Group cognitive behavioural therapy (gCBT) is commonly used in Increasing Access to Psychological Therapies (IAPT) services. However, there is limited knowledge of the efficacy of gCBT as a delivery format for generalised anxiety disorder (GAD). To address gaps in literature, this study aims to explore the efficacy and attrition of individual and group CBT interventions, respectively, at Step 3 for GAD using data from a routine IAPT service over a 24-month period. Data were retrospectively derived from a routine serviceʼs IAPTus database, separating those eligible for comparison into group (n = 44) and individual (n = 55) CBT for GAD. Outcomes were differences in pre–post self-reported anxiety (GAD-7) and depression (PHQ-9) scores, clinical recovery and attrition for gCBT and individual CBT. Both gCBT and individual CBT yielded significant reductions in self-reported anxiety and depression scores over time. Results indicate that 53% of patients attending individual CBT achieved clinical recovery, with similar but less competitive rates of 41% in gCBT. Attrition rates were similar between gCBT (29.5%) and individual CBT (27.3%), respectively. Preliminary results suggest that both individual and gCBT are effective interventions for GAD patients in IAPT, offering symptom alleviation and comparable recovery and attrition rates post-intervention. This observational design offers credibility and insight into a pragmatic evaluative and explorative comparison. gCBT may offer an acceptable and potentially economical alternative.

This paper is clinical practice-based, and examines the Greek cultural linguistic schema of Politeness Plural in the application of the Schema Therapy mode model. The philosophical principles of Schema Therapy and the importance the model ascribes on creating a warm therapist–client relationship as a pre-requisite for schema healing are discussed. We further explore the need for the therapist to be culturally sensitive to the linguistic use of Politeness Plural in Greek-speaking populations. We are looking into the reasons of why, whilst culturally sensitive, a schema therapist needs to remain inquisitive of potential maladaptive and/or internalized dysfunctional coping mechanisms of inter-relating that are masked by the use of the Politeness Plural linguistic schema. The implications the cultural linguistic schema of Politeness Plural can have in the therapy outcome are considered. Specifically, we argue that holding on to the Politeness Plural cultural linguistic schema may reinforce emotional distancing and compromise schema healing. The authors identify the need for more research to further understand the issues that are raised in this article. Although the focus of the article is on Greek populations, the matters under consideration may be valuable to other cultures.

Research on the relationship between military service and eating pathology has yielded mixed findings. Among those of military backgrounds, anorexia nervosa typically presents with co-occurring disorders that complicate diagnosis and treatment. The purpose of this paper is to present a case report of a retired Navy midshipman. The patient sought treatment for obsessive compulsive disorder (OCD), but his assessment revealed the primary pathology to be anorexia nervosa. This case illustrates ways in which military life may contribute to eating pathology and the complex overlap and differential diagnosis of anorexia nervosa and OCD.

The lifetime prevalence of OCD in the UK is estimated to be between 1 in 100 and 1 in every 50 people. It is therefore necessary to explore innovations in practice to expand the reach of the gold standard therapeutic approaches of exposure with response prevention (ERP) and cognitive behavioural therapy (CBT). The COVID-19 pandemic has facilitated such innovations with several services accommodating changes to routine practice by utilising digital platforms to provide videoconference-delivered therapy. Despite a growing evidence base demonstrating efficacy and scope for the use of videoconference-delivered CBT for obsessive-compulsive disorder (OCD), there remains qualitative research collated from clinicians which suggests that a lack of practitioner confidence and a low belief in positive outcomes are barriers to adopting remote therapy practices for clinicians. Therefore, this structured case report describes the assessment, formulation, intervention and outcome of an 11-week videoconference-delivered therapeutic intervention. Reflections are made regarding the use of the digital platform throughout the intervention, alongside the strengths and difficulties of applying videoconference-delivered CBT for OCD.

Kleptomania is an addiction to stealing without an economic motive; therefore, an examination of effective interventions as a preventive measure is needed. The effectiveness of cognitive behavioural therapy (CBT) combined with mindfulness for the treatment of addiction has been previously indicated, and it is presumed to be effective for kleptomania; however, this relationship remains unstudied. Therefore, this study aimed to examine the effectiveness of cognitive behavioural group therapy (CBGT) combined with mindfulness for treating kleptomania. The results of a 12-session programme of CBGT combined with mindfulness for 22 patients with kleptomania showed that kleptomania symptoms and quality of life (QOL) improved. Furthermore, the recovery process revealed that the improvement of distress tolerance affected the improvement of kleptomania symptoms and that the improvement of reward perception and distress tolerance affected the improvement of stress response and QOL. These results suggest that CBGT combined with mindfulness may be effective in improving symptoms and QOL in kleptomania.

