1. Comprehend, cope & connect an update and survey
Isabel Clarke
Consultant Clinical Psychologist

2. Comprehend, cope & connect This approach gets away from labels and stigma by:
Meeting people where they are – hearing their distress
Understanding what they do to manage it – for example:
Self harm
Attempting suicide
Withdrawing from life etc.
And offers different ways to manage distress

3. Comprehend, cope & connect Transforming acute and community mh
Comprehend, cope & connect Transforming acute and community mh. Services
A practical way of introducing whole team psychological working A formulation – way of understanding their problems worked out with the individual Shared with the team Informing psychological approaches that the whole team can deliver

4. Comprehend, cope & connect The Formulation
Wider protective factors - family, beliefs etc
Past: abuse, trauma etc.
Try to escape from the emotion by avoidance, self harm etc.
Recent triggering event
Feel better short term
Horrible
Feeling
Another maintaining cycle feeding the emotion
Bad longer term
consequences.
Aversive emotion worse.

5. Comprehend, cope & connect Therapeutic Approaches
Mindfulness
Grounding in the body and the present – where the individual can be in control
Arousal management
Emotion regulation skills to face the emotion
Psychosis: Unshared reality as an escape from emotion

6. Comprehend, cope & connect Therapeutic Approaches continued
The Compassionate Friend Programme
Treat yourself as you would a good friend
Emotional Coping Skills
Accepting and managing emotions
Encouraging behavioural change
Behaviours to increase
Behaviours to decrease

7. Skills groups – eg. Emotional Coping Skills
Comprehend, cope & connect Psychological skills development = the treatment
Whole staff team involved in teaching, coaching or supporting these skills
Skills groups – eg. Emotional Coping Skills
Psychotic Symptom Management
Daily Mindfulness on the ward
Staff offer skills coaching where needed

8. Comprehend, cope & connect Working across the care pathway and beyond.
Skills groups can be accessed by inpatients or in the community Formulation informs care across the pathway Where acute sevices have introduced the approach, community services often follow.

9. Comprehend, cope & connect The theory behind the approach

10. REASONABLE EMOTION MIND MIND
Comprehend, cope & connect- theory Different Circuits in the Brain (Adapted from DBT)
REASONABLE
MIND
EMOTION
MIND
WISE
MIND
Reasonable
Mind Memory
Emotion
Mind Memory
Though L does not refer to it specifically, the ICS split maps onto the basic DBT model of the mind, as follows: The idea of a shifting balance is central to DBT, so that the self is seen as moving between the minds. Wise mind is the same as the two central ss. in ICS working smoothly together; reasonable mind dominance suggests an avoidance of the emotional (because the physical state of arousal produced by memories is anticipated as too unpleasant). Emotional Mind is where the implicational is dominant, and a loop can be set up that excludes current reflection, and so revision of past patterns – whether of depressive rumination or impulsive action.
IN THE PRESENT
IN CONTROL 10

11. Comprehend, cope & connect - theory The ‘horrible feeling’
Human beings need to feel physically safe and OK about themselves Emotion Mind produces a sense of threat when those conditions are not met This signals the body to get ready for action – which in turn focuses the mind on threat Emotion Mind/ Emotion Mind memory presents past events as present (trauma) People develop ingenious ways of avoiding facing the sense of threat

12. Comprehend, cope & connect - theory WAYS OF COPING WITH THE HORRIBLE FEELING
Giving in - signalling submission (depression) Constant anxiety, worry and hypervigilance Anger - attribute elsewhere. Displacing anxiety – OCD, eating disorder Drink, drugs, etc. Dissociation – flipping between different experiences of the self Cutting out reasonable mind – psychosis

13. Comprehend, cope & connect - theory these are common ways of coping early trauma/adversity adds to current distress – making coping more difficult there is no “them and us” – “only us”

14. Comprehend, cope & connect The programme in action
Piloted in one hospital in Hampshire: 2004 – 2012
(featured in the book: CBT for Inpatient Units – see next slide)
Extended to all 4 Acute Services under the Southern Health Trust. in
Some Southern Health community services.
Surrey & Borders Partnership NHS Foundation Trust
Sheffield Health and Social Care Foundation Trust
NHS Lothian (Edinburgh) – all Acute.
Huddersfield, Harrogate & Dewsbury Community and Acute..

15. Comprehend, cope & connect

16. Evaluating the Programme:
Comprehend, cope & connect
Evaluating the Programme:
Southern Health NHS Foundation Trust
3 papers
Quantitative – pre and post measures
Published as Araci & Clarke 2016
Qualitative – Staff perceptions of impact on individual, team work and milieu – in submission
Qualitative 2 – Service user experiences of the programme
- In preparation.

17. Comprehend, cope & connect The comprehend, cope and connect approach in iapt
IAPT has a ca. 50% Recovery rate – what about the other 50%? Southern Health’s italk audited this group and identified that they chracteristically present with: Past issues complicating current coping Long therapy history Relationship/attachment issues. This trans-diagnostic, formulation led, approach is being piloted in italk for those identified with these characteristics.

18. Comprehend, cope & connect in italk
4 Sessions : Listening: formulation: goal setting
6 groups covering skills to break vicious circles identified in the formulation , on managing
arousal – up as well as down
attention – i.e. mindfulness
emotions – expression as part of management
Facing the past (without revisiting it) – building a healthy relationship with it
Positive anger work

19. Comprehend, cope & connect in italk
6 groups on relationship
Relationship with self - self compassion
Developing the internal good friend – both the encouraging friend and the honest friend
Relationship s with others.
Balancing priorities
Putting self in others shoes while avoiding getting sucked in
Managing intimacy
Internal relationship with different parts of the self
Recognizing the value and downside of each
Developing a mindful centre

20. DRAWING ON THE DIFFERENT ASPECTS OF THE SELF
An example
BACKWARDS X –
keeping the same is safer
UNIVERSAL CARER
Empathic. Willing to
help everyone
Keeps me locked in
the past
Taken advantage of.
Own needs neglected
YOU
Going forward
Mindfully.
Able to draw on the best of
all the aspects of
yourself
OBEDIENT PERFECTIONIST
Conscientious, effective. Achieves
THE REBEL.Wants to live
life to the full – accepts me as I am
Puts me in risky situations -
bad for self respect
Never good enough. Self
Critical, so avoids trying
anything

21. Comprehend, cope & connect in italk
Use of Mindfulness Mindfulness is used throughout as a tool to work on change. Important mindfulnesses: Of emotion – deconstructed as a physical event Of self compassion Of your strong centre Work in progress: 7 full programmes completed in 3 areas of Hampshire. 4 further programmes in preparation. 4th area about to come on stream

22. Evaluation: CASE SERIES
Sessions
PHQ9 start
PHQ9 end
Change
GAD7 start
GAD7 end 20 13 4 -9 17 7
-10 12 21 8
-13 18 -2 5 3
-15 10 1 25 -7

23. Comprehend, cope & connect and culture free therapy
A new initiative in the planning stages.

24. Comprehend, cope & connect Contact details, References and Web address
David Araci & Isabel Clarke (2016): Investigating the efficacy of a whole
team, psychologically informed, acute mental health service approach, Journal of MentalHealth, DOI: /
Clarke, I. & Wilson, H.Eds. (2008) Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units; working with clients, staff and the milieu. London: Routledge.
Durrant, C., Clarke, I., Tolland, A. & Wilson, H. (2007) Designing a CBT Service for an Acute In-patient Setting: A pilot evaluation study. Clinical Psychology and Psychotherapy. 14,