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Centre for Anxiety Disorders and Trauma

How our service can help you

The Centre for Anxiety Disorders and Trauma (CADAT) is an outpatient psychological therapy service. CADAT provides assessment and cognitive behaviour therapy (CBT) locally and nationally for specific anxiety disorders and depersonalisation disorder. Our service spans across primary, secondary, tertiary and highly specialist (Tier 4) care. GPs from outside our catchment area can also make referrals to our clinic directly using Patient Choice, with the exception of Depersonalisation referrals. Depersonalisation referrals can only be made via our National service stream and we always have to seek funding from the appropriate Clinical Commissioning Group in advance of being able to add the patient’s name to our assessment waiting list.

CADAT also forms a small part of each of Lambeth, Southwark and Lewisham’s Talking Therapy Services and each borough’s secondary care Integrated Psychological Therapies Teams (IPTT). CADAT holds a highly specialised service (HSS) contract, which is centrally funded by NHS England to provide treatment for people with OCD and BDD for whom numerous previous treatments have been unsuccessful. This particular contract is at no additional cost to clinical commissioning groups (CCGs).

  • Service Type: Adult Mental Health Services (Local) Service Borough Covers: National (Adult services) Treatment type: Outpatient

  • Contact the service

    Site Location: Maudsley Hospital Email: CADAT@slam.nhs.uk Phone Number: 020 3228 5215 Fax Number: 020 3228 2101
  • Disabled Access: No
  • Address: 99 Denmark Hill
    Maudsley Hospital
    Denmark Hill,
    London,
    SE5 8AZ
  • Business Hours/Visiting Hours:

    9am – 5pm (with occasional evening clinics)

    • Other essential information

  • Conditions: Addictions, Anxiety, Attention deficit hyperactivity disorder (ADHD), Autism, Bipolar disorder, Body dysmorphic disorder (BDD), Childhood degenerative disorders, Conduct disorder, Dementia, Depression, Dissociative disorders, Eating disorders, Learning disabilities, Neuropsychiatry, Obsessive compulsive disorder (OCD), Perinatal disorders, Persistent physical symptoms, Personality disorders, Post-traumatic stress disorder (PTSD), Psychosexual, Psychosis, Self-harm

Interventions

  • We provide validated cognitive behaviour therapy. Many of our treatments have been developed at our clinic, including trauma-focused cognitive behavioural therapy (CBT) for post-traumatic stress disorder (PTSD)
  • We offer assessments and if indicated CBT treatment for specific anxiety disorders and depersonalisation disorder are the main problem
  • Additionally, depersonalisation patients may be offered a one-off telephone psychiatric consultation if indicated and we may recommend onward referral to our neuropsychiatry colleagues where appropriate for more complex presentations
  • CBT treatments can be provided in a traditional weekly session format, or in some cases, in a more intensive format in which most of the treatment occurs within a single week
  • We provide a booster session post-treatment, to maintain therapeutic progress
  • We can also provide specialist advice on medication for patients being assessed under our highly specialised service for treatment refractory obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD)
  • Treatment packages are usually 12 to 20 weeks of hour-long therapy sessions. In some instances, more intensive outpatient packages can be offered
  • Depersonalisation treatment packages are usually up to 16 weeks of hour-long therapy sessions

Eligibility criteria

  • 18 years and over
  • Main presenting problem is an anxiety disorder of the type treated by the clinic: obsessive compulsive disorder, body dysmorphic disorder, post-traumatic stress disorder, depersonalisation disorder, social anxiety, misophonia, emetophobia, panic disorder, health anxiety and various other specific phobias.
  • Referrals taken from NHS primary, secondary, tertiary, highly specialist (Tier 4) care, as well as Patient Choice (GP) referrals
  • Willing to attend regular sessions and travel to the Maudsley for outpatient appointments
  • Willing to complete questionnaires to monitor progress
  • If taking psychotropic medication, the person should be on a stable dose prior to starting treatment

Exclusion

  • Private referrals
  • Non UK residents, or not currently residing in the UK
  • Current psychosis or bipolar disorder requiring treatment
  • Current alcohol or drug dependence requiring treatment in its own right
  • Current severe depression requiring treatment in its own right, in particular ongoing self-harm and immediate suicide risk
  • Personality disorder which requires treatment in its own right
  • Individuals with current or historical risk of violence towards others
  • Individuals requiring inpatient care
  • Moderate or severe learning disability
  • Dissociative identity disorder (DID)

Outcomes

We use all the recommended national improving access to psychological therapies (IAPT) outcome measures, as well as specific anxiety disorder measures related to each patient’s diagnosis, to track the progress of patients over the course of their treatments with us. 

