Transcript Psychology and Long

Weight Management within a
Primary Care Psychology Service
(Tier 1 and Tier 2)
Dr Jon Freeman
Clinical Psychologist
[email protected]
Swindon…
LIFT Psychology Swindon & Wilts
(formerly Primary Care Psychology)
 Established in 1990s
 Community-based psychology service
(staff grounded within each GP surgery)
 First wave IAPT site in 2006
 Recent developments re: long-term health
conditions
Model
Least
Intervention
First
Specialist Services
Time
Opt-in service
Secondary Services
STEP 3
STEP 2
More intensive CBT,
based on individual need
Self help, coping skills, 1:1s,
psycho-ed courses, CCBT,
behavioural programmes
Psychology?
Cognitive Behaviour Therapy
Tier 1
(LIFT psychology)
 Regular training and supervision to staff
(e.g. motivational interviewing and CBT skills)
 Increasing awareness of wider colleagues
(e.g. GPs, nurses, dietitians, diabetes specialists)
 part of obesity care-pathway
Tier 1 cont’d
 Psycho-educational course
(“Managing Weight and Changing your Lifestyle”)
Psycho-educational course
 CBT-based
 2 facilitators (Band 4/5 PCMHW,
plus dietitian for Week1):
 2 hours, 1 day/week across 5 weeks (fortnightly from week2)
 in community venues (e.g. GP surgery, community centre)
 Opt-in (following being signposted, e.g. on waiting list for Tier
2 or 3)
-
cycle of behaviour change
motivation
healthy balanced eating (dietitian)
goal-setting
barriers to change
physical and emotional hunger
emotional eating and riding urges
stress and relaxation
mindful eating
managing unhelpful thoughts (incl. childhood rules)
communication and social support
managing setbacks
Findings from the
psycho-educational course so far …
N=61
Psycho-ed Course
12
10
statistically and clinically
significant changes
8
Pre
6
Post
4
needs met: 6.7 / 8
2
0
1
PHQ-9
2
GAD-7
Qualitative feedback (anonymous)
 “I have lost weight and it has not been stressful for the first
time in my life”
 “It has made me think about what I am eating and portion
control”
 “It has helped me to realise whether I am eating for hunger
or habit”
 “It was helpful to Discuss issues with people who have the
same experiences and come up with potential solutions”
Scales??…
Tier 2
(community-based dietetics service)
 BMI >40 (or >35 with co-morbidities)
 Group and individual appts (3-months)
 Fed into Tier 3 if wish to explore surgery
 Consultation to dietitians (e.g. MI skills)
 Quid quo pro…
Thank you for listening
Any questions?