Infectious disease outbreaks have occurred sporadically over the centuries. The most significant ones of this century, as reported by the WHO, include the EVD epidemic, SARS pandemic, Swine Flu pandemic and MERS pandemic. The long-term mental health consequences of outbreaks are as profound as physical ones and can last for years post-outbreak. This highlights the need for enhancing the preparedness of pragmatic mental health service provision. Due to its magnitude, the novel COVID-19 pandemic has proven to be the most impactful. Compared to previous outbreaks, COVID-19 has also occurred at higher rates in frontline staff in addition to patients. Since COVID-19 is more contagious than earlier outbreaks, there is a need to identify infected people quickly and isolate them and their contacts. This is the current context in which mental health services including IAPT have had to operate. Evidently, IAPT services are a major mental health service provider in the UK which have demonstrated variability in their response to COVID-19. While some IAPT services quickly adapted their existing strengths and resources (e.g. remote working) other services were less prepared. To date there are no clear unitary guidelines on how IAPT services can use their pre-existing resources to respond to the long-term effects of outbreaks. In light of this, the current paper aims to reflect on the lessons learned from past outbreaks in order to consider how an enhanced remit of IAPT might integrate with other services to meet the long-term needs of patients and staff affected by COVID-19.

Background Long Covid is an unknown illness which has been shown to affect sufferers regardless of mild initial COVID-19 or age. There is still a lot unknown about long COVID illness. There has been a call to understand this illness not only from a professional standpoint but also through the lived experience of patients. Patient reported outcomes through lived experience research is one such angle. To date, no research has explored the overall lived experiences and long COVID illness trajectory perspectives of the patients. This study aimed to gather patient reported outcomes of their long COVID through lived experience research. It recruited adult participants aged 18-years and over who had been referred to a primary care integrated psychology service. The study employed qualitative research using semi-structured interviews and Interpretive Phenomenological Analysis methodology. Results A total of eighteen participants completed the study. From their lived experiences, the participants uncovered the varied symptoms of long COVID. They also uncovered their lived progression of living with an unknown chronic illness. Common themes included uncertainty, mental and social impacts, and the processes of self-advocacy, mastering their symptoms, subjective recovery and future coping. Conclusion This study uncovered the lived experience of long COVID in participants. The results from this study uncovered the lived subjective biopsychosocial experiences of long COVID chronic illness. Traditionally, patients receive care and recommendations from healthcare professionals. However, as long COVID is a new illness, this care model was limited. The participants in the current study described being left with a sense of uncertainty and role confusion. However, participants were able to realize their locus of control over their long COVID illness progression. This illustrates that patients have the resources to uncover the unknowns of this new illness which could inform clinical practice and further research. This suggests that that long COVID needs to be approached from a biopsychosocial perspective which emphasises patient involvement.

Abstract The main current intervention for post-traumatic stress disorder (PTSD) in adult primary care is individual trauma-focused cognitive behavioural therapy (TF-CBT). Group TF-CBT for PTSD has been advocated in order to improve access and cost. Barriers to the development of group TF-CBT include the need for a large number of sessions and therapist input in order to manage high levels of affect, possible dissociation and secondary traumatisation. This case study was prompted via our community engagement project when local women who had been involved in a single road traffic accident requested group therapy. The aim was to develop a NICE guideline-compliant brief 8-session group TF-CBT intervention that circumvented the above-mentioned barriers and is described in detail. In order to improve access, the group was delivered in the community. Standard and PTSD-specific measures were administered pre-therapy and post-therapy. Eight clients were offered treatment: two dropped out and six completed treatment. At the end of treatment, 3/6 clients attained reliable improvement in their PTSD symptoms. Two of these three clients also reached recovery. This change was maintained at 3-month follow-up where 4/6 clients attained reliable improvement, with three maintaining recovery. The remaining two clients showed minimal change in their PTSD symptoms. Overall, clients reported high-level satisfaction with the treatment protocol. This case study demonstrates a potentially clinically effective and cost-effective group TF-CBT intervention for non-complex single-incident PTSD. Key learning aims It is hoped that the reader of this case study will increase their understanding of the following: (1) Use of a brief group TF-CBT protocol to treat homogeneous single incident trauma in adults. (2) Adaptations to overcome barriers to group TF-CBT in adults. (3) Implementation of individualised reliving based on written-narrative rather than spoken-narrative. (4) Focus on the processes of PTSD, whilst using content as a theme to contextualise the symptoms. (5) Emphasis on the use of homework in order to enhance group affect-modulation and individual learning.

