Cognitive Behavioural Therapy (CBT) is a talking therapy known to help individuals manage and reframe thoughts which trouble them. In this article Kathy Burn, Cognitive Behavioural Therapy Lead at St Christopher’s in London talks about training and qualifying staff to use CBT for patients living with a life limiting condition and facing the end of life.
CBT can be a really effective approach if taken to the patient and used consistently by the healthcare professionals delivering the patient’s day to day continuing care. Until recently, training to use CBT in a practical, skills-based way had been unavailable, until the accredited programmes developed by Kathy Burn and colleagues, and delivered by St Christopher’s Education changed that.
I am an experienced clinical nurse specialist in Palliative Care at St Christopher’s Hospice. Following a basic CBT training programme I was inspired to train and qualify as a CBT specialist and began to use CBT with patients experiencing panic and struggling with their conditions. The positive outcomes led to the establishment of a CBT team at St Christopher’s where I see patients and lead the team in patient care. I also teach and support staff to grow their CBT skills through a series of study days plus three and six day accredited CBT programmes which we developed and are exclusive to St Christopher’s.
In 2008 the hospice carried out a research study which demonstrated the effectiveness of taking tools and techniques from CBT to the bedside through CBT-trained staff caring for patients. The study showed that this approach reduced patient’s levels of anxiety. The positive impact of CBT on patients’ wellbeing evidenced by this study, and the absence of accredited learning to develop staff skills prompted us to write a series of evidence-based programmes and study days which were awarded City & Guilds accreditation.
Our CBT programmes start with a series of study days for those new to CBT, and we offer learning from introductory to advanced level. Those with a basic understanding of CBT can undertake a three day programme which accredits the knowledge learned and provides skills-based practice. The six day programme develops practical skills which result in the competence to work with distressed, panicky, anxious patients with long term conditions and at the end of life, and is also accredited.
We know that up to 30 per cent of people with long-term conditions have an additional mental health diagnosis, so developing the basic CBT skills of health care professionals who are around patients on a daily basis is becoming increasingly important. What we had not expected was to see increased resilience in health care staff as they used their new found skills to manage their own behaviour. As one nurse told us: “The CBT model helped me to see how my thoughts, emotions and behaviours impaired my listening and stopped me from being with the patient. So, having worked on my thoughts, what I gradually learnt was to stay, breathe, calm and listen. I now have the skills to sit with them calmer, more receptive, listening, witnessing and sharing while I stay.”
The training has been evaluated and evidence of increased knowledge and skill was recently published. The CBT team at St Christopher’s is growing and we will continue to promote CBT and train health care staff to use it with patients at the bedside or in the home. Support and supervision for staff is key, and can be provided by more experienced staff with CBT skills, forming a cascade of support available and escalating to those patients who need it.
We can deliver these programmes within organisations for groups of staff or individuals can book onto programmes at the hospice. To find out more email St Christopher`s Education Team or call 0208 768 4663. For more information visit St Christopher’s Cognitive Behavioural Therapy courses