Depression and anxiety are major contributors to growing healthcare costs in the UK, particularly with an increasingly ageing population. However, identification of mental health needs in older adults has been overshadowed by a tendency to focus on physical health issues, despite the established co-morbidity of depression, anxiety and physical health conditions. When older adults seek psychological support, treatment options may vary and may be time limited, either because of protocol guidance or due to the resource constraints of psychology services. Time-limited treatment, common in many adult services, may not best meet the needs of older adults, whose physical, cognitive and emotional needs alter with age. It is, therefore, important to identify treatments that best meet the needs of older adults who seek psychological support, but who may arrive with complex mental and physical health histories. This paper aims to explore how a case formulation-driven approach that draws on the theoretical underpinnings of cognitive behavioural therapy (CBT) and compassion-focused therapy (CFT) can be used to reduce anxiety and depression in an older adult with a complex multi-morbid mental and physical health history. This study employs a single-case (A–B) experimental design [assessment (A), CBT and CFT intervention (B)] over 28 sessions. Results suggest the greatest reductions in depression and anxiety (as measured using PHQ-9 and GAD-7) occurred during the CFT phase of the intervention, although scores failed to drop below subclinical levels in any phase of the intervention. This case highlights the value of incorporating CFT with CBT in case formulation-driven interventions.

Mental health problems are prevalent among therapists and may have a negative impact on therapist effectiveness. To counteract such problems, therapist self-care (for example, striking a balance between personal and professional demands and seeking personal therapy), has received increased attention. Conceptually, self-care can be considered as part of a personal practice model, focusing on techniques that therapists engage with self-experientially with a focus on their personal and/or professional development. However, studies of the self-application of specific treatment techniques are lacking. We aimed to explore the use, and perceived usefulness, of cognitive behavioural therapy (CBT) techniques for self-care to prevent or treat own mental health problems among practising therapists. Participants were therapists (n = 228) of various professional backgrounds in Sweden. Data were collected using a web-based survey. Descriptive statistics were calculated, and non-parametric analyses conducted to investigate associations of 13 CBT techniques with therapist characteristics. Use of CBT techniques for self-care was highly prevalent among participants, and they perceived the techniques as useful, irrespective of characteristics such as gender, age, profession, years since graduation, clinical experience, level of training in CBT, and previous experience of personal CBT. The high prevalence among therapists of the use of treatment techniques for self-care is very encouraging. Therapist self-care, including the self-application of treatment techniques, may be an important factor for therapist effectiveness, which calls for further development of personal practice models with respect to self-care, and future studies investigating associations between therapist mental health, self-care, effectiveness and patient outcome.

This article provides guidance on the management of challenging behaviours (CBs) in dementia care, and introduces concepts from positive behavioural support not usually applied to dementia. While the use of formulations has received a lot of attention in recent years, the mechanisms of how to apply the formulation-led interventions requires more consideration. In order to assist caregivers to deliver effective interventions we need to have a better understanding of the CBs we are attempting to manage, and also produce management strategies with clearer goals. Ideally we would also want caregivers to be able to describe the skills they employ in a coherent manner in order to facilitate self-reflection and to be able to pass on their skills to junior colleagues. This paper attempts to fulfil these needs by integrating two new models with philosophies already used in dementia care. In terms of new concepts, the first is the Arousal Cycle, which gives caregivers an awareness of the five phases of a typical CB (wellbeing, trigger, escalation, CB, and recovery phase). In relation to the second, the Traffic Light analogy examines CBs in terms of four management stages: primary prevention, secondary prevention, reactive strategies, and calming strategies. It is proposed that we distinguish between these stages when composing our formulations and care plans, and thereby produce better targeted interventions. By the end of the paper the reader will have been presented with material integrating concepts from the fields of dementia and intellectual impairment, and been introduced to new ways of managing CBs.

Britain has increasingly become a multi-cultural society. In order to improve access to primary care psychological therapy including cognitive behavioural therapy (CBT), there has been an increase in focus on cultural adaptation and cultural responsiveness. To date, these adaptations have focused on domains such as language, beliefs and values. In this case, familism was the focus for adaptation. The client was a 22-year-old female from a black African-British background. She presented with severe symptoms of chronic depression as measured on routine standard questionnaires and the interview. She had minimal success from previous interventions and was struggling to make progress. Therapy was guided by the client’s views on what issues had a bearing on her difficulties. The client hypothesised that familism factors with themes around ‘my parents’ culture’ and ‘family comes first’ were interacting with her cognitive behavioural factors to maintain her problem. She requested the involvement of her family in her treatment plan. In line with the Improving Access to Psychological Therapies–Black, Asian and Minority Ethnic service user Positive Practice Guide, this was integrated as part of her formulation. Upon involvement of her father in a single session, the client attained reliable improvement. She attributed her improvement to this involvement. By the end of therapy, she reached recovery, which was maintained at 3-month follow-up. This study was responsive to the client’s own perceived cultural needs through the integration of familism into her CBT formulation. It illustrates a client-led cultural adaptation of CBT to treat chronic depression.

