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Increasing Access to CBT: Stepped Care and CBT Self-Help Models in Practice

Published online by Cambridge University Press:  01 November 2008

Chris Williams  and
Rebeca Martinez
Chris Williams*
Affiliation:
University of Glasgow, UK
Rebeca Martinez
Affiliation:
University of Glasgow, UK
*
Reprint requests to Chris Williams, Senior Lecturer in Psychiatry, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK. E-mail: chris.williams@clinmed.gla.ac.uk
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Abstract

The delivery of cognitive behaviour therapy (CBT) in the UK has moved through two phases. In the first phase specialist practitioners delivered bespoke CBT to individuals often experiencing complex and longer-lasting problems. This phase has been characterized by waiting lists and a high quality service delivered to a few. In the second phase of service delivery CBT has begun to be delivered in all sorts of different formats, including CBT self-help/guided CBT, behavioural activation, computerized CBT and group based CBT that aim to increase access to CBT delivered in these ways. It remains unclear how these varying models – “high intensity” (phase 1) and “low intensity” (phase 2) should relate – and even who does best with each. There are implicit assumptions by practitioners reflected in language such as “stepping up/down” that assumes high intensity working is superior in some way to low intensity. Few studies have however examined this in depth and what studies there are suggest these beliefs may be incorrect for many. How these new ways of working will be introduced, evaluated and integrated into existing services currently remains a challenge. A helpful way of resolving some of these issues is to view CBT using a learning/teaching paradigm. In this the focus is primarily on how the client wishes to learn to tackle their problems. This provides a helpful way for both introducing different and new ways of working, and also maintaining a focus on the client's needs at the centre of service development. Crucially, phase two CBT working does not replace phase one. How the two approaches complement each other and compare will be two of the interesting questions to be addressed over the next few years.

Keywords

Cognitive behaviour therapyself-helpbibliotherapycomputerized CBTlow intensitystepped care
Type
New and Emerging Areas
Information
Behavioural and Cognitive Psychotherapy , Volume 36 , Issue 6: Developments in the Theory and Practice of Cognitive and Behavioural Therapies , November 2008 , pp. 675 - 683
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2008

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