CBRT - the case for NHS Adoption. Written with support from NHS South of England.

1. CBRT™– the case for NHS Adoption
Providing patients with structured relaxation support sessions
which deliver measurable outcomes to IAPT standards.

2. CBRT is a new innovation in mental healthcare
NHS Change and transformation
CBRT (Colour Breathing Relaxation Technique) is a UK innovation which
provides all users with a simple, yet very effective, mind - body awareness
technique through structured and guided relaxation support sessions.
“Colour Breathing Relaxation Therapy is a vital tool that we use within our community to enable
relaxation and stress management techniques, which focuses and calms the mind”
Aidan Hamilton – CALM Programme Coordinator

3. A missing piece of the puzzle
• CBRT provides the NHS with a Value for Money, practical and unique system for physical
health, mental health and wellbeing.
• CBRT provides a ‘safe care’ and ‘right care’ solution to the ever growing requirement for
increased capacity within integrated care for patients with anxiety, mild to medium
depression and long term conditions. This need was highlighted in the report, “How Mental
Illness Loses Out in the NHS”, produced by a distinguished team of economists,
psychologists, doctors and NHS managers convened by Professor Lord Layard of the LSE
Centre for Economic Performance.
• CBRT can contribute to productive patient care and strengthen staff and patient
communication skills; CBRT is empowering.
• CBRT is a high quality, yet low cost product.
• A relaxation technique and therapeutic intervention - CBRT is a safe product. It is to become
registered as a CE mark, Class 1 Medical Device and is made of printed matter.
• CBRT is a motivational, inclusive, non-pharmaceutical, non-invasive, non-denominational
and non-tactile intervention, for all ages and abilities.

4. Relaxation supports patients’ rehabilitation
A positive outlook to aid patients’ wellbeing

5. Aligning with IAPT Commissioning goals
Feedback from an NHS Commissioner of Psychological Therapies
An NHS Commissioner of Psychological Therapies has written the
following about the CBRT Practitioner Training Programme and
accompanying written NHS Training Initiatives:
“The principles of building confidence and socialisation are good, as
commissioners we understand how important this is for a patient’s
recovery.”
“The proposal is very good and well presented, with a good evidence
base and clinical outcomes.”
“On paper, the savings are good, a reduction in primary care
presentations, and this is similar to IAPT where we also know there
are reductions in referrals to secondary care.”

6. NICE Quality Standards Programme
QS for Depression in adults
In March 2013, the CBRT Initiative was supported by the Innovation
Promotion Manager of NHS South of England. It was suggested that the
paper “NICE – Quality Standards Programme – Cost impact and
commissioning assessment: quality standard for depression in adults -
March 2011” should be provided as an example of potential cost savings
for the CBRT Initiative as it states on pages 8 and 9 that the total expected
saving per IAPT patient rounded as being £340.00 in a two year period.
http://www.nice.org.uk/media/01D/C3/DepressionQSCostAssessment.pdf
125 staff trained in CBRT would therefore only need to support a
minimum of 264 Patients in Year One (less than one per day)
to recoup the initial investment in the whole CBRT Training Initiative.
(2.11 Patients per trained staff member.)
Supporting more patients would, the NICE
paper suggests, result in a saving to the
organisation as well as enhanced quality
of care and experience for the patient.

7. The case for adoption – a talking therapy
“Grass roots” level patients support
• CBRT helps people with anxiety to learn a
simple technique and how to relax themselves
naturally.
• The benefits of individual and group therapy
are combined with a visually appealing and
easy to learn Mindfulness technique.
• Patients receiving individual CBRT sessions
are encouraged to talk about “how the colours
make them feel” using the CBRT Initial
Response Sheets© prior to receiving their
relaxation session - this is a popular activity.
• CBRT can provide Patients with a structured
relaxation intervention whilst waiting to join the
IAPT Programme.
• CBRT sessions can be provided by staff
from many disciplines including nursing,
allied healthcare and social care, across
primary and secondary care, occupational
therapy, physiotherapy and in many clinics
including obesity, insomnia, hypertension,
substance misuse issues, smoking
cessation, PTSD, trauma, bereavement,
maternity.

8. CBRT Intervention Evidence Base
“An intelligent amalgamation of Evidence Based Interventions”
Here are the key components of CBRT and
number of independent studies currently with
NHS Evidence:
• Mind-Body Relaxation Technique (74)
• breathing techniques (1,888)
• Mindfulness approach (375)
• positive thinking (7,383)
• self-help and guided self-help (2,935)
• MBSR (Mindfulness –based stress
reduction) (24)
• Mind-body interventions (5,418)
• creative visualisation (60)
• Meditation (565)
• group therapy (46,805)
• Anxiety breathing techniques (971)
Interventions embraced with CBRT
already with NICE approval include:
• CBT
• Guided relaxation
• Mindfulness based stress reduction.
When CBRT is introduced into NHS CCGs
and Trusts it will very quickly support NHS
staff and patients.
Within the first 24 months create CBRT
NHS case studies for NHS Evidence
studies.

