The term schema is often used to describe core beliefs, both functional and dysfunctional, developed in childhood. We believe that this view is rather mono-dimensional, and that by taking a broader perspective lessons can be learned from other fields. In this paper we examine the various theories of schema with a particular focus on the memory perspective to examine the acquisition of skills in sports. In terms of memory theory, performance of a set of actions (running a race, jumping a hurdle, playing chess) creates neural activity in the body across numerous domains (motor, visual, psychological), and repetition lays down a neural network that can be built upon and altered over time. We believe that the examples discussed in the context of sport can be used to help clinicians reflect on the concept of schema, and thereby re-examine assessment and treatment options.

In the UK there has been a drive towards facilitating swift access to psychological therapies. Groups are an efficient way to provide psychological interventions to a wide range of people and are recommended treatments for mild depression and anxiety, presentations commonly seen in primary care mental health teams. Group cognitive behavioural therapy (CBT) has been shown to be clinically effective, but less is known about the acceptability of groups to patients. This study evaluated patient satisfaction with CBT groups running within a primary care mental health team in Scotland. Data from a routinely administered patient satisfaction questionnaire were collected. Likert-scale responses were analysed via frequencies and percentages, and free text responses were analysed via thematic analysis. Among those who completed a group, overall satisfaction was high. The qualitative analysis revealed that for many a group environment was therapeutic in itself, and the intervention provided service users with a range of skills with which to tackle their difficulties. However, others indicated that a group environment was unsuitable for their needs, and perceptions around the accessibility and relevance of group content were mixed. Indeed, drop-out rates were high, and perceptions of groups among those who did not attend the final session are not included in this analysis. Group dynamics may be both a facilitator of and a barrier to therapeutic benefit, depending on individual factors. Future studies could evaluate satisfaction among service users who drop out of interventions in order to inform future service delivery.

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.

In slow-open groups as well as therapies of less than ten sessions, each group session holds importance. Patients, therapists and co-therapists have different perspectives and may gain different experiences from a group session. This study investigates the perspectives of patients, therapists and co-therapists on alliance, new insights and therapist techniques in the same group session. Do the three actors perceive these group aspects similarly or differently? Which group aspects are related with the outcome coping? One hundred and forty-nine sessions of a cognitive behaviour therapy group have been investigated. Patients, therapists and co-therapists gave ratings on their perceived alliance, group topics and insights as well as therapists’ technique competency. Concerning new insights, there was concordance between patients and co-therapists (r = .211, p < .05). Concerning alliance, there was a concordance between patients and therapists (r = .327, p < .01). Therapists focusing on alliance building was associated with lower patient outcomes in terms of work coping (β = –.391). The quality of therapeutic techniques was the same in groups with higher and lower outcomes. Patients’ perception of whether they felt good in the group session was explanative for session outcome, while therapists’ perceptions and context conditions (supervision, number of participants) was not. Patients, therapists and co-therapists have different perspectives on the same group therapy session. Patients’ perceptions are associated with session outcomes. A lower session outcome must not be associated with a poor technique performance of the therapist. Therapists should not only be aware of alliance building and correct technical performance, but they must also be aware of patients’ perceptions of the group process and outcome.

Anorexia nervosa (AN) is a notoriously costly and challenging psychiatric illness to treat. Despite an accumulating evidence base, psychological treatment fails to achieve symptom abstinence in many patients with eating disorders, a shortcoming that is likely to be further pronounced in AN. The case study reported here describes how a mutually agreed break in a course of psychotherapy following an initial lack of progress might have influenced outcome for a client with a severe eating disorder. The patient received 26 sessions of CBT and results, consistent with those of larger studies, showed significant improvement on primary symptom measures. These results are discussed in the context of relevant psychological theories and an exploration of the client's motivation. Consideration is also given to other factors that may have influenced outcome.

Mental health problems have a significant impact globally in terms of social and economic costs. Increasing access to and uptake of mental health interventions (particularly by men) remains a challenge for service providers. The current study sought to examine the efficacy of a delivering a Stress Control intervention in partnership with a community sporting organisation (the Gaelic Athletic Assocaition, GAA) in ameliorating mental health difficulties in a general population. Measures of anxiety, depression and quality of life were administered before and after the delivery of the 6-week programme. A focus group was conducted afterwards to gather qualitative data on participants’ experiences of the intervention. Statistically significant decreases in depression scores were found following attendance at the course: t (94) = 3.14, p = .002, with a large effect size (0.5) (n = 95). There was an increase in the number of male attendees compared with clinic-based courses. Thematic analysis of the focus group data revealed a number of key themes including increased accessibility in terms of the scale and context of the delivery of the course. Delivering large-scale psychoeducational courses like Stress Control in partnership with the GAA represents a promising avenue for increasing access (for males in particular) to an effective intervention for improving mental health outcomes

