Psychological Wellbeing Practitioners Research Articles

A feasibility and pilot additive randomised control trial of attachment security priming during behavioural activation.

There is some initial evidence that attachment security priming may be useful for promoting engagement in therapy and improving clinical outcomes. This study sought to assess whether outcomes for behavioural activation delivered in routine care could be enhanced via the addition of attachment security priming. This was a pragmatic two-arm feasibility and pilot additive randomised control trial. Participants were recruited with depression deemed suitable for a behavioural activation intervention at Step 2 of a Talking Therapies for Anxiety and Depression service. Ten psychological wellbeing practitioners were trained in implementing attachment security priming. Study participants were randomised to either behavioural activation (BA) or BA plus an attachment prime. The diagrammatic prime was integrated into the depression workbook. Feasibility outcomes were training satisfaction, recruitment, willingness to participate and study attrition rates. Pilot outcomes were comparisons of clinical outcomes, attendance, drop-out and stepping-up rates. All practitioners recruited to the study, and training satisfaction was high. Of the 39 patients that were assessed for eligibility, 24 were randomised (61.53%) and there were no study drop-outs. No significant differences were found between the arms with regards to drop-out, attendance, stepping-up or clinical outcomes. Further controlled research regarding the utility of attachment security priming is warranted in larger studies that utilise manipulation checks and monitor intervention adherence.

Therapist guided, parent-led cognitive behavioural therapy (CBT) for pre-adolescent children with obsessive compulsive disorder (OCD): a non-concurrent multiple baseline case series.

Cognitive behavioural therapy (CBT) including exposure and response prevention (ERP) is an effective treatment for preadolescent children with obsessive compulsive disorder (OCD); however, there is a need to increase access to this treatment for affected children. This study is a preliminary evaluation of the efficacy and acceptability of a brief therapist-guided, parent-led CBT intervention for pre-adolescent children (5-12 years old) with OCD using a non-concurrent multiple baseline approach. Parents of 10 children with OCD were randomly allocated to no-treatment baselines of 3, 4 or 5 weeks before receiving six to eight individual treatment sessions with a Psychological Wellbeing Practitioner. Diagnostic measures were completed prior to the baseline, 1-week post-treatment, and at a 1-month follow-up, and parents completed weekly measures of children's OCD symptoms/impairment. Seventy percent of children were 'responders' and/or 'remitters' on diagnostic measures at post-treatment, and 60% at the 1-month follow-up. At least 50% of children showed reliable improvements on parent-reported OCD symptoms/impairment from pre- to post-treatment, and from pre-treatment to 1-month follow-up. Crucially, the intervention was acceptable to parents. Brief therapist-guided, parent-led CBT has the potential to be an effective, acceptable and accessible first-line treatment for pre-adolescent children with OCD, subject to the findings of further evaluations.

Building resilience in the Improving Access to Psychological Therapy (IAPT) Psychological Wellbeing Practitioner (PWP) role: a qualitative grounded theory study.

Staff retention, particularly in the Psychological Wellbeing Practitioner (PWP) workforce, has historically been challenging for Improving Access to Psychological Therapy (IAPT) services. This study sought to develop an explanatory model of the resilience-building process in PWPs working within the IAPT programme. A qualitative design was conducted, using a grounded theory methodology. Participants were recruited from two IAPT services in the National Health Service (NHS), which were part of the same Mental Health Trust. Ten PWPs were interviewed via videoconferencing using semi-structured interviews. An explanatory model of resilience in PWPs encompassed three phases: the experience of work-related challenges, the connection with their values and the related appraisal of adversity in resilient ways, and the implementation of effective coping strategies. The model highlights that PWPs develop resilience through values-based sensemaking and by proactively engaging in effective coping mechanisms. This study contributes to the current understanding of the process of resilience in PWPs. More research is needed to explore the developmental processes underlying PWPs' resilience. The implications of the findings in relation to existing conceptualisations of resilience, staff wellbeing and retention are explored. Recommendations for future research are also given.

