Treatment recommendations for mental health are often founded on diagnosis-specific models; however, there are high rates of co-morbidity of mental health presentations and growing recognition of the presence of ‘transdiagnostic processes’ (cognitive, emotional or behavioural features) seen across a range of mental health presentations. This model proposes a novel conceptualisation of how transdiagnostic behaviours may maintain co-morbid mental health presentations by acting as a trigger event for the cognitive biases specific to each presentation. Drawing on existing evidence, psychological theory and the author’s clinical experience, the model organises complex presentations in a theory-driven yet accessible manner for use in clinical practice. The model offers both theoretical and clinical implications for the treatment of mental health presentations using cognitive behavioural approaches, positing that transdiagnostic behaviours be the primary treatment target in co-morbid presentations.

Online cognitive behaviour therapy (CBT), self-help and guided self-help (GSH) interventions have been found to be efficacious and cost-effective for treatment of anxiety and depression, but there are limited data from low- and middle-income countries on culturally adapted digital interventions for these common mental disorders. The aim of this study was to investigate the feasibility and acceptability of an online culturally adapted CBT-based guided self-help (CaCBT-GSH) for patients with anxiety and depression in Pakistan. This randomized controlled trial recruited 39 participants from primary care in Karachi, Pakistan and randomized them to two groups. The intervention group received seven modules of CaCBT-GSH plus treatment as usual (TAU) over 12 weeks. The control group was a waitlist control plus TAU. The primary outcomes were feasibility and acceptability. Clinical outcomes included results from the Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule 2 (WHODAS 2). Assessments were carried out at baseline and at 12 weeks. All 39 individuals who met eligibility criteria for the study agreed to participate. Adherence to the intervention was excellent, with 85% (17/20) completing more than five modules. Statistically significant improvements were found in all clinical outcomes in the intervention group. This was the first trial of an online CaCBT-GSH intervention, which was found to be feasible and acceptable to Pakistani patients with anxiety and depression. CaCBT-GSH may help improve symptoms, depression, anxiety and overall functioning in this population. The results provide rationale for a larger, confirmatory randomized controlled trial of digital CaCBT-GSH.

This study performed a systematic literature review to examine existing and recommended CBT support for staff working within mental healthcare, who experienced occupational traumatization. The following questions were posed: (1) What are the effects of differing levels of occupational trauma on the individual and/or organization? (2) Are there any current CBT-specific models, or treatment pathways, aimed at supporting those experiencing the effects of occupational trauma? Conclusions showed the effects of occupational trauma are significant, varied and predominantly negative to both employees, and the organizations where they work. There were no CBT-specific models or pathways sourced to address occupational trauma; however, interventions were highlighted which may form parts of a larger pathway. Reviewed evidence suggests that development of a stepped CBT pathway for occupational trauma will be beneficial.

Cognitive behavioural therapy (CBT) is a first-line strategy in reducing or delaying risk of transition to psychosis among young individuals with at-risk mental states (ARMS). However, there is little knowledge about its effects on other outcomes associated with ARMS. No study on CBT for ARMS has assessed worry, an important process associated with this condition. The present study investigated changes in worry at immediate post-treatment and 14-month follow-up after CBT for young individuals with ARMS seeking psychiatric care in mental health services. Thirty-seven young individuals (mean age = 26 years, SD = 6.07; 22.20% female) seeking psychiatric care in mental health services and classified as reporting ARMS through the Comprehensive Assessment of At-Risk Mental States were included. The Positive And Negative Syndrome Scales (PANSS) and Penn State Worry Questionnaire (PSWQ) were administered at baseline, post-treatment, and follow-up. CBT consisted of 30 weekly individual 1-hour sessions based on a validated CBT for ARMS manual enriched with components targeting worry [psychoeducation, problem-solving, (meta)cognitive restructuring, behavioural experiments]. Seven participants (18.91%) at follow-up had cumulatively made transition to psychosis. Repeated measures ANOVA with post-hoc pairwise comparisons showed significant changes in PSWQ scores from baseline to post-treatment and from baseline to follow-up; PSWQ scores remained stable from post-treatment to follow-up. This is the first study investigating changes in worry after CBT for ARMS, which appears to be a promising strategy also for this outcome. Future research with a larger sample size and control group may determine whether changes in worry are also associated with reduced transition risk.