73% of the patients who received treatment through our clinic in 2018 to 2019 made reliable improvement in their anxiety symptomatology by the end of their treatment with us, and 63% of patients were classified as having made a clinical recovery in terms of their anxiety. 22% of patients did not make reliable improvements with their anxiety symptomatology, and 5% of patients experienced a deterioration in their anxiety symptomatology by the end of treatment. 

For almost all of the anxiety disorders treated across our clinic, the change in our patients’ pre to post specific anxiety disorder specific ratings showed a large reduction in symptomatology. This is very important, because specific anxiety measures give a much better indication of whether the specific presenting anxiety disorders have been effectively treated, relative to general measures of anxiety levels, which may indicate that a patient’s general levels of anxiety have decreased, but not whether the anxiety disorder has been effectively treated.

Care Options

Outpatient

Care option: Outpatient assessment

Code: 93187

Unit: Per assessment

Description: Assessment for suitability for cognitive behaviour therapy (CBT) on an outpatient basis for people with specific anxiety and related disorders including obsessive compulsive disorder, body dysmorphic disorder, post traumatic stress disorder, complex post traumatic disorder, depersonalisation disorder, social anxiety, emetaphobia, panic disorder, health anxiety and various other specific phobias. Assessment involves completion of self-report questionnaires and a two hour interview with a therapist. The assessor will consult with the clinical team and provide a written report with full recommendations.

 

Care option: Outpatient treatment

Code: 93188

Unit: Per session

Description: Depending upon the disorder, treatment can involve on average between 12 and 20 weekly sessions of 60 to 90 minutes each of cognitive behaviour therapy (CBT) and typically involves at least one or two out of office sessions, such as a home visit or visit to site of trauma. Clinic sessions are recorded for patients and for supervision purposes and weekly self-report questionnaires are completed to monitor progress. A report is sent to the referrer, copied to the patient, at discharge. Our CBT treatment is offered for specific anxiety and related disorders as above.

 

Care option: Patient Choice assessment

Code: 93319

Unit: Per assessment

Description: For GP referrals from outside our local catchment area and that meet criterion. Assessment for suitability for cognitive behaviour therapy (CBT) on an outpatient basis for people with specific anxiety and related disorders as above. Assessment involves completion of self-report questionnaires and a two hour interview with a therapist. The assessor will consult with the clinical team and provide a written report with full recommendations.

 

Care option: Patient Choice treatment

Code: 93319

Unit: Per assessment

Description: Depending upon the disorder, treatment can involve up to 12 sessions of 60 to 90 minutes each of cognitive behaviour therapy (CBT) and typically involves at least one or two out of office sessions, such as a home visit or visit to site of trauma. Clinic sessions are recorded for patients and for supervision purposes and weekly self-report questionnaires are completed to monitor progress. A report is sent to the referrer, copied to the patient, at discharge. Our CBT treatment is offered for specific anxiety and related disorders as above.


 
Care option: NHS England HSS OCD assessment

Code: 70821

Unit: Per assessment

Description: Assessments for the Highly Specialised Service (HSS) are funded by NHS England and is a tier 6 specialist CBT outpatient service for those patients with severe, treatment resistant obsessive compulsive disorder (OCD). We are able to offer these to eligible patients without the need to be funded directly by local CCGs. Referrals should come from secondary mental health teams. Assessment involves completion of self-report questionnaires and a two hour interview with a senior therapist and will include a medication review by an ST5 or 70821 per assessment ST6 psychiatrist. The assessor will consult with the HSS teams and provide a written report with full recommendations.

 

Care option: NHS England HSS OCD treatment

Code: 70822

Unit: Per session

Description: Treatment can involve on average between 12 and 20 weekly sessions of 60 to 90 minutes each of cognitive behaviour therapy (CBT) and typically involves at least one or two out of office sessions, such as a home visit or visit to site of trauma. Clinic sessions are recorded for patients and for supervision purposes and weekly self-report questionnaires are completed to monitor progress. A report is sent to the referrer, copied to the patient, at discharge. Our CBT treatment is offered for patients with severe, treatment resistant OCD.


