Mindfulness Based Cognitive Therapy Segal, Williams & Teasdale, 2002 51
From MBSR From cognitive science • Cognitive formulation of • Structure of programme depression • Practices • Cognitive- behavioural elements of programme • Skills & Attitudes • Psycho-education • Teaching from experience • Clinical practice 52
Develop greater levels of meta-awareness and move towards observing thoughts as transient mental phenomena , rather than as facts or accurate descriptions of reality Bring a less judgemental and more compassionate attitude to the flow of thoughts, feelings and sensations that are experienced
Increasingly recognise habitual maladaptive cognitive processes , such as depressive rumination Become more skilled at disengaging from these unhelpful processes , for example by re- directing attention to present moment experience
MBCT – the course • 9 consecutive weeks • 8 x 2¼ hour classes – Practices – Discussion – CBT elements • Homework ++ • CDs / app • (One longer session) • Commitment ++
Effectiveness and Cost-effectiveness of Mindfulness-Based Cognitive Therapy compared with maintenance anti-depressant treatment in the prevention of depressive relapse. Lancet , 2016
Kuyken et al (2016). Efficacy and moderators of mindfulness-based cognitive therapy (MBCT) in prevention of depressive relapse: An individual patient data meta-analysis from randomized trials. JAMA Psychiatry. 58
MBCT vs active controls (892 patients; 385 relapses) Hazard Ratio = 0.79 (0.64 – 0.97) 59
Van Aalderen et al (2012) The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: a randomized controlled trial. Psychological Medicine. Van Aalderen et al (2015) Long-Term Outcome Of Mindfulness- Based Cognitive Therapy In Recurrently Depressed Patients With And Without A Depressive Episode At Baseline . Depression and Anxiety. 60
Van Aalderen et al (2012) MBCT can effectively reduce depressive symptoms Even when people are within an episode at baseline Stable during f/u period 61
Geschwind et al (2012). Efficacy of mindfulness-based cognitive therapy in relation to prior history of depression: randomised controlled trial. British Journal of Psychiatry . 62
Geschwind et al (2012) MBCT – significant reduction ( ~ 35%) of depressive symptoms No significant difference between those with 1- 2 episodes and those with ≥ 3 episodes TAU reduction ~ 10% 63
* Severity * * Response Remission
MBCT & other areas • Particular groups – Eg during pregnancy • Other mental health conditions – eg health anxiety, medically unexplained symptoms • Developmental life stages – eg adolescents • Medically ill groups – eg cancer, diabetes 66
"Even if a psychosocial intervention has compelling aims, has been shown to work, has a clear theory-driven mechanism of action, is cost-effective and is recommended by a government advisory body, its value is determined by how widely available it is in the health service."
UK Mindfulness Centres Collaboration
One training site per HEE Region. TEWV = site for Northern Region In collaboration with Oxford Mindfulness Centre and Bangor Centre for Mindfulness Research and Practice
Training for: • CBT therapists working in IAPT with at least 1 year post-qualification experience • Pre-existing interest in mindfulness, including personal practice • Prior participation in MBCT group
Bassetlaw Insight - Joanne Blackpool Bradford Calderdale Insight - Kelly Cheshire & Wirral Partnership Gateshead Halton Hartlepool and East Durham MIND Leeds – Ross & Lorraine Manchester – Graham and Pete Middlesbrough Insight - Sam Navigo (Grimsby) Newcastle - Naomi TEWV (North Yorkshire) Northumberland - Linda Pennine Care - Sophie Salford South Tyneside - Rob Trafford Tyne & Wear Insight Wigan - Pip TEWV (York & Selby) 34 (22) 12 (10)
Training outline – 10 days in Leeds • 1 day: overview of MBCT and underpinning theory • 4 x 2days: Exploring the MBCT curriculum in depth. Focus on experiential learning, guiding practices and enquiries etc • 1 day: assessment, inclusion criteria, safety, orientation, outcome monitoring
Followed by… • a 5-day residential retreat • ‘Supervised practice’ - 2 x MBCT courses • Submit video recording of 2 nd course to Oxford for MBI-TAC assessment • Course ends 31 st March 2019
Questions? Comments?
