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Isabel Clarke Consultant Clinical Psychologist

Comprehend, cope & connect GETTING TO THE SIMPLE HEART OF THE COMPLEX PROBLEM New ways to bring CBT to Acute Services, IAPT challenges and beyond. Isabel Clarke Consultant Clinical Psychologist. Comprehend, cope & connect This approach gets away from labels and stigma by:.

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Isabel Clarke Consultant Clinical Psychologist

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  1. Comprehend, cope & connectGETTING TO THE SIMPLE HEART OF THE COMPLEX PROBLEMNew ways to bring CBT to Acute Services, IAPT challengesand beyond Isabel Clarke Consultant Clinical Psychologist

  2. Comprehend, cope & connectThis approach gets away from labels and stigma by: • Meeting people where they are – hearing their distress • Understanding what they do to manage it – for example: • Self harm • Attempting suicide • Withdrawing from life etc. • And offers different ways to manage distress

  3. Comprehend, cope & connectTransforming acute services • A practical way of introducing whole team psychological working • A formulation – way of understanding their problems worked out with the individual • Shared with the team • Informing psychological approaches that the whole team can deliver

  4. Comprehend, cope & connectThe Formulation Wider protective factors - family, beliefs etc Past: abuse, trauma etc. Recent triggering event Try to escape from the emotion by avoidance, self harm etc. Feel better short term Horrible Feeling Another maintaining cycle feeding theemotion Bad longer term consequences. Aversive emotion worse.

  5. Comprehend, cope & connectTherapeutic Approaches • Mindfulness • Grounding in the body and the present – where the individual can be in control • Arousal management • Emotion regulation skills to face the emotion • Psychosis: Unshared reality as an escape from emotion

  6. Comprehend, cope & connectTherapeutic Approaches continued The Compassionate Friend Programme Treat yourself as you would a good friend Emotional Coping Skills Accepting and managing emotions • Encouraging behavioural change • Behaviours to increase • Behaviours to decrease

  7. Comprehend, cope & connectPsychological skills development = the treatment Whole staff team involved in teaching or supporting these skills • Skills groups – eg. Emotional Coping Skills • Psychotic Symptom Management Daily Mindfulness on the ward Staff offer skills coaching where needed

  8. Comprehend, cope & connectWorking across the care pathway • Skills groups can be accessed by inpatients or in the community • Formulation informs care across the pathway

  9. Comprehend, cope & connectThe theory behind the approach

  10. Comprehend, cope & connect- theoryDifferent Circuits in the Brain (Adapted from DBT) EMOTION MIND REASONABLE MIND WISE MIND Reasonable Mind Memory Emotion Mind Memory IN THE PRESENT IN CONTROL

  11. Comprehend, cope & connect - theoryThe ‘horrible feeling’ • Human beings need to feel physically safe and OK about themselves • Emotion Mind produces a sense of threat when those conditions are not met • This signals the body to get ready for action – which in turn focuses the mind on threat • Emotion Mind/ Emotion Mind memory presents past events as present (trauma) • People develop ingenious ways of avoiding facing the sense of threat

  12. Comprehend, cope & connect - theoryWAYS OF COPING WITH THE HORRIBLE FEELING • Giving in - signalling submission (depression) • Constant anxiety, worry and hypervigilance • Anger - attribute elsewhere. • Displacing anxiety – OCD, eating disorder • Drink, drugs, etc. • Dissociation – flipping between different experiences of the self • Cutting out reasonable mind – psychosis

  13. Comprehend, cope & connect - theorythese are common ways of copingearly trauma/adversity adds to current distress – making coping more difficultthere is no “them and us” – “only us”

  14. Comprehend, cope & connectThe programme in action • Piloted in one hospital in Hampshire: 2004 – 2012 • (featured in the book: CBT for Inpatient Units – see next slide) • Extended to all 4 Acute Services under the Southern Health Trust. in 2012 • Also being applied: • Surrey & Borders Partnership NHS Foundation Trust • Sheffield Health and Social Care Foundation Trust • NHS Lothian (Edinburgh)

  15. Comprehend, cope & connect

  16. Comprehend, cope & connect Evaluating the Programme: Southern Health NHS Foundation Trust • 3 papers • Quantitative – pre and post measures • Published as Araci & Clarke 2016 • Qualitative – Staff perceptions of impact on individual, team work and milieu – in submission • Qualitative 2 – Service user experiences of the programme • - In preparation.

  17. Comprehend, cope & connect Study 1 • Participants - 46 male, 85 female (N = 131) • Mean age of 38.15 (SD = 12.01) • 1 Asian British, 1 black British, 84 white British, 1 mixed race white and black Caribbean, 4 white other background, and 3 unstated • 35 non-psychotic (mild/moderate/severe), 31 non-psychotic (very severe and complex), 20 psychosis, and 8 organic (cognitive impairment)

  18. Comprehend, cope & connect Study 1

  19. Comprehend, cope & connectThe comprehend, cope and connect approach in iapt • IAPT has a ca. 50% Recovery rate – what about the other 50%? • Southern Health’s italk audited this group and identified that they chracteristically present with: • Past issues complicating current coping • Long therapy history • Relationship/attachment issues. • This trans-diagnostic, formulation led, approach is being piloted in italk for those identified with these characteristics.

  20. Comprehend, cope & connect in italk 4 Sessions : Listening: formulation: goal setting 6 groups covering skills to break vicious circles identified in the formulation , on managing • arousal, • attention • emotions 6 groups covering skills to break vicious circles identified in the formulation , on managing • relationship with self • relationship s with others Work in progress!

  21. Comprehend, cope & connect and culture free therapy • A new initiative in the planning stages.

  22. Comprehend, cope & connectContact details, References and Web address • Isabel.Clarke@southernhealth.nhs.uk David Araci & Isabel Clarke (2016): Investigating the efficacy of a whole team, psychologically informed, acute mental health service approach, Journal of MentalHealth, DOI: 10.3109/09638237.2016.1139065 • Clarke, I. & Wilson, H.Eds. (2008)Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units; working with clients, staff and the milieu. London: Routledge. • Durrant, C., Clarke, I., Tolland, A. & Wilson, H. (2007) Designing a CBT Service for an Acute In-patient Setting: A pilot evaluation study. Clinical Psychology and Psychotherapy. 14, 117-125. www.isabelclarke.org

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