Access to psychological therapies in primary care

1. Regarding counselling, which of the following is correct?

a.

Pre-test

Your

Correct

answer

answer

answer

It is a form of psychotherapy,
where the patient is encouraged
to nd solutions to a particular
problem or challenge

b.

Patients are told to try

activities they are avoiding
and analyse why they are
avoiding these activities

c.

It gives the patient

techniques to challenge
negative patterns of
thought

That's not right. The correct answer is a.

Counselling is a form of psychotherapy. The counsellor does

not give answers but listens and encourages. The patient is
encouraged to nd solutions to a particular problem or
challenge.
Behavioural activation encourages patients to try activities
that they are avoiding and analyse why they are avoiding
these activities. This is a type of low intensity treatment.
Cognitive behavioural therapy uses techniques to challenge
negative patterns of thought. Patients are encouraged to
keep a record of their thought processes and then learn to
recognise and challenge negative thoughts.
2. Regarding improving access to psychological therapies for
patients with anxiety, which of the following is correct?

a.

Patients with anxiety do not

qualify for referral to
improving access to
psychological therapies

b.

Patients with anxiety can

benet from psychological
therapy, so you can refer
them to the service for
assessment

Pre-test

Your

Correct

answer

answer

answer

That's not right. The correct answer is b.

Patients with anxiety disorders can benet from treatment

with psychological therapy. You can refer these patients to
improving access to psychological therapies for assessment
and treatment.
3. You do an audit of referrals to the practice counsellor.
Patients who are referred to the counsellor are given a leaet,
in English, telling them to ring to arrange an appointment.
You nd that only 20% of patients referred from black and
minority ethnic backgrounds contact the counsellor. You
want to improve access to psychological therapies. What
should you do rst?

a.

Employ a second
counsellor

b.

Employ counsellors who

are from black and minority
ethnic backgrounds

c.

Gather views from patients

of black and minority
ethnic backgrounds

Pre-test

Your

Correct

answer

answer

answer

That's not right. The correct answer is c.

You should gather views from these patients about why they
do not contact the counsellor when they are referred. You
can use this information to help you develop services that will

address the problems and improve access for patients.

4. Regarding patient health questionnaire 9 score, which of the

following is correct?

a.

It is used to assess patients

with anxiety

b.

It is used to assess patients

with obsessive compulsive
disorder

c.

It is used to assess patients

with depression

Pre-test

Your

Correct

answer

answer

answer

That's not right. The correct answer is c.

Patient health questionnaire 9 score is used to assess patients
in primary care who have depression. [ 6 ] [ 21 ] The tool can
help you classify the severity of the patient's symptoms and
monitor their progress.
Patient health questionnaire 9 score is not used to assess
patients with anxiety or obsessive compulsive disorder.
5. You see a father with his 12 year old son who has Down's
syndrome. The father tells you that he feels stressed because
he is caring for his son. You assess him as having moderate to

severe depression. His patient health questionnaire 9 score is

19 but he is not suicidal or harming himself. You start him on
antidepressant tablets. He would also like to see a therapist
but is concerned about attending appointments while caring
for his son. What should you do to help him?

a.

Offer exible appointments

with a therapist

b.

Refer him to see a therapist

in two months if he is not
improving

c.

Offer him self help

Pre-test

Your

Correct

answer

answer

answer

That's not right. The correct answer is a.

This patient has a son with disabilities and he has moderate to
severe depression. He would benet from treatment such as
cognitive behavioural therapy, but you need to offer exible
appointments with therapists for patients with children. This
may include offering appointments at home, longer
appointments, or appointments that t around childcare. It is
important to advise him to contact the surgery before any
next appointment if he notices any change in his mood, feels
suicidal or that he might harm himself.
This patient has moderate to severe depression, so it is not
acceptable to wait two months before referring him to a
therapist.

