Are you entitled to one-to-one CBT on the NHS in the UK?

[Sparkle1984]

Tomorrow afternoon I have a telephone appointment with the local NHS Wellbeing Service to discuss further support for my anxiety. I went along to a group taster session on Monday, and they seemed very keen to put everyone into large group therapy sessions, which I understand is the most cost-effective way, but it seems very much to be a generic one-size-fits-all approach, and I think my problems and history are probably more complex than most other people's. A lot of people worry about practical, day to day concerns, whereas my worries are more abstract and more to do with existential anxiety, so I'm not sure if the generic group therapy sessions would work well for me.

Furthermore, I already attended group Stress Control sessions back in 2012, but now I feel that one-to-one support would be more helpful for me.

I'm 3 weeks in re-starting my medication, and I'm really struggling at the moment.

So, are you entitled to request one-to-one therapy on the NHS, or are they allowed to only provide group therapy?

[ricardo]

I had one to one CBT at my home after a referel from my GP as I am agrophobic and have GAD.
I was initially assessed by the NHS psychiatrist but I get the feeling it may depend where you live
.In London it varies from borough to borough.

[MyNameIsTerry]

I'm guessin with it being a wellbeing service, it will be part of the IAPT network thus offering Level 2 & 3 services. If you are in Scotland, this won't be the case as they do not have IAPT and still have the old Level 4 style services only (the community mental health teams) and their mental health services are well behind England & Wales as their NICE equivalent doesn't even have guidance on treating anxiety disorders listed.

So, I'm going to assume you are in England & Wales with them offering group CBT which I doubt it likely under the old style used in Scotland.

If you are being treated for GAD, here is the NICE guidance explaining what an IAPT service should be offering:

https://www.nice.org.uk/guidance/cg1...ter/1-Guidance

Step 2: Diagnosed GAD that has not improved after step 1 interventions

Low-intensity psychological interventions for GAD

1.2.11 For people with GAD whose symptoms have not improved after education and active monitoring in step 1, offer one or more of the following as a first-line intervention, guided by the person's preference:

individual non-facilitated self-help

individual guided self-help

psychoeducational groups. [new 2011]

1.2.12 Individual non-facilitated self-help for people with GAD should:

include written or electronic materials of a suitable reading age (or alternative media)

be based on the treatment principles of cognitive behavioural therapy (CBT)

include instructions for the person to work systematically through the materials over a period of at least 6 weeks

usually involve minimal therapist contact, for example an occasional short telephone call of no more than 5 minutes. [new 2011]

1.2.13 Individual guided self-help for people with GAD should:

include written or electronic materials of a suitable reading age (or alternative media)

be supported by a trained practitioner, who facilitates the self-help programme and reviews progress and outcome

usually consist of five to seven weekly or fortnightly face-to-face or telephone sessions, each lasting 20–30 minutes. [new 2011]

1.2.14 Psychoeducational groups for people with GAD should:

be based on CBT principles, have an interactive design and encourage observational learning

include presentations and self-help manuals

be conducted by trained practitioners

have a ratio of one therapist to about 12 participants

usually consist of six weekly sessions, each lasting 2 hours. [new 2011]

1.2.15 Practitioners providing guided self-help and/or psychoeducational groups should:

receive regular high-quality supervision

use routine outcome measures and ensure that the person with GAD is involved in reviewing the efficacy of the treatment. [new 2011]

Step 3: GAD with marked functional impairment or that has not improved after step 2 interventions

Treatment options

1.2.16 For people with GAD and marked functional impairment, or those whose symptoms have not responded adequately to step 2 interventions:

Offer either

an individual high-intensity psychological intervention (see 1.2.17–1.2.21) or

drug treatment (see 1.2.22–1.2.32).

Provide verbal and written information on the likely benefits and disadvantages of each mode of treatment, including the tendency of drug treatments to be associated with side effects and withdrawal syndromes.