Although individual cognitive behavioural therapy for psychosis (CBTp) is a recommended treatment in the UK, studies evaluating participant experiences are limited, particularly in high-security (HS) conditions. Traditional methods of participant evaluation disadvantage HS patients. Individual chief-complaint orientated CBTp (C-Co CBTp), a variant of CBTp, is offered in a HS setting. The paper aimed first, to evaluate participant experiences of individual C-Co CBTp within HS conditions, and second, to evaluate collaborative group game design as a means of evaluating participants’ experiences. Collaborative group game design was used as a novel method of participatory action research to evaluate patient and practitioner experiences of C-Co CBTp. Fifteen participants (10 inpatients, five staff) developed a life-size game representing their experiences of C-Co CBTp and offered feedback on the process. The game comprised of 24 squares, each depicting and describing a therapy experience, and a set of game-play cards. Collaborative group game design is a viable means of evaluating participant experiences. Findings corroborate and add to the current evaluation literature. Participants placed particular emphasis on collaboration, the therapeutic relationship, therapy as a nonlinear process and vulnerability and hope.

Cognitive behavioural therapy (CBT) has been shown to be an effective treatment for anxiety disorders in children. However, the majority of studies conducted to date have included heterogeneous samples of children combining social anxiety disorder, generalized anxiety disorder and separation anxiety disorder (SAD) together. Few studies have examined the efficacy of CBT to specifically treat SAD. Moreover, research on the impact of CBT for SAD in children younger than 7 years old has been very limited. To address these issues, we examined the effects of a CBT parent training programme with six children with SAD aged between 4 and 7 years using a non-concurrent multiple baseline design. Parents completed semi-structured interviews, questionnaires and daily diaries to assess their child's anxiety symptoms, parental practices and parental stress. Results indicated that five of six children no longer met the criteria for SAD diagnosis after treatment and at 3-month follow-up. Moreover, the daily diaries showed that four of six children presented a systematic favourable change of the total weekly frequency of SAD symptoms. Finally, four mothers reported a decrease in overprotection, but we observed no changes in parental stress.

The psychological literature highlights experiential avoidance as a transdiagnostic maintenance factor for a number of psychopathologies. Some attention has been given to therapist experiential avoidance, with the suggestion that this interferes with the acquisition and execution of CBT skills; there is, however, a paucity of research directly examining this relationship. This study aimed to measure experiential avoidance in trainee cognitive behavioural therapists, and establish any relationships with observed clinical competence. Twenty-nine trainee therapists took part in the study; levels of experiential avoidance were measured using the Multidimensional Experiential Avoidance Questionnaire and were analysed in relation to observed CBT skills assessed using the Cognitive Therapy Scale (Revised). No overall relationship between therapist experiential avoidance and clinical competency was observed. However, a number of significant associations were observed between individual dimensions of therapist experiential avoidance and CBT skills in collaboration, guided discovery, conceptual integration and homework setting. Aspects of therapist experiential avoidance during training may therefore be associated with the acquisition of key CBT skills. Tentative interpretations and recommendations for CBT training and supervision have been made, although further investigation is required.

