COMPREHEND COPE CONNECT GETTING TO THE SIMPLE HEART

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: 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

COMPREHEND, COPE & CONNECT TRANSFORMING 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

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

COMPREHEND, COPE & CONNECT THERAPEUTIC 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

COMPREHEND, COPE & CONNECT THERAPEUTIC 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

COMPREHEND, COPE & CONNECT PSYCHOLOGICAL 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

COMPREHEND, COPE & CONNECT WORKING ACROSS THE CARE PATHWAY Skills groups can be accessed by inpatients or in the community Formulation informs care across the pathway

T E H T C E N E P CO N O &C D IN C , D H N E E H B E R Y P H M C R O O OA E TH PR AP T E H

COMPREHEND, COPE & CONNECT- THEORY DIFFERENT CIRCUITS IN THE BRAIN (ADAPTED FROM DBT) REASONABLE MIND WISE EMOTION MIND Reasonable Mind Memory Emotion Mind Memory IN THE PRESENT IN CONTROL

COMPREHEND, COPE & CONNECT - THEORY THE ‘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

COMPREHEND, COPE & CONNECT - THEORY WAYS 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

COMPREHEND, COPE & CONNECT - THEORY THESE ARE COMMON WAYS OF COPING EARLY TRAUMA/ADVERSITY ADDS TO CURRENT DISTRESS – MAKING COPING MORE DIFFICULT THERE IS NO “THEM AND US” – “ONLY US”

COMPREHEND, COPE & CONNECT THE 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)

COMPREHEND, COPE & CONNECT

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.

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)

Comprehend, cope & connect Study 1

COMPREHEND, COPE & CONNECT THE COMPREHEND, COPE AND CONNECT APPROACH IN 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.

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!

COMPREHEND, COPE & CONNECT AND CULTURE FREE THERAPY A new initiative in the planning stages.

COMPREHEND, COPE & CONNECT CONTACT 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 Mental. Health, 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