Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-02T20:37:22.023Z Has data issue: false hasContentIssue false
  • English
  • Français

Making friends with uncertainty: experiences of developing a transdiagnostic group intervention targeting intolerance of uncertainty in IAPT. Feasibility, acceptability and implications

Published online by Cambridge University Press:  27 October 2020

Layla Mofrad Open the ORCID record for Layla Mofrad [Opens in a new window] ,
Ashley Tiplady ,
Danielle Payne Open the ORCID record for Danielle Payne [Opens in a new window]  and
Mark Freeston
Layla Mofrad
Affiliation:
Talking Helps Newcastle (Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Insight Healthcare and The Newcastle upon Tyne Hospitals NHS Foundation Trust), Newcroft House, Market Street East, Newcastle upon TyneNE1 6ND, UK
Ashley Tiplady
Affiliation:
Newcastle Hospitals Occupational Health Service, Regent Point, Regent Farm Road, GosforthNE3 3HD, UK
Danielle Payne*
Affiliation:
Talking Helps Newcastle (Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Insight Healthcare and The Newcastle upon Tyne Hospitals NHS Foundation Trust), Newcroft House, Market Street East, Newcastle upon TyneNE1 6ND, UK
Mark Freeston
Affiliation:
School of Psychology, Newcastle University, Newcastle upon TyneNE1 7RU, UK
*
*Corresponding author: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Co-morbid mental health diagnoses present challenges for services structured to provide disorder-specific models of treatment, such as those structured around Improving Access to Psychological Therapies (IAPT). Intolerance of uncertainty (IU) has been identified as both disorder specific and transdiagnostic, although little research explores transdiagnostic approaches to treatment of IU alone. A cognitive behavioural therapy treatment targeting IU previously established for individual therapy was adapted for a group within an IAPT primary care service: the ‘Making Friends with Uncertainty’ (MFWU) group. Twenty patients presenting with symptoms of a range of disorders including generalised anxiety disorder, obsessive compulsive disorder and depression completed the intervention in three groups. Measures of IU, anxiety and depression administered in the first and final sessions of the group have been analysed as well as examining common themes in participant feedback and facilitators’ own reflections. The results showed that nine participants (45%) showed reliable change in IU following the group and 16 (80%) showed reliable change on a measure of depression or anxiety. A thematic analysis identified universality, tolerance and acceptance and the manifestation of IU in the group process as key. The results suggest that the MFWU group provides an effective and feasible option for individuals presenting to IAPT services, including those reporting co-morbid difficulties. Implications for future practice are discussed as iteration and evaluation of the framework and content will continue.

Key learning aims

  1. (1) To gain an overview of a transdiagnostic model of IU.

  2. (2) To develop understanding of a group intervention for building tolerance to uncertainty.

  3. (3) To describe some group processes observed and learn from the delivery of a transdiagnostic group intervention.

  4. (4) To consider applications of transdiagnostic treatment in a group setting in IAPT.

  5. (5) To understand how to structure a group treatment for IU, and which factors to consider.

Keywords

groupIAPTtransdiagnosticuncertainty
Type
Empirically Grounded Clinical Guidance Paper
Information
the Cognitive Behaviour Therapist , Volume 13 , 2020 , e49
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further reading

Bottesi, G., Mawn, L., Nogueira-Arjona, R., Sanchiz, P. R., Simou, M., Simos, G., & Freeston, M. H. (2020). A short-form version of the Intolerance of Uncertainty Scale: initial development of the IUS-5.CrossRefGoogle Scholar
Freeston, M. H., Tiplady, A., Mawn, L., Bottesi, G., & Thwaites, S. (2020). Towards a model of uncertainty distress in the context of Coronavirus (Covid-19).CrossRefGoogle Scholar

