First Step is committed to both applying the evidence-base and also helping to develop it. We are keen to collaborate on research with other partners and also lead our own research into relevant areas. Many staff choose to become involved in the projects and find that this helps them both improve the treatments they offer but also to develop themselves professionally (and prevent therapist burnout).
We have close links with the BABCP journals, and our Clinical Lead is currently the Editor-in-Chief of the Cognitive Behaviour Therapist (BABCP Practitioner Journal). We are keen to foster a culture where what we do is based on the strongest evidence available and we are aware of how to adapt and flex evidence-based approaches to provide the most effective service to our patients. Brief details below describe current or recent research that service staff have been involved in.
Examples of books and chapters authored by service staff.
The CBT home page
Northern IAPT Practice Research Network
First Step is pleased to be part of this network which brings together representatives from a number of psychological therapy services aligned to the ‘Improving Access to Psychological Therapies’ (IAPT) programme. At present, the membership of this network is entirely comprised of IAPT services in the north of England. The PRN is supported by academic collaborators with demonstrated expertise and track record in psychotherapy research and practice-based evidence.
The development of a dynamic progress feedback system to guide psychological treatment in primary care
We are currently working with Dr Jaime Delgadillo and colleagues at the University of Sheffield as part of project to develop algorithms that can identify when patients are not on track to recover according to a combination of characteristics and responses to therapy. This would then allow the therapist to reflect on what they are doing and potentially take appropriate action.
For more details please see https://www.researchgate.net/project/The-Development-of-a-Dynamic-Progress-Feedback-System-to-Guide-Psychological-Treatment-in-Primary-Care
Identifying and addressing burnout in NHS practitioners
We are currently working with Dr Jaime Delgadillo and colleagues at the University of Sheffield as part of project to help identify and understand burnout in health practitioners with a future upcoming project designed to pilot an intervention to reduce the likelihood of staff burnout.
Developing and implementing self-practice/self-reflection (SP/SR) programmes
SP/SR is an experiential learning and development method which involves therapists applying CBT to themselves and reflecting on the implications for themselves as therapists (and in their wider lives) and on their delivery of CBT. The current evidence suggests that this has a significant impact on the artistry of the therapy. Reflective skills and interpersonal skills (e.g. attunement, empathy) are improved which can help the therapist to apply evidence-based approaches with greater flexibility and understanding for the patient experience.
Working in collaboration with colleagues in Australia and New Zealand, First Step staff have taken part in several studies looking at the development and implementation of SP/SR programmes.
Bennett-Levy, J, & Thwaites, R. (2007). Self and self-reflection in the therapeutic relationship: A conceptual map and practical strategies for the training, supervision and self-supervision of interpersonal skills. In The therapeutic relationship in the cognitive-behavioural psychotherapies, edited by Paul Gilbert and Robert L. Leahy. London: Routledge, pp. 255-281.
Bennett-Levy, J., Thwaites, R., Chaddock, A. & Davis, M. (2009). Reflective practice in cognitive behavioural therapy: the engine of lifelong learning. In Reflective practice in psychotherapy and counselling, edited by Jacqui Stedmon and Rudi Dallos, 115-135.
Bennett-Levy J., Thwaites R., Haarhoff, B. & Perry, H. (2015). Experiencing CBT from the Inside Out: A Self-practice/Self-reflection CBT Workbook for Therapists. New York: Guilford.
Chaddock, A., Thwaites, R., Bennett-Levy, J. & Freeston, M. H (2014). Understanding individual differences in response to Self-Practice and Self-Reflection (SP/SR) during CBT training. The Cognitive Behaviour Therapist, vol. 7, e14. doi: 10.1017/S1754470X14000142
Chigwedere C, Thwaites R, Fitzmaurice B, Donohoe G. (2019). Self‐practice/self‐reflection as an alternative to personal training ‐ therapy in cognitive behavioural therapy training: A qualitative analysis. Clinical Psychology & Psychotherapy, 26:74-83. https://doi.org/10.1002/cpp.2331
Davis, M., Thwaites, R., Freeston, M.H. & Bennett-Levy, J. (2014). A measurable impact of a self-practice/self-reflection programme on the therapeutic skills of experienced cognitive behavioural therapists. Clinical Psychology & Psychotherapy. Published online: 26 January 2014. doi:10.1002/cpp.1884.
Freeston, M., Thwaites, R., & Bennett-Levy, J. (2019). ‘Courses for Horses’: Designing, adapting and implementing self practice/self-reflection programmes. The Cognitive Behaviour Therapist, 12, E28. doi:10.1017/S1754470X19000138
Haarhoff, B., & Thwaites, R. (2016). Reflection in CBT. London: Sage.
