Our research

NHS Oxfordshire Talking Therapies is routinely involved in service level and national research and audits, and locally we have a close and collaborative working relationships with the Oxford Centre for Anxiety Disorders and Trauma (OxCADAT).

In 2019 our research lead was voted Outstanding Primary Investigator by the NICHR Thames Valley which represents our positive and active involvement in all things research.

At present our research lead is implementing a new safeguarding process as an innovation, to improve the reporting and implementation of learning arising from safeguarding consultations. In addition to local research and audit, NHS Oxfordshire Talking Therapies is involved in the following research:

• Health Anxiety and Obsessive Compulsive Disorder treatment: digital adaptations with Professor Paul Salkovskis et al – Oxford University
• Collaboration with the Oxford Academic Health Science Network for Depression and Anxiety led by Professor David Clark – a feasibility study considering the efficacy of the IAPT blended model
• Employment Support and the potential augmentation effect with clinical work in collaboration with the Oxford Academic Health Science Network for Depression and Anxiety.

In addition to these more formal projects NHS Oxfordshire Talking Therapies also support Clinical Psychology Doctoral candidates with their research and carry out our own Audit and research on an ongoing basis.

Study: Improving Enquiry and Response to Disclosures of Domestic Abuse in NHS TTad Services

What was the problem? Domestic abuse is a major public health concern. It is intolerable, sometimes fatal and far too common. Staff working in mental health services such as NHS TTad are in a vital position to identify service users with indicators of domestic abuse and intervene early. Many staff are not very good at asking service users if they are experiencing domestic abuse domestic abuse or feeling confident in how to respond if people do disclose. The service identified a service gap in domestic abuse training.

What did we do? We interviewed staff to identify barriers to domestic abuse response, what they wanted training to cover and what service support they needed. We co-developed and co-delivered training with a local domestic abuse agency (Women’s Aid), Oxford Health Trust Senior Safeguarding Lead for the Domestic Abuse Working Group, Domestic Abuse Champions, experts by experience, and Clinical Psychologists. A half-day multimedia training event was delivered online for two NHS TTad services. Training involved myth-debunking quizzes, break-out rooms to apply skills with case studies, reflective spaces, and videos from people with lived-experience of domestic abuse.

 How did it help? 403/442 (91.2%) of staff completed the training. Training was very effective in improving staff knowledge and confidence. Staff rated the training highly, and found it thorough, clear, engaging and the lived experience was powerful. Staff wanted future training to expand the topic to LGBTQ+, perpetrators and across different cultures. Staff behaviour (e.g. domestic abuse risk assessments, referrals to services) did not significantly change three-months after training.

What have the service changed following training? Research shows that training alone can change staff confidence, but ongoing support from services is needed to change staff behaviour.

The services now have a clear flowchart procedure of how to ask and respond to domestic abuse. One service has added domestic abuse-specific questions into their routine assessments. One service now sends quarterly emails reminding staff about routine enquiry, examples of policy and sensitive questions. Resource packs, guides and risk assessments have been sent to all staff. The training was recorded and is now part of the new starter induction process to watch.

Future recommendations

• Looking at staff behaviour 8-months post-training will likely give more time to see meaningful clinical change.
• Keeping domestic abuse on the agenda in supervision
• Monthly drop-ins run by the domestic abuse champion / Women’s Aid to increase their visibility as a resource and capture recurring issues
• Continuing to build relationships with local domestic abuse organisations

Study: Using internet-based Cognitive Therapy for Posttraumatic Stress Disorder (iCT-PTSD) as early intervention for clients with recent traumas

A brief (6-week) version of iCT-PTSD that did not include memory work showed initial promise as a treatment option for those seeking help soon after a trauma. Link to paper: https://doi.org/10.1111/bjc.12419

Study: The addition of employment support alongside psychological therapy enhances the chance of recovery for clients most at risk of poor clinical outcomes. 

In a recent study, we found that offering people support with their employment, as well as psychological therapy, can be a helpful combination. This was particularly helpful for people who are struggling with many symptoms of anxiety and depression, and who are on welfare benefits. You can read the full article here:  https://doi.org/10.1017/S1352465823000474 . If you would like to know more about our employment support, please ask your clinician.

