Remote delivery of CBT training, clinical supervision and services: in times of crisis or business as usual.

The worldwide coronavirus pandemic has forced health services to adapt their delivery to protect the health of all concerned, and avoid service users facing severe disruption. Improving Access to Psychological Therapies (IAPT) services in particular are having to explore remote working methods to continue functioning. Australian IAPT services have utilised remote delivery methods and disruptive technologies at their core from inception. This was to maintain fidelity and clinical governance across vast distances but has allowed training, supervision and service delivery to continue virtually uninterrupted through coronavirus restrictions. On this basis, key recommendations for remote working are outlined. Remote methods are defined as (1) real time delivery, (2) independent delivery and (3) blended delivery. These are applied across three broad areas of remote training, remote clinical supervision and remote service delivery. Recommendations may be of great benefit to IAPT training institutions, clinical supervisors and service providers considering a move towards remote delivery. Challenges, adaptations and examples of applying remote methods are outlined, including case examples of methods applied to low-intensity and high-intensity cognitive behavioural therapy. Remote methods can safeguard service continuity in times of worldwide crisis and can contribute to reducing the impact of increased mental health presentations post-COVID-19. KEY LEARNING AIMS: To understand the core areas of remote training, clinical supervision and service delivery.To review and distinguish between three broad methods of remote working.To understand how to plan remote working via key recommendations and case examples.

NewAccess for depression and anxiety: adapting the UK Improving Access to Psychological Therapies Program across Australia.

OBJECTIVE: NewAccess is a Low Intensity Cognitive Behaviour Therapy (LiCBT) early intervention pilot, for mild to moderate depression and anxiety. In November 2015 the Australian Government Review of Mental Health Programmes and Services specifically highlighted the program, stating, "Primary Health Networks will.…be encouraged and supported to work towards better utilisation of low intensity 'coaching' services for people with lesser needs, building on evaluations of programmes such as the NewAccess model of care, and the Improving Access to Psychological Therapies model of stepped care implemented in the United Kingdom." NewAccess runs in three sites (Adelaide, Canberra and North Coast New South Wales) based on the successful UK Improving Access to Psychological Therapies (IAPT) model. NewAccess involves training in evidence-based interventions, regular clinical supervision and recording outcome measures every session. Key performance indicators include functional recovery,loss of diagnosis, return to employment and early intervention. CONCLUSIONS: Adaptation to Australia accommodated contextual issues such as geographical isolation and infrastructure of the healthcare system. Initial recovery rates and projected economic viability for NewAccess are very promising, supporting wider adoption of an IAPT model across Australia. In addition it has resulted in the emergence of a new Australian workforce in community mental health with the LiCBT 'Coach'.

Cognitive behaviour therapy for withdrawal from antidepressant medication: a single case series.

BACKGROUND: Research has clearly established the efficacy of pharmacotherapy and cognitive behaviour therapy (CBT) for depression. There is less literature addressing cessation of treatment, such as relapse during withdrawal from antidepressant medication. AIMS: The current study examines the role of psychological constructs that may influence relapse or fear of relapse and lead to resumption of medication. This hypothesizes that during withdrawal individuals may misinterpret normal variations in mood and dysphoric or other symptoms as reduced levels of medication in their bodies in keeping with a simplistic rationale for antidepressants. METHOD: The study uses an intensive single case AB style design in three cases during the withdrawal process. All participants had been treated with CBT plus antidepressants and had previously attempted to withdraw from antidepressants. The first part of the study naturalistically tracks belief changes as medication decreases; the second examines changes in these if/when a CBT intervention is introduced due to relapse or potential near-relapse. Daily self-monitoring diaries were used to measure target variables, together with standardized questionnaires up to 6 months follow-up. RESULTS: Changes in symptoms, appraisal of symptoms, and beliefs about medication changed throughout the study. All participants remained medication free at 6 months follow-up. Two cases received CBT intervention due to possible relapse; the third underwent an unproblematic withdrawal. CONCLUSIONS: Patterns of change are discussed in terms of current approaches to medication cessation and the role of CBT during withdrawal.

Exposure therapy for problem gambling via Videoconferencing: a case report.

This case report of a 31 year old woman who described her main problem as an uncontrollable urge to gamble on electronic gaming machines describes the application of exposure therapy (ET) by videoconferencing and the use of a clinical therapy assistant in the treatment of pathological gambling. The case study is used to demonstrate the effectiveness of this treatment with six sessions of therapy and 4 year follow up. The use of videoconferencing is discussed in relation to treatment effectiveness, ongoing follow up for the client and education and support for a community mental health nurse, therapy assistant, in a rural setting in South Australia. The implications of using this modality for the treatment of rural patients with problem gambling is discussed.