A range of clinicians (n = 72) were asked to provide a definition of a schema. The participants were selected from different parts of the broad church of the CBT community, with all having received some training in CBT – although only 26.4% had a formal CBT qualification. Fourteen themes were identified, suggesting that the concept is perceived to be complex. However, the mean number of themes identified per clinician's definition was small: 2.86 (mode = 2). We consider this finding reflects a problem concerning a lack of clarity with respect to the use of one of the key concepts in CBT.

Application of a self-practice self-reflection (SP/SR) framework to clinical training programmes for those learning cognitive behavioural therapy (CBT) have demonstrated positive outcomes. These programmes have typically resulted in reports of enhanced learning, improved clinical skills, heightened empathy, improved interpersonal skills, increased self-awareness, and self-development for those undertaking such training. However, the utility of specific activities within this framework for enhancing trainees’ learning still requires exploration. This study sought to explore the use of a low frustration tolerance (LFT) exercise to enhance trainee’s learning around issues relating to frustration and discomfort tolerance. It also further explored the possible application of SP/SR as a form of competency-based assessment. The study was based on 41 student trainees that engaged in a self-directed LFT exercise. Written reflections on these exercises were then thematically analysed. From a competency basis, the exercise provided an approach for observing the trainee’s competency with formulation skills, intervention planning, and self-reflective capacity. Participants reported both personal and professional development outcomes from the exercise. These included a ‘deepened’ understanding of cognitive behavioural principles related to their experiences, both in terms of principles relating to maintenance of dysfunction and to creating change. Increased self-awareness and learning outcomes relating to the development of interpersonal skills were also commonly reported by trainees.

This paper outlines a pilot validation study of the newly developed Behavioural Couple Therapy Scale for Depression (BCTS-D). The BCTS-D aims to assess therapist competence in delivering behavioural couple therapy (BCT) and provide therapists with summative and formative feedback on their performance. Completed by both therapist and supervisor, this will aid therapists’ reflection on practice and improve performance. This paper will report on two stages in the development of the BCTS-D: (a) a study evaluating content validity, face validity and usability and (b) a focus group examining usability and utility. Both parts of the study were conducted in the context of a BCT training course and included 20 participants who were either BCT supervisors or BCT trainees. Results suggest that the BCTS-D has good face validity, content validity and usability, and provides a useful tool for promoting self-reflection and providing formative feedback. The studies also provided insight into the strengths of the scale and into areas of refinement, and a number of modifications were undertaken to improve the BCTS-D in response to feedback collected. Future research will need to focus on evaluating the psychometric properties of the BCTS-D and continue to adapt the scale to its users’ needs.

Obsessive-compulsive disorder (OCD) is a common and debilitating disorder that frequently begins in childhood and adolescence. Previous work (Bolton et al., 2011) has demonstrated that brief CBT (5 sessions), supplemented by therapeutic workbooks, is as effective as more traditional length (12 sessions) therapist-delivered treatment for adolescents with OCD. However, as was typical at the time, the treatment was developed with very limited patient and public involvement (PPI) and was delivered in the context of a randomised controlled trial which might affect translation to routine child and adolescent mental health services (CAMHS). To be able to implement such treatment within routine clinical services, it is crucial that it acceptable to young people, their families and the clinicians delivering the treatment. The aim of this project was to improve the acceptability of the brief treatment through PPI and consultation with clinicians, and consider issues relating to implementation. This was done through written feedback, interviews and focus groups with five adolescents and two parents, and a focus group and a half-day workshop with 12 clinicians. This led to revisions to the workbooks and materials to improve (a) acceptability by updating the design through changes to wording, language and images, and to ensure that they were consistent with values of equality, diversity and inclusion, and (b) usability by clarifying, adding, removing content, and organising the materials in new ways. We emphasise the importance of continued PPI throughout the project to maximise the translation of findings into practice.

