Despite the increasing use of telehealth platforms to deliver cognitive behavioural group therapy programs, few studies have been conducted that explore the experience of using telehealth platforms for those living with bipolar disorder. The present study aimed to explore the impact of the telehealth platform on the delivery of a recovery-orientated well-being plan group program for participants living with bipolar disorder. A total of 19 participants completed the qualitative interviews (3 male, 16 female). Using content analysis, data were deductively coded in line with pre-existing codes and matrix categories with unexpected data that discussed the telehealth experience being coded using an inductive content analysis framework. Two themes were identified: (1) Social inclusion, which included the subthemes of (a) connection to others via telehealth and (b) feeling safe using telehealth; and (2) Barriers and engagement, which included the subthemes of (a) removing barriers by using telehealth and (b) symptom impacts to engagement using the telehealth platform. Participants reported increased connection with others using telehealth and feeling greater safety overall when using the telehealth platform; however, some noted that dominant personalities could contribute to feeling unsafe within the group at times. Overall, the platform reduced barriers and was easy to use with this being a convenient way to attend, even if in some instances the platform highlighted differences between the members.

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.

Despite a strong evidence base for cognitive behavioural therapy (CBT) for obsessive compulsive disorder (OCD), there is limited evidence regarding the effectiveness of group therapy compared to individual therapy. As services struggle to manage high demands, CBT for OCD is often offered in group format. This paper examines the current evidence base for group CBT for OCD considering both clinical outcomes and cost, and describes a group CBT intervention for people with OCD. A CBT group was set up, consistent with NICE guidelines, but slightly adapted from standard group protocols, in line with recommendations from experts in the field. It was evaluated as part of an audit of the service. Statistical analyses demonstrated significant improvements in both measures of depression and the impact of difficulties, and on specific measures of OCD, in clients who attended group CBT (n = 17). The analyses also demonstrated improved effectiveness of therapist hours for group therapy compared to individual therapy. It is concluded that group therapy for OCD should be considered as an alternative to individual therapy when there are significant demands on the service. Recommendations regarding specific adaptations to the standard group CBT format are made.

The inpatient unit faces many challenges in the effort to deliver comprehensive psychiatric care to acutely ill patients with minimal lengths of stay. Cognitive behaviour therapy (CBT), a structured, problem-focused, time-limited form of treatment has been shown to be a promising intervention with the inpatient population. This paper describes a group-oriented inpatient CBT programme for women and reports pilot data on the experiences of 78 adult female patients. Repeated-measures ANOVAs revealed that participants exhibited improved psychosocial functioning from admission to discharge, with gains maintained at 1 month post-discharge. Partial correlations indicated that participation and engagement in CBT groups is related to improved functioning at discharge. Participants diagnosed with major depressive disorder, bipolar disorder, and psychotic disorders all evidenced similar positive treatment trajectories, suggesting that group-oriented CBT programming may be a useful addition to standard inpatient care.

Specific phobia of vomiting (SPOV) can be a severe and debilitating anxiety disorder and affects women in the childbearing years. The perinatal period and early parenthood is a time of increased risk for the onset or exacerbation of anxiety problems, which can have an impact on both the woman and the developing child. There are particular issues pertinent to the physical experience of pregnancy and tasks of early caregiving that women with SPOV may find difficult or distressing to confront, but these are not well documented. Cognitive behavioural therapy (CBT) focused on exposure to vomit cues and processing distressing early memories of vomiting is an effective treatment for SPOV. This paper describes the successful CBT treatment of two young mothers with SPOV, outlining the challenges faced by parents at this time and the need to take this into account in treatment, using illustrative case material.

Gypsies and Travellers are at significantly increased risk of poor physical and mental health compared with the general population. Barriers to accessing mental health services include fear of stigma and discrimination from services, difficulties with signing up to services due to poor educational levels, and the taboo nature of mental health difficulties within the community. To the authors’ knowledge, no research has identified best practice for adapting psychological therapy to meet the needs of this community. This paper presents the case of John (pseudonym), an 80-year-old Irish Traveller, whose respiratory team referred him for psychological intervention for depression and anxiety symptoms. The psychology service was embedded within the respiratory team which enabled easy access to therapy services via an already trusted service. He received 10 sessions of cognitive behavioural therapy for depression, adapted to his age, physical health, and cultural background. His low mood was maintained by withdrawal from activities, rumination of losses, lack of confidence and avoidance of help-seeking. Treatment consisted of culturally adapted psychoeducation, behavioural activation, cognitive restructuring, and behavioural experiments to increase his activity, mood and confidence. The Patient Health Questionnaire and Generalised Anxiety Disorder Scale demonstrated improvements in both depressive and anxious symptoms at the end of therapy. The paper presents an overview of relevant literature before describing John’s case, formulation, culturally adapted intervention techniques and outcomes. Considerations to support best practice for clinicians working with Irish Travellers are made.

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.

Cognitive behaviour therapy (CBT) in an effective technique used widely in Western countries. However, there is limited evidence as to the utility, perception and understanding of CBT in developing countries. This study describes and investigates the experience of CBT training and practice in a group of practitioners in Tanzania. A qualitative approach to the investigation was used, and seven participants from Tanzania’s only psychiatric hospital who had completed CBT training were interviewed. The resulting verbatim transcripts were analysed via interpretative phenomenological analysis. Five superordinate themes emerged from the analysis: ‘the medical model’, ‘novelty’, ‘practicalities’, ‘process’ and ‘therapist effects’. The two themes ‘therapist effects’ and ‘process’ are discussed in detail as these may be particularly relevant to the clinical application of the therapy in a new culture and context. The implications for future development of CBT in Tanzania are considered. In developing CBT for dissemination in Tanzania, specific cultural and clinical issues highlighted by indigenous clinicians need consideration.

Since its inclusion in the DSM-III, various theories and treatment approaches have been developed for generalised anxiety disorder (GAD). Aaron T. Beck was the first to offer a cognitive conceptualisation of GAD in Anxiety Disorders and Phobias: A Cognitive Perspective. This original cognitive model of GAD was initially found to be promising in treating GAD but has not been developed further. Other theoretical models and treatments of GAD have gained more research attention, such as the Intolerance of Uncertainty model and Meta-Cognitive model. This article offers a brief overview of multiple theories and treatment approaches of GAD followed by an extensive discussion about the original cognitive model and a revised cognitive model of GAD in the Beckian tradition. Specifically, this paper describes how known key psychological maintenance factors of anxiety disorders, i.e. threat beliefs, safety-seeking behaviours and selective attention, can be used to conceptualise the experience of people with GAD and guide treatment. This is done with theoretical discussion as well as clinical examples. Finally, the paper offers suggestions for key ingredients to be included in cognitive therapy for GAD and future directions for research.

Providers of cognitive behavioural therapy (CBT) in adult mental health services in the UK are expected to deliver therapy suitable for adults of all ages. However, older people commonly present with co-morbidities that challenge delivery of single-diagnosis CBT protocols. Added to this, the difference in age between therapy-provider and service-user can compromise collaboration. In this paper, I consider two key areas of relevance for training and supervising CBT therapists for work with older people, namely multi-morbidities and intergenerational relations. The evolving evidence base for CBT with older people is summarised and a commentary provided on previous ‘old age’ case studies from the Cognitive Behaviour Therapist (tCBT). Strategies for collaborative relationships are discussed, as are strategies for ‘embedding the silver thread’. I conclude with recommendations for future directions for CBT training and supervision.