Although cognitive therapy (CT) has a large empirical base, research is lacking for CT supervision and supervision training, which presents an obstacle for evidence-based practice. A pilot CT supervision training programme, based on Milne's evidence-based supervision and Roth & Pilling's supervision competences was developed by the Northern Ireland Centre for Trauma and Transformation (NICTT), an organization specializing in CT therapy provision and training. This pilot study qualitatively explores CT supervisors’ perceptions of the impact the training had on their practice. Semi-structured interviews were conducted with seven participants, transcribed verbatim and analysed using Burnard's thematic content analysis. Findings illustrated that experienced CT supervisors perceived benefit from training and that the majority of supervisors had implemented contracts, used specific supervision models and paid more attention to supervisee learning as a result of the training. Obstacles to evaluating supervision included the lack of reliable user-friendly evaluation tools and supervisor consultancy structures. Recommendations are also made for future research to establish the long-term effects of supervision training and its effect on patient outcomes. Implications for future training based on adult learning principles are discussed.

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.

Cognitive behaviour therapy (CBT) is widely regarded as an effective treatment for social anxiety disorder (SAD) in Europe and North America. The theoretical orientations underlying CBT models and treatment interventions developed in Western cultures were typically constrained by Western conceptualizations of SAD. This case study reports on the use of CBT for Japanese SAD, demonstrating the successful implementation of cognitive techniques grounded in the Clark & Wells model. The patient was a Japanese female with excessively high standards for workplace social performance. Therapy mainly comprised case formulation, behavioural experiments, and opinion surveying based on the Clark & Wells model. These techniques allowed the patient to reduce the strength of maladaptive cognitions and lower her excessively high standards for social performance. CBT treatment using the Clark & Wells model was effective and suitable for Japanese SAD, at least in the present case. We also discuss the cross-cultural differences of SAD and adaptation of CBT.

While we now have a strong evidence base for cognitive behaviour therapy in managing mental health problems, the challenge is to disseminate it into real-world settings. Two dissemination approaches exist: the dominant ‘research to practice’ model, a linear sequence, taking interventions from the research laboratory and overcoming barriers so as to apply them in the real world and a more collaborative approach, in which researchers work together with clinicians and patients to adapt existing treatments for real-world settings. This article provides a detailed example of a collaborative approach to adapting cognitive behaviour therapy, by developing a very brief mental health intervention for patients in a primary-care (family doctor) setting.

This study examines the effectiveness of a group CBT (CBGT) intervention in reducing a variety of symptoms and problem areas associated with social anxiety disorder. A longitudinal cohort design assessed changes in standardized psychological scales assessing general mood and specific aspects of social anxiety. Questionnaires were completed pre-programme (time 1, n = 252), post-programme (time 2, n = 202), and at 12 months follow-up (time 3, n = 93). A consistent significant pattern was found for all variables: pre-intervention scores were significantly higher than both post-intervention scores and 12-month follow-up scores. Large effect sizes were found and rates of clinical significant changes varied, with over half of the participants recording clinically significant changes in general mood. Individual CBT can be translated successfully into a group format for social anxiety. Given the high completion rate, the intervention is acceptable to participants, feasible, and effective in a routine clinical service.

Cognitive behavioural therapy (CBT) is an empirically grounded approach which typically relies on formulation to guide the shape and course of therapy. Cognitive formulation is widely advocated but poorly understood at an empirical level. This study aimed to characterize how clinicians understand the structure and uses of formulation and how they report on using it in their clinical practice relative to an expert reference group. A total of 124 clinicians in routine clinical practice completed a questionnaire, which assessed their clinical use and understanding of formulation. For some aspects of the questionnaire a comparison with a reference group, 15 highly specialist CBT therapists, was used. High levels of self-rated expertise were noted and at levels comparable to that of the highly specialist group. Participants rated themselves as less capable in terms of their formulation skills relative to their self-rating in CBT overall. Formulation is typically rated as important by those with some professional commitment to CBT. There may be some gaps in the way formulation is applied in clinical practice that should be addressed at the level of training and supervision.

