, C., & Pentecost, C. (2013). Get Active Feel Good! Retrieved from: https://cedar.exeter.ac.uk/media/universityofexeter/schoolofpsychology/cedar/documents/BA_Control.pdf Google Scholar
Fat, N.G., Scholes, S., Boniface, S., Mindell, J., & Stewart-Brown, S. (2017). Evaluating and establishing national norms for mental wellbeing using the short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS): findings from the Health Survey for England. Quality of Life Research, 26(5), 1129–1144.CrossRefGoogle Scholar
Graaff, A. M, Cuijpers, P, Acarturk, C., Bryant, R., Burchert, S., Fuhr, D. C, Huizink, A. C., Jong, J., Kieft, B., Knaevelsrud, C., McDaid, D., Morina, N, Park, A., Uppendahl, J., Ventevogel, P., Whitney, C., Wiedemann, N., Woodward, A., & Sijbrandij, M. (2020) Effectiveness of a peer-refugee delivered psychological intervention to reduce psychological distress among adult Syrian refugees in the Netherlands: study protocol. European Journal of Psychotraumatology, 11, 1694347.CrossRefGoogle ScholarPubMed
Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.10.1046/j.1525-1497.2001.016009606.xCrossRefGoogle ScholarPubMed
Lovell, K., & Richards, D. (2012). A Recovery Programme for Depression. London, UK: Rethink Mental Illness.Google Scholar
McCabe, R., Garside, R., Backhouse, A., & Xanthopoulou, P. (2018). Effectiveness of brief psychological interventions for suicidal presentations: a systematic review. BMC Psychiatry, 18, 120.CrossRefGoogle ScholarPubMed
McCoy, C.E. (2017). Understanding the intention-to treat principle in randomized controlled trials. Western Journal of Emergency Medicine, 18, 1075–1078.CrossRefGoogle ScholarPubMed
Michelson, D., Malik, K., Krishna, M., Sharma, R., Mathur, S., Bhat, B., Parikh, R., Roy, K., Joshi, A., Sahu, R., Chilhate, B., Boustani, M., Cuijpers, P., Chorpita, B., Fairburn, C. G., & Patel, V. (2020). Development of a transdiagnostic, low-intensity, psychological intervention for common adolescent mental health problems in Indian secondary schools. Behaviour Research and Therapy, 130, 103439.10.1016/j.brat.2019.103439CrossRefGoogle ScholarPubMed
Morina, N. (2020). RECHARGE: A Brief Psychological Intervention to Build Resilience in Healthcare Workers During COVID-19. Clinical trial registration no. NCT04531774. Retrieved from: https://clinicaltrials.gov/ct2/show/NCT04531774 Google Scholar
Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. M. (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461–464.CrossRefGoogle ScholarPubMed
NHS England (2016/17). Mental Health Clustering Booklet (v5.0). Retrieved from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/499475/Annex_B4_Mental_health_clustering_booklet.pdf Google Scholar
NHS England (2015). Guidance to Support the Introduction of Access and Waiting Time Standards for Mental Health Services in 2015/16. Retrieved from: https://www.england.nhs.uk/wp-content/uploads/2015/02/mh-access-wait-time-guid.pdf Google Scholar
NICE (2011). Generalised Anxiety Disorder and Panic Disorder in Adults: Management. Retrieved from: https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance#stepped-care-for-people-with-panic-disorder Google Scholar
NICE (2017). NICE Guidance and Current Practice Report May 2017: Mental Health. Retrieved from: https://www.nice.org.uk/media/default/about/what-we-do/into-practice/measuring-uptake/nice-guidance-and-current-practice-report-mental-health.pdf Google Scholar
NICE (2018). Depression in Adults: Recognition and Management. Retrieved from: https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#stepped-care Google Scholar
Ping, N., Shoesmith, W. D., James, S., Nor Hadi, N. M., Yau, E., & Lin, L. J. (2020). Ultra brief psychological interventions for COVID-19 pandemic: introduction of a locally-adapted brief intervention for mental health and psychosocial support service. Malaysian Journal of Medical Sciences, 27, 51–56.CrossRefGoogle ScholarPubMed
Richards, D. A., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Warren, F. C., … & O’Mahen, H. (2016). Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. The Lancet, 388, 871–880.CrossRefGoogle ScholarPubMed
