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Developing Services for Patients with Depression or Anxiety in the Context of Long-term Physical Health Conditions and Medically Unexplained Symptoms: Evaluation of an IAPT Pathfinder Site

Published online by Cambridge University Press:  20 May 2016

Stephen Kellett ,
Kimberley Webb ,
Nic Wilkinson ,
Paul Bliss ,
Tom Ayers  and
Gillian Hardy
Stephen Kellett*
Affiliation:
University of Sheffield and Sheffield Health and Social Care Foundation NHS Trust, UK
Kimberley Webb
Affiliation:
University of Sheffield, UK
Nic Wilkinson
Affiliation:
Psychological Services, Sheffield Health and Social Care NHS Foundation Trust, UK
Paul Bliss
Affiliation:
Sheffield Improving Access to Psychological Therapies Service, UK
Tom Ayers
Affiliation:
Sheffield Improving Access to Psychological Therapies Service, UK
Gillian Hardy
Affiliation:
University of Sheffield, UK
*
Correspondence to Stephen Kellett, Department of Psychology, University of Sheffield, Sheffield S10 2TN, UK. E-mail: [email protected]
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Abstract

Background: There are national policy drivers for mental health services to demonstrate that they are effectively meeting the psychological needs of people with long-term health conditions/medically unexplained symptoms (LTC/MUS). Aims: To evaluate the implementation of a stepped-care service delivery model within an Improving Access to Psychological Therapies (IAPT) service for patients with depression or anxiety in the context of their LTC/MUS. Method: A stepped-care model was designed and implemented. Clinical and organizational impacts were evaluated via analyses of LTC/MUS patient profiles, throughputs and outcomes. Results: The IAPT service treated N = 844 LTC and N = 172 MUS patients, with the majority (81.81%) receiving a low intensity intervention. Dropout across the service steps was low. There were few differences between LTC and MUS outcome rates regardless of step of service, but outcomes were suppressed when compared to generic IAPT patients. Conclusions: The potential contribution of IAPT stepped-care service delivery models in meeting the psychological needs of LTC/MUS patients is debated.

Keywords

IAPTLTCMUSstepped-care
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 44 , Issue 5 , September 2016 , pp. 553 - 567
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2016 

