Low-intensity CBT Skills and Interventions. Группа авторов

Low-intensity CBT Skills and Interventions

Matching Questions

1 Each answer is worth one mark.

2 There are 15 answers.

3 The question is worth 15 marks.

4 There is negative marking.

5 Answer by clearly writing the capital letter associated with each option in the response boxes provided after each question.

6 More response boxes are provided than answers, so you are not required to put an answer in each response box.

7 For each question, only those answers supplied within the appropriate spaces will be marked as correct. If you make an error, put a cross through the space with the answer in it and add a new space with the answer on the appropriate line.

Table 3.3

Lead in: Select the 15 most commonly identified symptoms associated with each diagnosis. Each option can be used once, more than once, or not at all.

Procedural

Reaching a Probable Diagnosis

Read the case study and use the diagnosis decision support tool to reach the most probable diagnosis and determine the appropriate treatment. Provide a brief justification at each stage of the decision-making process.

Abdul is a 29-year-old man who has been feeling fatigued and had trouble sleeping. He presented to LICBT services for the first time with low mood. About a year ago he was promoted at work and is now responsible for a large team of people and has to pitch ideas to his chief executive and board at weekly meetings. The first time he did this he was acutely anxious. He was worried about messing it up and that both his subordinates and managers would think that he did not deserve his promotion and was not good enough to do the job. On that occasion he felt very hot, his heart was pounding and he could feel himself blushing, which made him much more anxious. He was worried that if the board saw that he was nervous, they would not believe he had confidence in what he was saying. He began breathing more quickly and felt nauseous, and he had to sit down. Abdul says that he struggled to cope with the situation and has since struggled through many similar situations, though the anxiety has been less intense than that first time. He has developed a few strategies to help him deal with these situations like having a bottle of cold water with him and tensing his legs under the desk as hard as possible to distract himself from his fears. All this has, however, been making him feel increasingly low in mood, fatigued and on occasions he has struggled to go in to work.

Complete Table 3.4

Table 3.4

Answers to Assessing Your Understanding questions can be found in the appendix on p. 334.

4 Clinical Decision-Making in Low-Intensity Cognitive Behavioural Therapy: Integrating Patient Choice, the Practitioner and Evidence Base

Jeffrey McDonnell, Nicola Kirkland-Davis and Rachel Newman

Learning Objectives

By the end of this chapter you should be able to:

Critically evaluate the fundamental role of decision-making within a stepped care model

Demonstrate awareness of the main factors informing clinical decision-making within low-intensity cognitive behavioural therapy

Apply low-intensity clinical-decision principles to ensure fidelity to the evidence base

Critically evaluate key factors that affect clinical decision-making

Background

The quality and cost of a healthcare system is determined by how well decisions are made and implemented by key stakeholders – clinicians, patients and policy-makers (Chapman and Sonnenberg, 2003). Across England, the manner by which clinical decisions are made in healthcare settings is determined by legislative policies (e.g. Department of Health, 2010) whereby low-intensity cognitive behavioural therapy (LICBT) practitioners are expected to be competent across several core characteristics associated with ‘shared decision-making’ (SDM). These have been specified within the National Curriculum for LICBT practitioners (Richards and Whyte, 2008; University College London, 2015).

Key Point

Characteristics of Shared-Decision Making (Elwyn et al., 2010)

Shared decision-making is an approach in which:

Both clinician and patient bring their respective expertise to the clinical issue upon which a decision is to be made

Patient autonomy is respected

Patient engagement in the decision-making process is promoted

The decision is reached with reference to reliable research-evidence.

While SDM intends to be based on research evidence, in practice several factors can result in drift from published guidelines and recommendations, rendering decisions less effective, for example when moving a patient between steps of care (Delgadillo et al., 2015).

Key Point

Factors Potentially Causing Drift from the Evidence Base in Decision-Making

Subjective: beliefs, attitudes and perceptions held by the patient and the clinician.

Contextual:Service resourcesCharacteristics of workforce – proportion of HICBT and LICBT practitionersWaiting lists.

Within the Improving Access to Psychological Therapies (IAPT) programme across England, ways to address several of the contextual factors have been outlined (National Collaborating Centre for Mental Health; NCCMH, 2018). Subjective factors need ongoing self-monitoring and acknowledgement by practitioners within clinical supervision.

Clinical Decision-Making within Stepped Care

The clinical effectiveness and efficiency of delivering LICBT within Step 2 of a stepped care service delivery model (NICE, 2011b; Chapter 1) is dependent on competency in clinical decision-making which can be considered across 4 key stages. These stages are informed by the core principles of the stepped care model (Bower & Gilbody, 2005; Richards et al. 2010).

Clinical Practice

Principles of the Stepped Care Model Informing Key Decision-Making Stages (Bower & Gilbody, 2005; Richards et al. 2010)

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Low-intensity CBT Skills and Interventions. Группа авторов