The current case study was conducted as part of the National Health Services and Health Education England implemented IAPT top-up training in trauma-focused cognitive therapy for post-traumatic stress disorder (PTSD). There has been an increase in the number of clients presenting to IAPT with COVID-19 intensive care unit PTSD since the pandemic. However, there are no current unitary guidelines for psychological therapy for this population. Treatment of PTSD using individual trauma-focused cognitive therapy has been shown to be effective for ICU-PTSD. The National Institute for Health and Care Excellence treatment guidelines recommend adapting existing protocols. This study describes how these recommendations were used in the treatment of COVID-19 ICU-PTSD in a 46-year-old male. It illustrates the use of trauma-focused cognitive therapy for PTSD and how ICU trauma memories including hallucinations were conceptualised. It also illustrates how the challenges of co-morbid panic attacks, long COVID and remote working were managed. The client attended 16 individual, 60- to 90-minute video sessions of trauma-focused cognitive therapy, conducted weekly via Microsoft Teams over a period of five months. The treatment plan was conducted in collaboration with the client’s general practitioner, physiotherapists, cardiopulmonary specialists, and his family. Treatment included a timeline, written narrative and imaginal reliving. It also applied stimulus discrimination, behavioural experiments and site visit. At the end of treatment, the client no longer showed clinically important symptoms of PTSD as assessed on the PCL-5 and interview. This was sustained at 3-month follow-up.

Intolerance of uncertainty (IoU) is important in the development and maintenance of worry and generalized anxiety disorder (GAD; Dugas et al., 1997). However, it remains unclear why some people respond so negatively to uncertainty and have poor clinical outcomes. We adapted the IoU model to include the influence of developmental and/or attachment factors, and their possible importance to intolerability of uncertainty and associated hypothetical worries. Seven consecutive GAD referrals for CBT were naturalistically treated with the novel approach. All participants completed the 7-item Generalized Anxiety Disorder Scale (GAD-7; Spitzer et al., 2006), the Penn State Worry Questionnaire (PSWQ; Meyer et al., 1990), as well as a novel 10-item Premonition Bias Questionnaire (PBQ; C. Chigwedere et al., unpublished). From pre- to post-treatment, results for both GAD (p=.001) and worry (p=.005) improved significantly. Clinically significant change or a post-treatment score within the normal population range were observed for both the GAD-7 and PSWQ. The change in believability of worry, measured on the PBQ was also significant from pre- to post-treatment (p=.008). Overall, the novel approach may be an alternative approach to treating GAD, with some potential, both as an adjunctive or standalone treatment. However, this is a small case series and the presented novel approach requires empirical support and evaluation in larger experimental studies.

Data collected from clinical populations indicate that magical ideation (MI) may play a causal or a mediating role in the expression of obsessive compulsive symptoms. If this is the case then when targeted in treatment, symptoms of obsessive compulsive disorder (OCD) should be altered. Two individuals diagnosed with OCD received a trial treatment targeting magical thinking. The intervention consisted of a series of procedures designed to undermine superstitious/MI without targeting obsessions or compulsions. The procedures involved critical analysis of the following material: (1) a free astrology offer; (2) a horoscope prediction exercise; (3) a description of four different cultural explanations of the origin of fire; (4) an instructive guide for Tarot card readers; (5) a report of a UFO sighting; (6) a video-clip describing a cult festival; (7) a description of a ‘hoax’ channeler and (8) a superstition exercise. Measures of obsessive compulsive symptoms, superstition, MI and thought–action fusion were administered pre-treatment, post-treatment and at 3 months’ follow-up. According to the twofold criterion of Jacobson et al. (Behaviour Therapy 1984, 15, 336–352), following treatment the patients were identified as being recovered on measures of magical and superstitious thinking and on the Padua Inventory.

Despite international guidelines, cognitive behavioural therapy for early psychosis (CBTep) is still under-used in daily clinical practice, mainly due to the lack of specific skills among mental health professionals. The aim of the study was to evaluate the feasibility and efficacy of a CBTep training course and to investigate the impact of trainees’ variables on the level of skills acquisition. An intensive and graded CBTep training programme consisting of 112 hours of plenary lectures, 30 hours of group supervision and 3 months of practical training was offered to mental health professionals of 65 Italian community Mental Health Centers (CMHCs). CBT expert psychologists were used as the comparison group. Participants underwent pre-planned exams to test the level of skills acquisition and were requested to complete a satisfaction survey. The vast majority of participants (93%) completed the training with medium–high evaluation scores and reported to be highly satisfied with the course. CMHCs staff members achieved high scores in the examinations and no major differences between them and CBT expert psychologists were found in most of the final exam scores. Our results support the feasibility and the efficacy of the training to build specific CBTep capacity in a large cohort of professionals working in Italian Generalist Mental Health Services.

