Can online CBT overcome diabetes distress?

Diabetes distress is a term used to describe the sense of frustration, anger and disillusionment that can lead to a reduction in a person’s ability to manage the condition over time and this neglect can have serious implications for the person’s health.

Although diabetes distress is very common, it is often not recognised by Diabetes Nurse Specialists (DNSs) or GPs for a number of reasons.  Firstly, there is not enough time in an appointment to ask a patient how they are feeling or if they are coping; secondly, many DNSs have said that they feel ill-equipped to cope with the response.

Coming to terms with the implications of life with diabetes takes a considerable adjustment; symbolically it can be equated to being given care of a baby that is never going to grow up.  However, there is little psychological support available for adults newly diagnosed with this condition.

If low mood and depression are detected some are referred to the Improving Access to Psychological Therapy programme, but as the therapists are not medically trained they cannot integrate the psychological care with the diabetes care.  So there are few places for DNS to signpost patients for psychological support.

To address this PsychologyOnline has secured Small Business Research Initiative for Healthcare (SBRI Healthcare) funding to see how its approach to cognitive behaviourial therapy (CBT) can be used to treat diabetes distress.

The collaborative project aims to improve glycaemic control and psychological wellbeing through integrated care.  It is led by Ann Hayes, chairman of PsychologyOnline, alongside Professor Khalida Ismail, who leads the Diabetes and Mental Health clinical service at King's College Hospital and Bruce Hellman, founder of uMotif, a health and wellbeing app.

Previous research at KCH has shown that specially trained DNSs delivering face-to-face CBT can help patients improve their blood glucose management.  So Prof Ismail, a specialist in liaison psychiatry, is very interested in the potential for online CBT.

She says that around a third of patients have psychological issues interfering with their confidence to manage their diabetes: “Living with diabetes requires lifelong skills in calculating insulin doses and carbohydrate portions, taking into account physical activity. It is therefore understandable that some people may need psychological support from time to time to help them build their confidence towards effective blood glucose control.

“On the other hand, people with diabetes also have busy lives so trying to find the time and money to travel and attend face-to-face therapy sessions on top of the diabetes appointments is not always possible.

“I am very interested to investigate how online CBT integrated into usual diabetes care delivered by a specialist nurse can be used to provide an effective intervention.”

Online CBT is very effective at treating anxiety conditions such as those developed during diabetes distress and PsychologyOnline’s Thinkwell service is available without a GP referral.

Opportunities for experienced CBT therapists discussed at BABCP conference

Sarah Bateup will be talking to therapists about opportunities to work for  PsychologyOnline at the BABCP conference this week. Rapid expansion has meant that the company is looking for more associates to join its team of clinical affiliates.

PsychologyOnline  provides live text-based Cognitive Behavioural Therapy (CBT) for clients who are referred via the NHS, who self refer or self-fund.

PsychologyOnline is an exciting and innovative new way of delivering live CBT. Therapists communicate with users through typed instant messaging in a secure virtual meeting room. All that is required is a computer and internet connection so the therapist doesn't need to travel.

Sarah says: “Demand for our service is growing, we are operating a number of contracts in collaboration with NHS providers in England and also allow self-funded patients to self refer through our Thinkwell service where PsychologyOnline is not available in their area.”

Flexibility is appreciated by the current team as Sarah explains: “Our therapists combine freelance work for PsychologyOnline with their existing workloads, managing their diaries to suit individual circumstances.  Although the majority of our therapists live in the UK, some live overseas, which means that we can provide a 24/7 service to clients and flexibility to therapists.

“Therapists are fully trained to use our system provided with regular clinical supervision and CPD, so there are lots of opportunities to develop your skills and gain new experiences. ”

PsychologyOnline is interested in hearing from BABCP-accredited therapist with more than three years post-qualification experience.

For more about this exciting opportunity please visit www.psychologyonline.co.uk/therapists.

West Kent: our service is now free for NHS patients in West Kent!

Our convenient, easy to use service is now FREE for NHS patients in West Kent over 18 years of age.

You can refer yourself to the service (although you do need to be registered with a GP in West Kent) or you can ask your GP for a referral.