Haarhoff, B., Thwaites, R., & Bennett-Levy, J. (2015). Engagement with self-practice/ self-reflection as a professional development activity: the role of therapist beliefs. Australian Psychologist, 50, 322-328. DOI: 10.1111/ap.12152
Thwaites, R., Bennett-Levy, J., & Haarhoff, B. (2015). Self-practice/self-reflection (SP/SR): contexts, challenges and ways forward. Australian Psychologist, 50, 344-349. DOI: 10.1111/ap.12166
Thwaites, R., Bennett‐Levy, J., Davis, M. & Chaddock, A. (2014). Using self‐practice and self‐reflection (SP/SR) to enhance competence and meta-competence. In A. Whittington & N. Grey (Eds.), How to Become a More Effective CBT Therapist: Mastering Metacompetence in Clinical Practice (pp.241-254). London: Routledge.
Thwaites R, Bennett-Levy J, Cairns L, Lowrie R, Robinson A, Haarhoff B, Lockhart L & Perry H (2017). Self-practice/self-reflection (SP/SR) as a training strategy to enhance therapeutic empathy in low intensity CBT practitioners. New Zealand Journal of Psychology, 46, 63-70.
Thwaites, R., Cairns, L., Bennett-Levy, J., Johnston, L., Lowrie, R., Robinson, A., Turner, M., Haarhoff, B., & Perry, H. (2015). Developing metacompetence in low intensity CBT interventions: evaluating a self-practice/self-reflection program for experienced low intensity CBT practitioners. Australian Psychologist, 50, 311-321. DOI: 10.1111/ap.12151
Adapting IAPT interventions for individuals with lower intellectual functioning
We are working closely with our colleagues in Learning Disability services to ensure we can identify individuals with lower intellectual functioning and adapt mainstream IAPT interventions to help them gain most benefit from interventions.
Dagnan, D., Masson, J., Thwaites, R. & Hatton, C. (2011) Poster: Training therapists using CBT for people with learning disabilities: Scale development and outcomes from four primary care mental health training groups. 11th Seattle Club Conference, 7-8 December. Selwyn College, University of Cambridge.
Dagnan, D., Masson, J., Cavagin, A., Thwaites, R. & Hatton, C. (2014). The Development of a Measure of Confidence in Delivering Therapy to People with Intellectual Disabilities. Clinical Psychology and Psychotherapy. doi: 10.1002/cpp.1898
Developing suicide risk assessment, formulation and management in First Step
See https://www.researchgate.net/profile/David_Sandford for papers published to date
This covers four overlapping planned projects:
1. Developing practitioner confidence in assessment and management of suicide behaviours
- Adapt an existing measure of practitioners’ confidence in assessment and management of risk (Delgadillo, 2014).
- Validate the adapted measure.
- Use the measure to evaluate risk assessment, formulation and management training within a mental health trust.
2. Understanding and mitigating the impact of patient suicide on practitioners
- Study the impact of patient suicide on practitioners within a mental health trust initially focussing on those in the relatively new role of PWPs (Psychological Wellbeing Practitioners – providing Step 2 guided self-help) within an IAPT service using questionnaires and semi-structured interviews.
- Develop an information leaflet for practitioners and evaluate the effect of the use and distribution of this.
3. Integrated Motivational and Volitional Model– theory into practice: developing practitioners’ skills in assessment and management of suicide behaviours
- Arrange training for practitioners in IMV model (O’Connor, 2011).
- Develop psychological interventions based on the IMV.
- Deliver training in these interventions.
- Use measures including confidence measure in 1) above to gauge impact of this training.
- Audit the quality of completed risk formulations.
4. Health promotion
- Development of self-help information on First Step pages of Trust website, including provision of Safety Planning app.
- Continuing the close working we have developed with some local media organisations, dissemination of information to local press outlets to provide opportunities to spread good practice guidance.
- Sharing of good practice with physical health services and General Practice staff
Sandford, D., Kirtley, O.J., Lafit, G., Thwaites, R., & O’Connor, R. C. (In press). Investigating the factor structure of the Attitudes to Suicide Prevention Scale. Crisis.
Using pre-therapy groups (Transdiagnostic Seminars) to help clients to get the most benefit from therapy
This project aimed to implement a series of three seminars offered to patients waiting to access step 3 CBT. The transdiagnostic seminars (TDS) were developed and piloted by Leeds IAPT between March 2013 and March 2014 and are now being rolled out across various IAPT sites in the North of England. The seminars have 2 functions; (1) to prepare patients to make the most of therapy by introducing them to some key aspects of CBT, and (2) to provide early access to self-help strategies and booklets.
Self management after therapy: relapse prevention
SMArT was a project which is developed by the South West Yorkshire Partnership NHS Foundation Trust and the University of Huddersfield.
First Step worked in collaboration with Professor Mike Lucock of the University of Huddersfield to pilot this intervention in Cumbria. This project aimed to develop and evaluate a new intervention to support individuals and prevent relapse after they have been discharged from a psychological intervention for depression.