Many National Health Service (NHS) Trusts in England have invested in dialectical behavioural therapy (DBT) for mental health service users. The experiences of NHS staff delivering DBT were explored using semi-structured interviews with six dialectical behaviour therapists working in secondary mental health services within the NHS. The aim was to consider the impact on staff of adding the DBT therapist role onto their existing job role. Interview data were analysed using thematic analysis. Six themes were inductively generated from the data: DBT as a useful framework; DBT as the most satisfying part of the job; ‘Worzel Gummidge heads’– conflicts in roles; ‘DBT buddies’– the importance of informal support; uncertainty about the future; and recursivity – using DBT skills personally. Interactions between themes, implications for the service and future research directions are discussed. Key findings suggest that the addition of the DBT therapist role, as well as the recursive nature of DBT, has a positive impact professionally and personally. However, the service context within which participants were working can lead this additional role to cause increased demands and therefore stress, reducing that positive impact.

The distress inherent in obsessive compulsive disorder (OCD) can often lead to partners, family members and friends becoming entangled with the OCD in terms of being drawn into performing certain behaviours to try and reduce the distress of their loved one. In the past this has often been referred to somewhat pejoratively as collusion, or more neutrally as accommodation. In this paper we emphasise that this is usually a natural human response to seeing a loved one in distress and wanting to help. This paper provides detailed clinical guidance on how to understand this involvement and how to include others in the treatment of OCD along with practical tips and hints around potential blocks that may require troubleshooting. It also details the relatively recently introduced concept of approach-supporting behaviours, and provides guidance on how to distinguish these from safety-seeking behaviours. The ‘special case’ of reassurance seeking is also discussed.

Comorbid anxiety and mood disorders are common but the majority of treatments tend to focus on a particular diagnosis. Previous research has found that cognitive behavioural therapy (CBT) targeted at a specific diagnosis can lead to improvements in comorbidities, especially in the case of CBT for panic. However, there is an emerging evidence base that transdiagnostic CBT, which addresses common underlying processes across presenting problems, may be effective at treating comorbidities simultaneously. Given the simple nature of the cognitive formulation of panic it is arguable that a panic-specific CBT intervention could help socialize patients to CBT before progressing to a transdiagnostic approach. This paper uses a single-case experimental design to illustrate an example of using diagnosis-specific CBT as a springboard to transdiagnostic CBT with a patient presenting with panic and agoraphobia, social anxiety, depression, uncontrollable worry, suicidality, self-harming behaviours and a history of bulimia. Results suggest that this was a well-received and effective intervention. Clinical implications are discussed as well as limitations and directions for future research

Internet-delivered cognitive behaviour therapy (ICBT) is effective for treating anxiety and depression among post-secondary students, although outcomes are modest. Booster lessons have been proposed for maintaining and improving outcomes but have not been investigated following ICBT for students. This study used a mixed-methods approach to examine student (N = 146) use of a self-guided booster lesson offered 1 month after a 5-week ICBT course, whereby the booster lesson provided a review of ICBT skills and suggestions for maintaining motivation and problem solving. A survey about the booster was administered shortly after the booster to understand student preferences for the booster lessons, reasons for completing/not completing the booster, and satisfaction with the booster. Approximately one-third of students (n = 47) utilized the booster lesson. Completing a greater number of lessons during the main ICBT course was associated with uptake of the booster. The booster survey was completed by 20 of the 47 (∼43%) students who completed the booster lesson and 42 of the 99 who did not (∼42%). Students varied in perceptions of the ideal timing of the booster (1–2 weeks to 3–6 months) and approximately 60% expressed preference for completing the booster independently. Among non-completers of the booster, academic-related time constraints were the primary barrier to booster completion. Among those who completed the booster, the booster lesson was perceived as worthwhile, satisfaction was high, and the length was perceived as appropriate. Future research should examine if flexible delivery of booster lessons in terms of timelines and therapist support would increase booster uptake.