How to Access this FREE service

• Self-referral

  To self-refer yourself for PsychologyOnline, please call 01954 230066 between 9am and 5.30pm (UK time). We will need some registration details from you, including details about your GP practice (if you are registered with one). Self-referring allows you to access our service promptly and easily without the need to visit your GP.
  We are working on enabling you to self-refer directly through this website. In the meantime, please call us as above.

• GP Referral

  Your GP can also refer you to our services. Please ask them to complete the PsychologyOnline referral form on their patient management system (called DORIS) and send it to us by email following the instructions on the form.

Once we receive your referral, you will be sent details on how to get started. You will be contacted by your therapist to arrange your first appointment at your convenience.

To find out where else we are available through the NHS, please go to http://www.psychologyonline.co.uk/NHS-patients.

Do you know the symptoms of postnatal depression?

FREE Webinar 10:00 – 11:00, 9 July 2014

About 15% of mothers will develop postnatal depression (PND) and it can affect women up to a year after they have given birth says Sarah Bateup, cognitive behavioural therapist and clinical lead at PsychologyOnline. Sarah is chairing our forthcoming webinar on PND which begins at 10:00 BST on 9 July 2014.

Sarah explains: “Most women will experience symptoms of feeling a bit tearful and tired, particularly in the first few weeks after birth.  This is perfectly normal and these feelings generally resolve without treatment.  With PND, these symptoms tend to be more severe and go on for longer.

“Postnatal depression often starts with feelings of sadness and low mood that last for three or more weeks without going away. Mothers lose pleasure and enjoyment in things and often avoid activities that they would usually participate in. Often mothers find that can worry excessively and find it hard to be reassured.

“These feelings can be accompanied by physical symptoms such as headaches, feeling sick, butterflies in the stomach, dizziness and a racing heart. Mothers may not want to be around other people or to leave the house. In extreme cases, they may stop sleeping, eating and taking general care of themselves and their baby.”

Sarah has successfully treated women with PND and says that, very often, it only takes a few sessions in order for people to begin to feel better.

“Cognitive behavioural therapy (CBT) is particularly beneficial for conditions like PND. It is a collaborative process where the therapist and patient work together to develop a good understanding of the processes that are maintaining the symptoms.

“Usually maintaining factors are driven by the way that our mind begins to interpret things (cognitions) and our consequential actions or behaviours. For example, when we feel anxious or low in mood it is very common for people to start to avoid doing things. Unfortunately, avoidance usually results in people feeling worse.

“Understanding these processes can be very helpful in itself. The therapist and patient can then 
work on developing ways to manage and improve the symptoms. CBT can be a very effective treatment.

“PsychologyOnline’s approach to CBT is particularly beneficial, as people do not need to leave their home for an appointment.  Instead, it allows them to work with a therapist online using secure instant messages and gain the skills and strategies needed to cope more effectively. There is no need for new-mums to even change out of their pyjamas!“

To better understand the factors that contribute to postnatal depression and why some women may not seek help, PsychologyOnline has run a national survey in partnership with Infertility Network UK and with the support of the online community Netmums.

The findings will be discussed in a webinar, which aims to raise awareness of how to recognise the condition and consider the types of support that mothers would find beneficial.

The free webinar “Can postnatal depression be predicted?’ will be held on 9 July 2014 at 10:00. If you would like to register your interest, please email info@psychologyonline.co.uk with “PND webinar” in the subject line giving your name, organisation (if applicable) and email address.

Commissioning 2014: Announcement of excellent clinical recovery rates

Commissioning 2014 will see the announcement of excellent clinical recovery results achieved by PsychologyOnline in support of the Surrey Mental Health CCG Collaboration; which was the first to commission the innovative online service.

One year on the instant messaging-based cognitive behavioural therapy (CBT) service is proving a successful way to treat patients with depression, anxiety and stress-related disorders. Many patients are choosing to have out-of-office hours therapy from the comfort of their own homes.

Headline findings:

•          67% of all appointments out of office hours;

•          Average hours of therapy before completion:

-          2.2 hours step 2 patients (mild to moderate anxiety & depression);

-          6.2 hours step 3 patients (moderate to severe anxiety & depression);

-          9.8 hours step 3+ patients (severe to complex anxiety & depression);

•          65% clinical recovery overall (national figure of 40-50%).