Britain has increasingly become a multi-cultural society. In order to improve access to primary care psychological therapy including cognitive behavioural therapy (CBT), there has been an increase in focus on cultural adaptation and cultural responsiveness. To date, these adaptations have focused on domains such as language, beliefs and values. In this case, familism was the focus for adaptation. The client was a 22-year-old female from a black African-British background. She presented with severe symptoms of chronic depression as measured on routine standard questionnaires and the interview. She had minimal success from previous interventions and was struggling to make progress. Therapy was guided by the client’s views on what issues had a bearing on her difficulties. The client hypothesised that familism factors with themes around ‘my parents’ culture’ and ‘family comes first’ were interacting with her cognitive behavioural factors to maintain her problem. She requested the involvement of her family in her treatment plan. In line with the Improving Access to Psychological Therapies–Black, Asian and Minority Ethnic service user Positive Practice Guide, this was integrated as part of her formulation. Upon involvement of her father in a single session, the client attained reliable improvement. She attributed her improvement to this involvement. By the end of therapy, she reached recovery, which was maintained at 3-month follow-up. This study was responsive to the client’s own perceived cultural needs through the integration of familism into her CBT formulation. It illustrates a client-led cultural adaptation of CBT to treat chronic depression. Key learning aims It is hoped that the reader will increase their understanding of the following from reading this case study: (1) Creating an environment where clients can freely discuss their perceived cultural factors from the outset. (2) Client-led cultural responsiveness to their expressed cultural needs. (3) Familism as a domain for adapting CBT.

Group therapy for adult post-traumatic stress disorder (PTSD) has been a subject of debate over the past few years. A recent update on five international clinical practice guidelines on the use of group-therapy for PTSD in adults ranged from moderate support (e.g. the International Society for Traumatic Stress Studies) to no recommendation (e.g. the National Institute for Health and Care Excellence, NICE). However, a unanimous recommendation was that practitioners collaborated with their clients and weighed up the guidelines and client preferences to make the appropriate decisions. The current case study was guided by these recommendations. A minority of clients presenting to the service expressed a preference for group therapy for their PTSD symptoms. The current study follows on from a previous shared-trauma therapy group. It illustrates how the service took the NICE guidelines fully into account alongside the clients’ needs and preferences to deliver a NICE-compliant heterogenous trauma-focused CBT group. Twenty-four clients presenting with PTSD from different single-incident traumas opted for group therapy. Clients attended one of three 8-session trauma-focused CBT groups depending on preference (e.g. date/time, location). The groups were conducted face-to-face on a weekly basis. Seventeen clients completed treatment. Eleven clients no longer showed clinically important symptoms of PTSD as assessed on the PCL-5 and interview. This was sustained at 3-month follow-up. Four other clients showed reliable change. Two clients showed minimal improvement. This study is discussed with reference to opportunities, challenges and recommendations for clinical practice and research. Key learning aims It is hoped that the reader of this case study will increase their understanding of the following: (1) Delivery of a trauma-focused CBT group for heterogeneous single-incident traumas. (2) Taking full consideration of the NICE guidelines alongside the clients’ needs and preferences. (3) Guiding the focus of therapy on processing the trauma memory and its aftermath. (4) Effective use of group processes to facilitate outcomes.