Base the choice of treatment on the person's preference as there is no evidence that either mode of treatment (individual high-intensity psychological intervention or drug treatment) is better. [new 2011]

High-intensity psychological interventions

1.2.17 If a person with GAD chooses a high-intensity psychological intervention, offer either CBT or applied relaxation. [new 2011]

1.2.18 CBT for people with GAD should:

be based on the treatment manuals used in the clinical trials of CBT for GAD

be delivered by trained and competent practitioners

usually consist of 12–15 weekly sessions (fewer if the person recovers sooner; more if clinically required), each lasting 1 hour. [new 2011]

1.2.19 Applied relaxation for people with GAD should:

be based on the treatment manuals used in the clinical trials of applied relaxation for GAD

be delivered by trained and competent practitioners

usually consist of 12–15 weekly sessions (fewer if the person recovers sooner; more if clinically required), each lasting 1 hour. [new 2011]

1.2.20 Practitioners providing high-intensity psychological interventions for GAD should:

have regular supervision to monitor fidelity to the treatment model, using audio or video recording of treatment sessions if possible and if the person consents

use routine outcome measures and ensure that the person with GAD is involved in reviewing the efficacy of the treatment. [new 2011]

1.2.21 Consider providing all interventions in the preferred language of the person with GAD if possible. [new 2011]

If you are being treated for OCD, its a little different:

http://www.nice.org.uk/guidance/cg31/chapter/guidance

1.5.1 Initial treatment options

Adults

The intensity of psychological treatment has been defined as the hours of therapist input per patient. By this definition, most group treatments are defined as low intensity treatment (less than 10 hours of therapist input per patient), although each patient may receive a much greater number of hours of therapy.

1.5.1.1 In the initial treatment of adults with OCD, low intensity psychological treatments (including ERP) (up to 10 therapist hours per patient) should be offered if the patient's degree of functional impairment is mild and/or the patient expresses a preference for a low intensity approach. Low intensity treatments include:

brief individual CBT (including ERP) using structured self-help materials

brief individual CBT (including ERP) by telephone

group CBT (including ERP) (note, the patient may be receiving more than 10 hours of therapy in this format).

1.5.1.2 Adults with OCD with mild functional impairment who are unable to engage in low intensity CBT (including ERP), or for whom low intensity treatment has proved to be inadequate, should be offered the choice of either a course of an SSRI or more intensive CBT (including ERP) (more than 10 therapist hours per patient), because these treatments appear to be comparably efficacious.

1.5.1.3 Adults with OCD with moderate functional impairment should be offered the choice of either a course of an SSRI or more intensive CBT (including ERP) (more than 10 therapist hours per patient), because these treatments appear to be comparably efficacious.

1.5.1.4 Adults with OCD with severe functional impairment should be offered combined treatment with an SSRI and CBT (including ERP).

1.5.1.5 Adults with BDD with mild functional impairment should be offered a course of CBT (including ERP) that addresses key features of BDD in individual or group formats. The most appropriate format should be jointly decided by the patient and the healthcare professional.

1.5.1.6 Adults with BDD with moderate functional impairment should be offered the choice of either a course of an SSRI or more intensive individual CBT (including ERP) that addresses key features of BDD.

1.5.1.7 Adults with BDD with severe functional impairment should be offered combined treatment with an SSRI and CBT (including ERP) that addresses key features of BDD.

1.5.2 How to use psychological interventions

Training

1.5.2.1 All healthcare professionals offering psychological treatments to people of all ages with OCD or BDD should receive appropriate training in the interventions they are offering and receive ongoing clinical supervision in line with the recommendations in Organising and Delivering Psychological Therapies (Department of Health, 2004)[1].

Adults

1.5.2.2 For adults with obsessive thoughts who do not have overt compulsions, CBT (including exposure to obsessive thoughts and response prevention of mental rituals and neutralising strategies) should be considered.

1.5.2.3 For adults with OCD, cognitive therapy adapted for OCD may be considered as an addition to ERP to enhance long-term symptom reduction.

1.5.2.4 For adults with OCD living with their family or carers, involving a family member or carer as a co-therapist in ERP should be considered where this is appropriate and acceptable to those involved.

1.5.2.5 For adults with OCD with more severe functional impairment who are housebound, unable or reluctant to attend a clinic, or have significant problems with hoarding, a period of home-based treatment may be considered.

1.5.2.6 For adults with OCD with more severe functional impairment who are housebound and unable to undertake home-based treatment because of the nature of their symptoms (such as contamination concerns or hoarding that prevents therapists' access to the patient's home), a period of CBT by telephone may be considered.

1.5.2.7 For adults with OCD who refuse or cannot engage with treatments that include ERP, individual cognitive therapy specifically adapted for OCD may be considered.

1.5.2.8 When adults with OCD request forms of psychological therapy other than cognitive and/or behavioural therapies as a specific treatment for OCD (such as psychoanalysis, transactional analysis, hypnosis, marital/couple therapy) they should be informed that there is as yet no convincing evidence for a clinically important effect of these treatments.