Obsessive-compulsive symptoms (OCS) are a common phenomenon in patients with schizophrenia and are associated with additional clinical and functional impairments. So far treatment approaches have been limited to mainly pharmacological interventions with restricted effectiveness. Because cognitive behavioural therapy (CBT) is considered treatment of first choice for patients with primary obsessive-compulsive disorder (OCD), it seems compelling to consider it as a treatment option for comorbid OCS in schizophrenia. This research was conducted in order to investigate the theoretical and empirical basis for CBT in the treatment of comorbid OCS/OCD in schizophrenia. A comprehensive review and analysis of published literature was performed. Outcome measures from case-reports and a case-series showed favourable results with a significant reduction of symptom severity in 24/30 patients treated with CBT and exposure and response prevention (ERP) or ERP alone. CBT appears to offer a valuable opportunity to reduce symptom severity in this highly impaired group of patients. Based on these results and with a strong focus on tolerability concerns, suggestions for possible CBT approaches for the comorbid group are proposed. Further research within this field and systematic clinical evaluations are highly desirable.

Anorexia nervosa (AN) and obsessive compulsive disorder (OCD) have been shown to have a number of commonalities, such as genetics, neurobiology, and symptoms. Approaches to treatment of AN have recently been described that take such findings into account, extending interventions recommended for obsessive compulsive and anxiety disorders to AN. The current paper aims to outline a formulation model of AN in adults, derived from the literature on OCD, and introduce this topic as a fruitful area to build on existing treatment techniques, and to prompt further discussion of such techniques. A formulation model is described, followed by a discussion of how this might be applied to AN, using examples from clinical practice. Potential benefits and difficulties are discussed. A formulation model is suggested that can easily be adapted to AN, complementing existing models in eating disorders.

Policy and legislation requires clinicians and services to address diversity and equalities including disability. Currently, practice, training and research do not do this adequately. This paper outlines why adapted CBT is important and presents some evidence to increase accessibility for people who have cognitive impairments, learning disabilities and/or neurodevelopmental disorders. It demonstrates how CBT can be made accessible through clinical examples using traditional, adapted and personalized assessment and intervention materials. Implications and recommendations are identified.

Misophonia is a condition of unknown cause characterized by atypically intense negative physiological and emotional reactions to hearing certain sounds – most often those associated with oral functions. Individuals with misophonia often report high levels of psychological distress and avoidance behaviours that seriously compromise their occupational and social functioning. As of yet, no effective treatment of misophonia has been identified, and health care providers often struggle when they encounter clients who have it. This case report describes the assessment, case formulation, and treatment of a client with misophonia using cognitive behavioural therapy (CBT), and serves as an initial contribution to the evidence base for the efficacy of CBT in the treatment of misophonia.

This study examines trainees’ evaluations of a postgraduate CBT training course to determine which aspects are perceived as having the greatest effect on competence. A course evaluation was completed by three cohorts (n = 73) of a yearlong master's-level CBT training course, and statistical comparisons were conducted to examine the perceived impact of discrete aspects of training. There were significant differences between endorsements of the impact of various aspects of the learning experience. Overall, supervision was perceived to have a greater influence on trainees’ competence than clinical instruction. Interactions with trainers were given the highest rating, followed by learning from personal reflection and peer interactions. The varied aspects of extensive CBT training were perceived by students to be differentially effective in enhancing CBT skills. Supervision was perceived to have the strongest impact on competence, and trainees’ own reflections on their practice in preparation for supervision perceived as an important contributor to supervision's efficacy. The relatively low rating of peer-related learning suggests acceptability for distance training (e.g. internet-based), which excludes peer interaction found in traditional training. Due to limitations inherent in study design, only tentative conclusions can be offered. Further research involving more rigorous hypothesis testing is recommended.