Psychological wellbeing practitioners’ experiences of improving access to psychological therapies (IAPT) services cultural competency training

PurposeThis study aims to explore whether the cultural competency training in Improving Access to Psychological Therapies (IAPT) services is sufficient to equip Psychological Wellbeing Practitioners (PWP) to support Black, Asian and Minority Ethnic (BAME) service users.Design/methodology/approachA qualitative design was adopted using semi-structured interviews with six PWP participants. Reflexive thematic analysis using Braun and Clarke’s (2006) six-step process was used in data analysis.FindingsThree themes revealed evaluations of PWP training, factors supporting PWPs’ cultural competency and points of improvement for PWP training. The training briefly and superficially covered cultural competency content; however, it encouraged PWPs to explore potential personal and cultural biases in therapy. PWP training can also be improved by providing more culturally relevant resources and involving BAME service users.Research limitations/implicationsA small sample size (N = 6) was used, impacting the findings’ generalizability.Practical implicationsPWP training does not sufficiently equip PWPs to support BAME service users. PWPs’ reflection of their own ethnic identity and personal experiences, when combined with training, can improve cultural competency. IAPT training should focus on cultural awareness, knowledge and skills to enhance therapeutic experience. Moreover, PWPs should reflect on their identity, personal biases and experiences when working with diverse communities.Originality/valueThis is one of the few qualitative studies evaluating the cultural competencies of PWPs in IAPT.

Clinician experiences on training and awareness of sexual orientation in NHS Talking Therapies Services for Anxiety and Depression

Abstract Previous research that explored sexual minority service users’ experiences of accessing NHS Talking Therapies for Anxiety and Depression Services highlighted the need for specific sexual orientation training. Inconsistent or lack of training may contribute to disparities in treatment outcomes between sexual minority service users and heterosexual service users. The aim of the study was to explore clinicians’ competencies working with sexual minority service users, their experiences of sexual orientation training, their view of current gaps in training provision, and ways to improve training. Self-reported sexual orientation competency scales and open-ended questions were used to address the aims of the study. Participants (n=83) included Psychological Wellbeing Practitioners (PWPs) and high-intensity CBT therapists (HITs). Responses on competency scales were analysed using Kruskal–Wallis tests and thematic analysis was used to analyse qualitative responses. Participants who identified as 25–29 years old had higher scores on the knowledge scale than 45+-year-olds. Bisexual participants also had higher scores on the knowledge subscale than heterosexual participants. Three over-arching themes were identified: (a) training received on sexual minority issues by Talking Therapies clinicians, (b) clinicians’ experiences of accessing and receiving sexual minority training, and (c) perceived gaps in current sexual minority training and ways to improve training. Findings were linked to previous literature and recommendations to stakeholders are made throughout the Discussion section with the view of improving sexual orientation training. Key learning aims (1) To understand current training provision of sexual orientation training across NHS Talking Therapies courses and services in England. (2) To consider clinicians’ experiences of challenges and barriers that may prevent them from accessing or implementing sexual orientation training in clinical practice. (3) To understand clinicians’ views of the current gaps in training and ways to improve training provision. (4) To make recommendations to NHS Talking Therapies for Anxiety and Depression courses and services in ways to improve training on sexual orientation to better meet the learning needs of clinicians and service users.

‘It’s been quite a poor show’ – exploring whether practitioners working for Improving Access to Psychological Therapies (IAPT) services are culturally competent to deal with the needs of Black, Asian and Minority Ethnic (BAME) communities

Abstract Cultural competency is a core clinical skill. Yet, psychological therapists may be inadequately trained to deal with the needs of service users from Black, Asian and Minority Ethnic (BAME) backgrounds. This can lead to dissatisfaction with mental health services, disengagement from therapy, and poorer treatment outcomes when compared to the White British population. The aim of this study was to explore whether practitioners working for Improving Access to Psychological Therapies (IAPT) services are culturally competent to deal with the needs of diverse communities. Semi-structured interviews were carried out with a range of practitioners, from early career psychological wellbeing practitioners (PWPs) to senior cognitive behavioural therapists (n=16). Reflexive thematic analysis (RTA) was used to analyse the data, guided by a six-phase process to produce a robust pattern-based analysis. Overall, three themes were generated: (1) encountering cultural dissonance within therapy; (2) challenges in making cultural adaptations to therapy; and (3) identifying cultural competency needs. Out of sixteen participants, only nine therapists received one-day formal training throughout their therapeutic career, whilst seven reported receiving no cultural competence training at all. Overall, it appears that there is an urgent need and desire for therapists to be offered cultural competency training so that they can better serve BAME communities. Clinical implications and future recommendations are made. Key learning aims (1) To briefly introduce cross-cultural theoretical models that may assist mental health professionals to think critically about Western notions of therapy and whether they are suited to the needs of ethnic minority communities. (2) To consider challenges IAPT practitioners encounter during therapy and identify examples of good practice. (3) To explore to what extent IAPT practitioners feel culturally competent to deal with the needs of BAME communities. (4) To encourage IAPT services and decision makers (e.g. training bodies and commissioners) to enhance cultural competence training so that practitioners can better serve ethnic minority communities.