Since this patient has moderate to severe depression, self

help is not appropriate. You should offer him high intensity
therapy such as cognitive behavioural therapy.
6. Your practice would like to offer patients the ability to self
refer for psychological therapy. Some of the staff are
concerned that patients will not appropriately self refer for
such therapy. What should you tell them?

a.

Patients who self refer

usually have symptoms
that are less severe than
patients who are referred
by the GP

b.

Patients who self refer

usually have a less chronic
condition than patients
referred by the GP

c.

Patients who self refer

often have mental health
symptoms that are as
severe as patients who are
referred by the GP

Pre-test

Your

Correct

answer

answer

answer

That's not right. The correct answer is c.

Patients who self refer to psychological therapies usually have

symptoms that are as severe as patients referred by the GP. [
15 ] Self referral can be an effective way to improve access to
psychological therapies for patients who do not want to see
their GP.
Patients who self refer are likely to have a more chronic
condition than patients referred by the GP
7. You see a 50 year old man who had a myocardial infarction six
months ago. He feels down because he is not as active as he
used to be. He used to work in a warehouse, but had to give
up his job. You diagnose him as having moderate depression.
You both agree that he will benet from treatment with an
antidepressant drug and start sertraline. What else could you
do?

a.

Refer him to improving

access to psychological
therapy

b.

Refer him to the

cardiologist

Pre-test

Your

Correct

answer

answer

answer

That's not right. The correct answer is a.

You could also refer this patient to the IAPT for an assessment
and psychological treatment plan. He may also benet from
seeing the cardiology rehabilitation team. This team can offer

him support and interventions to help him get back to

previous activities including work. They may also have a
psychologist working as part of the multidisciplinary team.
You do not need to refer him to a cardiologist. You can refer
him to IAPT and the cardiology rehabilitation team.
8. You see a 30 year old woman who has symptoms of anxiety.
Her GAD-7 score is 12 and you diagnose her as having
moderate anxiety. What should you do?

a.

Start medication

b.

Discuss the treatment

options

c.

Give her information about

self help

Pre-test

Your

Correct

answer

answer

answer

That's not right. The correct answer is b.

By discussing the treatment options you give the patient the
opportunity to raise concerns and questions and agree a
treatment plan. This may include referral to IAPT, a
combination of medication and psychological therapy, or self
help and other treatments such as medication.

9. Regarding psychological therapies that are low intensity,

which of the following is correct?

a.

They are offered to patients

with moderate to severe
depression

b.

Guided self help is a type of

low intensity treatment

c.

They are offered to patients

with a PHQ-9 score of more
than 20

Pre-test

Your

Correct

answer

answer

answer

That's not right. The correct answer is b.

Self help and guided self help are both types of low intensity
treatment.
Patients who have moderate to severe depression may also
be offered low intensity treatment which can be stepped up
to high intensity treatment if they fail to respond. [ 3 ] [ 5 ] Low
intensity treatments are usually offered to patients who have
mild to moderate depression. [ 3 ] [ 5 ]
Patients who have a patient health questionnaire 9 score of
more than 20 have severe depression. [ 6 ] These patients are
usually offered high intensity treatment. [ 5 ]

10. You review a 35 year old woman who was diagnosed with
depression three months ago. At that time her PHQ-9 score
was 12. She was started on medication and decided to try
guided self help. She still does not feel any better. She would
like some help. Her PHQ-9 score is now 14. What should you
do?

a.

Advise her to continue with

the guided self help for
another three months

b.

Refer her for behavioural

activation

c.

Review her medication and

refer her to improving
access to psychological
therapies

Pre-test

Your

Correct

answer

answer

answer

That's not right. The correct answer is c.

You should review her medication and refer her to improving
access to psychological therapies. They will assess the patient
and agree a treatment plan. They will also step up care to high
intensity treatment if she fails to respond. You can also
consider increasing her medication or changing it.
You should not advise her to continue guided self help for a
further three months because she may not improve.

You would not offer her behavioural activation because this is

a type of low intensity treatment.

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