The CBT Book Club (A psychoeducational triage model for health behaviour change)

Guest blogger Paul Russell writes about the success that he has had with “The CBT Book Club (A psychoeducational triage model for health behaviour change)”.

Paul has worked in substance misuse services for over 20 years, including developing cognitive behavioural therapy (CBT) and motivational interviewing (MI) programmes for residential services and in primary care over many years. He is deeply committed to developing an evidence based approach and helping make “talking therapies” more accessible and relevant.

The CBT Book Club for Adults was introduced initially as a triage model for people who were waiting to receive psychological therapy within IAPT, skilling people up over 12 weeks before they attend one-to-one counselling or stepped services.

The aims of the CBT Book Club are to:

  • Improve access to IAPT and reduce waiting times;
  • Introduce the CBT well-being model for depression and mood management;
  • Introduce anxiety coping skills and resilience training;
  • Provide an introduction to Health behaviour change model for patients concerned about e.g. weight management;
  • Engage patients with problematic alcohol/substance use not requiring Specialist services.

The CBT Book Club for Adults has been run in primary care for over twelve months, and was initially a natural follow on from the “Books on Prescription” scheme with 960 people attending through the year, with a retention rate of over 70% during each 3 month club with over 50% of users self-reporting they had met their initial goals and were feeling better than when they had started.

People presented with a range of issues, including ongoing depression, anxiety disorders, substance misuse and issues regarding weight management. Patients were mostly people who would have often been traditionally referred to specialist services. The intention is to introduce a well-being model to patients and thereby support them to develop resilience and coping strategies around a number of concerns.

We found this approach – a generic psychoeducational model, supporting people not to define themselves by any one particular issue and with a non-judgemental, nondirective approach – served to destigmatise attendance and engagement.

The model is based on a psychoeducational CBT approach and follows 12 chapters each covering a different topic such as: “Introduction to the CBT Model, Understanding Anxiety, Managing Depression, Developing Resilience and Understanding Behaviour Change”, with sub topics for example “Assertiveness, Managing Conflict, Understanding Stress”. Each week ends with set assignments and exercises and is based on a systemic skill based approach, the intention being that the patient is receiving support and developing coping strategies as they move through the waiting list to join formal IAPT services.

The Book Club model was chosen as it is already a well-known familiar format, which normalises and makes group therapy less daunting and off putting to people.

People are not asked to qualify why they want to attend, except wanting to do more of something and less of something else (having to identify a particular group to attend  was found to be a common barrier for many people).

A psychoeducational therapy approach was chosen as opposed to a process one i.e.  talking and  sharing which we found can generate a lot of resistance for people and can often result in a high drop-out rate,  The CBT Book club has been described as “group therapy for people who don’t want to do group therapy”. Many patients have gone on to form their own “book clubs” or discussion groups and spin-off groups have been formed such as:

CBT Book club for Teenagers
An abridged CBT model with age specific topics.

CBT Book club for Children
An abridged CBT model for younger children with age specific topics.

– Paul Russel