This paper reports a piece of practitioner research to explore the use of a Session Bridging Worksheet (SBW) with clients on their homework adherence, experience of their therapist, and clinical outcomes. Clients were divided into two groups randomly. One group received CBT as normal (TAU group) and the other group received CBT and used a session bridging worksheet (SBW group). The perception of the therapist's ability to address potential barriers was better when the SBW was used by the client and this seems to have had a small positive effect on homework adherence. Differences in symptom measures (BDI, BAI, BHS) between the two groups are inconclusive. The limitations of the design of the study are discussed with suggestions for future research.

In a previous feasibility trial, we found that transdiagnostic cognitive behavioural therapy (T-CBT) showed promising results in improving emotional disorders in adults from Saudi Arabia. The primary aim of this study was to replicate these findings and compare T-CBT results with results for counselling sessions. The overall sample consisted of 276 patients (175 in the T-CBT group and 101 in the counselling group). Of the overall sample, 110 patients (39.9%) completed the treatment plan, and 166 (60.1%) disengaged from treatment. The pre- and post-assessments of the clients who completed the treatment showed large effect sizes for almost all outcome measures for both the T-CBT and counselling groups. For patients who decided to disengage from therapy, T-CBT had medium effect sizes for all three measures (depression, anxiety and function), while counselling sessions had medium effect size for the anxiety measure only. This study provides additional evidence that T-CBT is suitable for patients from Saudi Arabia with emotional disorders. The study also provides information regarding when and why T-CBT or counselling was applied in a real clinical setting. Implications and recommendations are discussed.

Significant progress has been made internationally in the training of clinical supervisors, yet much remains to be done, such as refining training through the improved use of video material. A review of currently available video recordings used in supervisor training indicates that they are generally used informally, are manifestly lacking in procedural detail, are narrowly applied, and lack an educational rationale or research support. After reviewing current options, a more precise, comprehensive and educationally informed framework is proposed, broadening the video options to 10 complementary applications. Systematic links are made between these applications, the core supervision competencies, and the related workshop content (especially training objectives and learning outcomes), culminating in an educational rationale for the use of video within a supervisor training curriculum. It is concluded that application of this framework can enhance the effectiveness and efficiency of supervisor training, helping to maintain progress.

Socializing a client to the cognitive behavioural model is advised in almost every cognitive behavioural therapy (CBT) textbook, but there is limited evidence for whether socialization is measurable or important. The aim of the study was to pilot a written and interview-based measure of socialization to investigate whether socialization to the model can be measured in a sample of young people who have completed CBT. Sixteen participants (mean age 14.9 years, 75% female) completed a semi-structured socialization interview and a novel written measure of socialization. Treating clinicians were asked to provide subjective ratings of participant socialization. The structure and content of these measures was examined. A moderate but non-significant correlation was found between the novel written measure of socialization and clinician rating of socialization (r = .37). The concept of ‘socialization’ is not well understood and the socialization interview presented mixed, unclear results. This may be due to issues with the design, but may also be that socialization, as currently understood, is more complex than can be captured in this way. The important aspect of this study is introducing the concept of measuring socialization and factors that may be important in future research. Socialization to the model is an important construct within CBT but at present is a challenging concept to measure. Future research will need to focus on operationalizing the concept further and refining measures so that it can be accurately captured. Understanding which therapist and client behaviours contribute to the process of socialization could conceivably improve outcomes, but this cannot be done until this area is understood more fully.