Eleven cognitive behaviour therapy (CBT) trainees in Scotland were interviewed regarding their experiences of clinical supervision and its impact on their skill development. Using thematic analysis, the authors developed four main themes: Linking Theory to Practice, Mirroring CBT in Supervision, The Expert Supervisor, and Trainees’ Reluctance to Give Negative Feedback. Clinical supervision was essential in helping trainees to link theory to practice; particularly through audio recordings, discussing formulations, and modelling and role-play. A CBT-specific approach to supervision and a CBT expert supervisor were also identified as valuable to learning. Trainees were reluctant to give negative feedback to supervisors, fearing negative consequences. The findings inform supervision practice.

The main aim of this research was to investigate the effect of the 8-week group therapy intervention based on the integrative cognitive model (ICM) of bipolar disorder. The sample was composed of 10 patients with bipolar I and bipolar II diagnoses. The group sessions were held once a week for 1.5 hours. For the quantitative measures, the group participants were assessed during pre-test, post-test and 3-month follow-up using the Turkish versions of the Beck Depression Inventory, the Hypomanic Attitudes and Positive Predictions Inventory, the Psychological Well-being Scale and the Satisfaction with Life Scale. Quantitative analyses revealed that a reliable change was seen only in pre-test and post-test depression scores. However, this change could not be maintained at 3-month follow-up. For the qualitative analyses, data collected during semi-structured interviews were used. The thematic analyses results showed that the 8-week ICM-based group therapy was found to help participants make sound observations about their behaviors, decrease their feelings of loneliness and increase self-acceptance, and acceptance of the role of mood swings in their lives. Moreover, the results showed that participants found the following activities very beneficial: describing their emotions, evaluating the intensity of their emotions, identifying their life goals, coping with interpersonal conflicts, evaluating resources and going over strengths. In conclusion, the 8-week ICM-based group therapy had a positive impact on participants’ self-awareness, self-acceptance and self-perception.

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

This article provides clinical guidelines for basic knowledge and skills essential for successful work with clients who have obsessive-compulsive disorder (OCD) across ethnic, racial and religious differences. We emphasise multiculturalist and anti-racist approaches and the role of culture in shaping the presentation of OCD in clients. Several competencies are discussed to help clinicians differentiate between behaviour that is consistent with group norms versus behaviour that is excessive and psychopathological in nature. Symptom presentation, mental health literacy and explanatory models may differ across cultural groups. The article also highlights the possibility of violating client beliefs and values during cognitive behavioural therapy (CBT), and subsequently offers strategies to mitigate such problems, such as consulting community members, clergy, religious scholars and other authoritative sources. Finally, there is a discussion of how clinicians can help clients from diverse populations overcome a variety of obstacles and challenges faced in the therapeutic context, including stigma and cultural mistrust.

Co-morbid mental health diagnoses present challenges for services structured to provide disorder-specific models of treatment, such as those structured around Improving Access to Psychological Therapies (IAPT). Intolerance of uncertainty (IU) has been identified as both disorder specific and transdiagnostic, although little research explores transdiagnostic approaches to treatment of IU alone. A cognitive behavioural therapy treatment targeting IU previously established for individual therapy was adapted for a group within an IAPT primary care service: the ‘Making Friends with Uncertainty’ (MFWU) group. Twenty patients presenting with symptoms of a range of disorders including generalised anxiety disorder, obsessive compulsive disorder and depression completed the intervention in three groups. Measures of IU, anxiety and depression administered in the first and final sessions of the group have been analysed as well as examining common themes in participant feedback and facilitators’ own reflections. The results showed that nine participants (45%) showed reliable change in IU following the group and 16 (80%) showed reliable change on a measure of depression or anxiety. A thematic analysis identified universality, tolerance and acceptance and the manifestation of IU in the group process as key. The results suggest that the MFWU group provides an effective and feasible option for individuals presenting to IAPT services, including those reporting co-morbid difficulties. Implications for future practice are discussed as iteration and evaluation of the framework and content will continue.

