Increasing Access to CBT: Stepped Care and CBT Self-Help Models in Practice
Abstract
The delivery of cognitive behaviour therapy (CBT) in the UK has moved through two phases. In the first phase specialist practitioners delivered bespoke CBT to individuals often experiencing complex and longer-lasting problems. This phase has been characterized by waiting lists and a high quality service delivered to a few. In the second phase of service delivery CBT has begun to be delivered in all sorts of different formats, including CBT self-help/guided CBT, behavioural activation, computerized CBT and group based CBT that aim to increase access to CBT delivered in these ways. It remains unclear how these varying models – “high intensity” (phase 1) and “low intensity” (phase 2) should relate – and even who does best with each. There are implicit assumptions by practitioners reflected in language such as “stepping up/down” that assumes high intensity working is superior in some way to low intensity. Few studies have however examined this in depth and what studies there are suggest these beliefs may be incorrect for many. How these new ways of working will be introduced, evaluated and integrated into existing services currently remains a challenge. A helpful way of resolving some of these issues is to view CBT using a learning/teaching paradigm. In this the focus is primarily on how the client wishes to learn to tackle their problems. This provides a helpful way for both introducing different and new ways of working, and also maintaining a focus on the client's needs at the centre of service development. Crucially, phase two CBT working does not replace phase one. How the two approaches complement each other and compare will be two of the interesting questions to be addressed over the next few years.
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The structured CBT approach has been successfully adapted for use by CHWs to address mental health concerns in perinatal populations in rural Pakistan, showing effective use of CHWs to deliver such interventions in a Muslim population.
“It has been successfully adapted for use by CHWs to address mental health concerns in perinatal populations in rural Pakistan 23,24 , showing the effective use of CHWs to deliver such interventions in a Muslim population 23,28 .”
From Addressing Behavioral Health Disparities for Somali Immigrants Through Group Cognitive Behavioral Therapy Led by Community Health Workers (2017) · cites this paper as [28]
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“…of studies find positive results on delivering brief training to health clinicians (e.g. Miles & Milne, 2004; Mannix et al. 2006), while others advocate training models that focus on accessibility and different ways of delivering CBT other than at the expert level (Williams & Martinez, 2008).”
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Marshman, Z., & Williams, C. (2017) · Springer eBooks · doi:10.1007/978-3-319-48729-8_13 · Cited by 4 · see citing works
Self-citationRozental, A. (2016) · DiVA (Stockholm University) · Cited by 3 · see citing works
Friedberg, R. D. (2021) · Practice Innovations · doi:10.1037/pri0000164 · Cited by 2 · see citing works
Finazzi, E., MacLeod, E., & MacBeth, A. M. (2023) · PLoS ONE · doi:10.1371/journal.pone.0279263 · Cited by 2 · see citing works
“For example, for mild to moderate common mental health conditions, short-term low-intensity interventions are recommended including guided self-help, one-to-one talking therapies and computerized CBT [19].”
BackgroundCare for a Change? Tiered CBT for Youth
Friedberg, R. D. (2016) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-016-0260-0 · Cited by 2 · see citing works
Jenkins, P. E. (2019) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-019-00737-1 · Cited by 2 · see citing works
Developing and Maintaining a Working Alliance in CBT
Kennerley, H. (2014) · doi:10.1002/9781394266487.ch3 · Cited by 2 · see citing works
Cultural Considerations in Stepped-Care and E-Health Interventions
Borrego, J., & Klinkebiel, C. M. (2010) · Springer eBooks · doi:10.1007/978-1-4419-6510-3_15 · Cited by 1 · see citing works
Positive Encounters for Children to Prevent Dental Anxiety – Theory and Practice
RODD, H. D., Rønneberg, A., Fredriksen, T. V., Johnsen, I. B., & Marshman, Z. (2022) · Textbooks in contemporary dentistry · doi:10.1007/978-3-031-04248-5_9 · Cited by 1 · see citing works
A Child-Centred Service: The Voice of the Child
Marshman, Z., & Campbell, C. (2017) · Springer eBooks · doi:10.1007/978-3-319-48729-8_14 · Cited by 2 · see citing works
Naeem, F., Pikard, J. L., Ayub, M., & Munshi, T. A. (2017) · Canadian Journal of Community Mental Health · doi:10.7870/cjcmh-2017-008 · Cited by 1 · see citing works
“The concept is underpinned by a stepped care approach to delivering psychological therapies so that an effective, yet least resource-intensive treatment, is delivered to service users first (Williams & Martinez, 2008).”