Self-help therapies, such as bibliotherapy, are becoming increasingly more available to the general population as a treatment for psychological disorders, such as depression and anxiety. However, relatively few of these self-help books are properly evaluated to test their treatment efficacy. Two studies aimed to test a new self-help book to treat fears, phobias and anxiety in order to see if symptoms of anxiety and associated symptoms, such as functioning and coping, were improved compared to baseline scores and a waiting-list control group. Study 1 adopted a minimal guided approach (experimental group: n = 25; waiting-list control group: n = 29) whereas Study 2 adopted a non-guided approach (experimental group: n = 17; waiting-list control group: n = 16). In both studies, functioning and coping were improved and the current state of phobic symptoms was reduced. The main phobia improved only when adopting a guided approach and general psychological distress only reduced when adopting a non-guided approach. These studies provide preliminary support for a modest effect in a subclinical population. The results could have good implications for the treatment of anxiety and the use of self-help methods as an additional treatment aid or as a preventative treatment.

Within the field of adult mental health, self-help is now a pivotal treatment modality. However, earlier research indicates that some individuals react negatively to this. Through three, small-scale studies, this paper explores both clinicians’ experience of harm in patients as a response to self-help materials as well as patients’ own reports. In Study 1, a postal survey was administrated to clinicians; in Study 2, semi-structured interviews were conducted with clinicians; and in Study 3, patients were sent a postal survey. Over 18% of clinicians indicated that they had experienced self-help materials resulting in harm to patients. The interviews uncovered four main themes: the patients’ clinical presentation, how the materials were presented within the therapeutic contact, certain personality characteristics in patients, and the characteristics of some materials. Between 12% and 24% of patients reported experience of negative effects (depending upon how this is defined), although the latter finding is limited by a small sample size. Proposals are made that are linked to best practice and it is suggested that there is a generic training need for clinicians in materials’ use.

Competencies for psychiatric training have been developed that reflect what psychiatrists have to be able to do in order to function in their role. Although the need for a formally delivered psychotherapy experience is assumed and associated competencies are represented in the curriculum, it is not clear which competencies thereby achieved can be translated into generic practice. This paper reports the outcomes of a workshop held at an academic regional meeting of the Royal College of Psychiatrists. Potential competencies to be achieved following training and experience in CBT were presented. Small group review of the frameworks and subsequent feedback demonstrated broad support for requirements of CBT knowledge and attitudinal competencies that could inform day-to-day practice, within a generic psychotherapeutic skills framework. New competencies that were related to CBT and considered meaningful in daily psychiatric practice emerged. Further development of these ideas from the workshop in this paper leads to a set of coherent competencies that would be helpful in non-CBT specialist practice and are congruent with the context of generic psychiatric practice. These enable models of training other than the delivery of a single ‘brief’ psychotherapy case to be considered.

Cognitive behaviour therapy (CBT) is now the psychological treatment of choice for psychosis but meta-analyses indicate a low effect size on delusions, so further innovations are clearly needed, and group CBT for psychosis (GCBTp) is an under-researched area. This study aimed to service-evaluate the feasibility, satisfaction, safety, and effectiveness of a CBT group specifically targeting medication-resistant single delusions in early psychosis patients (EI-GCBTp). Three separate EI-GCBTp groups were run resulting in a total of 11 medication-resistant early psychosis patients. A within-subjects design tested for group change across two time points: pre-baseline (4 weeks before treatment) to baseline (session 1 of treatment) and sessions 1–8 (the treatment period). Thirteen delusion dimensions were measured from three psychosis-specific questionnaires: The Psychotic Symptom Rating Scale (PSYRATS), Characteristics of Delusion Rating Scale, and the Belief Rating Scale. At least three patients attended each group, satisfaction scores were high, and no harm to patients was identified. With reference to effectiveness, the pre-baseline period showed virtually no change. In contrast, across the EI-GCBTp treatment period, the PSYRATS total demonstrated a statistically significant decrease in delusional severity (p < 0.01), a 31% symptom reduction, and a large effect size (Cohen's d = 1.2, 95% confidence interval = −2.53 to 0.05), statistically significant across four delusion dimensions. EI-GCBTp appears feasible, acceptable, safe, and preliminary uncontrolled effectiveness results suggest merit for larger-scale more rigorous testing of this treatment format for possible dimensional improvements of persistent delusions.

