Ieso Insights Issue 4

I E S O I N S I G H TS ISSUE 4 JUNE 2021

COVID-19, One year on: The emerging trends in digital therapy

Are we seeing the end of Face-to-Face?

The current trends in mental health services A therapist’s life in a year like no other

We must ask ourselves what adaptations can we make next?

We have all faced exceptionally difficult challenges this past year, both personally and professionally. We have witnessed huge change and adaptation in service delivery, working to meet the needs of patients, all while managing a workforce experiencing the biggest single challenge in the history of care. As we pause to reflect on the past 12 months and look into the future the physical health challenge of COVID-19 is beginning to subside. We know that the challenge of meeting additional demand for mental health services will be here for some time and we must ask ourselves what adaptations can we make next?

James De Bathe, Director of Partnerships and Market Development

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James De Bathe, Director of Partnerships and Market Development

Ieso Insights

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The current trends in mental health services

Corona Correlations. COVID-19 and mental health – the emerging trends

Ieso’s dedicated IAPT event

Face-Off? Are we seeing the end of Face-to-Face?

A therapist’s life in a year like no other

Join our Clinical Network

The early warning signs of a ‘mental health tsunami’

Expanding patient choice with online video therapy

What our patients say

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The current trends in mental health services To hold relevant and constructive conversations about improving access to therapy, we need to understand the current trends in the market. Ieso’s Digital Health’s Head of Accounts Sharon Harrison and Head of Business Development, Nii Lante Wallace-Davies, describe some of the changes they’ve witnessed, the challenges mental services are facing, and what the next year will look like.

Sharon Harrinson, Ieso’s head of Accounts

Demand is on the rise – and capacity issues will get worse.

“We’re seeing a big shift in demand, with referrals going up, in sharp contrast to last year. The tide has turned, and services are feeling the strain. Waiting lists are long, and there isn’t enough capacity to deal with them. Services are maxed out.”

Sharon Harrison

Nii Lant Wallace-Davies, Ieso’s head of Business Development

“Increasing referrals, more complex patient needs, and not enough therapists… it’s a perfect storm” The sector is finally embracing the potential of digital.

Providers were already struggling to meet NHS access targets, and these have increased significantly so the pressure is huge. Workforce capacity is a big problem; they can’t get the staff they need. Everything indicates that referral numbers will steadily rise over the next two to three years as a result of COVID; people tend to sit on their conditions for some time before seeking support, and they’ve been visiting GPs less often. We can expect a flood as lockdown eases. Increasing referrals, more complex patient needs, and not enough therapists…it’s a perfect storm.”

“Initially, providers turned to us to help clear waiting lists – 200 to 300 patients in some cases. Now, we’re becoming part of the ongoing solution. Digital providers have a role to play in offering solutions and best practices to deal with the challenges. Services are using us to encourage self-referrals, to tap into new audiences, and to enable a digital-only treatment pathway. We also see more providers investigating how they might deploy digital tools to improve efficiency, such as booking systems and triage tools.

The sector is embracing digital, whereas the year before the pandemic they were still keeping it at arm’s length. This wouldn’t have happened without COVID.”

Nii Lante Wallace-Davies

Sharon Harrison

“2021 will be the year of the growing waiting list!

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“We’re becoming part of the ongoing solution. Digital providers have a role to play in offering solutions and best practices to deal with the challenges”

“There’s no way that mental health services could have coped in the last year if digital delivery capabilities hadn’t been in place before the pandemic. The technology brought in has enabled services to keep running.”

Patient engagement has been strong – but dropped during the winter.

Nii Lante Wallace-Davies

were better. People were turning up to their appointments, and they had more time to focus on their treatment. As the pressure piles back on this might not continue!”

Providers are re-evaluating their services.

“As lockdown eases, rather than going back to ‘normal’ they’re taking the opportunity to think about what they want and need their service to look like now. They have some massive questions to answer – for example, what percentage of treatment will be digital, and what percentage face-to-face? Will it be a blended approach?”

Sharon Harrison

“What percentage of treatment will be digital, and what percentage face-to-face? Will it be a blended approach?”

“In the early months of the pandemic the average number of sessions went up, and recovery figures

Nii Lante Wallace-Davies “There’s evidence of some disengagement with services over the winter months, and recovery rates took a hit. The long winter and lockdown meant people didn’t have the mindset for therapy. And it’s hard to do things like behaviour experiments, for example, when you can’t get out and do the activities you’d usually do. We might see a change in engagements and outcomes now. We can already see a shift in the severity of presentations coming through the door.”

