Clients' perceptions of unhelpful factors in CBT in IAPT serving a deprived area of the UK

Abstract

Aim/Purpose: Improving access to psychological therapies (IAPT) is a main provider of psychological therapy for adults within the NHS. NHS Digital (2016) reported the dropout rate in IAPT to be as high as 43%. Proctor (2014) found that unhelpful factors in therapy could contribute to the dropout rate. As CBT is the main modality in IAPT, it is important to explore unhelpful factors in CBT as they might be contributing to the dropout rate in IAPT.Design/Methodology: Nine clients (five men and four women) for whom CBT was not helpful were interviewed using a semi-structured protocol. The interviews were analysed using thematic analysis.Results/Findings: Six themes have been identified: 1) Difficulties with CBT itself (e.g.identifying and challenging negative thoughts and finding alternative evidence as well as homework); 2) Negative perception of therapists (e.g. queried if therapists were committed and had empathy); 3) Clients' unhelpful internal patterns (e.g. unrealistic expectations or feeling self-critical); 4) Physical health, mental health and psychosocial barriers (e.g. feeling too depressed or anxious to undertake CBT); 5) Unhelpful IAPT processes (e.g. difficulties with outcome measures and assessments); and 6) Consequences of unhelpful treatment (e.g. not addressing core underlying issues and clients feeling worse). Conclusions/Implications (including practice implications):The findings indicate that all practitioners should consider unhelpful factors in therapy, as they have potentially detrimental effects on clients' outcomes. Additionally, this research found that therapeutic interventions need to be tailored to clients' goals, internal patterns and preferences. Importantly, it was found that unhelpful factors extend to health and psychosocial issues which should be addressed prior to therapy. K E Y W O R D SCBT, IAPT, unhelpful factors, clients in deprived area

Improving Access to Psychological Therapies (IAPT) has potential but is not sufficient: How can it better meet the range of primary care mental health needs?

“…Examination of longitudinal outcomes of those completing IAPT therapy could elucidate how many return due to underlying causes not having been treated. Studies such as that of Omylinska-Thurston et al (2019) raise stark questions about how much the rigidity of IAPT services fits with clinical need. IAPT needs to integrate service user feedback into operational development to ensure the pathway is clinically effective.…”

“…The national dropout rates are not explicitly published though it can be inferred that while some of this figure will be accounted for by dropouts, it may also be accounted for by IAPT services not meeting the clinical need of the cohort referred. Omylinska-Thurston, McMeekin, Walton, and Proctor's (2019) qualitative analysis on clients' perceptions of unhelpful factors within IAPT noted there were issues regarding outcome measures, assessments, and CBT as the 'go-to model'. This poses the question does the apparent limited remit of IAPT meet the presented need?…”

A pragmatic factorial randomized controlled trial of transdiagnostic internet-delivered cognitive behavioural therapy: Exploring benefits of homework reflection questionnaires and twice-weekly therapist support

“…Unexpectedly, the HWRQ had somewhat of a negative impact on engagement (i.e., fewer logins and fewer days accessing the course), whereas 2W support had somewhat of a positive impact on engagement (i.e., patients sent more emails to therapists than in 1W condition). Reasons for such difference are not known but could suggest that having to complete HWRQ may be an aversive experience for some patients as has been noted in some face-to-face CBT literature (e.g., Omylinskaa-Thurston et al, 2019 ) and could act as a deterrent to logging in. Another possibility is that simply having more questions to answer was more demanding and reduced the positive benefits of the questions themselves.…”

Better than expected: client and clinician experiences of videoconferencing therapy (VT) during the COVID-19 pandemic

“…Previous research has noted the importance of clinician and client attitudes in the acceptability and feasibility of treatment (Apolinário-Hagen et al, 2017;Békés and Aafjes-van Doorn, 2020;Omylinska-Thurston et al, Omylinska-Thurston et al, 2019). To date there is a shortage of qualitative research exploring client and clinician experiences of VT. A qualitative approach may contribute to a deeper understanding of beliefs and attitudes towards VT, which can give a richer insight into its application.…”