 
Care option: NHS England HSS BDD assessment

Code: 70811

Unit: Per assessment

Description: Assessments for the HSS are funded by NHS England and is a tier 6 specialist CBT outpatient service for those patients with severe, treatment resistant body dysmorphic disorder (BDD). We are able to offer these to eligible patients without the need to be funded directly by local CCGs. Referrals should come from secondary mental health teams. Assessment involves completion of self-report questionnaires and a two hour interview with a senior therapist and will include a medication review by an ST5 or ST6 psychiatrist. The assessor will consult with the HSS teams and provide a written report with full recommendations.

 

Care option: NHS England HSS BDD treatment

Code: 70812

Unit: Per session

Description: Treatment can involve on average between 12 and 20 weekly sessions of 60 to 90 minutes each of cognitive behaviour therapy (CBT) and typically involves at least one or two out of office sessions, such as a home visit or visit to site of trauma. Clinic sessions are recorded for patients and for supervision purposes and weekly self-report questionnaires are completed to monitor progress. A report is sent to the referrer, copied to the patient, at discharge. Our CBT treatment is offered for patients with severe, treatment resistant BDD.


 
Care option: Team assessment

Code: 53431

Unit: Per assessment

Description: Team assessments are offered for referrers who are seeking expert guidance and recommendations for the future management of their patients. People who may have complex problems including failing to respond to previous treatments, a problem that is severe, extensive co-morbidity, or where diagnosis is unclear. Team assessments can take up to three hours and are carried out by two members of staff, usually including a senior clinician and an ST6 doctor or consultant psychiatrist, who may also undertake a medication review. A member of the patient’s local team can also attend if they so wish. Assessment results are discussed by the clinical team and a thorough report, including recommendations for future management and review of the diagnosis and formulation are provided for the referrer.

 

Care option: Depersonalisation assessment

Code: 59531

Unit: Per assessment

Description: Assessment for suitability for cognitive behaviour therapy (CBT) on an outpatient basis for people with depersonalisation and derealisation disorder. Assessment involves completion of self-report questionnaires and a two hour interview with a therapist. The assessor will consult with the clinical team and provide a written report with full recommendations for further investigations or treatment. A one-off telephone psychiatric consultation may be offered if clinically indicated.


 
Care option: Depersonalisation treatment

Code: 59531

Unit: Per session

Description: Treatment can involve up to 16 weekly sessions of 60 minutes each of cognitive behaviour therapy (CBT). Clinic sessions are recorded for patients and for supervision purposes and weekly self-report questionnaires are completed to monitor progress. A report is sent to the referrer, copied to the patient, at discharge. Our CBT treatment is offered for depersonalisation and derealisation disorder.

Referrals

Referral Form: https://forms.office.com/pages/responsepage.aspx?id=SuTPoS5olUqOctA7m1iHqgT6SuYUNJRHu4LwGo0aBBFUMjVMVVJJUkVFRTBYUUxKR1IwVFJaSDU3Ty4u&web=1&wdLOR=c4FC89CA1-7707-CB42-83C9-D69D7F997B3E

All referrals to specialist services are subject to referral criteria as described within the terms of reference for both the tertiary and outpatient panel. 

We are unable to receive private referrals and/or for non-UK residents. 

Patient Choice referrals can be made to the clinic by GPs, in cases where the patient has an anxiety disorder of the type treated by our clinic, has discussed treatment options with their GP and has elected to be seen by our clinic, and is not receiving any other local treatment currently for that presenting problem. 

Please note that we are unable to accept Patient Choice referrals from GPs with a registered address within the South East London Clinical CCG. These cover Lambeth, Southwark, Lewisham, Bexley, Bromley and Greenwich.

For non-Patient Choice referrals, funding is requested from local clinical commissioning groups. 

We are also unable to receive direct referrals from other Trust services. Lambeth, Southwark and Lewisham primary care referrals should be routed via Talking Therapies and secondary care referrals for all boroughs within the South East London CCG should be routed via local Funding Panels. The only exception to this if for the Highly Specialist (NHSE funded service) see below. 

For the highly specialist (NHSE funded service) for treatment resistant OCD and BDD, patients must remain under the care of their local mental health services during and after treatment through our clinic. NHSE funded assessments can be done to determine whether entry requirements into this service are met – if approved, treatment will be offered through the clinic. If not, the patient will either be discharged, or funding will be requested from the CCG.

Hoarding referrals: We regret we are unable to offer home-based treatments for hoarding outside the boroughs of Lambeth, Southwark and Lewisham. In these cases we may suggest referral to local mental health services.

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