Improving access and treatment effectiveness using low intensity cognitive behavioural therapy for mild to moderate level mental health disorders, including medically unexplained symptoms, in Northern Ireland.

Student thesis: Doctoral Thesis


The main aim of the current thesis was to evaluate a new psychological therapy service in Northern Ireland (NI), which is designed to treat adults with mild to moderate level mental health difficulties, primarily depression and anxiety. The particular mental health service model which was implemented and subsequently evaluated in the current study, was designed and delivered in accordance with the English "Improving Access to Psychological Therapies" (IAPT) service model. This service facilitates the delivery of low intensity cognitive behavioural therapy (LICBT) by psychological wellbeing practitioners (PWPs).

Chapter 1 provided detailed background information on the English IAPT initiative and a detailed overview of mental health and services in NI. The key papers presented in the introductory chapter clarify the framework for the current project. Specifically the rationale for the widespread implementation of IAPT was discussed with a focus on clinical and economic arguments. Important reports in relation to mental health in NI highlighted the key issues there. The justification for evaluating an IAPT type service model in NI was thereby strongly clarified within the first chapter.

The methodologies employed in the main evaluation were the primary focus of Chapter 2. One of the primary objectives of the research was to examine the effectiveness of the new LICBT service in terms of the reliable change of symptomatology. Literature focused on evaluations of the English IAPT initiative was discussed in Chapter 3 therefore, in order to clarify the rationale for the evaluation methods employed. More specifically, within Chapter 3, rates of reliable improvement, deterioration and recovery were determined in relation to both symptoms of depression and anxiety in order to present outcomes comparable with English IAPT outcomes. Furthermore, the longer term effectiveness of the treatment was examined by determining how rates of reliable change in symptomatology may or may not have been maintained at a four month follow up point after the end of treatment.

In addition to this evaluation, a subsequent arm of the quantitative evaluation presented in Chapter 4 identified which individual level pre-treatment variables potentially increased or decreased the effectiveness of the intervention by employing a growth mixture modelling method. The research discussed in Chapter 4 highlighted the reasons for employing this method, in addition to a discussion of previous literature on predicting treatment outcomes.

The final arm of the evaluation was carried out using qualitative methods and these outcomes were presented in Chapter 5. Specifically this explored the perspectives of service providers in relation to how this new service model may or may not have improved access to psychological therapies in NI. The research literature discussed in this chapter elaborated on the meaning of 'improving access' and in particular explored issued around availability, utilization, efficiency and equity.

Finally the project considered how the new service model evaluated in the current thesis, might be delivered to other suitable patient populations in NI, namely those with medically unexplained symptoms (MUS) and associated anxiety. This final research question was addressed by presenting the outcomes of a service needs analysis in Chapter 6 and subsequently in Chapter 7, a systematic review of the evidence for low intensity interventions in relation to MUS. The needs analysis presented in Chapter 6 specifically reported on the prevalence of non-cardiac chest pain (NCCP) in an ED in NI. In addition to the outcomes of the needs analysis, literature highlighting the links between NCCP and anxiety was discussed in order to clarify the rationale for potentially offering a PWP service to these patients. The effectiveness of psychological interventions for this and similar patient populations was examined through the systematic review presented in Chapter 7, with a view to highlighting the feasibility of using PWPs.

A more detailed overall summary of the thesis findings, their wider impact and implications, recommendations for clinical practice and future research, was discussed in Chapter 8.
Date of AwardMay 2019
Original languageEnglish
SupervisorMark Shevlin (Supervisor), Karen Kirby (Supervisor) & Orla Mc Bride (Supervisor)


  • low intensity CBT
  • PWP
  • IAPT
  • depression
  • anxiety

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