Sharon Harrison

Treatment for LTCs is a key priority.

“There’s a lot of service redesign going on across IAPT. A couple of services I work with have already reduced their estates, and become primarily digital. Digital therapy has definitely become more normalised as a result of COVID-19.”

“Using talking therapies to manage long-term conditions (LTCs) is very much on the agenda for the market currently. What can mental health services do for patients with long COVID, for example? To help drive this, Ieso has appointed an LTC lead who will head up the development of our product and roll it out to IAPT.”

Nii Lante Wallace-Davies

Sharon Harrison

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Face-Off?

Are we seeing the end of Face-to-Face?

Ieso’s in-house writer Tancred Newbury sits down with UK Clinical Director Shazna Khanom, and UK Clinical Lead, Jeremy Cripps, to discuss what the future may hold for face-to-face therapy?

Last spring, when the global coronavirus pandemic forced all CBT delivery to go online, there were rumblings, concerns, and collective fears in the NHS, other providers, and among many clinicians, that recovery was going to be negatively impacted. Some even suggested that for the next six months the focus for IAPT services shouldn’t even be on recovery, because CBT delivered via video or typed online platforms was likely going to be less effective. As Shazna Khanom, Ieso’s UK Clinical Director, puts it, “I think there was a very stubborn kind of idea in the world of psychotherapy that you have to

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be in the room with the person. You have to see all their body language.” CBT exercises, many felt, had to be done together, in the same room.

While we at Ieso could have pointed out that our online recovery rates were as high or in some cases higher than face-to-face, we were specialists who had already trained in and mastered online therapy delivery. In-person NHS CBT practitioners, on the other hand, would have to adapt and learn how to deliver online therapy, and that learning curve could also lessen the effectiveness of the CBT being provided.

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A viable alternative emerges In the end, these fears proved to be unfounded. As Jeremy Cripps, Ieso’s UK Clinical Lead, points out, despite CBT moving online, and many IAPT therapists having to adapt and learn new techniques, “recovery rates have actually held up particularly well for most disorders. There are a lot of conditions that can be treated remotely completely effectively. And we can see that the data – not just our own data, that of the NHS too. It’s been the biggest enforced experiment for remote therapy that you can imagine, because everything went remote from March last year. And in the data we’ve got and in that of the NHS, the outcomes have held up.

“It’s been the biggest enforced experiment for remote therapy you can imagine, and in the data the outcomes have held up” “There’s a lot of very good work still being done by therapists. Given the restrictions of online therapy, they’ve had to adapt quite quickly, but they have adapted, and they’ve been very, very efficient, which is great. How do you design behavioural experiments, to allow exposure in ways which won’t compromise their safety or require them to break lockdown rules, for

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example? Therapists had to be imaginative about that, but they have been, and it’s been quite successful. Overall, if you look at our benchmark cohort this year (that’s a benchmark which is just depression and GAD in selfreferral contracts), we’ve averaged about 68 percent 69% – very close to 70% – which we’ve never had before!”

From a practical perspective, online therapy seems to be working well for both patients and therapists, says Shazna. For patients this has been “the practicality of not having to travel, not having to find parking and having to take time away from work. You can fit it in a lunch break”. There has been a significant positive shift in adherence to therapy and the NHS experienced this as well. People are turning up to appointments through remote therapy more regularly than they did when it was face to face because they don’t have to travel to a clinic. “We were definitely seeing fewer dropouts,” adds Jeremy. “Fewer DNAs (did not attend appointment) and cancellations. People have had fewer distractions. Fewer things competing for their time. They have probably also had a bit more time and space to focus on themselves.”

So, is face to face on the way out?

Online therapy has been so successful that people are asking whether we’re seeing the end of face to face. To Jeremy, that feels unlikely, but he does expect a big shift to online. “All my customers are saying yes that as NHS providers that they’re going to be expecting quite a lot of their sessions to be

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remote-delivered ahead.” Shazna agrees. “I think now that we’re coming out of lockdown a lot of private practitioners are saying they are now not going to go

want to be in a safe environment, like their home, when they talk about their trauma. But some people who are very compartmentalised might prefer not to have

back to face to face and their patients are choosing to stay online…. It is cost saving, isn’t it? You don’t have to hire a room out to see private patients. I think it’s more practical.”

that happening in their own home. ‘This is my home.