Study: The role of self-compassion in readiness to engage in treatment and treatment outcomes for OCD

We have recently been involved in a study jointly run with NHS Buckinghamshire Talking Therapies (formerly known as Healthy Minds) and University of Oxford. We thank all the service users and staff who have kindly been involved in this project. Please see below a brief summary of the study and its findings.

Why was the study conducted? It is important people experiencing OCD access suitable treatment promptly.  This study looked to see whether self-compassion (i.e:, the ability to be kind to oneself, to understand that distress is a common human experience and to tolerate difficult experiences) plays a role in how ready people feel to engage in treatment and how well treatment works to inform effective treatments.

What was done: Adults awaiting treatment for OCD through local IAPT services were asked whether they were willing to be contacted about the study. In total 80 people completed questionnaires on their obsessive beliefs, how ready they felt to start treatment and their self-compassion level. They also completed some mood questionnaires routinely completed in IAPT. These measures were completed before and after treatment and data on demographics (e.g. age/gender) and clinical characteristics (e.g. duration of OCD, treatment type) were pulled from the record with consent.

What was found:

• People low in self-compassion felt significantly less ready to engage in treatment (i.e.. had more concerns about starting treatment). They also experienced more severe symptoms of low mood, anxiety and OCD and had more obsessive beliefs.
• People’s self-compassion level marginally predicted how ready they felt to start treatment above how severe their symptoms of low mood, anxiety and OCD were.
• We are continuing to collect data on the post-treatment questionnaires to see whether self-compassion predicts how well treatment works.

Implications: Low self-compassion appears to marginally affect how ready people feel to engage in treatment. Research is ongoing to see whether this impacts how well people later engage with treatment and how well treatment works. If so, it may be that using a questionnaire to assess people’s self-compassion level before treatment and/or considering treatment focused on improving their readiness for treatment or self-compassion level first may be helpful.

Study: Evaluation of the online delivery of individual Step 3 therapy in the TalkingSpace Plus IAPT service during the Covid-19 pandemic and how best to inform the post-pandemic service model

At TalkingSpace Plus (TSP), we wanted to find out how the transition of moving from in-person to remote therapy (e.g.: cognitive behavioural therapy (CBT)) impacted on patient recovery rates. To investigate this, we analysed data from patients who finished CBT between either June 2019 to March 2020 (pre-pandemic; face-to-face therapy) or March 2020 to December 2020 (during pandemic; remote therapy).

Overall, more people accessed treatment during the remote period and recovery rates improved. In particular, recovery rates for females, working aged adults (aged 18 to 65 years) and those receiving treatment for depression improved significantly. For those receiving treatment for OCD, recovery rates were poorer during the remote period.

The findings suggest that, overall, the sudden transition to remote therapy within TSP was not detrimental to patient recovery rates. Due to this, remote delivery of therapy could form a substantial part of the TSP service model going forwards. This needs to be offered whilst also taking into account patient preference and digital exclusion. In addition, treatment for OCD should continue to be monitored to consider if the effect was due to the pandemic itself or remote delivery and thereafter, consideration could be given to prioritising this group of patients for in person work.

Our publications

Thew, G.R., Popa, A., Allsop, C., Crozier, E., Landsberg, J., & Sadler, S. (2023). The addition of employment support alongside psychological therapy enhances the chance of recovery for clients most at risk of poor clinical outcomes. Behavioural and Cognitive Psychotherapy, https://doi.org/10.1017/S1352465823000474

Browne, N., Carragher, N., O’Toole, A., Pimm, J., Ryder, J., & Thew, G. (2022). Evaluating user experiences of SHaRON: An online CBT-based peer support platform. The Cognitive Behaviour Therapist, 15, E18. doi:10.1017/S1754470X22000150

Thew, G. R. (2020). IAPT and the internet: the current and future role of therapist-guided internet interventions within routine care settings. The cognitive behaviour therapist 13.

Elliot M, Salt H, Dent J, Stafford C, Schiza A. (2014). Heart2Heart: An integrated approach to cardiac rehabilitation and CBT. British Journal of Cardiac Nursing 9 (10): 338-394