PsychologyOnline uses instant messaging to support live CBT one-on-one with an experienced therapist via a secure internet connection on a computer, tablet or smartphone.

PsychologyOnline is assisting a growing number of commissioning groups to address the government's  “no health without mental health” pledge, which promises better access to psychological therapy, more effective and higher-quality treatments, and improved support for those caring for a mentally ill friend or relative.

The Surrey CCG collaboration was the first NHS organisation to adopt PsychologyOnline and a year on it has achieved some impressive results.

Dr Michael Reilly, director of Business Development for PsychologyOnline, be discussing the findings at the show and demonstrating how commissioners can extract greater knowledge from the extensive data PsychologyOnline collects. 

Commissioning is 25 – 26 June 2014 at the Excel conference centre in London.  You can visit PsychologyOnline on stand MM75.

(Webinar) Postnatal depression: Coming into the light

Webinar 10:00 – 11:00 9th July 2014

Postnatal depression transformed former midwife Joanne Morton’s life in many ways. She will be talking about her experiences in our forthcoming webinar on postnatal depression at 10:00, 9 July 2014.

“Pregnancy can bring about all sorts of anxieties; a woman’s body and mind change dramatically as you prepare to give birth and take responsibility of a tiny human life.  It is not surprising some mothers struggle to cope” says Joanne.

The symptoms of postnatal depression are often not recognised, even by health professionals.

Joanne continues: “The months after my son’s birth were difficult.  In the early stages of the illness, I felt some ups and downs but put this down to tiredness.  After five months, I felt absolutely panic-stricken for no apparent reason and this anxiety led me to stop eating properly. I lost a significant amount of weight.

“I couldn’t sleep and was utterly exhausted.  I was afraid to go outside or speak to people and often wouldn’t answer the phone if it rang.  I was often in tears and couldn’t explain why.  

“At this point I knew it couldn’t continue and I spoke to my GP and health visitor.  I was put on an NHS waiting list to receive counselling but the thing with postnatal depression is that you need to get treatment straight away, not in many months time. 

“I eventually decided to pay for private counselling. I developed a brilliant relationship with my counsellor and now feel 100% recovered, but I could still not get over the alarming lack of support for mothers like me.  I knew I had to do something about it.”

Joanne’s experience prompted her to retrain as an integrative counsellor and establish House of Light, a postnatal depression support group based in Hull, and to campaign for better support for women with this condition.

Joanne adds: “A big misconception people have is that they think if they admit to having postnatal depression, their child or children will be taken away.  This just isn’t true. 

“Families and partners need to become more aware of the warning signs of postnatal depression by being told what to look out for before their partner or daughter gives birth.

“All some mothers need is an objective person to talk through their feelings and concerns and they will often get better very quickly.”

If you would like to book your place at the webinar "Can Post Natal Depression be Predicted" on 9 July, send your name, organisation (if relevant) and email address to info@psychologyonline.co.uk with “PND webinar” in the subject field.

Can post-natal depression be predicted?

Webinar 10:00 - 11:00 9th July 2014

Many women (and their babies) are suffering needlessly from post-natal depression as the symptoms are not widely recognised and effective treatment is not always available quickly enough.

To better understand the factors that contribute to post-natal depression and why some women may not seek help, PsychologyOnline has run a national survey in partnership with Infertility Network UK and with the support of the online community Netmums.

The survey used the Edinburgh Postnatal Depression Scale to provide a widely recognised indicator of the severity of depression. It also asked women about their personal circumstances (support network) and their attitudes to talking about their feelings.

The findings have indicated an association between the perceptions of the women, their personal circumstances and a score for degree of depression. This suggests that a predisposition to post-natal depression may be detectable before childbirth and if so it may create an opportunity to target support effectively.

To explore the issues further PsychologyOnline is hosting a webinar 10:00 on 9^th July 2014. 

Who should participate?

While it is aimed at health professionals – midwives, GPs, clinicians, therapists, commissioners - others with an interest in PND support are also welcome to join.

Discussion to cover

-           What is PND and how do you recognise the signs? 

-           What do professionals working with new mothers think causes PND?

-           Are the results from the survey borne out by practical experience?