This is where I’m peaceful. This is where I’m a mother or sister and that happened to me a long time ago.

I’d rather go to an office, so a clinical room, a clinical setting, where I can contain that there.’”

“There will be some return to face to face for people who need it,” says Jeremy. Let’s say you are stuck with an abusive partner or certain trauma presentations you probably don’t want to be talking about at home. Some OCD work would be better face to face so you can do exposure work together and things like that.” EMDR can be done through video but it’s immeasurably easier in person. In Shazna’s experience severe depression could well be better treated face-to-face: “For patients with depression, if they go out and to go to the therapy session, I think the fact that they go out, helps recovery – it’s the combination of sessions and getting out of the house that makes the difference. Whereas somebody with depression could get stuck easily in the house, and then the therapy is happening in the house as well and there’s no kind of motivation to go out.”

As for therapists, Shazna wonders if some therapists have their identity tied up in face-to-face. “They may think ‘this is who I am as a therapist and I get dressed in a certain way and I drive to my therapy room, this is where I conduct my work with my bookcases’. I wonder if they’ve got an old-style image of what it is to do therapy, with a nice brown leather chair.”

“Some people might not want to open up at home, especially if it’s trauma work”

Many patients may find therapy from home unhelpful for other reasons too. “Some people might not want to open up at home, especially if it’s trauma work. Though that can go both ways. Some people

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Shazna also draws attention to the growing body of research on nature and combining nature and therapy “Walking-talking therapies are becoming a thing. Green space therapy. When you conduct the therapy outside and you utilize a different part of the brain, so it loosens things up you’re much more open just because you’re not like a face to face. Staring at each other. The pressure isn’t there.”

In the end she concludes, “just having more options is more likely to mean that everybody can find the thing that works best for them, so it’s good that we’re doing both video and typed, and that face to face will be available again soon. ” u

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The early warning signs of a ‘mental health tsunami’ An international team, led by researcher Becky Inkster from the University of Cambridge’s Wolfson College, has collaborated with more than 40 digital mental health providers to investigate the impact of the COVID-19 crisis on mental health and wellbeing. Becky Inkster – who will be presenting at Ieso’s IAPT event in June – has shared some of the findings with us.

As governments attempt to contain the spread of the virus, it’s vital to mitigate the impact of the pandemic on mental health – especially given that predictions made by the WHO prior to COVID-19 already indicated that by 2030 depression will be the single biggest cause of ill health in the world.

Understanding the nature and scale of the mental health crisis requires more granular, real-time information – a possible source of which is the digital mental health services used by millions of people globally. During the pandemic, traditional services and related activities declined due to the closure of outpatient clinics, the redeployment of mental health staff, and inpatient wards being converted into COVID-19 units.

Becky and the Digital Mental Health Data Insights Group (DMHDIG) gathered data and observations from digital mental health services providers, financial services providers (due to the established links between health, social and economic factors) and other relevant sources, to explore the scale and nature of the impact of COVID-19. The information sourced gave the team data on a user base of at least 10 million people but potentially upwards of 50 million.

Demand has risen – and changed in nature.

One recurring observation was that demand for digital mental health support has risen. Not only this, but the nature of the demand also appears to have changed since COVID-19, with an increased presentation of anxiety and loneliness.

According to Google Trends data, searches for “anxiety symptoms” doubled between 8 March and 22 March 2020, while Mental Health America (MHA)

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“One recurring observation was that demand for digital mental health support has risen” witnessed a 22% increase in the Generalized Anxiety Disorder 7-item (GAD7) anxiety screens taken in March 2020 compared with February 2020.

Ieso Digital Health reported up to a third of patients mentioning COVID-19 as a reason for presenting for mental health treatment. We also noted a rise in patient worries about viruses, and up to 15% of worries mentioned by patients during their appointments were about COVID-19.

Greater anxiety, uncertainty, sadness and loneliness The data shared with the DMHDIG team highlights the diversity of individuals’ mental health needs.

MHA figures show that 45% of the people who took an anxiety screen in March scored for severe anxiety. In a questionnaire issued to its members by The Mighty, 89% reported that their daily life had been at least somewhat impacted by increased anxiety; 43% that it had been extremely impacted. Unmind and Wysa reported higher anxiety levels in health staff than in the rest of their populations.