Richards, D. A., Hill, J. J., Gask, L., Lovell, K., Chew-Graham, C., Bower, P., Cape, J., Pilling, S., Araya, R., Kessler, D., Bland, J. M., Green, C., Gilbody, S., Lewis, G., Manning, C., Hughes-Morley, A., & Barkham, M. (2013). Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomized control trial. BMJ, 347, f4913.CrossRefGoogle Scholar
Richards, D. A., & Whyte, M. (2011). Reach Out: National Programme Student Materials to Support the Delivery of Training for Psychological Wellbeing Practitioners Delivering Low Intensity Interventions (3rd edn). London, UK: Rethink Mental Illness.Google Scholar
Shafran, R., Myles-Hooton, P., Bennett, S., & Öst, L-G. (2021). The concept and definition of low intensity cognitive behaviour therapy. Behaviour Research and Therapy, 138, 103803.10.1016/j.brat.2021.103803CrossRefGoogle ScholarPubMed
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.10.1001/archinte.166.10.1092CrossRefGoogle ScholarPubMed
Sprong, A. J., Clare, I. C. H., Galante, J., Crawford, M. J., & Jones, P. B. (2021). Brief psychological interventions for borderline personality disorder. A systematic review and meta-analysis of randomised controlled trials. Clinical Psychology Review, 83, 101937.CrossRefGoogle Scholar
Stewart-Brown, S., Tennant, A., Tennant, R., Platt, S., Parkinson, J., & Weich, S. (2009). Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): a Rasch analysis using data from the Scottish Health Education Population Survey. Health & Quality of Life Outcomes, 7, 15.10.1186/1477-7525-7-15CrossRefGoogle ScholarPubMed
Turkington, D., Kingdon, D., Rathod, S., Hammond, K., Pelton, J., & Mehta, R. (2006). Outcomes of an effectiveness trial of cognitive-behavioural intervention by mental health nurses in schizophrenia. British Journal of Psychiatry, 189, 36–40.CrossRefGoogle Scholar
Vaingankar, J. A., Abdin, E., Chong, S. A., Sambasivam, R., Seow, E., Jeyagurunathan, A., … & Subramaniam, M. (2017). Psychometric properties of the short Warwick Edinburgh mental well-being scale (SWEMWBS) in service users with schizophrenia, depression and anxiety spectrum disorders. Health and Quality of Life Outcomes, 15, 153–164.10.1186/s12955-017-0728-3CrossRefGoogle ScholarPubMed
Wakefield, S., Kellett, S., Simmonds-Buckley, M., Stockton, D., Bradbury, A., & Delgadillo, J. (2020). Improving Access to Psychological Therapies (IAPT) in the United Kingdom: a systematic review and meta-analysis of 10-years of practice-based evidence. British Journal of Clinical Psychology, 60, 1–37.CrossRefGoogle ScholarPubMed
Waller, H., Garety, P. A., Jolley, S., Fornells-Ambrojo, M., Kuipers, E., Onwumere, J., … & Craig, T. (2013). Low intensity cognitive behavioural therapy for psychosis: a pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 44, 98–104.10.1016/j.jbtep.2012.07.013CrossRefGoogle ScholarPubMed
Waller, G., Tatham, M., Turner, H., Mountford, V. A., Bennetts, A., Bramwell, K., Dodd, J., & Ingram, L. (2018). A 10-session cognitive-behavioral therapy (CBT-T) for eating disorders: outcomes from a case series of nonunderweight adult patients. International Journal of Eating Disorders, 51, 262–269.CrossRefGoogle ScholarPubMed
World Health Organization (2016). International Statistical Classification of Diseases and Related Health Problems (10th edn). https://icd.who.int/browse10/2016/en Google Scholar
Wright, I., Travers-Hill, E., Gracey, F., Troup, J., Parkin, K., Casey, S., & Kim, Y. (2020). Brief psychological intervention for distress tolerance in an adult secondary care community mental health team: an evaluation. The Cognitive Behaviour Therapist, 13, e50.10.1017/S1754470X20000513CrossRefGoogle Scholar
Zahra, D., Qureshi, A., Henley, W., Taylor, R., Quinn, C., Pooler, J., … & Byng, R. (2014). The Work and Social Adjustment Scale: reliability, sensitivity and value. International Journal of Psychiatry in Clinical Practice, 18, 131–138.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.