Shock of the Old

By Kerry Ardern

Cognitive Behaviour Therapy has always been at the forefront of adopting new modes of treatment delivery, such as internet-delivered therapy. While developments in new technologies continue to arise, the use of the phone – a device that most people own and use daily – never caught on as a way of delivering CBT. That was until the COVID-19 pandemic.

There are, though, lots of reasons in favour of telephone-delivered treatment. The phone is a ubiquitous presence in most people’s lives. Most households (95%) in the UK have one or more mobile phones. It also removes barriers to attending face-to-face appointments, physical or financial difficulties, time and location constraints, and stigma. There is also solid evidence that telephone-delivered treatment is as effective as face-to-face treatment, represents good value for money for services, and is acceptable to people receiving the treatment.

So why was it that, up until COVID-19 prevented face-to-face delivery, telephone treatment represented only a small percentage of the appointments offered by primary care mental health services, such as Improving Access to Psychological Therapies (IAPT) services?

Attempting to tackle this matter is the ‘Enhancing the Quality of Psychological Interventions delivered by Telephone’ (EQUITy) project. Funded by the National Institute of Health Research’s Programme Grants for Applied Research funding stream, EQUITY is a £2.4 million, 5-year research programme that began in April 2018. Organised into five inter-related work-streams and involving multiple university and IAPT sites, its aim is to increase engagement in telephone-delivered psychological interventions for mild-moderate depression and anxiety in primary care, whilst improving clinical and cost-effectiveness.

The first stage of EQUITy involved understanding the challenges of telephone treatment within IAPT through interviews and focus groups with professionals and service users, and an analysis on the IAPT data. From the knowledge gained, EQUITy have developed a feasible, evidence-based intervention to help services improve the quality of telephone treatments, and a smartphone app to enhance the exchange of therapeutic information between the service user and practitioner. Now, they plan to assess whether thier evidence-based intervention increases patient engagement, whilst improving clinical and cost effectiveness of telephone delivered psychological interventions, for adults with mild-moderate depression and/or anxiety. This is necessary, and timely, and throughout, EQUITy will embed best practice by disseminating their findings to service-users, practice and policy-makers.

The EQUITy team are currently 2 years into the 5-year project. Research into patients’ and stakeholders’ perspectives of telephone delivered guided self-help have been published (an exploration of practitioners’ perspectives will be available in due course) and can be accessed via the hyperlinks above. Additionally, a conversation analysis of PWP assessment and treatment sessions has been submitted for publication; the main findings from this have been presented here. EQUITy are now finalising their ‘training intervention’ and ‘smartphone app’ with support from service users, psychological wellbeing practitioners, admin staff and service managers.

Given that practice has changed so rapidly (to predominately telephone-delivered psychological treatment) during this pandemic – which, of course, is necessary; will we see the same resistance to telephone treatment in future? EQUITy resources should be of great help during, and after, these unprecedented times.

If you would like to find out more information about the programme, you can email them at equitymh@manchester.ac.uk