Members of the Kooth community demonstrated increases in sadness (up 161%), health anxiety (+155%), sleep difficulties (+90%), loneliness (+23%) and bereavement (+20%). A survey from The Mental Health Foundation survey found that people were feeling increasingly lonely, and that this was most pronounced for people aged 18–24 (44%) and 25–34 (35%).

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Support seeking behaviours increased.

A unique data set

Ieso reported an 84% increase in referrals for online CBT in the weeks since the first lockdown was announced in the UK, relative to the same period in 2019. Vala Health recorded that mental health-related consultations with GPs doubled in volume between 10 March and 8 April 2020.

To the DMHDIG team’s knowledge, its study was the first of its kind to bring together digital data insights from a large number of private organisations about the mental health concerns of millions of people online.

The National Alliance on Mental Illness (NAMI) experienced a 41% increase in demand for HelpLine resources and information, while Wyse witnessed a 77% increase in new users during February and March 2020, compared with the same period in 2019.

By week 4 of the UK lockdown, general health enquiries had returned to almost pre-COVID levels, but mental health consultations continued to rise.

“Ieso reported an 84% increase in referrals for online CBT in the weeks since the first lockdown was announced in the UK, relative to the same period in 2019” Individuals sought practical resources and coping strategies.

Participants in the ‘It’s Ok To Talk’ discussion platform raised questions about anxiety, and looked for strategies to manage work, studies, sleep, dealing with domestic violence, and difficult home relationships. Babylon reported that many patients

The data could help to inform future studies – for example by increasing the research community’s awareness of the digital mental health landscape, and helping researchers to understand what questions to ask to generate the inputs they require to monitor and respond to mental health needs.

Becky and the team will continue to work with providers to capture follow-up insights at regular intervals, and engage with individuals who have a range of experiences of distress and service use.

“An important next step will be to develop a way to bring together public and private sector data to monitor mental health needs in real-time” An important next step will be to develop a way to bring together public and private sector data to monitor mental health needs in real-time – just as contact tracing has been used to manage the viral epidemic. This can fuel research and understanding, and help to inform high-quality global and local responses. And as time goes on, it will be of particular importance to capture insights that relate to resilience and recovery. u

were seeking information about local council support services, advice on activities to keep busy and healthy, and how to access food and support with financial concerns.

Insights from financial services providers illustrated the interrelation between mental health and financial health worries. Qualitative insights also made it clear how both emotive and tangible the impacts of financial concerns and outcomes are on mental health worries and outcomes.

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Corona Correlations COVID-19 and mental health – the emerging trends

By Jeremy Cripps, Ieso’s UK Clinical Lead Even before our clinical team started looking for trends in our dataset, it seemed obvious to us that something as colossal as a global pandemic – and the radical measures put in place to contain it – were going to have an impact on our patients. Not just fears of the virus, but masks, food shortages, lockdowns and bubbles were inevitably going to affect the makeup of the patients coming through our service and the symptoms they were experiencing. What was less obvious, was the exact nature of the impact COVID-19 was going to have on our cohort. Indeed, the effect turned out to be often quite surprising.

Jeremy Cripps, Ieso’s Clinical Lead

Some unexpected dips One unforeseen trend we noticed was a decrease in a lot of the symptoms for depression and anxiety. People, in a way, felt better when the first lockdown started – at least in our cohort. We don’t know if that applies to the general population or if it’s just the patients that were coming through Ieso, of course. But people seemed to be less tired and have fewer problems with their low self-esteem.

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Perhaps the most unexpected pattern was fewer people reporting “thoughts that you would be better off dead or of hurting yourself in some way”. This seemed counterintuitive. After all, we’d seen severity increasing in certain areas, and you would expect that symptom to track with this increase. One explanation may be that people had a common link to others – something that united them with everyone around them. This happens with the World Cup or

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the Olympics. There is a comradery and togetherness, and that measure of risk does decrease because people don't feel quite so alone with their problems. Even though obviously in lockdown they often are alone, they feel less alone because there's a common strand: everybody's in the same situation. Though the reason is unclear what is certain is over a very sustained period we saw a small but noticeable shift: on average people were saying they were less likely to have thoughts of suicide or self-harm.

“Perhaps most surprising was fewer people reporting thoughts of suicide or self-harm” Most of the dips for these symptoms held true throughout all the lockdowns. The dip in tiredness and in low self-esteem, for example, is sustained from the first lockdown all the way until now. More recently, in the latest lockdown we’ve seen sleep symptoms rising, so people are having more difficulties with sleep: falling asleep, staying asleep, and sleeping too much.