9. CBRT Initiative for NHS Trusts and CCGs
Taking the lead in Patient Care and Innovation
From 1st May 2018, CBRT will focus on working initially with NHS Trusts and CCGs:
• To train staff in NHS Trusts and CCGs
• Where requested to provide “Train the Trainer” for regions
• Each Regional CBRT Trainer to train a minimum 60 Practitioners per annum to
retain licence and evaluate Post Training assessment papers and case studies from
each individual NHS Trust and CCG group and provide these as additional case
studies for NHS Evidence.
• Work with CBRT Training Management to create an NHS quality database for
Assessment Paper(s) feedback; Case Studies Feedback; Patients/Users feedback.
• Work to RCN CPD Accreditation standards (and similar process e.g. with COT (The
College of Occupational Therapists.)

10. CBRT Training is delivered in two days
Training and Evaluation
Before training:
Learner skills and knowledge is assessed
During training:
Short tests are conducted at regular
intervals during activities and learning
including:
CBRT “Initial response sheets”
Listening Exercise
Working as a group and in pairs
Techniques of evaluation used include:
Observation
Questionnaires
Listening skills
Validating learning
Post Training Programme Paperwork:
40 question Assessment paper
10 case studies (2 groups of 5 users - twice,
2 individuals – twice.)
Evaluating feedback - After training:
Learner provides course feedback.
CBRT provides course assessment feedback to
the learner.
Actual outcomes.
Follow up:
- Transfer of learning to the workplace
- Patient feedback
- Results and impact on organisation
- ROI Return of investment study
- CBRT intend to provide NHS staff and CBRT
Trainers with CPD refresher training every 12
months.

11. NHS Trust – a strong case for adoption – QiPP
Meeting challenges whilst serving a need
• The purpose of CBRT is to improve quality,
and safety and provide value for money in
the NHS through the provision of structured
and guided relaxation support sessions for
patients.
• Designed to support NHS savings targets.
• An “invest to save” programme.
• An Innovation that supports mental health
and wellbeing - national NHS priorities.
• Enhances both Productivity and Prevention
• Helps address the demand for anti-
depressants which is growing annually.
• CBRT can be used in conjunction with
programmes associated with reducing
the use of antipsychotic drugs
particularly with dementia sufferers.
• Person centred care is provided though
guided group support sessions.
• CBRT is a very flexible relaxation
intervention - so is not “just about group
therapy” - it can easily be used as a “one
off” intervention for the anxious ward
patient for example.
• > 12,000 patients in a single Trust could
benefit each year, including a reduction
in primary care referrals and secondary
care.
• CBRT is a unique innovation and
system.
• Commissioners may note that
Regulation 5 provides for commissioners
to award a new contract without a
competition where there is only one
capable provider.

12. 5 Case Model – Improving Patient Care Now
• The Strategic Case - CBRT provides a response to
‘Francis’ empowering patients and staff. As an IAPT
technique evidence would suggest it can reduce
prescribing and dependency on other services. It is a
quality health improvement and modernisation
programme through training staff. It addresses the call for
‘Compassion in Practice’ 6C’s.
• The Economic Case – CBRT optimises Value for Money
–A ‘compelling case’ for innovation supporting mental
health as an NHS priority. The Health and Care Act
highlights the importance of integration and a mind and
body approach to care
• The Commercial Case – CBRT requires a modest initial
investment and is commercially viable. In May 2012,
CBRT scored 92.53% with the NHS National Innovation
Technology Scorecard process. As a non-referral
baseline activity, help to reduce unnecessary admissions
and length of stay targets. Pre-admission clinics and
prevention strategy.
• The Financial Case – Improve your local public services
and integrated self care programmes. CBRT is financially
affordable and provides a demonstrable improvement in
care and a demonstrable return on investment
• The Management Case – CBRT is all inclusive and can
be taught to and delivered by all nursing and allied
healthcare staff.
“I have no idea why healthcare
providers do not offer relaxation
classes to Patients suffering from
long term conditions. Following an
accident, I now live with chronic pain
syndrome and bouts of depression...
I am not surprised so many people
suffer with depression. Group
contact and regular support is far
more important than a packet of
tablets.”
Mrs P.
NHS Patient, South of England

