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Publisher: Cambridge University Press   (Total: 387 journals)

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Showing 1 - 200 of 387 Journals sorted alphabetically
Acta Neuropsychiatrica     Hybrid Journal   (Followers: 6, SJR: 0.733, CiteScore: 2)
Acta Numerica     Hybrid Journal   (Followers: 5, SJR: 6.709, CiteScore: 10)
Advances in Animal Biosciences     Full-text available via subscription   (Followers: 14)
Advances in Applied Mathematics and Mechanics     Full-text available via subscription   (Followers: 2, SJR: 0.441, CiteScore: 1)
Aeronautical J., The     Hybrid Journal   (Followers: 7)
Africa     Hybrid Journal   (Followers: 20, SJR: 0.582, CiteScore: 1)
African Studies Review     Full-text available via subscription   (Followers: 20, SJR: 0.437, CiteScore: 1)
Ageing & Society     Hybrid Journal   (Followers: 44, SJR: 0.756, CiteScore: 2)
Agricultural and Resource Economics Review     Open Access   (Followers: 6, SJR: 0.414, CiteScore: 1)
AI EDAM     Hybrid Journal   (Followers: 2, SJR: 0.375, CiteScore: 1)
AJIL Unbound     Open Access  
AJS Review     Full-text available via subscription   (Followers: 4, SJR: 0.128, CiteScore: 0)
American Political Science Review     Hybrid Journal   (Followers: 319, SJR: 5.587, CiteScore: 4)
Anatolian Studies     Full-text available via subscription   (Followers: 5, SJR: 0.528, CiteScore: 1)
Ancient Mesoamerica     Hybrid Journal   (Followers: 12, SJR: 0.478, CiteScore: 1)
Anglo-Saxon England     Hybrid Journal   (Followers: 36, SJR: 0.1, CiteScore: 0)
animal     Hybrid Journal   (Followers: 3, SJR: 0.842, CiteScore: 2)
Animal Health Research Reviews     Hybrid Journal   (Followers: 3, SJR: 0.69, CiteScore: 2)
Animal Science     Full-text available via subscription   (Followers: 11)
Annals of Actuarial Science     Full-text available via subscription   (Followers: 1)
Annual of the British School at Athens     Full-text available via subscription   (Followers: 17, SJR: 0.177, CiteScore: 0)
Annual Review of Applied Linguistics     Hybrid Journal   (Followers: 43, SJR: 3.223, CiteScore: 4)
Antarctic Science     Hybrid Journal   (Followers: 1, SJR: 0.643, CiteScore: 1)
Antichthon     Full-text available via subscription   (Followers: 3, SJR: 0.101, CiteScore: 0)
Antiquaries J., The     Full-text available via subscription   (Followers: 12, SJR: 0.106, CiteScore: 0)
Antiquity     Hybrid Journal   (Followers: 33)
ANZIAM J.     Open Access   (Followers: 1, SJR: 0.216, CiteScore: 0)
Applied Psycholinguistics     Hybrid Journal   (Followers: 25, SJR: 0.945, CiteScore: 2)
APSIPA Transactions on Signal and Information Processing     Open Access   (Followers: 9, SJR: 0.404, CiteScore: 2)
Arabic Sciences and Philosophy     Hybrid Journal   (Followers: 9, SJR: 0.101, CiteScore: 0)
Arbor Clinical Nutrition Updates     Full-text available via subscription   (Followers: 5)
Archaeological Dialogues     Hybrid Journal   (Followers: 38, SJR: 0.898, CiteScore: 1)
Archaeological Reports     Full-text available via subscription   (Followers: 5, SJR: 0.128, CiteScore: 0)
Architectural History     Full-text available via subscription  
arq: Architectural Research Quarterly     Hybrid Journal   (Followers: 7, SJR: 0.123, CiteScore: 0)
Art Libraries J.     Full-text available via subscription  
Asian J. of Comparative Law     Hybrid Journal   (Followers: 11, SJR: 0.129, CiteScore: 0)
Asian J. of Intl. Law     Hybrid Journal   (Followers: 18, SJR: 0.135, CiteScore: 0)
Asian J. of Law and Society     Hybrid Journal   (Followers: 7, SJR: 0.195, CiteScore: 0)
Astin Bulletin     Full-text available via subscription   (Followers: 1, SJR: 0.878, CiteScore: 1)
