This project evaluated the outcomes of acceptance and commitment therapy (ACT)-informed interventions for individuals with Type 1 or Type 2 diabetes mellitus experiencing mental health distress related to their condition or self-management burden. A within-subjects design evaluated the effectiveness of ACT-informed interventions using pre- and post-psychological wellbeing and diabetes specific outcome measures and HbA1C data. The interventions were part of the Croydon Community Diabetes service which began in October 2020. Fifty-six service users completed psychological wellbeing outcome measures (PHQ-9, GAD-7 and CORE-10) and 38 of these service users fully completed the diabetes specific measure (either DDS or the PAID). Thirty-nine service users had HbA1C data before the start of treatment and following the end of treatment. Wilcoxon’s signed rank test was used to analyse psychological outcomes and HbA1c data. Descriptive statistics were used for diabetes specific measures due to small sample sizes. Statistically significant reductions in levels of depression, generalised anxiety, and general psychological distress were found following ACT-informed interventions. Statistically significant reductions were also observed for HbA1c readings. Although inferential statistics were not used, the data highlighted that n=21 and n=14 reported reduction in scores on the DDS and PAID, respectively. Preliminary evidence suggests that ACT-informed interventions in an NHS community diabetes clinic for a sample of people living with Type 1 or Type 2 diabetes are associated with improved psychological wellbeing and diabetes distress.

Key learning aims

1. (1) To learn about the current evidence base and missing gaps in research on the use of acceptance and commitment therapy (ACT) for people living with Type 1 or Type 2 diabetes mellitus.

2. (2) To provide clinicians with an example of brief individualised ACT informed psychological interventions based on a sample of people living with diabetes in South London.

3. (3) To learn about the implementation of ACT informed psychological interventions in a naturalistic evaluation of a community Diabetes NHS service that reflects realistic treatment delivery.

4. (4) Through the limitations discussed in this paper, we provide future suggestions for psychologists working in diabetes care for evaluating their service in a naturalistic setting. This includes the collection of data through various sources such as the use of physical health measures and therapy process measures.

Whilst behavioural activation (BA) is an empirically supported treatment for depression, some patients do not benefit. The aim of this study was to evaluate the effectiveness of two treatment augmentations to an extant manualized 8-session group version of BA. The two treatment augmentations were (a) dose–response psychoeducation to improve attendance and (b) implementation intentions to improve clinical outcomes. A cohort comparison design in routine practice comparing standard group BA (n=31, drawn from a sample of n=161, from 22 BA groups) with treatment-augmented group BA (n=31 from 3 BA+ groups). There was no effect of the two treatment augmentations on attendance or in overall mean reductions to depression (mean improvement difference=2.2), anxiety (mean improvement difference=1.9) or impaired functioning (mean improvement difference=1.5). Rates of reliable improvement in depression were significantly higher for augmented BA (odds ratio=3.21 for BA+ compared with BA). Efforts should be made to still improve outcomes for empirically supported interventions, with any treatment augmentations tested in well-controlled studies.

Moral injury is the profound psychological distress that can arise from exposure to extreme events that violate an individual’s moral or ethical code; for example, participating in, witnessing, or being subjected to behaviours that harm, betray or fail to help others. Given that the experience of moral transgression is inherent to moral injury-related post-traumatic stress disorder (PTSD), it is important to consider patients’ religious beliefs and formulate how these may interact with their distress. In this article we describe how to adapt cognitive therapy for PTSD (CT-PTSD) to treat patients presenting with moral injury-related PTSD, who identify as religious. Anonymised case examples are presented to illustrate how to adapt CT-PTSD to integrate patient’s religious beliefs and address moral conflicts and transgressions. Practical and reflective considerations are also discussed, including how a therapist’s personal beliefs may interact with how they position themselves in the work.

Key learning aims

1. (1) To understand the importance of patients’ religious beliefs in the context of moral injury-related distress.

2. (2) To understand how patients’ religious beliefs can be integrated into Ehlers and Clark’s (2000) model when working with moral injury-related PTSD.

3. (3) To offer practical adaptations for CT-PTSD to integrate patients’ religious beliefs and practices, including how to set up a consultation with a religious expert in therapy.

4. (4) To aid therapist reflection on how their personal beliefs interact with how they position themselves in therapeutic work with religious patients.