The emergence of the psychological practitioner: What can we learn from the development of the psychological wellbeing practitioner for a sustainable future workforce?

The Psychological Professions have undergone unprecedented workforce expansion in recent years. Growth of the new role of psychological wellbeing practitioner, provides us with an opportunity to learn about the factors that underpin successful implementation of the growing family of additional new psychological practitioner roles and consider what workforce and education development issues need attention in order to allow the psychological practitioners to grow and flourish with sustainability.

Acceptability of integrating smoking cessation treatment into routine care for people with mental illness: A qualitative study.

Improving Access to Psychological Therapies (IAPTs) Services could offer smoking cessation treatment to improve physical and psychological outcomes for service users, but it currently does not. This study aimed to understand participants' views and experiences of receiving a novel smoking cessation intervention as part of the ESCAPE trial (intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety). We used the Capability, Opportunity and Motivation Model of Behaviour (COM-B) to understand the (i) acceptability of the integrated smoking cessation treatment, (ii) views of psychological well-being practitioners' (PWPs) ability to deliver the smoking cessation treatment and (iii) positive and negative impacts of smoking cessation treatment. This was a qualitative study embedded within a feasibility randomized-controlled trial (ESCAPE) in primary care services in the United Kingdom (IAPT). Thirty-six participants (53% female) from both usual care and intervention arms of the ESCAPE trial, including both quitters and nonquitters, were interviewed using semi-structured interviews. Data were analysed using a framework approach to thematic analysis, using the COM-B as a theoretical frame. Psychological Capability: Integrated smoking cessation treatment was acceptable and encouraged participants to reflect on their mental health. Some participants found it difficult to understand nicotine withdrawal symptoms. Participants were open to change during the event of presenting to IAPT. Some described being motivated to take part in the intervention by curiosity, to see whether quitting smoking would help their mental health. Physical Opportunity: IAPT has a natural infrastructure for supporting integrated treatment, but there were some barriers such as session duration and interventions feeling segmented. Social Opportunity: Participants viewed PWPs as having good interpersonal skills to deliver a smoking cessation intervention. People with common mental illness generally accepted integrated smoking cessation and mental health treatment. Smoking cessation treatment fits well within IAPT's structure; however, there are barriers to implementation. Before data collection, we consulted with people with lived experience of smoking and/or mental illness and lay public members regarding the aims, design and interview schedules. After analysis, two people with lived experience of smoking and mental illness individually gave feedback on the final themes and quotes.

Practitioners' experience of the working alliance in a blended cognitive-behavioural therapy intervention for depression: qualitative study of barriers and facilitators.

Digital technologies have been widely acknowledged as a potentially useful resource for increasing mental healthcare access. The working alliance is a key influence on outcomes in conventional psychotherapy, but little is known about therapists' experiences of forming an effective working alliance in blended interventions that involve in-person psychotherapy and a digital programme. To investigate psychological well-being practitioners' (PWPs') experiences of the working alliance in a trial of blended cognitive-behavioural therapy (b-CBT) for depression. Trial registration ISRCTN12388725. Semi-structured qualitative interviews were conducted with 13 PWPs who delivered b-CBT in a two-arm, non-inferiority randomised controlled trial investigating the effectiveness of b-CBT compared with face-to-face CBT. Thematic analysis was used to analyse the data. Participants reported four facilitating factors when building and maintaining a working alliance in b-CBT: having more time to deliver treatment, access to a wider toolkit, capacity to tailor components of b-CBT and receiving appropriate training and support. Participants also identified four barriers to building and maintaining a working alliance: time and resource constraints, usability challenges, limited flexibility to tailor the digital programme to patients' needs and lack of confidence in delivering b-CBT. Our study is the first specifically to investigate practitioners' perceived facilitators and barriers to forming a working alliance in b-CBT for depression. Findings suggest that PWPs' experiences of the working alliance can be improved by: accounting for the time required to deliver b-CBT in service workflows to reduce time pressures; increasing opportunities to tailor the digital programme through offering transdiagnostic tools and adaptable features; and providing appropriate b-CBT training and technical support.