Australasian J. of Organisational Psychology     Hybrid Journal   (Followers: 9, SJR: 0.154, CiteScore: 1)
Australian J. of Environmental Education     Full-text available via subscription   (Followers: 9, SJR: 0.403, CiteScore: 1)
Australian J. of Indigenous Education, The     Full-text available via subscription   (Followers: 10, SJR: 0.26, CiteScore: 1)
Australian J. of Rehabilitation Counseling     Full-text available via subscription   (Followers: 6, SJR: 0.144, CiteScore: 0)
Austrian History Yearbook     Full-text available via subscription   (Followers: 11, SJR: 0.161, CiteScore: 0)
Behavioral and Brain Sciences     Hybrid Journal   (Followers: 39, SJR: 0.595, CiteScore: 1)
Behaviour Change     Full-text available via subscription   (Followers: 13, SJR: 0.508, CiteScore: 1)
Behavioural and Cognitive Psychotherapy     Hybrid Journal   (Followers: 180, SJR: 0.976, CiteScore: 2)
Bilingualism: Language and Cognition     Hybrid Journal   (Followers: 42, SJR: 1.446, CiteScore: 2)
Biofilms     Full-text available via subscription   (Followers: 1)
Bird Conservation Intl.     Hybrid Journal   (Followers: 25, SJR: 0.581, CiteScore: 1)
BJPsych Advances     Full-text available via subscription   (Followers: 57, SJR: 0.275, CiteScore: 0)
BJPsych Intl.     Open Access   (Followers: 2)
BJPsych Open     Open Access   (Followers: 3)
Brain Impairment     Full-text available via subscription   (Followers: 2, SJR: 0.321, CiteScore: 1)
Breast Cancer Online     Full-text available via subscription   (Followers: 4)
Britannia     Full-text available via subscription   (Followers: 11, SJR: 0.111, CiteScore: 0)
British Actuarial J.     Full-text available via subscription  
British Catholic History     Hybrid Journal   (Followers: 2, SJR: 0.133, CiteScore: 1)
British J. for the History of Science     Hybrid Journal   (Followers: 24, SJR: 0.235, CiteScore: 0)
British J. of Anaesthetic and Recovery Nursing     Full-text available via subscription   (Followers: 8)
British J. of Music Education     Hybrid Journal   (Followers: 24, SJR: 0.564, CiteScore: 1)
British J. Of Nutrition     Hybrid Journal   (Followers: 90, SJR: 1.612, CiteScore: 4)
British J. of Political Science     Hybrid Journal   (Followers: 215, SJR: 4.661, CiteScore: 4)
British J. of Psychiatry     Hybrid Journal   (Followers: 221, SJR: 2.844, CiteScore: 3)
Bulletin of Entomological Research     Hybrid Journal   (Followers: 13, SJR: 0.805, CiteScore: 2)
Bulletin of Symbolic Logic     Full-text available via subscription   (Followers: 2, SJR: 0.555, CiteScore: 1)
Bulletin of the Australian Mathematical Society     Full-text available via subscription   (Followers: 2, SJR: 0.44, CiteScore: 0)
Bulletin of the School of Oriental and African Studies     Hybrid Journal   (Followers: 21, SJR: 0.146, CiteScore: 0)
Business and Human Rights J.     Full-text available via subscription   (Followers: 4, SJR: 0.536, CiteScore: 1)
Business Ethics Quarterly     Full-text available via subscription   (Followers: 18, SJR: 1.098, CiteScore: 2)
Business History Review     Hybrid Journal   (Followers: 16, SJR: 0.347, CiteScore: 1)
Cambridge Archaeological J.     Hybrid Journal   (Followers: 150, SJR: 1.121, CiteScore: 1)
Cambridge Classical J.     Full-text available via subscription   (Followers: 24, SJR: 0.101, CiteScore: 0)
Cambridge J. of Postcolonial Literary Inquiry     Hybrid Journal   (Followers: 7)
Cambridge Law J.     Hybrid Journal   (Followers: 199, SJR: 0.213, CiteScore: 0)
Cambridge Opera J.     Hybrid Journal   (Followers: 4, SJR: 0.14, CiteScore: 0)
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 11, SJR: 0.299, CiteScore: 1)