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References

Aggarwal, V. R., McBeth, J., Zakrzewskai, J. M., Lunt, M. and McFarlane, G. J. (2006). The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors. International Journal of Epidemiology, 35, 468–476.Google Scholar
Chalder, T., Wallace, P. and Wessley, S. (1997). Self-help treatment of chronic fatigue in the community: a randomized controlled trial. British Journal of Health Psychology, 2, 189–197.Google Scholar
Chan, S. and Adams, M. (2014). Service use, drop-out rate and clinical outcomes: a comparison between high and low intensity treatments in an IAPT Service. Behavioural and Cognitive Psychotherapy, 42, 747–759.Google Scholar
Deary, V., Chalder, T. and Sharpe, M. (2007). The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clinical Psychology Review, 27, 781–797.Google Scholar
Department of Health (2011a). Ten Things You Need to Know about Long-term Conditions. Department of Health website. Available at: www.dh.gov.uk/en/Healthcare/ Google Scholar
Department of Health (2011b). No Health Without Mental Health. UK: Department of Health; http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123766 . Google Scholar
Dewhurst, E., Novakova, B. and Reuber, M. (2015). A prospective service evaluation of acceptance and commitment therapy with refractory epilepsy. Epilepsy and Behaviour, 46, 234–241.Google Scholar
Egede, L. E. and Ellis, C. (2010). Diabetes and depression: global perspectives. Diabetes Research and Clinical Practice, 87, 302–310.Google Scholar
Flo, E. and Chalder, T. (2014). Prevalence and predictors of recovery from chronic fatigue syndrome in a routine clinical practice. Behaviour Research and Therapy, 63, 1–8.CrossRefGoogle Scholar
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N. and Turk, D. C. (2007). The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin, 133, 581–624.CrossRefGoogle ScholarPubMed
Goodwin, R. D., Davidson, K. W. and Keyes, K. (2009). Mental disorders and cardiovascular disease among adults in the United States. Journal of Psychiatric Research, 43, 239–246.CrossRefGoogle ScholarPubMed
Hopko, D. R. and Colman, L. K. (2010). The impact of cognitive interventions in treating depressed breast cancer patients. Journal of Cognitive Psychotherapy, 24, 314–328.Google Scholar
IAPT (2011). IAPT Programme Review. Department of Health. http://www.iapt.nhs.uk/silo/files/iapt-programme-review-december.pdf Google Scholar
IAPT (2014a). Medically Unexplained Symptoms/functional Symptoms Positive Practice Guidelines. Department of Health. http://www.iapt.nhs.uk/silo/files/medically-unexplained-symptoms-postive-practice-guide-2014.pdf Google Scholar
IAPT (2014b). Measuring Recovery and Improvement in Adult Services. Department of Health. http://www.iapt.nhs.uk/silo/files/recovery-improvement-adult-services-2015.pdf Google Scholar
Ismail, K., Winkley, K. and Rabe-Hesketh, S. (2004). Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. Lancet, 363, 1589–1597.Google Scholar
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.Google Scholar
Konnopka, A., Schaefert, R., Heinrich, S., Kaufmann, C., Luppa, M., Herzog, W., et al. (2012). Economics of medically unexplained symptoms: a systematic review of the literature. Psychotherapy and Psychosomatics, 81, 265–275.Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J.B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.Google Scholar
Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O. and Löwe, B. (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity and detection. Annals of Internal Medicine, 146, 317–326.Google Scholar
Kroenke, K., Spitzer, R. L., Williams, J. B. and Lowe, B. (2010). The Patient Health Questionnaire somatic, anxiety and depressive symptom scales: a systematic review. General Hospital Psychiatry, 32, 345–359.Google Scholar
Lindsay, C., Greve, B., Cabras, I., Ellison, N. and Kellett, S. (2015). Assessing the evidence base on health, employability and the labour market: lessons for activation in the UK. Social Policy and Administration, 49, 143–160.Google Scholar
de Lusignan, S., Chan, T., Tejerina-Arreal, M. C., Parry, G., Dent-Brown, K. and Kendrick, T. (2013). Referral for psychological therapy of people with long term conditions improves adherence to antidepressants and reduces emergency department attendance: controlled before and after study. Behaviour Research and Therapy, 51, 377–385.CrossRefGoogle ScholarPubMed
Lundahl, B. and Burke, B. L. (2009). The effectiveness and applicability of motivational interviewing: a practice-friendly review of four meta-analyses. Journal of Clinical Psychology, 65, 1232–1245.Google Scholar
Marquis, M. M., de Gucht, V., Gouveia, M. J., Leal, I. and Maes, S. (2015). Differential effects of behavioral interventions with a graded physical activity component in patients suffering from Chronic Fatigue (Syndrome): an updated systematic review and meta-analysis. Clinical Psychology Review, 40, 123–137.CrossRefGoogle Scholar
McCracken, L. M. and Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: model, process and progress. American Psychologist, 69, 178–187.Google Scholar
Morris, R., Dowrick, C., Salmon, P., Peters, S., Dunn, G., Rogers, A., et al. (2007). Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms. British Journal of Psychiatry, 191, 536–542.CrossRefGoogle Scholar
Moss-Morris, R., McAlpine, L., Didsbury, L. P. and Spence, M. J. (2010). A randomised controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care. Psychological Medicine, 40, 85–94.Google Scholar
Moss-Morris, R. and Wearden, A. (2013). Medically Unexplained Symptoms: functional symptoms/syndromes. IAPT presentation.Google Scholar
Ost, L-G. (2008). Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis. Behaviour Research and Therapy, 46, 296–321.Google Scholar
Richards, D. and Whyte, M. (2009). Reach Out: national programme educator materials to support the delivery of training for practitioners delivering low intensity interventions (2nd edn). London: Rethink. Available at: http://www.IAPT.nhs.uk/publications.Google Scholar
Rimes, K. A., Wingrove, J., Moss-Morris, R. and Chalder, T. (2014). Competences required for the delivery of high and low-intensity cognitive behavioural interventions for chronic fatigue, chronic fatigue syndrome/ME and irritable bowel syndrome. Behavioural and Cognitive Psychotherapy, 42, 760–764.Google Scholar
Roth, A. and Pilling, S. (2007). The Competencies Required to Deliver Effective Cognitive and Behavioural Therapy for People with Depression and Anxiety Disorders. London: Department of Health. www.ucl.ac.uk/clinicalpsychology/CORE/CBT_Comptencies/CBT_Comptence_list.pdf Google Scholar
Sage, N., Sowden, M., Chorlton, E. and Edeleanu, A. (2008). CBT for Chronic Illness and Palliative Care: a workbook and toolkit. Chichester: Wiley.Google Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. and Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.CrossRefGoogle ScholarPubMed
Unigwe, C., Rowett, M. and Udo, I. (2014). Reflections of the management of medically unexplained symptoms. British Journal of Psychiatry Bulletin, 38, 252.Google Scholar
White, P. D., Goldsmith, K. A., Johnson, A. L., Potts, L., Walwyn, R., Decesare, J. C., et al. (2011). Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet, 377, 823–836.CrossRefGoogle Scholar
Wileman, L., May, C. and Chew-Graham, C. (2001). Medically unexplained symptoms and the problem of power in the primary care consultation: a qualitative study. Family Practice, 19, 178–182.CrossRefGoogle Scholar
Wroe, A. L., Rennie, E. W., Gibbons, S., Hassy, A. and Chapman, J. E. (2015). IAPT and long-term medical conditions: what can we offer? Behavioural and Cognitive Psychotherapy, 43, 412–425.Google Scholar
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