Perinatal mental health services in pregnancy and the year after birth: the ESMI research programme including RCT

Perinatal mental health services in pregnancy and the year after birth: the ESMI research programme including RCT

The acceptability of cognitive analytic guided self-help in an Improving Access to Psychological Therapies service.

An Improving Access to Psychological Therapies (IAPT) service in England has implemented cognitive analytic therapy guided self-help (CAT-GSH) alongside cognitive behavioural guided self-help (CBT-GSH) in order to support enhanced patient choice. This study sought to explore the acceptability to psychological wellbeing practitioners (PWPs) of delivering CAT-GSH. This study used a qualitative design with semi-structured interviews and associated thematic analysis (TA). A sample of n=12 PWPs experienced in delivering CAT-GSH were interviewed. Five over-arching themes (containing 12 subthemes) were identified and conceptually mapped: (a) the past-present focus (made up of working with clients' pasts and the different type of change work), (b) expanding the treatment offer (from the perspective of PWPs and clients), (c) the time and resources required to effectively deliver CAT-GSH (to enable safe and effective delivery for clients and personal/professional development for PWPs), (d) understanding CAT-GSH (made up of confidence, learning new therapeutic language/concepts and appreciating the difference with CBT-GSH) and (e) joint exploration (made up of therapeutic/supervisory relationships and enhanced collaboration). CAT-GSH appears an acceptable (but challenging) approach for PWPs to deliver in IAPT services. Services should prioritise training and supervision for PWPs to ensure good governance of delivery.

Stress, resilience and coping in psychological wellbeing practitioner trainees: a mixed-methods study

Abstract In this study, a convergent parallel mixed-methods design was used to explore stress, resilience and coping in psychological wellbeing practitioner (PWP) trainees (n = 90) at the beginning of their training. Psychometric tests were used to measure levels of self-reported stress, resilience and dispositional coping styles. Open-text survey data regarding the perceived sources of stress at the beginning of training were also qualitatively analysed using thematic analysis (TA). Results indicated that in the early weeks of their training, trainees reported lower levels of resilience and higher levels of stress than those found in the general population. Statistically significant negative correlations were found between stress and resilience, and between stress and the coping styles ‘Planning’, and ‘Active Coping’. Statistically significant positive correlations were found between stress and the coping styles of ‘Denial’ and ‘Focus on and Venting of Emotions’. The qualitative findings provided a context within which to understand these quantitative results. The three themes ‘I can find the unknown quite unsettling’, ‘I question my competences’ and ‘Learning, consolidating and putting it all into practice’ were generated through the qualitative analysis. These themes were connected by an over-arching theme which suggests that the perceived responsibility of the role is an important source of stress for PWP trainees. Implications for future research and the training of PWPs are discussed. Key learning aims (1) To establish the levels and perceived sources of stress in trainee PWPs at the beginning of their training. (2) To identify relationships between stress and resilience, and between stress and styles of coping at the beginning of training. (3) To use a mixed-methods approach to provide a comprehensive account of stress at the outset of training.

\u2018Asking for help\u2019: a qualitative interview study exploring the experiences of interpersonal counselling (IPC) compared to low-intensity cognitive behavioural therapy (CBT) for women with depression during pregnancy