Cambridge Yearbook of European Legal Studies     Full-text available via subscription  
Camden Fifth Series     Full-text available via subscription   (Followers: 3)
Canadian Entomologist     Hybrid Journal   (Followers: 5, SJR: 0.482, CiteScore: 1)
Canadian J. of Emergency Medicine     Hybrid Journal   (Followers: 13, SJR: 0.624, CiteScore: 1)
Canadian J. of Law & Jurisprudence     Full-text available via subscription   (Followers: 11, SJR: 0.237, CiteScore: 0)
Canadian J. of Law and Society     Hybrid Journal   (Followers: 20, SJR: 0.259, CiteScore: 1)
Canadian J. of Mathematics / J. canadien de mathématiques     Hybrid Journal  
Canadian J. of Neurological Sciences     Full-text available via subscription   (SJR: 0.549, CiteScore: 1)
Canadian J. of Political Science/Revue canadienne de science politique     Full-text available via subscription   (Followers: 25, SJR: 0.385, CiteScore: 1)
Canadian J. on Aging     Hybrid Journal   (Followers: 13, SJR: 0.426, CiteScore: 1)
Canadian Mathematical Bulletin     Hybrid Journal  
Canadian Yearbook of Intl. Law / Annuaire canadien de droit international     Full-text available via subscription   (Followers: 3)
Cardiology in the Young     Hybrid Journal   (Followers: 34, SJR: 0.372, CiteScore: 1)
Central European History     Full-text available via subscription   (Followers: 32, SJR: 0.159, CiteScore: 0)
Children Australia     Partially Free   (Followers: 2, SJR: 0.255, CiteScore: 0)
China Quarterly     Hybrid Journal   (Followers: 52, SJR: 2.289, CiteScore: 3)
Chinese J. of Agricultural Biotechnology     Full-text available via subscription   (Followers: 4)
Church History : Studies in Christianity and Culture     Full-text available via subscription   (Followers: 75, SJR: 0.106, CiteScore: 0)
Classical Quarterly     Full-text available via subscription   (Followers: 35, SJR: 0.204, CiteScore: 0)
Classical Review     Full-text available via subscription   (Followers: 29)
CNS Spectrums     Hybrid Journal   (Followers: 3, SJR: 1.391, CiteScore: 3)
Cognitive Behaviour Therapist     Hybrid Journal   (Followers: 14)
Combinatorics, Probability and Computing     Hybrid Journal   (Followers: 4, SJR: 0.839, CiteScore: 1)
Communications in Computational Physics     Full-text available via subscription   (Followers: 3, SJR: 1.048, CiteScore: 2)
Comparative Studies in Society and History     Full-text available via subscription   (Followers: 49, SJR: 0.585, CiteScore: 1)
Compositio Mathematica     Full-text available via subscription   (SJR: 3.139, CiteScore: 1)
Contemporary European History     Hybrid Journal   (Followers: 34, SJR: 0.263, CiteScore: 1)
Continuity and Change     Hybrid Journal   (Followers: 12, SJR: 0.107, CiteScore: 0)
Dance Research J.     Full-text available via subscription   (Followers: 15, SJR: 0.211, CiteScore: 0)
Development and Psychopathology     Hybrid Journal   (Followers: 9, SJR: 2.068, CiteScore: 4)
Dialogue Canadian Philosophical Review/Revue canadienne de philosophie     Full-text available via subscription   (Followers: 5, SJR: 0.156, CiteScore: 0)
Diamond Light Source Proceedings     Full-text available via subscription   (Followers: 1)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 14, SJR: 0.471, CiteScore: 1)
Du Bois Review: Social Science Research on Race     Full-text available via subscription   (Followers: 10, SJR: 0.561, CiteScore: 1)
Early China     Hybrid Journal   (Followers: 3)
Early Music History     Hybrid Journal   (Followers: 9, SJR: 0.101, CiteScore: 0)
Earth and Environmental Science Transactions of the Royal Society of Edinburgh     Hybrid Journal   (Followers: 5)
East Asian J. on Applied Mathematics     Full-text available via subscription   (SJR: 0.418, CiteScore: 1)
