Laura Warbrick
I am an early career clinical-researcher, with a clinical background in low-intensity CBT / IAPT ‘PWP’ practice. I'm interested in translational research, IAPT services and building capacity in the mental health service 'gap' – particularly for individuals who continue to have unmet needs within existing mental health services; and those who may have been excluded from accessing support – including individuals who struggle to manage emotions, relationships and their sense of self – who may have been given the label ‘personality disorder’.
I’m interested in clinical research across the phases of intervention development and implementation; as well as pragmatic approaches and embedding research and evaluation into routine care. I’m also passionate about building research capacity in underserved psychological professions, such as the low intensity/ PWP workforce.
My clinical interests include behavioural interventions and transdiagnostic, wellbeing-focused approaches.
Award Title: Mental Health Fellowship
Start Date: 1st November 2021
End Date: 31st March 2024
Location of Research: The South West Peninsula
Other associated academic organisations:
APEX primary care research group, University of Exeter
- CAPC Primary care research group, University of Bristol
Project Title: Development and evaluation of brief GP and IAPT clinician training to improve the care of patients with underlying personality difficulties.
Brief summary: Some people who have lived through adverse early life experiences go on to have difficulties managing their relationships, their emotions and/or their sense of self as adults. These difficulties are sometimes referred to as personality difficulties and sometimes are diagnosed as ‘personality disorder’. People with these problems often have other mental health difficulties, such as depression, anxiety or self-harm. They may seek help from their GP practice and others try to access help from ‘Improving Access to Psychological Therapy (IAPT) services’.
IAPT therapists are not routinely trained to help individuals experiencing the complex emotional needs associated with personality difficulties. This can mean that an individual is seen as being “too complex” for IAPT services, yet at the same time “not ill enough” to need help from secondary mental health services. When this happens, the person must look for other sources of support and treatment, often with the help of their GP. However, GPs are not trained to help people with personality difficulties, even though other research has shown that individuals with these difficulties frequently attend primary care services and are costly for the health service to manage.
This research will evaluate a new training programme designed to improve IAPT therapists’ management of depression and anxiety among people with personality difficulties, and develop a training programme aimed to support GPs to work with individuals with these difficulties more effectively.
Methods:
This is a mixed methods approach to training intervention development and evaluation. Two separate training packages aimed skilling up primary care clinicians (GPs and IAPT therapists) to work more effectively with individuals with experiences consistent with the personality difficulty/disorder spectrum within their care context.
Workstream 1: IAPT services
- To refine an existing training workshop aimed at supporting HI IAPT therapists to understand and assess for personality difficulties/disorder and develop skills in subtly adapting depression and anxiety treatments to accommodate these additional experiences.
- To evaluate feasibility and acceptability of the training and examine training’s effectiveness to improve therapist knowledge skill and confidence to work with this client group (across at least 3 diverse IAPT settings).
- To preliminarily explore proof of concept that training has potential to improve clinical outcomes for this client group
Workstream 2: GP Practice
- To develop a novel training package for GPs to assist them in their management and consulting with individuals with personality difficulties, including understanding and assessing for current severity, understanding referral pathways and how to subtly adapt consulting to accommodate these patient’s needs.
- Conduct a preliminary pilot evaluation of the feasibility and acceptability of the training in at least one cohort of GPs
- Feed back learning into the training development
Anticipated benefits:
- At least 120 IAPT therapists receiving training aimed at improving knowledge skill and confidence to work with individuals with personality difficulties accessing depression and anxiety treatments
- Novel intervention developed targeting a GP audience to improve knowledge, skill and confidence to consult effectively with this group.
- Improved understanding of how staff training can lead to positive attitudinal shifts and how this may relate to clinical outcomes for clients.