13. The case for adoption – Staff Skills,CPD Training
• The CBRT programme provides staff with
skills transferable to many different clinical
scenarios.
• It offers a Team building opportunity.
• Smaller CCGs can be provided the two day
CBRT Training Programme for 12 - 20 staff .
• CBRT provides Performance Measured
Training (PMT) . Upon completion of two
day training programme, staff are required
to complete an online 40 question
Assessment paper and 10 templates for
their CBRT user case studies – (3 groups of
five people twice and two individuals twice.)
• Upon successful completion and marking of
papers, staff receive assessment grade and
a certificate is issued (within 8 -10 weeks of
training.* Staff are then allowed to provide
CBRT Relaxation Support Sessions to
patients. (*Based on staff completing
paperwork to agreed schedule.)
“Training and education should be an integral part of any proposed service if it is to be
of high quality and sustainable.”
NHS Confederation – “Clinical responses to the downturn.”
Measurable outcomes – All CBRT case
study templates contain recognised
health and wellbeing statements

14. CBRT as a Service Improvement
Helping your Trust respond to “The Francis Report”
• CBRT provides a unique product, service and results - with measurable outcomes.
• Integrated healthcare for “whole patient” and self care pathway. Greater commitment
and ownership Designed for easy large scale change and adoption.
• Embedding Equality, Diversity and Inclusion.
• The CBRT Initiative is a Project with a Value Stream – to quickly provide professional,
structured, relaxation support sessions for all patients. A robust, quick diffusion model.
• CBRT supports NHS staff training and resources appropriately, in the most serious
period of financial constraint ever faced.
• Meeting national policies – long term conditions, mental
health, health prevention, innovation, QiPP.
• Innovation procurement to meet local strategic needs.
• Extends patient choice prior to IAPT Programme.
• Designed for easy large scale change and adoption.

15. CBRT Initiative Goals
“Any project worth doing is worth doing fast and right.”
CBRT Initiative Project Goals:
• Improve Quality - Patient experience,
mental health and wellbeing provision .
Staff make shared time with patients
“Make Time to Save Time.”
• Meet RCN and COT CPD Training
standards and requirements.
• Reduce waiting times of IAPT
interventions, through Innovation and
practical application of this new
technology.
• Reduce Total Costs – examples
include: Group relaxation support
provision, Length of stay – reducing
length of stay.
• Improves patient choice and
experience. Learn how to relax before
starting a medication pathway. A tool
kit to help reduce boredom on the
ward.
• NHS Staff and Trainers to complete
training paperwork to agreed time
Long term goals:
• To contribute to improving Patient
experience through innovation led
Compassion in Care.
• To deliver cash releasing savings.
• To provide independent NHS led
evidence to work towards NICE
approval as a relaxation intervention
and technology.
• The NHS Change model includes need
for “Rigorous Delivery.”
• Each member of staff trained will aim
to support a minimum of 10 patients or
staff members per week.
• NHS Staff and Trainers to complete
training paperwork to agreed time.
• NHS Trainers to attend a CBRT
“Refresher” Training programme every
year.

16. CBRT Technique - a Safe & Flexible Intervention
• Individual and groups of patients - of all ages and abilities, including children.
• Correct breathing pattern. Mindfulness, focus, concentration, positive thinking .
• Guided group relaxation sessions found to be supportive; individual or groups of up to 20
patients
• Focused breathing on one colour also effective - in just 5 – 10 mins.
• Once a Patient has learnt how to use CBRT it can be self-delivered – a form of self-
therapy.
• Most effective sessions last between 30 – 50 mins. A practical, visual tool – easy to use.
• Patients participation in relaxation process empowers them as individuals.
• Patients select their own Affirmation Cards for focus – able to express “how they feel.”
• “CBRT Initial Response Sheets©” - form of ‘talking therapy’ - used with individual patients.

17. Responding to Patients’ Needs
Helping your Trust respond to “The Francis Report”
Compassion in Practice and the 6 C’s :
• Care quality/safety
• Compassion
• Commitment
• Communication - understanding
• Courage – change, adopting innovations
• Competency
Patients also need:
• To have a vehicle to express their
thoughts and needs
• To feel they are being heard
• Feel respected
• Experience calm
• Learn relaxation skills
• Positive thinking
• Develop self – care tendencies
• Feel involved and cared for
• Interconnection.

18. An easy to use, ongoing self-care programme
• CBRT provides Patients with a non-pharmaceutical intervention choice.
• Patients are able to continue self directed Colour Breathing Technique everyday as the
CBRT Kit is safe and suitable for home use.
• CBRT encourages patients to become proactive in self-care.
• Each CBRT Kit comprises: full colour book, set of seven
Colour Breathing Disks easel set, Audio CD.
• The new 2018 “Daily Observations Diary” will enable
users to record their feelings and moods and which
affirmations they choose to use each day. This will provide
NHS staff with improved communication and regular
weekly feedback from Patients in a simple format.