Cognitive behavioural therapy (CBT) with youth owns a solid and growing empirical literature base. CBT also recognizes the contribution a good therapeutic relationship makes to favourable treatment outcome. However, it is argued that the therapeutic relationship is insufficiently operationalized and the extant definitions neglect the role of therapeutic presence, immediacy, and transparency. Indeed, presence, immediacy, and transparency represent critical elements in creating the necessary therapeutic alchemy leading to propitious symptom change. Accordingly, therapeutic presence, immediacy, and transparency are defined and explained. Additionally, clinical parameters for using presence, immediacy, and transparency in clinical encounters with young patients are articulated. Finally, these crucial processes pervade cognitive behavioral modules such as self-monitoring, cognitive restructuring and behavioural experiments/exposures are explicated through specific examples and therapeutic dialogues.

This study aimed to examine how people change in order to achieve and maintain a personally comfortable weight and what changes for them as they change. Six students who changed to achieve and maintain a personally comfortable weight for a minimum of 1 year were recruited. Semi-structured interviews explored participants’ experiences of what changed and how they changed. The interviews were analysed using interpretative phenomenological analysis. Two superordinate themes emerged. The first was ‘awareness’ which contained the subthemes: unaware self, revelation, and conscious monitoring and maintenance of awareness. The second was ‘goals and needs’ which contained the subthemes: social- vs. self-acceptance, removing negative emotions, weight control vs. other life goals, and ideal vs. perceived health and appearance. The findings are discussed in relation to the existing literature on the development of eating problems, involving social acceptance, self-esteem, coping with negative moods, and weight control. Perceptual Control Theory was used to provide an explanation for how these participants changed and maintained their change.

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.

This study provides the first assessment of the latent structure of the Profile of Emotional Distress (PED). The PED is a self-report measure of emotional distress (ED) associated strongly with its links to Rational Emotive Behaviour Therapy (REBT). To date, the PED has been weakly conceptualized using both unitary and binary models of ED. In this study, the dimensionality of the PED was examined within an alternative models’ framework using confirmatory factor analysis and bifactor modelling techniques. A total of 313 law enforcement, military, and related emergency-service personnel completed the PED. Results indicated that a bifactor model conceptualization was the best fit of the data. The bifactor model included a single general factor (ED) and four grouping factors (Concern, Anxiety, Sadness, Depression). Model parameter estimates indicated that the ED factor accounts for the majority of covariance among the observable indicators. Low factor loadings were observed on each of the grouping factors, thus subscale construction is not recommended. Composite reliability results demonstrated that the ED factor possesses excellent internal reliability. The PED was found to be a reliable and valid measure of emotional distress.

The scope of the Improving Access to Psychological Therapies (IAPT) initiative has been extended to include the treatment of medically unexplained symptoms (MUS). However, MUS was not one of the original common mental health problems that the therapists were trained to treat. No studies have explored whether primary-care cognitive behavioural therapists feel competent to treat people with MUS. This paper aimed to explore and gain an understanding of primary-care therapists’ perceived competence in providing cognitive behavioural therapy (CBT) to people with MUS. Eight CBT therapists working in primary care participated in semi-structured interviews; the Framework approach was used to analyse the data. Five themes were generated by the data analysis, regarding the therapists’ perceived competence. The therapists described unfamiliarity with MUS. They also described some issues in engaging clients in therapy and that progress in therapy could sometimes be slow. Participants often used more general CBT skills and techniques, rather than models and interventions designed specifically for MUS. They had a number of different emotional reactions to this work. CBT therapists in primary care described unfamiliarity with MUS, in comparison to common mental health problems. They identified some difficulties in treatment, but most did not see this group as being more complex to treat. All were interested in receiving training about this client group.

This qualitative study investigated clinicians’ experiences and attitudes towards conducting mental health assessments over the telephone in an IAPT service. Nine participants completed a semi-structured questionnaire and data were evaluated using a Thematic Analysis model. Participants were largely apprehensive about telephone working, but many reported positive experiences. Telephone assessments were felt to be structured, focused and comprehensive, and therapeutic rapport was able to be established. However, concerns persisted around whether risk assessments could be adequately conducted over the telephone. Reports of spontaneous feedback from patients during telephone triage suggested that there was appreciation for this method of assessment and that it increased access to the service. Further research is needed to better understand what, for clinicians, contributes to acceptable assessment of complex and subjective situations, such as risk and feeling states, over the telephone.