References

Askey-Jones, S., Tiplady, A., Thwaites, R., Meares, K., & Freeston, M. H. (2017, July). Developing a module to target intolerance of uncertainty in the transdiagnostic treatment of anxiety: conceptual, clinical, and practical challenges. In M. H. Freeston (Chair), Targeting Intolerance of Uncertainty in the treatment of anxiety: Rationale, description, and preliminary outcomes. Symposium conducted at 45th Annual Conference and Workshops of the British Association of Behavioural and Cognitive Psychotherapies, Manchester, UK.Google Scholar
Askey-Jones, S. (2018) Into the Unknown: An Exploration of an IU Module in Anxiety Disorders. Unpublished doctoral dissertation, Newcastle University, Newcastle upon Tyne, UK.Google Scholar
Beckwith, H. (2016). Attachment relationships from infancy to early adulthood and the development of (in)tolerance to uncertainty. Unpublished doctoral dissertation, Newcastle University, Newcastle upon Tyne, UK.Google Scholar
Bennett-Levy, J. (2003). Reflection: a blind spot in psychology. Clinical Psychology, 27, 16–19.Google Scholar
Bennett-Levy, J., & Thwaites, R. (2007). Self and self-reflection in the therapeutic relationship. In The Therapeutic Relationship in the Cognitive Behavioral Psychotherapies, pp. 255–281.Google Scholar
Bennett-Levy, J., Turner, F., Beaty, T., Smith, M., Paterson, B., & Farmer, S. (2001). The value of self-practice of cognitive therapy techniques and self-reflection in the training of cognitive therapists. Behavioural and Cognitive Psychotherapy, 29, 203–220.CrossRefGoogle Scholar
Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013). Intolerance of uncertainty: a common factor in the treatment of emotional disorders. Journal of Clinical Psychology, 69, 630–645.CrossRefGoogle ScholarPubMed
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.CrossRefGoogle Scholar
Brosschot, J. F., Verkuil, B., & Thayer, J. F. (2018). Generalized unsafety theory of stress: unsafe environments and conditions, and the default stress response. International Journal of Environmental Research and Public Health, 15, 464.CrossRefGoogle ScholarPubMed
Cairns, M. (2014). Patients who come back: clinical characteristics and service outcome for patients re-referred to an IAPT service. Counselling and Psychotherapy Research, 14, 48–55.CrossRefGoogle Scholar
Carleton, R. N., Norton, M. P. J., & Asmundson, G. J. (2007). Fearing the unknown: a short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21, 105–117.CrossRefGoogle Scholar
Carleton, R. N. (2016). Into the unknown: a review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30–43.CrossRefGoogle ScholarPubMed
Carleton, R. N., Duranceau, S., Freeston, M. H., Boelen, P. A., McCabe, R. E., & Antony, M. M. (2014). ‘But it might be a heart attack’: intolerance of uncertainty andpanic disorder symptoms. Journal of Anxiety Disorders, 28, 463–470.CrossRefGoogle Scholar
Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International Review of Psychiatry, 23, 375–384.CrossRefGoogle ScholarPubMed
Ellis, K. A. (2018). Identifying and addressing barriers to men seeking help for depression. British Journal of Mental Health Nursing, 7, 130–136.CrossRefGoogle Scholar
Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791–802.CrossRefGoogle Scholar
Freeston, M. H. (2015, May). Intolérance à l’incertitude: facteur spécifique dans le TAG, processus transdiagnostique ou les deux en même temps? Invited keynote address. 1er colloque Francophone de pratiques en Thérapie cognitive et comportemental. Lyons, France.Google Scholar
Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.CrossRefGoogle ScholarPubMed
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefGoogle ScholarPubMed
Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., & Herzberg, P. Y. (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care, 266–274.CrossRefGoogle Scholar
Mackenzie, C. S., Gekoski, W. L., & Knox, V. J. (2006). Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes. Aging and Mental Health, 10, 574–582.CrossRefGoogle ScholarPubMed