1.5.2.9 When family members or carers of people with OCD or BDD have become involved in compulsive behaviours, avoidance or reassurance seeking, treatment plans should help them reduce their involvement in these behaviours in a sensitive and supportive manner.

1.5.2.10 Adults with OCD or BDD with significant functional impairment may need access to appropriate support for travel and transport to allow them to attend for their treatment.

1.5.2.11 Towards the end of treatment, healthcare professionals should inform adults with OCD or BDD about how the principles learned can be applied to the same or other symptoms if they occur in the future.

The OCD side is more complex in terms of treatment so there is more in there.

I've only pasted the treatment main section for OCD. For GAD, I have pasted Level 2 & 3 which IAPT would offer. Where it mentions "multidisciplinary teams" in the OCD one, thats more the community mental health teams.

I suspect group therapy, for the NHS that is, is more about money & reducing waiting lists than it is about patient need. For some, it offers even more support and could help but it does depend on your issues because if your issues are nothing like the others, whilst CBT can be taught in a general way I can't see how it could be classed as high intensive when it isn't tailored.

Have they said which level you are getting? I know Level 2 for GAD offers groups but Level 3 states "individual" for a reason. I know another member on here was told he was going to get Level 3 in a group format but that was by MIND. They were being funded in his area to provide CBT for IAPT so they should be working to the framework but my area using part of Rethink and they did individual only therapies, no group work.

You could raise the issue and see what they say.

[Sparkle1984]

Thanks, Terry. Yes I'm in England so the IAPT rules will apply. I'm not sure what level of support I'll be getting though. It's just over 2 hours now until my appointment.

I'll post an update later today to say how I got on.

[Sparkle1984]

The appointment lasted almost half an hour and it went well - they asked me lots of questions about how I've been feeling lately, the sort of things I worry about and so on. They suggested going on a group-based worry workshop, but I had to decline that as it conflicts with my working hours, so they then suggested weekly one-to-one telephone calls with a therapist, although they couldn't guarantee that I'd definitely be able to have appointments in the evening after work. Apparently the therapists work until 8pm in the evening, but I can imagine the time slots between 6 and 8pm are probably the most popular, so I may have to wait a while. They said they would arrange for me to have a telephone assessment appointment with a Psychological Wellbeing Practitioner, and that I would receive a letter in the post giving me the details of the date and time. I don't know how long the waiting lists are. So I'll just have to see how it goes.

[MyNameIsTerry]

Thats a Level 2 then as PWP's don't deliver CBT at Level 3 as that is a High Intensity Therapist. The Wellbeing Workshop ties in with this because they are the Psychological Groups mentioned above.

I would expect a Level 2 therapy format to be delivered quite quickly as they don't last long. I had this first and it was 4-5 telephone appointments lasting about 20 minutes each.

Its CBT based but it won't be CBT if you have the same as me as its too short and level 2 is Guided Self Help.

My service told me I couldn't have CBT until I had passed through Level 2 even though the PWP admitted she couldn't help me and I needed a longer therapy than she was allowed to delivery. I took it because any help was better than known and it offered some interesting booklets but she was clearly not able to help with my issues in the telephone sessions.

Its worth a try though. Back then I knew nothing about anxiety and with your knowledge from your own research and support on here, you may find it easier to work with than I did.

Good luck!

[Giraffe11]

I have one-to-one CBT every Friday (sessions stop when I say so too! Currently on session 7) and I live in Buckinghamshire. We have 'Bucks Healthy Minds' .. I am seeing a trainee therapist who is around 3 months from qualification, but she is fantastic and up to date on everything new.

The best part of all - I self referred on the Monday morning and saw her on the Friday!

[ricardo]

I have one-to-one CBT every Friday (sessions stop when I say so too! Currently on session 7) and I live in Buckinghamshire. We have 'Bucks Healthy Minds' .. I am seeing a trainee therapist who is around 3 months from qualification, but she is fantastic and up to date on everything new.

The best part of all - I self referred on the Monday morning and saw her on the Friday!

You appear to be the exception.Good luck to you.

[pulisa]

Are you royalty?

[Giraffe11]

Haha quite possibly... ;-)

I think we just have a very good service here. The last time I had a few CBT sessions years ago I self referred to the same place and only waited two weeks then.