Some less-surprising trends Less surprising but still intriguing was a dip in social anxiety symptoms. Social phobia was interesting to track because it dropped off during lockdown, with fewer people presenting with it. There was a distinct correlation with lockdowns, with the symptom increasing again in the period between lockdowns when people were forced back to work or back out into the community. So, lockdowns were perhaps more comfortable for people with social phobia, in certain respects. It’s hard to say if that will now return to normal as restrictions lift once and for all and people feel that they have to go back to normal life.

Even less of a shock was a higher proportion of patients presenting with anxiety since the pandemic began. It’s been a time of uncertainty and a lot of people with GAD struggle with tolerating uncertainty – in fact, it’s a key focus of treatment. On top of that, we didn’t know much about how severe COVID was going to be. And people were much more isolated: if you suffer from anxiety and you’ve been furloughed, all you’re doing is sitting at home during lockdown, so your worries are going to find it easier to dominate your thoughts.

“Social phobia was interesting to track because it dropped off during lockdown”

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“A third of patients are talking about COVID or viruses in their Self-Assessment” We also looked at how frequently people were talking about COVID, viruses or similar in their SelfAssessment Questionnaire: when they enrol and explain what the problem is, and what’s bringing them to therapy. We found that about a third of patients are talking about COVID or viruses in their SelfAssessment, which is not surprising, and it doesn’t mean that COVID is driving their mental health problem in any way. But it does mean they’re talking about it, which given it’s dominating the world’s way of functioning, is far from remarkable. Within sessions we also had an increase in the number of worries

At the beginning of the pandemic, there was a predictable rise in OCD and health anxiety as a proportion of our referrals. But if you have difficulties with intrusive thoughts about health and then in a pandemic these anxieties are almost affirmed. And in terms of treatment, where do you go with that? How do you use exposure techniques? You can’t really ask somebody to expose themselves by taking their masks off and skipping down the aisle in Tesco’s. The same goes for OCD. Many of these patients will have felt vindicated by the pandemic and will likely have resisted attempts to lessen their anxiety.

The most noticeable surge was a very, very obvious peak in worries about “something awful might happen”. There’s a particular question in the GAD 7 questionnaire that asks about that, and we see a very clear sharp peak as the first lockdown begins. And things were a bit crazy: queues at the supermarket, no fresh food in the shops. It was awful. That normalized quickly within a few weeks as those things became less acute, and that peak decreased in line with this, staying within normal bounds for the remainder of the lockdowns. As you would expect, there are some differences in symptom scores within age groups.

Older groups are slightly higher in their anxiety about “bad things happening”, for example.

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that people express around viruses and COVID, in particular. 10 - 15% of worries in sessions have been about COVID and viruses. But to put this into perspective, worries about family have been around 40%, and stay stable throughout. So that’s still the dominating worry that people are bringing to therapy.

Recent shifts and beyond Particularly at the end of last year, in the December/ January period we saw, on various contracts, the proportion of people presenting with very severe issues has increased. Now close to 30% of our intake is presenting as very severe. There was a slight spike at the start – and actually the spikes correspond fairly neatly with the waves. But then there was a big spike at the end of the year, and we’re feeling this in the system a little bit now. Those patients are currently in treatment, and our customers have reported similar things on the ground in their services as well. Even the acuity or severity of patients as a proportion of the population, points to a larger percentage being treated with a very severe low mood. Maybe that increase reflects that we were in midwinter, lockdown seemed to be indeterminable, Christmas was cancelled, and April felt a very long way away in January…. We’re obviously going to continue to monitor that ahead, as we are with all the other trends, to see if these were just isolated incidents, and we look forward to sharing more of our findings in the coming months. u

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A therapist’s life in a year like no other Similar to many of us, therapist Keely’s life was turned on its head when COVID-19 hit – from both a professional and personal perspective. We asked her to share her experiences of working during a global pandemic, and what she learned.

Keely Tagg has more than 12 years’ experience of working as a CBT therapist, for the NHS and also privately. Married with two daughters, her husband is in the fire service, and the couple both continued to work throughout lockdown.

Spring 2020 When the first lockdown began, it was all about adjusting how I worked. I got a call from my manager telling me ‘don’t go in, you’ve got to stay home’ – and that was it. I’d been treating patients face-to-face and online, so virtual therapy wasn’t alien to me, but it was quite frightening to realise we had to move really quickly to working in a completely different way.

