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.

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.

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.

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.

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.

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.

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.

Social anxiety disorder (SAD) is characterized by significant distress regarding social performance situations. Patients experience strong embarrassment about how they are perceived by others due to increased self-focused attention. This case report presents two cases of SAD and the effects of cognitive behavioural therapy (CBT) on ‘picturing of self’ (e.g. self-picturing and self-projection). The goal was to demonstrate the changes in ‘picturing of self’ using brief video feedback (VF) as a treatment and projective drawing as an assessment method of CBT, especially with SAD. The CBT consisted of psychoeducation and case formulation, cognitive restructuring, and behavioural experiments. In one case VF was used to provide additional means by showing the patient's own actual moving figure, the self-picture. For the other case, the patient was instructed to ‘draw a person’ and the changes in drawing style were assessed. Through the course of CBT, Liebowitz Social Anxiety Scale scores reduced significantly in both cases. ‘Picturing of self’ changed as a result of the use of CBT. Brief VF and projective drawing would be useful for individuals to see the change in themselves.

Supervision is probably the single most effective method for helping therapists to develop competence, capability and a professional identity (Falender & Shafranske, 2004; Callahan et al. 2009; Watkins & Milne, 2014). Supervision is also perceived by supervisees as the main influence on their practice (Lucock et al.2006), and has been recognized by governments as an essential component of mental health services in the 21st century (e.g. Care Quality Commission, 2013). Paradoxically, supervisors themselves may receive inadequate support and guidance. This is an unacceptable strategic and moral oversight, one which presumably undermines the fidelity of CBT while increasing burnout: in one survey, 82% of participating supervisors expressed dissatisfaction over their support arrangements (Gabbay et al. 1999). Recent surveys of CBT supervisors indicate that despite an overall sense of satisfaction with supervision, considerably more can be done to support supervisors in terms of developing improved supervisory and training materials (Reiser & Milne, 2016). The phrase ‘something does not compute’ sums up this paradox succinctly (Watkins, 1997, p. 604).

This study examined expectancy judgement and current concerns in high and low depression and anxiety participants. Expectancy judgement was measured using the Personal Future Task. Depression and anxiety symptoms were measured using the Depression and Anxiety Stress Scale (DASS). A novel scale, the Current Concerns Checklist, was developed to measure ten current concerns that were thought to relate to the most salient concerns of common Axis I disorders. Using the DASS, 19 participants were allocated to the distressed group and 17 to the non-distressed group. As hypothesized, there was a main effect for the current concern concept; participants thought of more future events regarding their current concern than their non-concern. However, the hypothesis that the distressed group would generate more negative relative to positive responses than the non-distressed group within the domain of their most prominent current concern was not supported. Future research and implications for CBT are discussed.

There are theoretical challenges in distinguishing obsessions from overvalued ideas (OVIs) and delusions. The latter can be defined by its rigid nature and unusual content, but obsessions and OVIs are also reported with such characteristics. Clinically, what are the implications when this distinction is not entirely clear? In this case study, these issues are explored with a man who presented with commonly reported symptoms of obsessive compulsive disorder (OCD) and a belief about transforming into a giant fly. Clinically meaningful gains were made following a course of 17 sessions of CBT, providing some additional support for the effectiveness of CBT for abnormal beliefs within OCD.

The effect of cognitive behavioural therapy (CBT) is well-documented for individual interventions for depression. Studies of group interventions for depression using CBT principles are more sparse. Hence the reason for this naturalistic study that reviews the results of a short term 12-session manualized CBT group intervention offered in an inpatient setting at the Specialized Treatment Unit for Depression and Anxiety at the Psychiatric Centre Copenhagen, Bispebjerg Hospital, over a 5-year period. The aim of the study was the treatment and relapse prevention of depressive symptoms by teaching patients cognitive behavioural therapeutic methods. The manual deviated only slightly from Melanie Fennell's treatment model. Sixty-two patients were referred and 48 participated, 45 of these had been inpatients with moderate to severe major depression admitted to the ward with a depressive episode or recurrent depressive episodes of at least 2 weeks and up to 2 years’ duration. So far the results are promising, measured by the decrease in the Beck Depression Inventory (BDI-II) score at session 12 [mean BDI-II score at baseline: 30.7 (s.d. = 9.9); post-treatment: 20.4 (s.d. = 12.6), p<0.0001], relapse was measured by the rate of readmissions compared to data published in a previous register-based study on Danish patients with unipolar depression, which showed significantly lower rates of readmission in our sample (p = 0.003) and patients’ self-reported improvement, indicating that treatment in groups can be recommended, although a 12-session programme may have to be extended for people with more complex and longstanding personality impairments and recurring depression. Secondary gains not originally intended, but pointed out in patient feedback, were the strengthening of social skills and self-esteem.

Practitioners have mixed views about the value of cognitive behavioural therapy (CBT) manuals, with some preferring to work based on professional judgement. The workbook represents a compromise, providing guidance and resources without prescribing standardised procedures. Workbooks have not previously been widely addressed in the CBT literature. This exploratory study analysed how practitioners use a CBT workbook (Think Good – Feel Good, TGFG) to support therapeutic work with young people (YP). Practitioners (n=238) completed an online survey about how TGFG is used and how it supports CBT. A convergent mixed-methods design was pursued. Qualitative and quantitative data were analysed using content analysis, descriptive statistics, and chi-squared tests before themes were defined to summarise the dataset. When deciding whether to use TGFG, practitioners consider a YP’s presenting difficulty, level of understanding, motivation, and availability of systemic support. Practitioners use TGFG inside and outside the therapeutic space to plan sessions, revise CBT concepts, and complete worksheets (particularly those with a cognitive focus). Practitioners use TGFG flexibly and pragmatically (combining it with other therapeutic approaches), and they adapt resources to suit a YP’s understanding and interests. TGFG appears to be a widely used resource for practitioners across the range of experience.

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.

In a previous paper auditing individual therapy in the STEPS team, we demonstrated a significant problem with attrition for both CBT and person-centred therapy. We argued that a root-and-branch change to the referral process was needed. This paper looks at the system which replaced it. ‘Callback’ allows self-referral with service users able to leave a phone message at any time. Clinicians call back and carry out a protocol-driven assessment, arranging, where appropriate, services at the end of the call. Reporting on the first 2500 calls, 92% of callers were successfully called back. Individuals were, on average, called back in 8.4 hours. Eighty-six percent of callers were offered an intervention within the STEPS service. They entered these STEPS services, on average, 9.4 days after the initial phone call. Of all callers 15.6% were offered individual therapy. Of these, 93% attended the first appointment and 82% completed a course of treatment. The results suggest that Callback is a significant improvement on the GP-referral system it replaced and provide evidence supporting the utility of ‘multi-level, multi-purpose’ services in primary care.