19. Adoption of CBRT – long term conditions
As part of Patients’ Care Pathways CBRT may deliver many benefits
• Relaxation awareness
• Mindfulness, focus 
• Inner calm 
• Breathing improvement, awareness 
• Positive thinking 
• Group support 
• Quality time with nursing staff 
• Self-help in action 
• Group participation 
As part of a whole pathway holistic approach
CBRT can contribute to:
• Cardiac and stroke prevention
• Respiratory Smoking cessation 
• Long term conditions support 
• Mild – medium depression 
• Anxiety, Insomnia toolkit 
• Mild dementia , easy to use technique
• Antenatal, Postnatal skills 
• Rehabilitation pathway tool 
• Medication reduction support
The Colour Breathing book is very easy to read and printed in full colour

20. How does CBRT support NHS staff?
CBRT training to strengthen communication skills & team building
• CBRT offers Quality Improvement - made
simple.
• Team building and Engagement to Mobilise.
Nurses, Allied healthcare and Social Care
Teams have the opportunity to train together,
attending a two day CBRT Training
Programme.
• Through interaction and learning how to use
CBRT with both individuals and groups of
patients, staff enhance their natural
communication skills of listening, focus,
timing, patience and awareness.
• Staff may feel more valued by management
when given the opportunity to undertake
additional training.
• Structured CBRT Relaxation Support
Sessions – whether patients experience
this as a ‘once-only experience’ or in
a series of 8 – 10 sessions, provides time
and space for positive, uplifting, calming
dialogue between staff and patients,
contributing to overall staff and patients’
wellbeing.
• CBRT is a vehicle for engaging with
Patients with Care and Compassion.
• CBRT Relaxation Support Sessions could
also be provided to support NHS staff.
• In the community, clinics, wards, rest
rooms...CBRT is a flexible tool and
efficient way to deliver a relaxation
intervention in a group setting.

21. CBRT™ Relaxation Support Sessions are a productive model and an efficient way of
delivering group therapy. An established method, CBRT requires :
• A trained member of staff.
• 20 – 45 minutes of uninterrupted time.
• A suitable, well ventilated room.
• Comfortable seating, with table space, if possible.
• Colour Breathing Disks – 1 set per user.
• Colour Breathing Affirmation Cards – 1 set per group.
• Initial Response Sheets (Individual use only)
How CBRT is delivered...

22. Users feedback of “CALM Programme”
Participants of the CALM Programme were
asked about their experience of CBRT
training: their responses included:
• Meeting new people that they can learn
from, both other participants and the
trainer;
• Learning new skills that they can apply
and building self-confidence;
• A positive environment to come to and
bring them out of their shell where they
need to;
• Promoting positive mental health and
reducing suicide;
• The way it has been delivered and the
interaction between the group;
• The CBRT is a valuable resource they
now have available to them.
“Colour Breathing Relaxation Therapy is a vital tool that we use within our community to enable
relaxation and stress management techniques, which focuses and calms the mind”
Aidan Hamilton – CALM Programme Coordinator

23. The next 5 slides demonstrate actual
feedback received from 85 CBRT Users
who received CBRT sessions from 5 newly
trained practitioners

24. 85 Users - Overall improvement after 2 CBRT sessions
Questions - Physical health & Mental Health

25. 85 Users - Overall improvement after 2 CBRT sessions
Questions : enjoyment of life and optimism

26. 85 Users - Overall improvement after 2 CBRT sessions
Questions : feeling useful and feeling relaxed

27. 85 Users - Overall improvement after 2 CBRT sessions
Questions: dealing with problems, thinking clearly

28. 85 Users - Overall improvement after 2 CBRT sessions
Questions: Feeling close to other people, able to make up own mind

29. CBRT creating a flexible solution
For NHS CCGs and Trusts
CBRT NHS bespoke versions
All products are printed in full colour and to a
high quality.
As CBRT is also an independent publishing
house, there is great flexibility and capacity
to create bespoke localised versions of all
CBRT products for NHS Trusts and CCGs as
requested. E.g. The CBRT Book Kit can be
produced to include up to 10 pages of
relevant NHS Trust /CCG local information
in full colour for their patients, with the
minimum print run being only 3,000 units per
product.
CBRT can also create CBRT products and
information leaflets:
• In different language editions* :
• Braille
• Larger font
• All formats - special needs.
CBRT future products
• CBRT are to create additional sets of
boxed Affirmation Cards to provide
positive thoughts and a low cost
solution to further support and address
specific conditions and life such as:
• Hypertension, Anxiety, Stress,
Insomnia
• Mild to medium depression
• Long term conditions
• Obesity, healthy weight
• Substance misuse conditions
• Bereavement, Dementia.

30. nationalhealth@colourbreathing.com
Supporting “Compassion In Practice and Innovation Health and Wealth”
www.colourbreathing.com © Alison Bourne 1997 – 2018 CBRT Healthcare Innovation Systems Ltd
CBRT HIS Ltd has a key NHS pilot initiative programme
ready to action now and benefit 45,000+ NHS patients.