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Improving access to psychological therapies

The Improving Access to Psychological Therapies (IAPT) Expansion Programme builds on the ground breaking IAPT programme that started in 2008.


Through the rapid expansion of training psychological therapists and the commissioning of new teams to work in primary care, the IAPT programme has led the way in improving availability of NICE recommended treatments for people suffering with anxiety disorders and depression. We are working with NHS England to deliver the objectives of the Five Year Forward View (FYFV) Independent Taskforce Report. The report outlines a need to further expand access to integrated psychological therapies for adults with anxiety and depression, with the aim of meeting 25% of need and a focus on those with long-term physical health conditions and people who are out of work. We're developing a sustainable plan for growth and further development of the IAPT workforce over the next five years through workforce planning and education commissioning - expanding and up-skilling the IAPT workforce to increase access and develop robust integrated models for delivering psychological therapies in primary care. The IAPT Manual describes  the IAPT model in detail and how to deliver it, with a focus on the importance of providing NICE-recommended care as well as creating a resilient, thriving workforce to support its delivery.

Training for core IAPT

All clinicians who work in IAPT services should be qualified to deliver the treatments that they supply or be a trainee on an IAPT approved training course.

Psychological Wellbeing Practitioner (PWP training) is commissioned by the NHS and delivered by local universities. PWP training usually consists of one day per week academic work and four days supervised practice. PWP training follows a national curriculum and trainees are all taught the same specific low intensity interventions including; behavioural activation, graded exposure, cognitive restructuring and panic management. Training is typically completed within 12 months and the curriculum is accredited by the British Psychological Society (BPS).

High intensity therapy (HIT) Cognitive-Behaviour Therapy (CBT) trainees undertake training on a specifically commissioned high intensity CBT course accredited by the British Association for Behavioural and Cognitive Psychotherapies (BABCP). Training, which follows a national curriculum, consists of two days a week at university and three days supervised practice in a clinical setting over a 12-month period.

The IAPT programme also provides shorter courses for existing mental health professionals who wish to develop their skills in other NICE recommended psychological therapies for depression. Each course is based on a national curriculum and is accredited by an appropriate professional body. The courses are specifically developed for people who are already working in IAPT services or are contracted to do so in the near future. As well as attending workshops, trainees see a prescribed number of depression training cases while receiving regular supervision. Course information can be found below and all documents can be accessed on SharePoint:

 

Documents listed can be found on SharePoint

- Psychological Wellbeing Practitioner (PWP) Curriculum

- HIT Cognitive Behaviour Therapy Curriculum (depression and all anxiety disorders)

- HIT Counselling for Depression Curriculum (suitable for BACP accredited counsellors)

- HIT Behavioural Couples Therapy for Depression Curriculum (suitable for qualified Relate Counsellors)

- HIT Behavioural Couples Therapy for Depression Curriculum (suitable for other HI CBT Therapists)

- HIT Couples Therapy for Depression curriculum (suitable for qualified Relate Counsellors)

- HIT Couples Therapy for Depression curriculum (suitable for other HI CBT Therapists)

- HIT Interpersonal Psychotherapy for Depression (suitable for BACP accredited counsellors and other qualified mental health professionals)

- HIT Brief Psychodynamic Psychotherapy for Depression Curriculum

- HIT Mindfulness based Cognitive Therapy Curriculum for reducing relapse in recurrent depression (This treatment is recommended by NICE as a second line intervention to reduce relapse rates in individuals who have already received a first line intervention - psychological or pharmacological- for a depressive episode. The training is designed for qualified high intensity CBT therapists who are already working in IAPT services).

 

Core IAPT therapist manuals

Therapist manuals are a useful adjunct to therapist training courses and are an invaluable resource for therapists who have completed their training. Most manuals describe the theoretical rationale for a treatment, outline the key procedures, and provide practical tips about how and when the procedures should be used.

Below is a non-exhaustive list of the therapist manuals that were developed to support the NICE recommended therapies supported by the IAPT programme. Some manuals are free and can be downloaded direct from this website or other websites via the provided link. Other manuals are available to purchase from commercial outlets.

General

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 edition). London: Rethink Mental Illness. http://cedar.exeter.ac.uk/media/universityofexeter/schoolofpsychology/ce...

Depression

Richards DA, Rhodes S, Ekers D, McMillan D, Taylor RS, Byford S, et al. Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive behavioural therapy for depression. Health Technology Assessment 2017;21(46) https://www.journalslibrary.nihr.ac.uk/hta/hta21460#/abstract   (Open access.  This is the final report of the Cobra project that used Behavioral Activation to treat depression. Appendix 7 contains the therapist manual. One UK RCT has demonstrated the efficacy of BA based on this manual and delivered by low intensity workers)

 

Panic Disorder

Clark, D.M. and Salkovskis P. (2009) Cognitive Therapy for Panic Disorder: Manual for IAPT high intensity therapists (Free download. This manual describes the cognitive therapy for panic disorder programme that was derived from Clark’s theoretical model of panic disorder and has been delivered in randomized controlled trials in UK, Netherlands, Norway and Sweden)

Social Anxiety Disorder

Cognitive therapy for social anxiety disorder based on the Clark & Wells model has demonstrated efficacy in randomized controlled trails in the UK, Sweden, Germany, Norway and Japan. Several published articles and chapters are available that describe all, or part of, the treatment. A single guide covering the treatment of adults and adolescents is available as a free download from the Oxford Centre for Anxiety Disorders and Trauma website. https://www.psy.ox.ac.uk/research/oxford-centre-for-anxiety-disorders-an... )

Warnock-Parkes, E., Wild, J., Stott, R., Grey, N., Ehlers, A. and Clark, D.M. (2016). Seeing is believing: using video feedback in cognitive therapy for social anxiety disorder. Cognitive and Behavioral Practice, 24(2), 245-255. (available Open Access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5627505/  Describes video feedback procedure and provides link to a video illustration of the key techniques)

Posttraumatic stress disorder (PTSD)

The HIT CBT curriculum recognizes three different CBT approaches (Ehlers, Foa, Resick) to the treatment of PTSD. All three have demonstrated efficacy in multiple RCTs. It is recommended that courses teach trainees at least one of the approaches.