This paper describes a service development which arose from an adult mental health inpatient ward team who wanted to be able to work more effectively to help patients who had major difficulties with emotion regulation. It was proposed that enhancing mindfulness through a Mindfulness-based Cognitive Therapy (MBCT) programme within the core staff team would enhance therapeutic milieu and therefore general outcomes associated with engagement and recovery. The training delivered was an adapted 8-week MBCT programme. A double baseline design was used with measures taken at 1 month before training and immediately before the programme started. Standardized and non-standardized measures were administered at pre-, mid-, post-, and 1-month follow-up points. Workshops and interviews supported the investigation of staff experience and impact of MBCT training. Participants in the training were nursing and occupational therapy staff. The trainer was the first author (C.M.), who is a cognitive behavioural therapist and mindfulness teacher at Newcastle Cognitive and Behavioural Therapies Centre, specializing in emotion regulation and stabilization. Results showed that staff reported a significant increase in mindfulness which had a positive impact upon their wellbeing and perceived ability to respond skilfully to challenging situations at work and at home. Gains were mostly in the first half of training but were maintained to the end and to follow-up. This adapted mindfulness training course appeared to be effective in meeting the need for a group of clinical staff to develop mindfulness. The potential impact upon patient engagement has been identified but further research into this area is indicated.

Multi-morbidity, having more than two diagnosed health conditions, is becoming increasingly common within healthcare services. Approximately one third of these patients are likely to have a mental health condition. Those with multi-morbidity with physical and mental health conditions have poorer outcomes in terms of their health, increased mortality rates, and higher usage of healthcare services.

This paper presents a case of a patient with multi-morbidity, with associated mental health conditions of anxiety and depression. She was seen as part of an integrated service which provides psychological support at home alongside the nursing team. The intervention used was based on transdiagnostic cognitive behavioural therapy (tCBT), provided over nine initial sessions and two additional booster sessions. Self-report measures were completed at intervals throughout the intervention and at follow-up. Improvements on the depression and anxiety measures were seen over the initial nine sessions, followed by a relapse at the 3-month follow-up. This was the result of a deterioration in physical health which led to a deterioration in mental health. The booster sessions mitigated further deterioration in mental health, despite the physical health worsening during this time.

This case suggests that tCBT can be helpful in reducing anxiety and depression in people with multi-morbidity. However, additional booster sessions may be required as further physical deterioration can re-trigger core beliefs and result in further mental health problems.

Hoarding disorder is a surprisingly common problem which impacts on most areas of life. People who hoard typically have multiple agencies involved in their care due to the complex health and safety impact and risks associated with hoarding. ‘Treatment’ involves finding ways of supporting discarding large amounts, typically underpinned by CBT principles. We evaluated the impact and outcomes of a conference designed to boost professionals’ confidence and understanding in working with hoarding problems, both individually and with other agencies with a view to improving inter-agency service provision. Changes in professionals’ confidence and understanding were evaluated immediately before and after the conference. Conference participants’ qualitative responses related to service improvements were analysed using content analysis. People with personal experience of hoarding issues subsequently participated in a focus group where the results of the conference were presented. These data were analysed using thematic analysis. Confidence and understanding in working with hoarding problems substantially increased from pre- to post-conference. Professionals identified a range of possible improvements, most commonly working more closely and improving communication with other agencies. People with personal experience suggested improvements across three over-arching themes: developing an improved understanding of hoarding, the need for improved resources, and improved multi-agency working. A multi-agency conference increased confidence and understanding in professionals working with hoarding problems, and improvements specified by both people with personal experience and professionals provide a useful guide to service improvement. Results provide a framework in which CBT approaches should be embedded.

Scotland and Wales share the opportunities of devolved government as well as challenges such as urban deprivation and remote rural communities. Such commonalities make a comparison of their approaches to psychological therapies relevant. The Scottish and Welsh governments have both published guidance concerning improved access to psychological therapies and these reveal different approaches. The Scottish Government has provided clear and concrete guidance for services, retains a close overview of progress, and plans training from the centre. The Welsh Government has published guidance which is unspecific, has largely devolved responsibility for implementation to local health boards and has no central plan for training. Scottish guidance provides clear information about who can expect to receive specific evidence-based therapies, the number of sessions they can expect to receive, and crucially the level of training and competence required for therapists. Welsh guidance documents have not yet specified which patient groups can expect to access formal psychological therapies, which psychological therapies are considered to have a sound evidence base, the number of sessions patients can expect, or the level of training and competence required for practitioners. Welsh policy documents make no reference to competence frameworks for therapists.