Distress intolerance has been suggested to be a maintaining factor in several mental health conditions. Distress tolerance skills training has been found to be beneficial in emotionally unstable personality disorder (EUPD) and post-traumatic stress disorder (PTSD). Short-term targeted interventions are increasingly being implemented in response to demand. This study investigates the efficacy of a distress tolerance brief psychological intervention (DT BPI) delivered by non-psychologists within an adult secondary care mental health service. Questionnaire data (pre and post) are reported from 43 participants who completed the intervention. Results suggest that the intervention was associated with significant improvements in distress tolerance, mood, anxiety and wellbeing. This indicates that a DT BPI can be effective when delivered by non-psychologists to real-world adult secondary care clients. The findings offer promising evidence that DT BPI could be a beneficial, cost-effective intervention and warrants further large-scale investigation.

One-session treatment for specific phobias (OST; Öst, 2012) has been found to be efficient and effective in reducing the severity of phobia in an adult population. This study aimed to investigate the feasibility of OST in an Improving Access to Psychological Therapy (IAPT) primary care service in the North East of England. Participants were four women and one man between the ages of 21 and 46 years; all presented with needle phobia. Treatment consisted of three clinical contacts: a 1-hour pre-treatment interview to identify the catastrophic belief centred on the phobic situation; a 2.5–3-hour treatment session using exposure in vivo (i.e. images, videos and handling of a syringe – no actual injections) and participant modelling in accordance with OST protocol; and a 30-minute follow-up telephone appointment. Outcome was measured with standard IAPT and additional psychometrics, as well as qualitative client feedback. The outcome suggests the application of OST to be effective for needle phobia, as well as feasible and cost- and resource-efficient in its application to an IAPT primary care service. Further research needs to investigate its effects in comparison with multiple single sessions of cognitive behavioural therapy in an adult population, as well as appropriate outcome measures to suit an IAPT application.

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.

Research on self-practice/self-reflection (SP/SR) programmes in training cognitive behavioural therapy (CBT) have shown promising outcomes over the past decade. To date, the SP/SR framework research has generally focused on entire programmes and has rarely assessed the utility of specific exercises as teaching tools. This study aimed to determine the utility of an exposure intervention known as a shame attack in helping to facilitate CBT training in a clinical psychology programe when delivered in a SP/SR framework. It also sought to examine the potential for the exercise to be used as a form of competency-based assessment. Forty-one student trainees engaged in self-directed shame attack exercises and provided written reflections on their experiences. The reflections were then studied via thematic analysis. The results indicate that the exercise provides an avenue for competency-based assessment of trainee therapists’ conceptual knowledge, formulation skills and intervention planning. It also promoted learning outcomes relating to a ‘deeper’ and more nuanced appreciation of CBT theory and practice. The shame attack exercise provided for personal development and the opportunity to experience typical client challenges with engaging in exposure interventions, which have the potential for enhancing empathy and cognitive behavioural skills.

Like any treatment, cognitive behavioural therapy (CBT) may have negative as well as positive outcomes, and the same is true of CBT supervision. This is recognized in definitions of supervision, which prioritize helping supervisees to ‘do no harm’ to their patients. Client harm is associated with personal distress in supervisees (therapists), such as burnout, resulting in sub-standard therapy which causes harm to patients. Some supervisors have contributed to the supervisees’ distress, and consequently to patient harm. Harm may also arise from other staff members, or from situational factors that impact negatively on various aspects of the healthcare environment. At a more distal level, the host organization may create a context that allows such problems to go unchecked (e.g. a failure to train or support supervisors adequately). It follows that a large-scale framework is necessary to fully understand and address this multi-dimensional and systemic context for harm. Therefore, this theoretical review sketches out a preliminary ‘infidelity framework’ in order to classify ten types of problem behaviour that commonly contribute to harm that is linked to supervision. Drawing on related frameworks and neighbouring literatures, the infidelity framework also offers an understanding of the typical antecedents and consequences of each of these ten behaviours. This generic functional analysis leads to examples of evidence-based CBT supervision that might prevent or rectify harm.