BackgroundTreating depression early in pregnancy can improve health outcomes for women and their children. Current low-intensity psychological therapy for perinatal depression is a supported self-help approach informed by cognitive behavioural therapy (CBT) principles. Interpersonal counselling (IPC) may be a more appropriate low-intensity talking therapy for addressing the problems experienced by pregnant women with depression. A randomised feasibility trial (ADAGIO) has compared the acceptability of offering IPC for mild-moderate antenatal depression in routine NHS services compared to low-intensity CBT. This paper reports on a nested qualitative study which explored women’s views and expectations of therapy, experiences of receiving IPC, and Psychological Wellbeing Practitioners (PWPs - junior mental health workers) views of delivering the low-intensity therapy.MethodsA qualitative study design using in-depth semi-structured interviews and focus groups. Thirty-two pregnant women received talking therapy within the ADAGIO trial; 19 contributed to the interview study from July 2019 to January 2020; 12 who had IPC and seven who had CBT. All six PWPs trained in IPC took part in a focus group or interview. Interviews and focus groups were recorded, transcribed, anonymised, and analysed using thematic methods.ResultsPregnant women welcomed being asked about their mental health in pregnancy and having the chance to have support in accessing therapy. The IPC approach helped women to identify triggers for depression and explored relationships using strategies such as ‘promoting self-awareness through mood timelines’, ‘identifying their circles of support’, ‘developing communication skills and reciprocity in relationships’, and ‘asking for help’. PWPs compared how IPC differed from their prior experiences of delivering low-intensity CBT. They reported that IPC included a useful additional emotional component which was relevant to the perinatal period.ConclusionsIdentifying and treating depression in pregnancy is important for the future health of both mother and child. Low-intensity perinatal-specific talking therapies delivered by psychological wellbeing practitioners in routine NHS primary care services in England are acceptable to pregnant women with mild-moderate depression. The strategies used in IPC to manage depression, including identifying triggers for low mood, and communicating the need for help, may be particularly appropriate for the perinatal period.Trial registrationISRCTN 11513120. 02/05/2019.

Integrating mental health care into home-based nursing services: A qualitative study utilising normalisation process theory.

To identify barriers and facilitators to implementing community nurses being trained as psychological wellbeing practitioners and integrating this practice into home-based primary care nursing, through key stakeholders' perceptions. Current drivers in UK primary care aim to increase access to mental health services and treatment, to achieve parity of esteem between physical and mental health care for patients who are housebound. However, there remains limited evidence on how to successfully implement this. Training community nurses as psychological wellbeing practitioners to offer mental health care alongside their current home-based services is one option. A pluralistic qualitative study. This study followed the COREQ checklist for reporting qualitative research. Twenty key stakeholders were purposively recruited and interviewed including twelve health professionals and eight patients. Semi-structured interviews were analysed using a theoretical thematic analysis informed by normalisation process theory concepts of coherence, cognitive participation, collective action and reflexive monitoring, to explore the barriers and facilitators to implementation. Staff and patients reported high coherence and cognitive participation, valuing the integrated roles. Facilitators included the development of clearer referral pathways and increased mental health knowledge in the wider team. However, sustainability and current siloed healthcare systems were identified as barriers to implementation. A key obstacle to long-term implementation was the practical structures and financial boundaries of siloed healthcare systems, making long-term sustainability unviable. Community nurses with additional mental health training can integrate these skills in practice and are valued by their team and patients offering holistic care to patients within their home and informal knowledge transfer to the wider team. However, long-term sustainability is required if this is to be adopted routinely. Further evidence is needed to better understand the positive outcomes to patients and potential cost savings.

"Pacing does help you get your life back": The acceptability of a newly developed activity pacing framework for chronic pain/fatigue.

We have developed and feasibility tested an activity pacing framework for clinicians to standardise their recommendations of activity pacing to patients with chronic pain/fatigue. This study aimed to explore the acceptability and fidelity to this framework in preparation for a future trial of activity pacing. Acceptability and fidelity were explored using semi-structured interviews. Data were analysed using framework analysis. Patients who attended a rehabilitation programme for chronic pain/fatigue underpinned by the framework, and clinicians (physiotherapists and psychological wellbeing practitioners) who led the programmes. Seventeen interviews were conducted, involving 12 patients with chronic pain/fatigue and five clinicians. The framework analysis revealed four deductive themes: (1) Acceptability of the activity pacing framework, (2) Acceptability of the feasibility study methods, (3) Processes of change and (4) Barriers and facilitators to activity pacing; and one inductive theme: (5) Perspectives of patients and clinicians. The activity pacing framework appeared acceptable to patients and clinicians, and adherence to the framework was demonstrated. Processes of behaviour change included patients' regulation of activities through activity pacing. Barriers to pacing included work/social commitments and facilitators included identifying the benefits of pacing on symptoms. Different perspectives emerged between clinicians and patients regarding interpretations of symptom-contingent and quota-contingent strategies. The framework recognises fluctuations in symptoms of chronic pain/fatigue and encourages a quota-contingent approach with flexibility. Future work will develop a patient friendly guide ahead of a clinical trial to explore the effects of pacing.

Evaluating process and effectiveness of a low-intensity CBT intervention for women with gynaecological cancer (the EPELIT Trial).

