Low intensity CBT interventions: a revolution in mental health care

Bennett–Levy, James; Richards, David; Farrand, Paul

doi:10.1093/med:psych/9780199590117.003.0001

Cited by 164 publications

(151 citation statements)

References 18 publications

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“…Low intensity treatments (LIT) consisted of brief (<8 sessions lasting 30 minutes) psychoeducational interventions based on principles of cognitive behavioural therapy (CBT). These were highly structured interventions, supported by didactic materials and delivered by a workforce of psychological wellbeing practitioners trained to a standard national curriculum (Bennett-Levy et al, 2010). High intensity treatments (HIT) were lengthier (up to 20 sessions lasting around 60 minutes) interventions including CBT and counselling for depression.…”

Section: Setting and Interventionsmentioning

confidence: 99%

Case complexity as a guide for psychological treatment selection.

Delgadillo

Huey

Bennett

et al. 2017

Journal of Consulting and Clinical Psychology

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Case complexity as a guide for psychological treatment selection. Journal of Consulting and Clinical Psychology, 85 (9). pp. 835-853. ISSN 0022-006X https://doi.org/10.1037/ccp0000231 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. AbstractObjective: Some cases are thought to be more complex and difficult to treat, although there is little consensus on how to define complexity in psychological care. This study proposes an actuarial, data-driven method of identifying complex cases based on their individual characteristics.Method: Clinical records for 1512 patients accessing low and high intensity psychological treatments were partitioned in 2 random subsamples. Prognostic indices (PI) predicting post-treatment reliable and clinically significant improvement (RCSI) in depression (PHQ-9) and anxiety (GAD-7) symptoms were estimated in one subsample using penalized (Lasso) regressions with optimal scaling. A PI-based algorithm was used to classify patients as standard (St) or complex (Cx) cases in the second (cross-validation) subsample. RCSI rates were compared between Cx cases that accessed treatments of different intensities using logistic regression.Results: St cases had significantly higher RCSI rates compared to Cx cases (OR = 1.81 to 2.81). Cx cases tended to attain better depression outcomes if they were initially assigned to high intensity (vs. low intensity) interventions (OR = 2.23); a similar pattern was observed for anxiety but the odds ratio (1.74) was not statistically significant. Conclusions:Complex cases could be detected early and matched to high intensity interventions to improve outcomes. 3What is the public health significance of this article?Complex cases tend to have a poor prognosis after psychological treatment for depression and anxiety problems. An evidence-based model of defining complexity is proposed to guide therapists in matching patients to treatments of differing intensity. The findings indicate that this personalized method of treatment selection could lead to better outcomes for complex cases and could improve upon decisions that are informed by clinical judgment alone.

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Section: Setting and Interventionsmentioning

confidence: 99%

Case complexity as a guide for psychological treatment selection.

Delgadillo

Huey

Bennett

et al. 2017

Journal of Consulting and Clinical Psychology

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“…A key development has involved 'low-intensity' interventions. Although there is a lack of consensus over precise definitions, common features of low-intensity interventions include: 11 l typically CBT based l communicate CBT principles in accessible ways and delivered in flexible forms (e.g. telephone, e-mail) l involve a health technology (e.g.…”

Section: Cognitive-behavioural Therapy and Low-intensity Interventionsmentioning

confidence: 99%

Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive–compulsive disorder: the Obsessive–Compulsive Treatment Efficacy randomised controlled Trial (OCTET)

