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Psychological perspectives in primary care (PPiPCare)

The Psychological perspectives in primary care (PPiPCare) programme offers professional, evidence-based training and development opportunities in advanced primary care consultation skills and cognitive behavioural therapy (CBT) techniques to GPs and other primary care health professionals to:

  • maximise their contact with patients and build resilience through supporting self-care and self-management
  • support an integrated approach to physical and associated psychological distress in primary care consultations, including long-term conditions and medically unexplained symptoms (MUS)
  • enable primary care staff to offer optimal Step 1 support to those suffering with mild to moderate depression and anxiety. 

The PPiPCare training programme consists of a two-streamed approach with short toolkit modules (30, 60 or 90 minutes) which cover techniques and frameworks, as well as three longer (half-day) teaching modules for more in-depth skills development (ten-minute CBT master classes), see details below:

  1. Detecting anxiety and depression: This module has been designed to enhance existing clinical skills and give primary care health professionals the opportunity to reflect upon (a) the difficulties that clinicians may face in diagnosing depression and anxiety, and (b) how best these can be overcome or minimised
  2. Motivational interviewing techniques: This module describes a simple method of engaging patients and facilitating change, whether in mental health or long-term physical conditions; it has been specifically designed for use within the primary care setting and has the potential to be of use for patients who are considering any form of behaviour change e.g. lifestyle changes, weight loss, smoking cessation, medication issues etc.
  3. Problem solving techniques: This module discusses a number of simple techniques which are drawn from problem-solving therapy. It is particularly relevant for patients with anxiety and/or depression, for whom problem-solving may be a particular challenge, but is also highly relevant for anyone who has to deal with problems in everyday living (i.e. everyone)
  4. Behavioural activation techniques: This module describes techniques taken from full behavioural activation therapy and may be particularly relevant for mildly depressed patients; it is a simple and often fast-acting technique that seeks to introduce relevant pleasant activities to those with chronic low mood in order to break the cycle of withdrawal and foster a sense of enjoyment, pleasure and mastery
  5. Guided self-help: This module describes how GPs and other healthcare professionals can support patients to work through self-help material (self-help is up to ten times more effective when the patient is guided rather than left on their own); it will also cover a selection of appropriate self-help material, and reviewing progress
  6. Detecting depression and anxiety in older adults: This module supports GPs and others to look for depression and anxiety in older adults and distinguish this from ‘old age complaints’; CBT treatment is very effective in treating older adults suffering with depression/anxiety and it is important that a diagnosis and a referral for treatment is made where indicated.

The longer sessions, the PPiPCare ‘Ten-minute CBT skills master classes’, include three training modules covering CBT skills and structures in more depth. Each module is delivered in a three-hour session supported by a dedicated, 80-minute training DVD. These longer training sessions teach a wide range of interventions that can be used in a standard ten-minute patient appointment for those with mental health problems, long-term physical health problems and those patients suffering with health anxiety and medically unexplained symptoms.

Module 1: Mental Health covers a range of common mental health issues and teaches CBT approaches that can be used in each case. The accompanying DVD includes separate film clips showing a brief CBT approach being used with a:

  • depressed mother with a young child
  • young man suffering from stress at work
  • woman experiencing panic attacks
  • young female patient with generalised anxiety disorder
  • male patient suffering from insomnia.

Module 2: Physical Health and Long-term Conditions uses a similar approach to psychological and emotional problems that tend to accompany physical conditions and film clips include:

  • pain and emotional distress associated with chronic back pain
  • fear of the future following treatment for breast cancer
  • encouraging healthy behaviour change in a patient with Type II diabetes
  • anxiety in an asthma patient
  • coping with low self-esteem (for an MS sufferer)
  • building confidence in a patient with speech problems after a stroke.

Module 3: Health Anxiety and Medically Unexplained Symptoms offers frameworks, techniques and skills to better manage those patients suffering with health anxiety and medically unexplained symptoms and film clips include:

  • management of patients with high levels of anxiety about their health
  • how to build rapport and avoid excessive investigations and referrals
  • managing frequent attendances at primary care services
  • managing patients with ‘tired all the time’ complaints
  • managing irritable bowel syndrome.

Sessions are offered by local IAPT staff free of charge and usually delivered at local medical centres.

The modules have been selected by GPs and written by experts in the field, including Professor Christopher Martell, Professor Stephen Rollnick, Professor Nezu and Dr Lee David who developed the ‘ten-minute CBT’ concept.

They are not designed to replace the IAPT Step 2/3 services provided by IAPT (talking therapies) nor are they designed to turn GPs or other health professionals into psychotherapists. They provide development opportunities to enhance primary care consultations skills so that patients receive better quality, integrated care and health professionals make more effective use of their short consultation sessions.

For all modules, attendees will be encouraged to bring along their own case examples for discussion.