Improving survival from gynaecological cancers is creating an increasing clinical challenge for long-term distress management. Psychologist-led interventions for cancer survivors can be beneficial, but are often costly. The rise of the Psychological Wellbeing Practitioner (PWP) workforce in the UK might offer a cheaper, but equally effective, intervention delivery method that is more sustainable and accessible. We aimed to test the effectiveness of a PWP co-facilitated intervention for reducing depression and anxiety, quality of life and unmet needs. We planned this trial using a pragmatic, non-randomised controlled design, recruiting a comparator sample from a second clinical site. The intervention was delivered over six-weekly sessions; data were collected from participants at baseline, weekly during the intervention, and at one-week and three-month follow-up. Logistical challenges meant that we only recruited 8 participants to the intervention group, and 26 participants to the control group. We did not find significant, between-group differences for depression, quality of life or unmet needs, though some differences at follow-up were found for anxiety ( p<.001). Analysis of potential intervention mediator processes indicated the potential importance of self-management self-efficacy. Low uptake into the psychological intervention raises questions about (a) patient-driven needs for group-based support, and (b) the sustainability of this intervention programme. This study failed to recruit to target; the under-powered analysis likely explains the lack of significant effects reported, though some trends in the data are of interest. Retention in the intervention group, and low attrition in the control group indicate acceptability of the intervention content and trial design; however a small baseline population rendered this trial infeasible in its current design. Further work is required to answer our research questions, but also, importantly, to address low uptake for psychological interventions in this group of cancer survivors. ClinicalTrials.gov, NCT03553784 (registered 14 June 2018).

Views about integrating smoking cessation treatment within psychological services for patients with common mental illness: A multi-perspective qualitative study.

BackgroundTobacco smoking rates are significantly higher in people with common mental illness compared to those without. Smoking cessation treatment could be offered as part of usual outpatient psychological care, but currently is not.ObjectiveTo understand patient and health care professionals' views about integrating smoking cessation treatment into outpatient psychological services for common mental illness.DesignQualitative in‐depth interviews, with thematic analysis.ParticipantsEleven Improving Access to Psychological Therapies (IAPT) psychological wellbeing practitioners (PWPs), six IAPT patients, and six stop smoking advisors were recruited from English smoking cessation, and IAPT services.ResultsPatients reported psychological benefits from smoking, and also described smoking as a form of self‐harm. Stop smoking advisors displayed therapeutic pessimism and stigmatizing attitudes towards helping people with mental illness to quit smoking. PWPs have positive attitudes towards smoking cessation treatment for people with common mental illness. PWPs and patients accept evidence that smoking tobacco may harm mental health, and quitting might benefit mental health. PWPs report expertise in helping people with common mental illness to make behavioural changes in the face of mood disturbances and low motivation. PWPs felt confident in offering smoking cessation treatments to patients, but suggested a caseload reduction may be required to deliver smoking cessation support in IAPT.ConclusionsIAPT appears to be a natural environment for smoking cessation treatment. PWPs may need additional training, and a caseload reduction. Integration of smoking cessation treatment into IAPT services should be tested in a pilot and feasibility study.Patient or public contributionService users and members of the public were involved in study design and interpretation of data.

A survey of psychological practitioner workplace well-being.

The well-being of the psychological workforce is an area of concern. However, it has been sparsely studied in a holistic manner encompassing workplace well-being as well as burnout. This study reports a survey of 1,678 psychological practitioners accessed through professional networks. The short Warwick Edinburgh Mental Well-being Scale (SWEMWBS) and the Psychological Practitioner Workplace Well-being Measure (PPWWM) were administered with a demographic questionnaire. The mean for the SWEMWBS was below that of a national population survey. The intercorrelation of these tests was .61. Subgroup analyses showed significant differences: assistant psychologists, counsellors and psychological well-being practitioners demonstrated better than average workplace well-being. But for general well-being (SWEMWBS), trainee clinical psychologists and assistant psychologists showed lower than average well-being, whereas psychological well-being practitioners were higher than average. Other factors associated with well-being were contract type-both measures (higher workplace well-being in those with temporary contracts and the self-employed); employment sector-for PPWWM only (private organisation/independent workers and third sector/charitable organisation workers scored above the PPWWM mean); ethnicity-for both measures (Asian groups except Chinese had higher well-being than average for the PPWWM and SWEMWBS) and disability was strongly associated with lower well-being on both measures. Harassment, feeling depressed or a failure and wanting to leave the National Health Service (NHS) were associated with lower well-being. Greater age, pay and years of service were negatively correlated with well-being. A five-factor structure was obtained with this sample. The results confirmed psychological practitioners as an at-risk group and identified a number of factors associated with workplace well-being.

