IAPT: Improving Access to Psychiatric Training. CBT delivery by junior psychiatrists in primary care is good for the service, good for training and good for patients

Abstract

The feasibility and effectiveness of trainee psychiatrists providing CBT in primary care was assessed by a triangulated procedure of service overview, trainee feedback and assessment of clinical measures. Hitherto trainees sought ‘suitable’ cases by individual request. In the primary-care setting: 82% of 11 trainees (50% previously) completed a ‘short case’ treatment within a 6-month attachment; 86% of trainees found the level of supervision ‘about right’; depression and anxiety scores for patients (n = 16) achieved statistically significant gains and showed moderate to large effect sizes. Although there was no comparator group, findings were just above the IAPT aim of a 50% recovery. Conclusions are that completion of their ‘short case’ experience within a 6-month attachment is feasible in a primary-care setting. Evidence that patients and the service also benefited demonstrates this to be good and ethical ‘business’ for the service provider. Integrating these skills into routine medical psychiatric practice may remain a later supervision need. Other training experiences including psychological treatments could initially be best met in less testing clinical encounters than those experienced in secondary care. Locally agreed formal arrangements would facilitate this and there is potential for the development of greater cross-service understanding in the longer term.

Psychiatry trainees' experiences of cognitive-behavioural therapy training in a UK deanery: A qualitative analysis

“…A larger study would be beneficial in exploring this, continuing with the idea to source cases from primary care. 17 This could help to relieve the pressure for the trainee to complete one ‘ideal’ CBT case, and thus the patient being a barrier to learning could have less impact. It was also suggested that it could be beneficial to provide a follow-up course that can be accessed freely to ensure that skills are maintained over time.…”

“…These include lack of supervision, 10 limited availability of suitable cases for training, 9 and lack of protected learning time. 4,11–16 A small study 17 suggested working with low-complexity patients in the primary care setting as a way of overcoming these barriers, with protected time to do so. However, this has not been trialled on a wider scale, and limited data are available about whether this is a preferred route of training.…”

“…However, this has not been trialled on a wider scale, and limited data are available about whether this is a preferred route of training. 17 Indeed, little qualitative research exists on the experiential accounts of psychiatric trainees undergoing the current training programme.…”

A new short version of the Cognitive Therapy Scale Revised (CTSR-4): preliminary psychometric evaluation

“…A possible explanation for the inconclusive associations between CBT competence and patient outcome could be other mediating variables, such as the therapeutic alliance [ 19 ]. Another explanation could be that the associations are not linear—once a therapist competence level sufficient to help most patients, no further increase lead to improved patient outcome [ 13 , 20 , 21 ]. It is also possible that most patients’ needs are met by therapists of moderate competence, and that only a small group of patients require therapists with higher levels of competence [ 22 – 24 ].…”