Lovell

Bower

Gellatly

et al. 2017

Health Technol Assess

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BackgroundThe Obsessive–Compulsive Treatment Efficacy randomised controlled Trial emerged from a research recommendation in National Institute for Health and Care Excellence obsessive–compulsive disorder (OCD) guidelines, which specified the need to evaluate cognitive–behavioural therapy (CBT) treatment intensity formats.ObjectivesTo determine the clinical effectiveness and cost-effectiveness of two low-intensity CBT interventions [supported computerised cognitive–behavioural therapy (cCBT) and guided self-help]: (1) compared with waiting list for high-intensity CBT in adults with OCD at 3 months; and (2) plus high-intensity CBT compared with waiting list plus high-intensity CBT in adults with OCD at 12 months. To determine patient and professional acceptability of low-intensity CBT interventions.DesignA three-arm, multicentre, randomised controlled trial.SettingImproving Access to Psychological Therapies services and primary/secondary care mental health services in 15 NHS trusts.ParticipantsPatients aged ≥ 18 years meetingDiagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for OCD, on a waiting list for high-intensity CBT and scoring ≥ 16 on the Yale–Brown Obsessive Compulsive Scale (indicative of at least moderate severity OCD) and able to read English.InterventionsParticipants were randomised to (1) supported cCBT, (2) guided self-help or (3) a waiting list for high-intensity CBT.Main outcome measuresThe primary outcome was OCD symptoms using the Yale–Brown Obsessive Compulsive Scale – Observer Rated.ResultsPatients were recruited from 14 NHS trusts between February 2011 and May 2014. Follow-up data collection was complete by May 2015. There were 475 patients randomised: supported cCBT (n = 158); guided self-help (n = 158) and waiting list for high-intensity CBT (n = 159). Two patients were excluded post randomisation (one supported cCBT and one waiting list for high-intensity CBT); therefore, data were analysed for 473 patients. In the short term, prior to accessing high-intensity CBT, guided self-help demonstrated statistically significant benefits over waiting list, but these benefits did not meet the prespecified criterion for clinical significance [adjusted mean difference –1.91, 95% confidence interval (CI) –3.27 to –0.55;p = 0.006]. Supported cCBT did not demonstrate any significant benefit (adjusted mean difference –0.71, 95% CI –2.12 to 0.70). In the longer term, access to guided self-help and supported cCBT, prior to high-intensity CBT, did not lead to differences in outcomes compared with access to high-intensity CBT alone. Access to guided self-help and supported cCBT led to significant reductions in the uptake of high-intensity CBT; this did not seem to compromise patient outcomes at 12 months. Taking a decision-making approach, which focuses on which decision has a higher probability of being cost-effective, rather than the statistical significance of the results, there was little evidence that supported cCBT and guided self-help are cost-effective at the 3-month follow-up compared with a waiting list. However, by the 12-month follow-up, data suggested a greater probability of guided self-help being cost-effective than a waiting list from the health- and social-care perspective (60%) and the societal perspective (80%), and of supported cCBT being cost-effective compared with a waiting list from both perspectives (70%). Qualitative interviews found that guided self-help was more acceptable to patients than supported cCBT. Professionals acknowledged the advantages of low intensity interventions at a population level. No adverse events occurred during the trial that were deemed to be suspected or unexpected serious events.LimitationsA significant issue in the interpretation of the results concerns the high level of access to high-intensity CBT during the waiting list period.ConclusionsAlthough low-intensity interventions are not associated with clinically significant improvements in OCD symptoms, economic analysis over 12 months suggests that low-intensity interventions are cost-effective and may have an important role in OCD care pathways. Further research to enhance the clinical effectiveness of these interventions may be warranted, alongside research on how best to incorporate them into care pathways.Trial registrationCurrent Controlled Trials ISRCTN73535163.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 37. See the NIHR Journals Library website for further project information.

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“…These interventions are aimed to provide evidence-based treatments that reduce therapist time [43]. They are supported by Psychological Wellbeing Practitioners, who are graduate psychologists with training in delivering low-intensity interventions, and support is offered through electronic communication means or by telephone.…”

Section: Icbt In Iapt Servicesmentioning

confidence: 99%

Internet-Delivered Cognitive Behaviour Therapy

Richards¹,

Enrique²,

Palacios³

et al. 2018

Cognitive Behavioral Therapy and Clinical Applications

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The delivery of cognitive behaviour therapy over the internet (iCBT) has developed in tandem with recent technological advancements. In this chapter, we briefly explore the background of iCBT and its ongoing evolution in the relatively short period that has been available. We summarise the empirical evidence that supports the efficacy and effectiveness of iCBT in different settings, and for different populations. We provide an overview on how an iCBT platform works for service users, and we offer some thoughts on the processes involved in repurposing an evidence-based treatment protocol into an online format. Using iCBT service, users can avail of the benefits of cognitive behaviour therapy in a flexible manner, with or without support. The case presentation provided an illustrative on some of these advantages and highlights opportunities for the individual. The service delivery examples describe the use of iCBT and its application in different contexts. Lastly, we discuss several areas of importance for the future research and practice of iCBT.

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Low intensity CBT interventions: a revolution in mental health care

Cited by 164 publications

References 18 publications

Case complexity as a guide for psychological treatment selection.

Case complexity as a guide for psychological treatment selection.

Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive–compulsive disorder: the Obsessive–Compulsive Treatment Efficacy randomised controlled Trial (OCTET)

Internet-Delivered Cognitive Behaviour Therapy

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