Ecclesiastical Law J.     Full-text available via subscription   (Followers: 6, SJR: 0.114, CiteScore: 0)
Econometric Theory     Hybrid Journal   (Followers: 18, SJR: 2.915, CiteScore: 1)
Economics and Philosophy     Hybrid Journal   (Followers: 18, SJR: 0.622, CiteScore: 1)
Edinburgh J. of Botany     Hybrid Journal   (SJR: 0.283, CiteScore: 1)
Educational and Developmental Psychologist     Full-text available via subscription   (Followers: 10, SJR: 0.146, CiteScore: 0)
Eighteenth-Century Music     Hybrid Journal   (Followers: 13, SJR: 0.113, CiteScore: 0)
English Language and Linguistics     Hybrid Journal   (Followers: 24, SJR: 0.52, CiteScore: 1)
English Profile J.     Hybrid Journal   (Followers: 2)
English Today     Hybrid Journal   (Followers: 13, SJR: 0.279, CiteScore: 0)
Enterprise & Society : The Intl. J. of Business History     Hybrid Journal   (Followers: 18, SJR: 0.245, CiteScore: 1)
Environment and Development Economics     Hybrid Journal   (Followers: 40, SJR: 0.617, CiteScore: 1)
Environmental Conservation     Hybrid Journal   (Followers: 60, SJR: 1.028, CiteScore: 2)
Environmental Practice     Full-text available via subscription   (Followers: 3, SJR: 0.145, CiteScore: 0)
Epidemiology & Infection     Hybrid Journal   (Followers: 18, SJR: 1.128, CiteScore: 2)
Epidemiology and Psychiatric Sciences     Hybrid Journal   (Followers: 3, SJR: 1.494, CiteScore: 2)
Episteme     Hybrid Journal   (Followers: 12, SJR: 0.756, CiteScore: 1)
Ergodic Theory and Dynamical Systems     Hybrid Journal   (Followers: 2, SJR: 1.193, CiteScore: 1)
Ethics & Intl. Affairs     Full-text available via subscription   (Followers: 17, SJR: 0.557, CiteScore: 1)
European Constitutional Law Review (EuConst)     Full-text available via subscription   (Followers: 35, SJR: 1.009, CiteScore: 1)
European J. of Applied Mathematics     Hybrid Journal   (SJR: 0.52, CiteScore: 1)
European J. of Intl. Security     Hybrid Journal   (Followers: 1)
European J. of Sociology     Hybrid Journal   (Followers: 36, SJR: 0.643, CiteScore: 1)
European Political Science Review     Hybrid Journal   (Followers: 27, SJR: 1.816, CiteScore: 2)
European Review     Hybrid Journal   (Followers: 19, SJR: 0.131, CiteScore: 0)
Evolutionary Human Sciences     Open Access  
Experimental Agriculture     Hybrid Journal   (Followers: 14, SJR: 0.542, CiteScore: 1)
Expert Reviews in Molecular Medicine     Hybrid Journal   (Followers: 1, SJR: 1.647, CiteScore: 4)
Fetal and Maternal Medicine Review     Hybrid Journal   (Followers: 6)
Financial History Review     Full-text available via subscription   (Followers: 15, SJR: 0.238, CiteScore: 1)
Foreign Policy Bulletin     Hybrid Journal   (Followers: 6)
Forum of Mathematics, Pi     Open Access   (Followers: 1)
Forum of Mathematics, Sigma     Open Access   (Followers: 1)
Genetics Research     Hybrid Journal   (Followers: 4, SJR: 0.483, CiteScore: 1)
Geological Magazine     Hybrid Journal   (Followers: 16, SJR: 0.966, CiteScore: 2)
Glasgow Mathematical J.     Full-text available via subscription   (SJR: 0.604, CiteScore: 0)
Global Constitutionalism     Hybrid Journal   (Followers: 17)
Global Mental Health     Open Access   (Followers: 9)
Global Sustainability     Open Access  
Government and Opposition     Full-text available via subscription   (Followers: 24, SJR: 0.965, CiteScore: 2)
Greece & Rome     Partially Free   (Followers: 30, SJR: 0.113, CiteScore: 0)
Hague J. on the Rule of Law     Full-text available via subscription   (Followers: 15, SJR: 0.271, CiteScore: 1)
Harvard Theological Review     Full-text available via subscription   (Followers: 80, SJR: 0.165, CiteScore: 0)
Health Economics, Policy and Law     Hybrid Journal   (Followers: 29, SJR: 0.745, CiteScore: 1)
