Gellatly Judith, Pedley Rebecca, Molloy Christine, Butler Jennifer, Lovell Karina, Bee Penny
Division of Nursing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
BMC Psychiatry. 2017 Feb 22;17(1):77. doi: 10.1186/s12888-017-1238-x.
Obsessive-compulsive disorder (OCD) is a debilitating mental health disorder that can substantially impact upon quality of life and everyday functioning. Guidelines recommend pharmacological and psychological treatments, using a cognitive behaviour therapy approach (CBT) including exposure and response prevention, but access has generally been poor. Low intensity psychological interventions have been advocated. The evidence base for these interventions is emerging but there is a paucity of information regarding practitioners' perceptions and experiences of supporting individuals with OCD using this approach.
Qualitative interviews were undertaken with psychological wellbeing practitioners (PWPs) (n = 20) delivering low intensity psychological interventions for adults with OCD within the context of a large pragmatic effectiveness trial. Interviews explored the feasibility and acceptability of delivering two interventions; guided self-help and supported computerised cognitive behaviour therapy (cCBT), within Improving Access to Psychological Therapies (IAPT) services in NHS Trusts. Interviews were recorded with consent, transcribed and analysed using thematic analysis.
PWPs acknowledged the benefits of low intensity psychological interventions for individuals experiencing OCD symptoms on an individual and population level. Offering low intensity support provided was perceived to have the opportunity to overcome existing service barriers to access treatment, improve patient choice and flexibility. Professional and service relevant issues were also recognised including self-beliefs about supporting people with OCD and personal training needs. Challenges to implementation were recognised in relation to practitioner resistance and intervention delivery technical complications.
This study has provided insight into the implementation of new low intensity approaches to the management of OCD within existing mental health services. Benefits from a practitioner, service and patient perspective are identified and potential challenges highlighted.
Current Controlled Trials: ISRCTN73535163 . Date of registration: 5 April 2011.
强迫症(OCD)是一种使人衰弱的心理健康障碍,会对生活质量和日常功能产生重大影响。指南推荐采用认知行为疗法(CBT),包括暴露与反应阻止法的药物和心理治疗,但总体上治疗途径不佳。有人提倡采用低强度心理干预。这些干预措施的证据基础正在形成,但关于从业者使用这种方法支持强迫症患者的看法和经验的信息却很少。
在一项大型实用性有效性试验的背景下,对为患有强迫症的成年人提供低强度心理干预的心理健康从业者(PWP,共20名)进行了定性访谈。访谈探讨了在国民健康服务信托基金的改善心理治疗可及性(IAPT)服务中提供两种干预措施(指导性自助和支持性计算机化认知行为疗法(cCBT))的可行性和可接受性。访谈经同意后进行录音,转录并使用主题分析法进行分析。
心理健康从业者承认低强度心理干预对有强迫症症状的个体和总体人群都有益处。提供低强度支持被认为有机会克服现有的治疗服务障碍,改善患者的选择和灵活性。还认识到了与专业和服务相关的问题,包括对支持强迫症患者的自我信念和个人培训需求。认识到在实施方面存在与从业者抵触和干预实施技术并发症相关的挑战。
本研究深入了解了在现有心理健康服务中实施新的低强度强迫症管理方法的情况。从从业者、服务和患者的角度确定了益处,并突出了潜在挑战。
当前受控试验:ISRCTN73535163。注册日期:2011年4月5日。