Ehlers approach

Ehlers, A. & Wild, J. (2015). Cognitive Therapy for PTSD: Updating memories and meanings of trauma. In U. Schnyder and M. Cloitre (Eds.), Evidence based treatments for trauma-related psychological disorders (pp. 161-187). Cham, Switzerland: Springer. (A more detailed account of clinical procedures. Available to download from Oxford Centre for Anxiety Disorders and Trauma website. https://www.psy.ox.ac.uk/research/oxford-centre-for-anxiety-disorders-an...)

To support the expansion of the Improving Access to Psychological Therapies (IAPT) programme, we are commissioning continued professional development (CPD) training for qualified Psychological Wellbeing Practitioners and High Intensity Therapists. The training focuses on high intensity and low intensity approaches to support people with mental health problems and physical long-term conditions or persistent and distressing medically unexplained symptoms. The IAPT Education and Training Expert Reference Group have developed evidence based curricula to support the commissioning of two new training programmes.

IAPT-LTC Curricula

- PWP top-up curriculum

- HI top-up curriculum for CBT therapists

- HI non-CBT psychological therapies for Depression in the context of LTC

Documents listed can be found on SharePoint.

IAPT-LTC Therapist Manuals

Below is a non-exhaustive list of the therapist manuals that were developed to support the NICE recommended therapies supported by the IAPT-LTC programme. Some manuals are free and can be downloaded direct from this website or other websites via the provided link. Other manuals are available to purchase from commercial outlets.

Therapist manuals are a useful adjunct to therapist training courses and are an invaluable resource for therapists who have completed their training. Most manuals describe the theoretical rationale for a treatment, outline the key procedures, and provide practical tips about how and when the procedures should be used.

IAPT-LTC short-guide: https://www.england.nhs.uk/publication/the-improving-access-to-psycholog...

NCCMH website with full implementation guidance: https://www.rcpsych.ac.uk/workinpsychiatry/nccmh/mentalhealthcarepathway...

Long term conditions/Chronic Illness

The COINCIDE trial manuals, updated for long term conditions and depression / anxiety. PWP manual, Patient workbook, Patient manual: http://www.clahrc-gm.nihr.ac.uk/our-work/mental-health/collaborative-int...

Heart Disease and diabetes

The COINCIDE trial manuals for depression and heart disease / diabetes. The PWP manual, patient workbook and patient manual can be found under this link:  http://www.bmj.com/content/350/bmj.h638?panels_ajax_tab_tab=jnl_bmj_tab_...

Chronic obstructive pulmonary disease (COPD)

Dupont S. & Howard, C. (2014) The COPD breathlessness manual

Dupont S. & Howard, C. (2014) The COPD breathlessness manual: a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease. NPJ primary care respiratory medicine, 24, 14076. https://www.nature.com/articles/npjpcrm201476

Chronic Fatigue Syndrome (CFS) and myalgic encephalomyelitis (ME)

Burgess, M. & Chalder, T. (2004). Manual for therapists. Cognitive behaviour therapy for CFS/ME (Describes the CBT approach used in the PACR trial: https://www.qmul.ac.uk/wolfson/media/wolfson/current-projects/3.cbt-ther...)

Bavinton J., Darbishire L., White P.D. (2004) Manual For Therapists: Graded Exercise Therapy for CFS/ME: https://www.qmul.ac.uk/wolfson/media/wolfson/current-projects/5.get-ther...

Diabetes

Ismail, K., Thomas, S. M., Maissi, E., Chalder, T., Schmidt, U., Bartlett, J., Patel, A., Dickens, C.M., Creed, F. & Treasure, J. (2008) Motivational enhancement therapy with and without cognitive behavior therapy to treat type 1 diabetes: a randomized trial. In: Annals of internal medicine, 149(10), 708-719. (https://www.ncbi.nlm.nih.gov/pubmed/19017589)

Chronic Pain

Ehde, D., Dillworth, T., & Turner, J. (2014). Cognitive-Behavioral Therapy for Individuals With Chronic Pain: Efficacy, Innovations, and Directions for Research. In: American Psychologist, 69(2) 153-166. https://books.apa.org/pubs/journals/releases/amp-a0035747.pdf

Irritable bowel syndrome

Chalder T., Windgassen S., Sibelli A., Burgess M., Moss-Morris R. (2016) Regul8: A self-management programme for IBS. Therapist manual.

Medically Unexplained Symptoms (MUS)

Salkovskis, P., M., Gregory, J., D., Sedgwick-Taylor, A., White, J., Opher, S. & O´lafsdottir, S. (2016) Extending Cognitive-Behavioural Theory and Therapy to Medically Unexplained Symptoms and Long-Term Physical Conditions: A Hybrid Transdiagnostic/Problem Specific Approach. Behaviour Change, Volume 33, Number 4, 2016, pp. 172–192

 

 

 

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