Date: 15 March 2017
Category: Collaborative care
I have been a psychological wellbeing practitioner in an IAPT service for five years now, working my way along the career pathway. First, gaining a postgraduate certificate in evidence-based psychological therapy, then another enabling me to supervise other therapists and lead a team.
I really like the work. We see a wide range of people with mild to moderate depression and different types of anxiety. Using a standardised package of Cognitive Behavioural Therapy (CBT), we help people to think differently about the way they see the world and what’s happening in their lives.
I’m based in a centre that was selected for the COBRA trial and I was interested to be allocated to deliver the Behavioural Activation arm. This meant I was delivering a different therapy. Longer sessions, over a longer period than our usual CBT, to people who had been screened by local GPs as suitable for the study. In over two and a half years, I saw a total of 27 patients in this way.
It was a 20-session package, starting with a structured assessment and then formulating a plan to address the patient’s difficulties and issues. We asked patients to monitor what they did each week, exploring what improved their mood and what changed it.
Together we would build up a package of activity the patient found helpful. This might include specific activities that made them feel better, and would usually include work on how they solve problems as they encounter them, how they think about their health state, how they communicate with people around them, and so on. We used the new techniques and learning to apply this to different issues each week. This helped them generalise use of their coping strategies.
COBRA is described as a high-intensity intervention and it is quite demanding for the patient. They are asked to record what they have been doing and how they felt more frequently than with ‘conventional’ CBT – sometimes once an hour. This gives the therapist and patient lots of fruitful material to work on when they meet.
As a therapist, working in this way and having more time to devote to the work with the patient made the therapeutic relationship grow strongly. It was different from the usual CBT but I felt it was more likely patients would be able to sustain the changes in their life afterwards.
I was pleased the COBRA trial found Behavioural Activation wasn’t inferior to standard CBT. I could see my patients in the trial benefitting from the Behavioural Activation approach and I would like to see BA routinely offered as an alternative therapy so patients could get the therapy that is best for them. Since the trial finished I have used some of the BA tools and techniques in my routine practice and I am introducing newly qualified practitioners to them as well. Taking part in COBRA has been an enriching experience.
Jamie Short, a psychological wellbeing practitioner, found being part of the COBRA trial gave him a new insight into using behavioural activation.
Psychological Wellbeing Practitioner