I went out clapping on Thursdays at 8pm. There was a kind of camaraderie effect at that point, where we were all supporting each other. I think that helped to get people through.

“I was adjusting in my personal life too, trying to manage my own anxiety as well as being there for everybody else”

Patients had to adapt as well. There were people who were midpoint in therapy, those who’d just started, and others at the end – and suddenly they couldn’t do it in person. Some adapted really well, but others just didn’t want to do it remotely.

We found that the problems patients used to come

Working with patients experiencing health anxiety was particularly challenging, and it did seem to elevate.

Some clients were really worried about catching the virus, and became isolated and very anxious about going out anywhere.

patients could and couldn’t control.

I was adjusting in my personal life too, trying to manage my own anxiety as well as being there for everybody else. I remember collecting my daughter from school when we went into lockdown – it was suddenly her last day. Pupils were crying, teachers were upset.

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Summer 2020 to us for help with were no longer at the forefront.

Instead, they were worried about getting ill, and panicking about toilet rolls disappearing off the shelves. I focused a lot on resilience building, and what When you’re working remotely you’ve got to work a lot harder to pick up non-verbal cues and cognitive shifts. If someone gets upset, you’ve still got to notice and validate that. You can’t see the person, so you’ve got to listen more.

When you’re face-to-face with someone there’s a lot of sharing, for example you draw the CBT formulation

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out together. We had to find different ways to be collaborative. Exposure and behavioural experiments were also harder to do. Working for Ieso helped me, because with online therapy you never see the patient. So if someone had social anxiety with a fear of being judged in public, for example, I’d get them to go shopping and message me in between sessions about how it went and what they learned.

My younger daughter missed out on big things in her life that summer, like taking her GCSEs and her prom.

She’d worked so hard, and was predicted to do pretty well, and she was deprived of an opportunity to shine.

That was taken away from the entire year group, which was really sad. I think they’ve grown up really quickly.

Mindfulness helped me a lot. I focused on being thankful for what I’d got and where I was, and I also ran five miles every day. I encouraged patients to exercise too because I knew that was helping me. You get the release of serotonin.

“When you’re working remotely you’ve got to work a lot harder to pick up non-verbal cues and cognitive shifts” Autumn 2020 I really noticed how the virus was changing people’s behaviour. In the first lockdown, I think they saw it as a kind of break, but then realised ‘we’re really not getting out of this’. We’d all lost things we loved doing, which used to lift our mood and help us cope if something happened. Some people were drinking more and eating more. Others really embraced the chance to develop themselves.

I started to train as a yoga teacher, and also began courses in meditation and trauma-focused CBT. The diaphragmatic breathing in yoga helps to calm the system and activate the relaxation response. I was also doing a lot of mindfulness with people, helping them gather their scattered minds by focusing on where they were right now.

It was around this time the infection rates started going up, as school started again and more young people were going out and about. My oldest daughter

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never went back to university – her course stayed online. She’s doing fashion management, and she’s also a fashion influencer on Instagram and TikTok. She channelled her energy into that, and it really flourished.

“Video will also enable people to source the right therapist wherever they are, which is wonderful and will reduce waiting lists” Winter 2020/2021 Christmas came, and I can’t say I felt very festive! It was just ‘let’s get this ticked off’. I got busier and had more referrals. Lots of patients had lost someone and were dealing with devastating grief. Lockdown three was in the winter months and it was darker; I think that made it worse for everybody.

Because I was taking on board a lot of upset and distress, I just needed to be quiet sometimes. I also watched a lot of rubbish on TV! Sci-fi was good escapism. I watched films from the eighties, like Dirty Dancing, which transported me back to a lovely time in my life.

As lockdown started easing, some patients were excited to get back out, whereas others were very anxious – not just because of the virus, but because they’d formed a new habit. People were also asking themselves ‘do I want to go back to that life, or to live in a different way’?

In terms of treating patients, I hope video therapy carries on. I picked up things from people being at home that you wouldn’t necessarily get in the clinic.

I could also look at behaviours ‘live’ – for example, someone with OCD could show me what they were doing – and that worked really well. Video will also enable people to source the right therapist wherever they are, which is wonderful and will reduce waiting lists.