Mahoney, A. J., & McEvoy, P. M. (2012). Changes in intolerance of uncertainty during cognitive behavior group therapy for social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 43, 849–854.CrossRefGoogle ScholarPubMed
Mawn, L., (2018). Comorbid OCD and psychosis: The role of transdiagnostic processes. Unpublished doctoral dissertation, Newcastle University, Newcastle upon Tyne, UK.Google Scholar
McLean, F. (2016). Parenting, Intolerance of Uncertainty and Anxiety. Unpublished doctoral dissertation, Newcastle University, Newcastle upon Tyne, UK.Google Scholar
Milne, S., Lomax, C., & Freeston, M. H. (2019). A review of the relationship between intolerance of uncertainty and threat appraisal in anxiety. The Cognitive Behaviour Therapist, 12.CrossRefGoogle Scholar
Miranda, R., Fontes, M. & Marroquín, B. (2008). Cognitive content-specificity in future expectancies: role of hopelessness and intolerance of uncertainty in depression and GAD symptoms. Behaviour Research and Therapy, 46, 1151–1159.CrossRefGoogle ScholarPubMed
Moriarty, A. S., Gilbody, S., McMillan, D., & Manea, L. (2015). Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis. General Hospital Psychiatry, 37, 567–576.CrossRefGoogle ScholarPubMed
National Collaborating Centre for Mental Health (2019). The Improving Access to Psychological Therapies Manual. Retrieved from: https://www.rcpsych.ac.uk/docs/default-source/improving-care/nccmh/iapt/the-iapt-manual--final--republished-7-3-18.pdf?sfvrsn=a192d1af_0 Google Scholar
Norton, P. J. (2012). Group Cognitive-Behavioral Therapy of Anxiety: A Transdiagnostic Treatment Manual. Guilford Press.Google Scholar
Norton, P. J., & Philipp, L. M. (2008). Transdiagnostic approaches to the treatment of anxiety disorders: a quantitative review. Psychotherapy: Theory, Research, Practice, Training, 45, 214.CrossRefGoogle ScholarPubMed
Noyes, R. (2001). Comorbidity in generalized anxiety disorder. Psychiatric Clinics of North America, 24, 41–55.CrossRefGoogle ScholarPubMed
Ruiz, M. A., Zamorano, E., García-Campayo, J., Pardo, A., Freire, O., & Rejas, J. (2011) Validity of the GAD-7 scale as an outcome measure of disability in patients with generalized anxiety disorders in primary care. Journal of Affective Disorders, 128, 277–286.CrossRefGoogle ScholarPubMed
Sankar, R. (2015). A Descriptive Investigation into Behavioural Manifestations of Intolerance of Uncertainty. Unpublished doctoral thesis, Newcastle University, Newcastle upon Tyne, UK.Google Scholar
Sankar, R., Robinson, L., Honey, E., & Freeston, M. H. (2017). ‘We know intolerance of uncertainty is a transdiagnostic factor but we don’t know what it looks like in everyday life’: a systematic review of intolerance of uncertainty behaviours. Clinical Psychology Forum, 296, 10–15.Google Scholar
Seidler, Z. E., Dawes, A. J., Rice, S. M., Oliffe, J. L., & Dhillon, H. M. (2016). The role of masculinity in men’s help-seeking for depression: a systematic review. Clinical Psychology Review, 49, 106–118.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.CrossRefGoogle ScholarPubMed
Steketee, G., Frost, R. O. and Cohen, I. (1998). Beliefs in obsessive-compulsive disorder. Journal of Anxiety Disorders, 12, 525–537.CrossRefGoogle ScholarPubMed
Talkovsky, A. M., & Norton, P. J. (2016). Intolerance of uncertainty and transdiagnostic group cognitive behavioral therapy for anxiety. Journal of Anxiety Disorders, 41, 108–114.CrossRefGoogle ScholarPubMed
Tiplady, A., Freeston, M., & Meares, K. (2017). The Development of a Transdiagnostic Intervention Targeting Intolerance of Uncertainty using Single Case Experimental Design. Unpublished doctoral thesis, Newcastle University, Newcastle upon Tyne, UK.Google Scholar
Wilkins, F. (2016). Exploring the Origins of Intolerance of Uncertainty: The impact of life events. Unpublished doctoral dissertation, Newcastle University, Newcastle upon Tyne, UK.Google Scholar
Vygotsky, L. S. (1980). Mind in Society: The Development of Higher Psychological Processes. Harvard University Press.CrossRefGoogle Scholar
Yalom, I. D. (1995). The Theory and Practice of Group Psychotherapy. Basic Books (AZ).Google Scholar
Submit a response

Comments

No Comments have been published for this article.