More than half of college students endorse experiencing at least one traumatic event. Consistent with other populations, the rate of post-traumatic stress disorder (PTSD) for college students has been reported at around 12%. Despite this, empirically supported treatments for PTSD have not been widely disseminated in University Counselling Centers (UCCs). This study examines outcomes using cognitive processing therapy (CPT) with a sample of n = 26 college students in a UCC setting. This study also examines therapist experience, length of degree and symptom severity on outcome. After completing training, n = 8 therapists completed CPT consultation and certification. Students who participated in individual CPT during this process were administered the PCL-5 and PHQ-9 at weekly sessions. A retrospective chart review was completed. PCL-5 and PHQ-9 scores were separately examined as outcome variables using linear mixed models where session, therapist experience, length of therapist degree, and severity of symptoms were included as fixed effects, and subjects were assumed to have a random effect. Significant reductions in PCL-5 and PHQ-9 scores were observed across treatment. In this sample, 84.6% of students were treatment responders. Results were unchanged when adjusting for therapist level of experience or training. CPT shows strong potential for UCC settings. CPT can be successfully implemented with novice therapists.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition, characterised by unexplained and excessive fatigue, muscle pain and sleep disturbances. Health anxiety is common in ME/CFS and accurate measurement is essential in facilitating therapeutic gains. However, there are clinical concerns over the utility of the Short Health Anxiety Inventory (SHAI) in measuring health anxiety in this population. This study aims to use qualitative responses from two ex-service users and specialist health clinicians to explore the barriers to completing the SHAI within a specialist ME/CFS service. Qualitative responses from a focus group consisting of 15 specialist health professionals including occupational therapists, physiotherapists, dieticians, cognitive behavioural therapists, counsellors, clinical psychologists and assistant psychologists were transcribed and analysed for themes. Patient voices were represented by two former service users through individual semi-structured interviews on the telephone, which were recorded, transcribed and later analysed thematically. Clinicians and service user involvement agreed on core difficulties with the utility of the SHAI in the ME/CFS population. The timing of the SHAI being administered pre-diagnosis, the language of the SHAI and lack of context around the questionnaire were identified as barriers that were likely to contribute to the SHAI not being completed by service users. Sensitive and accurate measurement is required in order to retain patient engagement, which could further facilitate appropriate assessment and treatment of health anxiety and ME/CFS. Findings suggest that adaption of the SHAI is vital for use with ME/CFS.

Many parents of children with anxiety tend to engage in varying levels of family accommodation (FA) in order to alleviate anxiety symptoms. This can exacerbate anxiety symptoms and have adverse effects for psychological treatments. A small number of general and specific interventions have been developed for FA but treatment research is at a nascent stage. Acceptance and commitment therapy (ACT) may be an effective treatment for FA. This article reviews the potential advantages and uses of ACT and how ACT’s six core processes can help target particular features of FA. The theoretical support for ACT is reviewed relevant to FA. The article concludes by conjecturing how ACT may be a useful and adaptive treatment in targeting FA.

Cognitive Behavioural Therapy (CBT) including Exposure and Response Prevention (ERP) is recommended by NICE as the psychological treatment of choice for obsessive compulsive disorder (OCD). Twenty-five percent of OCD patients refuse ERP, and many psychologists advocate formulation-driven cognitive therapy, including ERP, as opposed to ERP alone. However, a recent meta-analysis suggested there is insufficient evidence to suggest ERP is improved by cognitive methods. This paper proposes to contribute to this debate by providing a detailed description of the treatment of a patient with intrusive cognitions of a sexual nature, who was treated successfully using behavioural experiments designed to test cognitions, rather than ERP. This is, arguably, the way in which most cognitive behavioural therapists would work with someone with OCD. However, this approach is not reflected in the literature at present. The authors report the patient's feedback that therapeutic change was brought about through cognitive shift, as a result of the formulation-driven behavioural experiments.

The NICE guidance states that cognitive behavioural therapy (CBT) should now be offered to everyone with psychosis in the UK. This has rightly resulted in an increased demand for adherent therapy from qualified clinicians. Individualised formulation is a key component of CBT for psychosis, yet many trainees struggle to make sense of and apply the theoretical models on which these are based. This study explored trainee and recently qualified therapists’ experience of formulating CBT for psychosis, to help us understand how best to guide training and clinical practice. We ran focus groups with trainees who were completing, or had recently completed, postgraduate training in CBT for psychosis. We then analysed verbatim transcripts of the semi-structured interviews. and completed a thematic analysis of the data using inductive open coding. Three over-arching themes were generated: (1) purpose of formulation, (2) formulation in practice, and (3) (reflection on) learning to formulate. Training programmes and clinical supervisors should focus on fostering trainees’ and newly qualified therapists’ ability to develop simple, targeted formulations. These will draw on maintenance and developmental models of psychosis, depending on the person’s needs and goals. Opportunities for procedural learning are likely to improve skilful formulation, and use as the basis for therapeutic change.