Above all, the pandemic has brought much more awareness about mental health – I just feel sad that it’s taken so long. I love my job, and I’m so passionate about what I do. One thing I’ve learned in the last year is that you never stop learning! u

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Expanding patient choice with online video therapy In conversation with Emily Marshall, Clinical Partnership Manager, Ieso Digital Health

Ieso recently launched online CBT video therapy to expand the options we can offer to clients. The new mode will complement typed therapy, with patients able to select the approach they prefer.

Each modality has clear advantages that are likely to lend themselves well to different learning styles, personalities and conditions.

Allowing patients to choose how they access mental health treatment is extremely important.

Not only does this help to make therapy more widely available; it also has the potential to drive better outcomes. If people can participate in the way that suits them best, the more engaged they’ll be, and the more effective the treatment process.

Video has the edge when it comes to picking up non-verbal cues – and this goes both ways. The therapist can observe the patient’s physical reactions, while the patient sees the therapist responding, for instance nodding when they understand and making facial expressions that indicate compassion. For some people this is an important factor in building trust and rapport.

However the anonymity of typed therapy helps others to open up more easily and honestly. “The invisibility makes them less self-conscious and inhibited,” explains Emily Marshall, Ieso’s Clinical Lead.

“They’re also not distracted by trying to interpret the therapist’s expressions, or wondering ‘what are they thinking of me?’. There are fewer tech and practical things to think about too. The patient doesn’t have to worry about a slow connection or whether their position in front of the camera is right, for instance.”

It’s very possible to develop a strong bond with another person through the written word alone, thanks to something called ‘solipsistic introjection’.

When we read a novel we automatically build an image of the characters in our minds, and the same thing happens when we communicate with someone online.

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“It’s very possible to develop a strong bond with another person through the written word alone, thanks to something called solipsistic introjection” Writing also gives people the option to pause and consider what they want to say. “Patients can feel less put on the spot and under pressure to respond than if someone was looking at them expectantly,” says Emily Marshall. “This can lead to stage fright, or make them rush their answer.” They can also read back over the transcripts of past sessions, to reflect on and consolidate what they’ve learned.

Some people find it easier to express themselves more fluently when they’re speaking – perhaps because they’re concerned about typos or feel they need to word things ‘perfectly’. In this case, they would probably get more out of video-based sessions. A patient who has ADHD or Asperger’s syndrome might find it easier to focus when someone is in front of them, albeit virtually.

Video has evident benefits when it comes to treating certain conditions. Phobias are tackled through exposure, for example, where patients are gradually exposed to what triggers their anxiety in order to reduce it. The visual element allows the therapist to share photos and videos and see how the patient responds in real time. Behavioural experiments are a technique used to help patients manage a range of different difficulties. Video makes it possible to

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“Video has evident benefits when it comes to treating certain conditions” do behavioural experiments ‘live’, with the therapist watching as the patient carries them out.

Techniques such as exposure and behavioural experiments remain highly effective when applied in typed therapy, as Emily Marshall points out. “As therapists we’ve adapted how we do things to elicit the same response and get a full picture. It’s about explicitly asking for information, and being more sensitive to reactions. If I’m working with someone who has a phobia, I can send a video clip and ask them to describe how they feel. We use the SUBS rating, which patients use to score their anxiety, and this shows us how well the exposure is working.”

With all face-to-face therapy sessions having to move to video or other remote modalities during lockdowns, is the virtual approach likely to replace inperson treatment?

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“Face-to-face will definitely return, but not to the level it was at previously,” says Emily Marshall.

“Recovery rates have proved to be the same or better with online therapy. But for certain individuals face-toface will remain the best option – for instance, when you’re dealing with traumas it’s most effective if the patient is physically present in the room. It will come down to personal preference, and which mode of treatment is optimal taking all the circumstances into account.”

“Recovery rates have proved to be the same or better with online therapy” Over time, we’ll learn which modality – typed or video – works best for particular conditions, and also which techniques work best in which context. We’ll be able to apply improvements our clinicians are making in one approach to the other. The more we do, the more we’ll learn. And ultimately that will improve outcomes for patients. u

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Invitation to Ieso’s dedicated IAPT event of expert talks and peer discussions - June 24th Since March 2020, IAPT services have seen the delivery of their therapy services dismantled and rebuilt. Never has so much change happened so quickly and the response from IAPT was both rapid and impressive. Now that we are entering a new phase of the pandemic, where many are vaccinated and pent up demand may be released, what are the key learnings, considerations and choices for IAPT? The world has not returned to normal yet, and IAPT services face both ongoing pressures and uncertainty.