-           What would effective treatment/support look like?

Format 

Three short presentations and then discussion and questions.

Presentations

Sarah Bateup: Clinical lead therapist at PsychologyOnline

Sarah Bateup, BABCP-accredited cognitive behavioural therapist with 27,000 hours of cognitive behaviour therapy (CBT), a lecturer at the University of Exeter and has trained GPs to deliver CBT.

Sarah will provide the context for the webinar and discuss some of the findings of PsychologyOnline’s survey.  She will also discuss how CBT can help mothers recover from post-natal depression by giving them tools and strategies to enable them to better cope with the triggers of their depression. 

Jo Morton: House of Light PND support group

An experienced midwife, Jo Morton developed post-natal depression herself following the birth of her son eight years ago and finding no other forms of assistance sought private therapy to help her recover.  She went on to establish House of Light, a support organisation for PND.

Sharon Davidson: Infertility Network UK

Sharon Davidson developed PND both after the birth of her IVF son and following the adoption of her daughter.  She now helps women affected by the condition as part of her role with IN U K and ACeBabes.

Sharon believes PND is an emotional response to the circumstances of caring for a newborn or young child and not solely a physical reaction caused by changing hormones. She believes more research is needed into this field and has spoken anecdotally to countless mums who have experienced PND following fertility treatment.

If you would like to book your place at the webinar, which will last for one hour, send your name, company and email address to info@psychologyonline.co.uk with “PND webinar” in the subject field.

At PULSE Live PsychologyOnline reports out-of-hours therapy success

Out-of-hours therapy for anxiety and depression is proving popular – with 86% of appointments made in the early evening – according to interim data from a project introduced by the Isle of Wight NHS Trust (IOW NHS Trust) to improve access to therapy.

This type of data is unique to PsychologyOnline and provides GPs and commissioners with new insights into patient response to therapy.  The company will be discussing how it collects clinical evidence at Pulse on stand 4.

The IoW project, financed under Commissioning for Quality and Innovation (CQUIN), demonstrates that online therapy from PsychologyOnline is improving access to psychological therapies.

Shelley Weir, interim service lead for the IOW NHS Trust, says that patient choice was part of the decision to include PsychologyOnline within its portfolio of providers.

She adds: “As a largely rural community not everyone has the ability to easily travel to appointments.  With online therapy, our patients don’t have to get on a bus or drive; it can be done from home, which is especially beneficial for people with long-term or recurring mental health problems.

“Patients working on the mainland are rarely back before our office closes at 19:00 for face-to-face treatment. Now they can benefit from therapy after work or at weekends, with less disruption to their lives.”

The Mental Health team at IOW NHS Trust is offering text-based, online CBT to up to 40 patients classified as “step three”.  These patients suffer from moderate to severe mental health conditions such as depression, anxiety and panic disorders, which require a higher intensity intervention.

Data from PsychologyOnline – which uses instant-messaging to deliver one-on-one cognitive behavioural therapy (CBT) with an experienced psychotherapist – shows the majority of the appointments were made between 19:00 and 21:00 on a weekday.

The Isle of Wight data also shows that GPs should not be concerned about offering online services to older people.  About 18% of patients referred to the service are over 50 with the oldest being 63.  The online consulting room is simple to use; if patients can send an email they can use the service.

It is also possible to track patient progress through the therapy providing useful data for commissioners on uptake of services. 

PsychologyOnline are showcasing its unique approach to text-based CBT on stand four at Pulse Live at the Manchester Central Convention Centre on 12-13 June 2014 and GPs are welcome to visit to discuss the features and benefits of this innovative service.   

Anxiety aware: Thinkwell supports Mental Health Awareness Week

If going out for a meal, speaking on the phone or using a public toilet are frightening prospects, then you may be suffering from an anxiety disorder.  This year’s Mental Health Awareness Week aims to make more people “anxiety aware” and promote ways to reduce anxiety in everyday life.

“A prolonged and marked sense of dread and worry about social situations is the main symptom of social anxiety disorder,” says Sarah Bateup, clinical lead for PsychologyOnline.  “There’s a fear of public embarrassment and that people will think you are foolish, stupid or incapable as a result.