Towards a conceptual framework of the working alliance in a blended low-intensity cognitive behavioural therapy intervention for depression in primary mental health care: a qualitative study.

ObjectivesTo examine and adapt a conceptual framework of the working alliance (WA) in the context of a low-intensity blended (psychological well-being practitioner (PWP) plus computerised program) cognitive behavioural therapy intervention (b-CBT) for depression.DesignPatient involvement was enlisted to collaboratively shape the design of the project from the onset, before data collection. In-depth semi-structured interviews were carried out with participants who experienced b-CBT as part of the E-compared trial. A thematic analysis was conducted using a constant comparative method informed by grounded theory.SettingRecruitment was carried out in four psychological primary care services across the UK.ParticipantsNineteen trial participants with major depressive disorder who completed at least one computerised program and face-to-face session with a PWP in the b-CBT arm were recruited to the study.ResultsQualitative interviews that were guided by WA theory and patient involvement, revealed four themes: (1) a healthcare provider (PWP and computerised program) with good interpersonal competencies for building a working relationship with the client (‘bond’); (2) collaborative efforts between the client and the provider to appropriately identify what the client hopes to achieve through therapy (‘goals’); (3) the selection of acceptable therapeutic activities that address client goals and the availability of responsive support (‘task’) and (4) the promotion of active engagement and autonomous problem solving (‘usability heuristics’). Participants described how the PWP and computerised program uniquely and collectively contributed to different WA needs.ConclusionsThis study is the first to offer a preliminary conceptual framework of WA in b-CBT for depression, and how such demands can be addressed through blended PWP-computerised program delivery. These findings can be used to promote WA in technological design and clinical practice, thereby promoting engagement to b-CBT interventions and effective deployment of practitioner and program resources.Trial registration number ISRCTN12388725.

What influences practitioners\u2019 readiness to deliver psychological interventions by telephone? A qualitative study of behaviour change using the Theoretical Domains Framework

BackgroundContemporary health policy is shifting towards remotely delivered care. A growing need to provide effective and accessible services, with maximal population reach has stimulated demand for flexible and efficient service models. The implementation of evidence-based practice has been slow, leaving many services ill equipped to respond to requests for non-face-to-face delivery. To address this translation gap, and provide empirically derived evidence to support large-scale practice change, our study aimed to explore practitioners’ perspectives of the factors that enhance the delivery of a NICE-recommended psychological intervention, i.e. guided self-help by telephone (GSH-T), in routine care. We used the Theoretical Domains Framework (TDF) to analyse our data, identify essential behaviour change processes and encourage the successful implementation of remote working in clinical practice.MethodThirty-four psychological wellbeing practitioners (PWPs) from the UK NHS Improving Access to Psychological Therapies (IAPT) services were interviewed. Data were first analysed inductively, with codes cross-matched deductively to the TDF.ResultsAnalysis identified barriers to the delivery, engagement and implementation of GSH-T, within eight domains from the TDF: (i) Deficits in practitioner knowledge, (ii) Sub-optimal practitioner telephone skills, (iii) Practitioners’ lack of beliefs in telephone capabilities and self-confidence, (iv) Practitioners’ negative beliefs about consequences, (v) Negative emotions, (vi) Professional role expectations (vii) Negative social influences, and (viii) Challenges in the environmental context and resources. A degree of interdependence was observed between the TDF domains, such that improvements in one domain were often reported to confer secondary advantages in another.ConclusionsMultiple TDF domains emerge as relevant to improve delivery of GSH-T; and these domains are theoretically and practically interlinked. A multicomponent approach is recommended to facilitate the shift from in-person to telephone-based service delivery models, and prompt behaviour change at practitioner, patient and service levels. At a minimum, the development of practitioners’ telephone skills, an increase in clients’ awareness of telephone-based treatment, dilution of negative preconceptions about telephone treatment, and robust service level guidance and standards for implementation are required. This is the first study that provides clear direction on how to improve telephone delivery and optimise implementation, aligning with current mental health policy and service improvement.