Increasing Access to CBT: Stepped Care and CBT Self-Help Models in Practice

Abstract

The delivery of cognitive behaviour therapy (CBT) in the UK has moved through two phases. In the first phase specialist practitioners delivered bespoke CBT to individuals often experiencing complex and longer-lasting problems. This phase has been characterized by waiting lists and a high quality service delivered to a few. In the second phase of service delivery CBT has begun to be delivered in all sorts of different formats, including CBT selfhelp/guided CBT, behavioural activation, computerized CBT and group based CBT that aim to increase access to CBT delivered in these ways. It remains unclear how these varying models -"high intensity" (phase 1) and "low intensity" (phase 2) should relate -and even who does best with each. There are implicit assumptions by practitioners reflected in language such as "stepping up/down" that assumes high intensity working is superior in some way to low intensity. Few studies have however examined this in depth and what studies there are suggest these beliefs may be incorrect for many. How these new ways of working will be introduced, evaluated and integrated into existing services currently remains a challenge. A helpful way of resolving some of these issues is to view CBT using a learning/teaching paradigm. In this the focus is primarily on how the client wishes to learn to tackle their problems. This provides a helpful way for both introducing different and new ways of working, and also maintaining a focus on the client's needs at the centre of service development. Crucially, phase two CBT working does not replace phase one. How the two approaches complement each other and compare will be two of the interesting questions to be addressed over the next few years.

Addressing Behavioral Health Disparities for Somali Immigrants Through Group Cognitive Behavioral Therapy Led by Community Health Workers

“…In this work we drew on a structured CBT approach 25,26 , which has been established as effective 27 . It has been successfully adapted for use by CHWs to address mental health concerns in perinatal populations in rural Pakistan 23,24 , showing the effective use of CHWs to deliver such interventions in a Muslim population 23,28 . Task shifting to using CHWs to deliver interventions primarily delivered by behaviorists can be seen as an important aspect of delivering more accessible, efficient, cost-effective services 29,30 .…”

Bringing Technology to Training: Web-Based Therapist Training to Promote the Development of Competent Cognitive-Behavioral Therapists

“…There are several barriers to patient access to CBT and other evidence-based practice (EBP), but one of the main factors is the lack of professionals trained in their use (Cartreine, Ahern, & Locke, 2010;Olfson et al, 2009;Weissman et al, 2006;Weisz, Hawley, & Jensen-Doss, 2004;Williams & Martinez, 2008). Consistent with the advances made in mental health treatment and the ongoing calls from key organizations (e.g., National Institute of Mental Health; Association for Behavioral and Cognitive Therapies [ABCT]) to "[promote] the utilization, expansion, and dissemination of behavioral, cognitive, and other empirically-derived practices" (ABCT, 2008), more and more resources are being allocated to dissemination and implementation efforts.…”

Interventions for alcohol-related brain damage (ARBD): Do specific approaches restrict the evolution of comprehensive patient care?

“…However, these authors noted that cognitive restructuring techniques may be problematic within ARBD rehabilitation, due to impaired memory and issues with abstract thought. It is therefore suggested that low intensity behavioural strategies, such as behavioural activation may be more beneficial in the psychosocial rehabilitation of ARBD (Williams & Martinez, 2008).…”