Thanks paul.bernard@nhs.net
Yorkshire and the Humber IAPT Providers Network A Strategic Vision for Workforce Wellbeing in IAPT Services: Table Top Discussion All www.england.nhs.uk
Questions to consider On your tables please spend 25 minutes discussing the following questions. Please use the templates provided to write down the key points discussed. 1. What are you doing to support wellbeing in your services? 2. How do you manage your own wellbeing as managers and senior clinicians? 3. How do you support the wellbeing of your staff? 4. What could the Network do to support you? www.england.nhs.uk
Time for some lunch? www.england.nhs.uk
Yorkshire and the Humber IAPT Providers Network Provider Presentation: Kirklees and Calderdale IAPT John Butler, Laura Firth and Nichola Hartshorne, Kirklees IAPT www.england.nhs.uk
John Butler, Team Manager Step 2 Laura Firth, Data Quality Lead, Nichola Hartshorne, Clinical Lead We make up part of the leadership team
Kirklees IAPT is funded by a block contract Calderdale is funded by an AQP arrangement. Both services sit under the umbrella of the South West Yorkshire Partnership NHS Foundation Trust, under the community arm of the Business delivery unit providing predominantly secondary care mental health. For the purposes of this presentation we will focus on Kirklees IAPT.
Kirklees IAPT reports to two CCG’s ◦ Greater Huddersfield ◦ North Kirklees We report separately and then add the two together to achieve an overall figure
Greater Huddersfield ◦ Prevalence population of 28,330 ◦ With an access target of 397 a month North Kirklees ◦ Prevalence population of 22,493 ◦ Which gives an access target of 315 a month Kirklees (combined) 50,823 and 712 a month
I joined the service in September 2016, my role was to manage the HI therapists. Currently already in service was John who was employed part-time and was responsible for managing step 2 and another service within the organisation. 2 senior PWP’s, 1 was on maternity leave and the other was part time. Previous to this there had been no consistent management structure.
We also had a clinical system that didn’t really work for us as an IAPT service It was difficult to use clinically Getting data reports were very difficult We were working blind without up-to-date data
Except for our Access target…….
Kirklee lees s IAP APT - % Prevalence valence % Target % Prevalence / Access 1.80% 1.60% 1.59% 1.50% 1.47% 1.40% 1.30% 1.24% 1.20% 1.19% 1.20% 1.16% 1.01% 1.00% 1.00% 1.04% 0.86% 0.80% 0.60% Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Handing leaflets out in supermarkets, as well as all the usual places. G.P’s surgeries, chemists, leaflets included in bounty packs Talking to local business’s Providing workshops for local business’s Attending team meetings with colleagues in the Trust
Designed a new website Assessing some of the referrals that came into our secondary mental health Team (SPA)
This target became our world, We had by this time increased the leadership team to include: ◦ A CBT Lead Team lead ◦ 2 full time Senior PWP’s ◦ A Long Term Conditions Manager ◦ A Data Quality Lead The general manager of the BDU and her deputy were enlisted to help!
The team met weekly to scrutinise the figures, We increased the number of PWP Assessment appointments we offered We had been chosen as part of the wave 1 LTC project, we worked with our colleagues in physical health to promote mental health
It was at this point the Intensive support team contacted the Trust and asked permission to became involved in order to support us to offer a solution People had different responses to this offer
I think it’s safe to say the three of us welcomed the idea And work began on providing detailed information on figures, narratives, case studies etc.etc All of this was done before the visit
A meeting was held with the providers, the CCG and the IST, where more questions were asked and more information provided. It felt for us as a service a very validating and supportive experience
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