“Living with a social phobia can be debilitating as it often means avoiding situations that make you fearful, for example eating in a restaurant or going to a busy shopping centre.  This can cause disruption to both personal and professional lives and leave you feeling lonely and isolated.

“Having to confront your fear may intensify the sense of dread and it’s not uncommon to experience physical symptoms such as a racing heartbeat, sweating, nausea, stomach pain and rapid breathing.  For some people this can develop into a panic attack which can be incredibly distressing,” Sarah adds.

Cognitive behavioural therapy (CBT) has been approved by the National Institute for Health and Care Excellence as an effective treatment option for social anxiety.  CBT helps you identify what it is about certain situations that worries you and provides tools and strategies to help you cope more effectively with the triggers and resulting symptoms.

If leaving the house or meeting new people is distressing, then Thinkwell from PsychologyOnline, could provide the help you need.  This internet-enabled CBT allows you to have therapy in the safety of your own home.  It uses secure instant messaging to allow users to converse confidentially to their therapist and sessions can be booked at any time of day, including evenings and weekends.  All you require is a computer or smartphone and an internet connection and you never need to meet your therapist. 

Sarah explains: “Face-to-face therapy is difficult for those with social anxiety disorder. People often worry about making eye contact, what to say to the therapist and how they might come across in the therapy session. With Thinkwell, the embarrassment factor is removed.  As it is all done with text it allows people to be more open and honest and this accelerates recovery.”

After the session is over – the transcript of the session is available to be read whenever it’s needed.  This helps to revisit the helpful parts of the session and reinforces the learning so the benefit is sustained.

The results speak for themselves.  PsychologyOnline’s data shows more than 74% of people recover from mild to moderate mental illness with on average 40% fewer sessions than is expected with “traditional” talking therapies. 

Social anxiety disorder is more common than is realised.  The Mental Health Foundation estimate 8.2 million people were diagnosed with some form of anxiety in 2010.  It often starts during a person’s childhood or teenage years, perhaps following an embarrassing public experience they cannot forget.

Thinkwell has been developed by PsychologyOnline and is available without the need for a GP referral via our website www.thinkwell.co.uk.  For more information on Mental Health Awareness Week, please visit: http://www.mentalhealth.org.uk/our-work/mentalhealthawarenessweek/

PsychologyOnline to speak at Medical Innovations Summit

Barnaby Perks, chief executive of PsychologyOnline, is to share the stage with campaigners, innovators, and entrepreneurs at the Medical Innovations Summit hosted by the Royal Society of Medicine (RSM), which promises an inspirational programme of speakers from across the world.

Sarah Bateup, clinical lead at PsychologyOnline, will join Barnaby to talk about the company’s growing success. By offering text-based cognitive behavioural therapy (CBT) with a therapist over the internet, PsychologyOnline’s unique service can be accessed from home at a time to suit the individual. It has now been implemented by five NHS clinical commissioning groups with excellent recovery rates.

Improving access to support is also the theme of a presentation by television presenter and campaigner Esther Rantzen CBE. She will be talking about The Silver Line, a free confidential telephone helpline which seeks to help older people who may feel isolated, lonely and depressed. The service, set up after a successful pilot funded by Comic Relief, received more than 1,500 requests for help in its first week of operation. 

Also talking the floor will be Jen Hyatt, founder and chief executive of the Big White Wall.  She will describe how this digital healthcare service offers a social online forum for accessing mental wellbeing resources.

Using technology to improve healthcare is a pervasive theme of the Medical Innovations Summit which also features a video game to blast cancer and an intelligent knife that can “sniff out” tumours.

Sarah says that we are increasingly familiar with technology of all kinds:  “Communicating through written social media is familiar to many people. We have found that using text-based dialogue is particularly beneficial for CBT. It creates an opportunity for the person to reflect on situations as they are written down and this helps get to the root of the problem more quickly.

“People often have ‘light bulb’-type realisations during CBT when they see how to change their behaviours, but this can be transient. With a downloadable transcript it is possible to go back over the session later to regain that benefit.”

For more information about the entrepreneurs and innovators presenting at the RSM’s Medical Innovations Summit please visit: www.rsm.ac.uk/innovations/.  You can also register for the event, which takes place on 5 April 2014, free of charge.