Over the last year, technology adoption has changed what is possible and also allowed us to collect more data than ever before. The choice is not whether to stay virtual or return to face to face, but how to evolve and progress each service for the future, using everything we have learnt and all that is newly possible.

Opportunities for all IAPT leads to explore together are few and far between. With time to learn and time to discuss, this morning event is designed to provide answers and shape new questions for therapy service delivery at this crucial stage of the pandemic.

Your attendance and contribution is warmly invited.

Places are limited so please book early. There is no cost to attend this event. u

Join IAPT colleagues for a morning of expert talks and peer discussions to explore: •

the experiences of other IAPT services and the surprising learnings from Covid-19

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the truth about a possible ‘mental health tsunami’ from the team of scientists who have studied it

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where next for IAPT services, amidst pressures and uncertainty

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24th June 2021

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9:15am – 1:15pm

the future of marketing IAPT services to patients - how to create access where people are: on their phones.

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Online event - join via Zoom

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Sign up here: www.iesohealth.com/iapt-event

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Covid-19 One Year On: What’s Next for Digital Therapy?

Ieso Insights

Join our Clinical Network Flexible roles for brilliant practitioners We’re growing fast and we’re looking for exceptional mental health practitioners to deliver care to our patients. At Ieso, you can manage your own time and caseload (minimum of 5 patients) and treat patients online at times that work for you both. Our clinical research and digital tools will help you become the best clinician you can be. So as your patients get better, so do your skills.

The Ieso approach With Ieso, UK-based practitioners get a more flexible way of working plus all the benefits of our collective learning – like insights, tools and ongoing feedback. It all helps you make sound clinical decisions and deliver the best possible treatment to patients.

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Improve your practice You’ll receive supportive feedback and lots of opportunities for Continuous Professional Development (CPD).

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Rewards and recognition Choose how you contribute and be recognised and rewarded for what you love to do with a selection of different progression milestones to choose from and work towards.

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Backed by research By analysing the language used in treatment, we provide insights that help practitioners make sound decisions throughout treatment.

Explore our published research.

Be part of something bigger •

Work flexibly Manage your own caseload (minimum 5 patients) and see patients when it works for both of you.

By treating our patients, you’re helping us to learn about the language and techniques that work, and helping more people get better faster.

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Support and supervision The Ieso team is organised, collaborative and supportive and you’re never just a number.

If you are ready to add a flexible caseload, receive the latest CPD, and get high-quality support apply here: www.iesohealth.com/careers

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Ieso Insights

What our patients say My experience with IESO was very positive My experience with IESO was very positive. Firstly the digital platform was very easy to use. I really liked how I could see a transcript of previous sessions, as it enhanced my therapy to look back over what we had talked about. Secondly, my therapist was great. She really understood what I was struggling with and not only helped me to work on a few key things but she was honest & open about possible issues with thinking and behaviour. It has been really helpful and I thank you.

Emma

Highly recommended I had never had online therapy previously and wasn’t sure how it would work. But I soon got into the rhythm of answering questions, offering my own reflections and having a proper conversation with the therapist.

In some ways, it felt easier and more liberating to use the keyboard, rather than speaking on the phone or face-to-face.

I got a lot out of our sessions and feel so much better than I did at the start. I have definitely progressed and now have strategies and tools to help me when things get tough.

Just do it, it works!

I was dubious to start with, but once I had had my first couple of sessions with my counsellor, I settled in really quickly. the knowledge they have, the therapy they give you, they work, they help. They give you techniques to deal with your situation. I would 100% recommend this service to anyone that is struggling right now.

Scott

This is an incredible service This is an incredible service. I gained so much out of the experience and was just sad when it had to come to an end. I won’t lie, when I first found out this was going to be an online chat situation, I didn’t think it was going to be for me or any help at all. How wrong I was!

I gained useful information and ideas using CBT and how I can change my mindset and I looked forward to my sessions each week.

I can’t thank the service enough!

Laura

The therapist was professional, emphatic and really seemed to understand my issues. It felt good to have someone who was able to help at such a deep level so quickly.

Liz

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Ieso Insights

Contact us today info@iesohealth.com 0800 074 5560 Ieso Digital Health The Jeffreys Building Cowley Road Cambridge Cambridgeshire CB4 0DS

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