MethodScreening and Evaluation Platform for Depression and Suicidality in Primary Healthcare
Cassola, F., da Costa, A. S. V., Henriques, M. R., Rocha, A., Silva, M. S., Gomes, P. V. T., Ferreira, T. B., Cunha, C. A. C., & Salgado, J. (2017) · International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE) · doi:10.5220/0006369002100215 · Cited by 1 · see citing works
“Several important dimensions not currently taken into account by the decision support module need to be considered when assessing depression degrees and suicide risks, such as, the patient’s current physical state, medical health history and other psychosocial grades (Williams & Martinez, 2008).”
BackgroundMethodTelephone-delivered group CBT for anxiety: Experiences of group members
Coughtrey, A. E. (2013) · UCL Discovery (University College London)
Stepped-Care Research in Clinical Psychology and Psychotherapy
L’Abate, L. (2012) · Springer eBooks · doi:10.1007/978-1-4614-4451-0_5
Evaluating a dental nurse-led anxiety management service
Porritt, J. M., Jones, K., & Marshman, Z. (2016) · BDJ Team · doi:10.1038/bdjteam.2016.117
BRIEF REPORT: PREVENTING LATE-LIFE DEPRESSION IN LOW – AND MIDDLE – INCOME COUNTRIES (LMICS)
Serdarević, M. (2021) · Epiphany · doi:10.21533/epiphany.v14i1.356
Ching, B. C. F., Bennett, S. D., Rojas, N. K., Heyman, I., Liang, H., Catanzano, M., Coughtrey, A. E., Ashraf, T., Jones, W. D., Male, A. M., et al. (2022) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x22000551
“…in children; interventions are usually briefer and require fewer resources for providers, can be delivered by trained practitioners (e.g. assistant psychologists without clinical qualifications), and completed over telephone or email (Shafran et al ., 2021; Williams and Martinez, 2008).”
Bibliyoterapi ve Şema Terapi Temelli Mutluluk
Korkmaz, Z. (2023) · Akademisyen Kitabevi eBooks · doi:10.37609/akya.2598
An App-based CBT Program tailored for College Students: A Randomized Controlled Trial (Preprint)Preprint
Kim, M. H., & Chung, K. (2024) · doi:10.2196/preprints.50006
A University Partnership Model for Equitable Mental Health Services in Public Schools
Villarreal, V., Sullivan, J. R., Castro‐Villarreal, F., Davis, J. L., & Meca, A. (2025) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-80592-132-520251001
Clinicians' views of computer-guided CBT in adult mental health and factors related to referrals
Varley, M. C. (2011) · ERA
- Authors
- Williams, C., & Martinez, R.
- Affiliations
- University of Glasgow (GB)
- Corresponding author
- Williams, Chris
- Venue
- Behavioural and Cognitive Psychotherapy
- Publisher
- Cambridge University Press (CUP)
- Published
- 2008-11
- Volume
- 36
- Issue
- 6
- Pages
- 675-683
- ISSN
- 1352-4658 (ISSN-L)
- 1469-1833
- OpenAlex
- W2120702186
- Cited by
- 81
- References
- 28
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 4 · 2022: 2 · 2021: 8 · 2020: 1 · 2019: 7 · 2018: 3 · 2017: 8 · 2016: 9 · 2015: 5 · 2014: 3 · 2013: 7 · 2012: 9
- FWCI
- 5.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavioural and Cognitive Psychotherapy (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- cognitive behavioral therapy, stepped care, behavioral activation, group cognitive behavioral therapy, access to mental health care, waiting lists
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