Wales has not adopted the English IAPT system and has no centralized training plan for developing cognitive behavioural therapy (CBT) in Wales. However, Welsh Government policy expresses an ambition to improve access to evidence-based psychological therapies for people in Wales. This study focuses on one Welsh Health Board's plan to improve access to CBT. The study aims to benchmark support for effective delivery of CBT in the Health Board against NICE and Department of Health standards, and to establish whether the Health Board's plan is succeeding in developing staff capability and access to evidence-based CBT. Mental health staff funded by the Health Board to complete accredited training in CBT were asked to complete an online questionnaire asking about their training, accreditation, use of CBT, and experience of workplace support for delivering CBT. The standards were taken from the Department of Health competency framework for CBT, NICE guidelines and BABCP safety and confidentiality criteria. The Health Board performed well across seven standards of workplace support for the delivery of evidence-based CBT. Staff funded to undertake accredited CBT training continued to develop and to use CBT in their everyday clinical practice. The study indicates that the Health Board is succeeding in offering good standards of workplace support for CBT, including access to accredited CBT training. A recommendation is made that this be shared with other Welsh Health Boards and that a comparable study be undertaken within an IAPT service.

Due to the growing evidence base supporting the hypothesis of common processes across different mental health problems, transdiagnostic interventions are receiving increased research attention. Transdiagnostic approaches have the potential to produce better outcomes, to reduce waiting times and to increase cost-effectiveness in stretched mental health services. Research into transdiagnostic cognitive behaviour therapy (CBT) in group format has demonstrated positive results in participants with anxiety disorders, with some studies extending the inclusion criteria to secondary and comorbid symptoms. This study evaluates a transdiagnostic CBT-based intervention, delivered by a secondary-care mental health team and includes participants with a range of diagnoses typical of this population. The real-world setting and lack of exclusion criteria based upon diagnosis provides an ecologically valid evaluation of a transdiagnostic CBT-based intervention. The results suggest that the intervention was associated with reductions in self-reported symptomatology and improvements in social functioning of individuals who attended in a secondary-care mental health service.

In this paper, rational emotive behaviour therapy (REBT) is presented as the most comprehensive cognitive behavioural therapy (CBT) to date, with over-arching influence on most of the other therapies that came after it. However, despite REBT’s comprehensiveness and the limitations inherent in other CBT approaches, REBT has its limitations. Limitations in REBT theory are explored and an argument is made in favour of rectifying these limitations by incorporating other approaches into REBT (namely cognitive therapy and compassion-focused therapy) to create a more complete integrative psychotherapy model. It is then argued that psychotherapy integration is the future of CBT mainly due to the fact that it reflects how most therapists practise, and due to its utilization of the common factors theory. Finally, the integrative model – which I call Assimilative Integrative Rational Emotive Behaviour Therapy – is presented and demonstrated using a clinical case example.

The identification of personality disorder among mental health service users is problematic but important because it is associated with high levels of comorbidity and possibly ineffective service delivery. This study assessed the prevalence of personality disorder using the Millon Clinical Multiaxial Inventory – 3rd edition (MCMI-III) compared with prevalence using frequency of assignment of diagnosis in people referred to an in-patient CBT clinical psychology service. Prevalence rates differed from 85% (MCMI-III) to 16% (diagnosis) using these different measures. Reasons for this difference and implications for CBT therapists' practice are discussed.

Borderline personality disorder (BPD) is a mental health condition characterized by emotion dysregulation, interpersonal impairment, and high suicidality. Dialectical behaviour therapy (DBT) is the most widely studied psychotherapeutic treatment for BPD. To date, the vast majority of DBT research has focused on cisgender women, with a notable lack of systematic investigation of sex and/or gender differences in treatment response. In order to encourage effective, equitable treatment of BPD, further investigation into treatment targets in this population is critical. Here, we employed a systematic strategy to delineate gaps in the DBT literature pertaining to sex and gender differences and propose directions for future research. Findings demonstrate a significant discrepancy in measurement of sex and gender, particularly among gender-diverse individuals. Exploring DBT treatment response across the full spectrum of genders will facilitate the provision of more tailored, impactful care to all individuals who suffer from BPD.