Having and building a romantic relationship is an important aspect of development in young adulthood. However, there are some challenges in relationships, including basic principle differences such as faith and culture that lead to fights and break-ups. Going through a break-up is not easy for some people and is considered to be one of the stress sources in people’s lives that often links to depression symptoms. It is crucial to focus on intervention aiming at the cognitive aspects, including negative thoughts and bias when dealing with depression, such as cognitive behavioural therapy (CBT). However, CBT in the Indonesian context, especially with religious and ethnic problems in a romantic relationship before marriage, is limited. This study aims to explore this by presenting the case of a 26-year-old Indonesian male with depressive episodes after a painful break-up due to religious and cultural differences. The previous history of childhood abuse and problems in social adjustment and communication had also worsened his conditions. CBT was used for treatment as he developed many negative thoughts about himself and had maladaptive beliefs about his conditions and his future. This case study report shows the effectiveness of CBT intervention in decreasing depression symptoms, such as sadness and the thought of being unworthy, as well as increasing self-confidence in facing difficulties.

Clinical supervision is a cornerstone in psychotherapist training, but research in this area is hampered by a lack of validated tools for assessing supervision quality. Short–SAGE (Supervision: Adherence and Guidance Evaluation) is an observational instrument designed for evaluating supervision in cognitive behavioural therapy. The aim of this study was to evaluate the inter-rater reliability of Short–SAGE. Four experienced clinical psychologists participated in three 3-hour Short–SAGE coding training sessions, followed by an additional meeting and coding instructions. In a cross-over design, codings of 20 supervision sessions were then assessed with intraclass correlations (ICC), for both the 3- and 7-point scales of the instrument. In the single measure analyses for both scales, only one item showed ICC in the good range, and the rest of the 14 item ICCs were in the poor to fair range. Moreover, on the 3-point scale, five of the 14 inter-rater correlations were non-significant. For research and training purposes, validated tools to assess supervision quality are highly needed. However, instruments for measuring adherence and/or competence are of little value if the coders do not attain inter-rater reliability. Whether quality of supervision is associated with improvements in supervisees’ competencies is not yet clear. Short–SAGE provides a tool that may enable empirical research in this area. Further studies are needed to assess whether extensive training can improve the inter-rater reliability of Short–SAGE.

The current literature extensively recommends making cultural adaptations to psychological therapies, in order to address the differences in values, beliefs and attitudes that patients from different ethnic groups might hold. Although this approach has shown positive outcomes in some settings, it is not well established yet whether such adaptations are needed for all therapies and in all cultures. Therefore, the main aim of this study was to systematically review the literature regarding culturally adapted and ‘conventional’ cognitive behavioural therapy (CBT) for Latin American patients, within Latin American and non-Latin American countries. Sixty empirical studies regarding the effectiveness of culturally adapted and conventional CBT were included in this review. The included studies were carried out in Latin American and non-Latin American countries. The information from all studies was synthesized and assessed, including intervention effect sizes, patient retention rates, methodological quality of the papers, and the type of cultural adaptation made to the therapy. There were no differences between the sets of studies in terms of effectiveness, retention rates, methodological quality, or proportion of statistically significant interventions. Most of the cultural adaptations were peripheral or unspecified. The evidence to date indicates that both conventional and culturally adapted CBT offer the same benefits for Latin American patients in terms of effectiveness and retention rates. Rather than focusing on cultural adaptations, clinicians are encouraged to improve the way they deliver CBT through training and supervision.

Sexual minorities, including those identifying as lesbian, gay, bisexual or queer (LGBQ) are at heightened risk of experiencing mental health problems. Nationally, treatment outcomes within England’s Improving Access to Psychological Therapies (IAPT) services are worse for sexual minority patients than for heterosexuals. An IAPT service in London developed a cognitive behavioural therapy (CBT) group specifically for sexual minority patients to provide a safe, affirmative intervention to learn skills for overcoming depression, anxiety and stress. A qualitative online survey was emailed to all 59 service users who had completed the eight-session intervention, to explore their experiences inductively. Survey data were analysed using qualitative content analysis. Themes were identified in participants’ responses in order to establish which aspects of the group intervention were deemed to be helpful and unhelpful, and to explore suggestions for group improvement. Eighteen people completed the survey (response rate 30.5%). Respondents reported that they found the CBT frame of the group useful, with the LGBQ focus experienced as particularly beneficial, often enhancing engagement with CBT concepts and tools. In addition to generic elements of group therapy that some found difficult, others reported that intragroup diversity, such as generational differences, could lead to a reduced sense of connection. Several suggestions for group improvement were made, including incorporating more diverse perspectives and examples in session content and focusing more on issues relating to intersectionality. These results provide preliminary evidence that a culturally adapted CBT group intervention developed specifically for sexual minorities is acceptable and perceived as offering something unique and helpful.