Hegel Bulletin     Full-text available via subscription   (Followers: 2)
High Power Laser Science and Engineering     Open Access   (Followers: 3, SJR: 0.901, CiteScore: 3)
Historical J.     Hybrid Journal   (Followers: 39, SJR: 0.247, CiteScore: 1)
History in Africa     Full-text available via subscription   (Followers: 9)
Horizons     Partially Free   (Followers: 1, SJR: 0.129, CiteScore: 0)
Industrial and Organizational Psychology     Hybrid Journal   (Followers: 27, SJR: 0.916, CiteScore: 1)
Infection Control and Hospital Epidemiology     Full-text available via subscription   (Followers: 41, SJR: 1.97, CiteScore: 3)
Intl. & Comparative Law Quarterly     Full-text available via subscription   (Followers: 251, SJR: 0.369, CiteScore: 1)
Intl. Annals of Criminology     Full-text available via subscription  
Intl. J. of Asian Studies     Hybrid Journal   (Followers: 13, SJR: 0.143, CiteScore: 0)
Intl. J. of Astrobiology     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Intl. J. of Cultural Property     Full-text available via subscription   (Followers: 13, SJR: 0.253, CiteScore: 1)
Intl. J. of Disability Management Research     Full-text available via subscription   (Followers: 9, SJR: 0.105, CiteScore: 0)
Intl. J. of Law in Context     Hybrid Journal   (Followers: 17, SJR: 0.275, CiteScore: 1)
Intl. J. of Legal Information     Full-text available via subscription   (Followers: 343)
Intl. J. of Microwave and Wireless Technologies     Hybrid Journal   (Followers: 10, SJR: 0.184, CiteScore: 1)
Intl. J. of Middle East Studies     Hybrid Journal   (Followers: 72, SJR: 0.434, CiteScore: 0)
Intl. J. of Technology Assessment in Health Care     Hybrid Journal   (Followers: 14, SJR: 0.714, CiteScore: 1)
Intl. Labor and Working-Class History     Full-text available via subscription   (Followers: 14, SJR: 0.182, CiteScore: 0)
Intl. Organization     Full-text available via subscription   (Followers: 106, SJR: 8.527, CiteScore: 5)
Intl. Psychogeriatrics     Hybrid Journal   (Followers: 13, SJR: 1.048, CiteScore: 2)
Intl. Review of Social History     Full-text available via subscription   (Followers: 27, SJR: 0.315, CiteScore: 1)
Intl. Review of the Red Cross     Full-text available via subscription   (Followers: 13, SJR: 0.214, CiteScore: 0)
Intl. Theory: A J. of Intl. Politics, Law and Philosophy     Hybrid Journal   (Followers: 19, SJR: 2.293, CiteScore: 2)
Iraq     Full-text available via subscription   (Followers: 4)
Irish Historical Studies     Hybrid Journal   (Followers: 6, SJR: 0.103, CiteScore: 0)
Irish J. of Psychological Medicine     Hybrid Journal   (Followers: 2, SJR: 0.221, CiteScore: 0)
Israel Law Review     Hybrid Journal   (Followers: 2, SJR: 0.165, CiteScore: 0)
Italian Political Science Review / Rivista Italiana di Scienza Politica     Hybrid Journal  
Itinerario     Full-text available via subscription   (Followers: 11, SJR: 0.158, CiteScore: 0)
J. of African History     Hybrid Journal   (Followers: 21, SJR: 0.348, CiteScore: 1)
J. of African Law     Full-text available via subscription   (Followers: 3, SJR: 0.113, CiteScore: 0)
J. of Agricultural and Applied Economics     Open Access   (Followers: 2, SJR: 0.263, CiteScore: 1)
J. of Agricultural Science     Full-text available via subscription   (Followers: 8, SJR: 0.563, CiteScore: 1)
J. of American Studies     Hybrid Journal   (Followers: 20, SJR: 0.164, CiteScore: 0)
J. of Anglican Studies     Hybrid Journal   (Followers: 6, SJR: 0.101, CiteScore: 0)
J. of Applied Animal Nutrition     Hybrid Journal   (Followers: 4)
J. of Asian Studies     Full-text available via subscription   (Followers: 41, SJR: 0.591, CiteScore: 1)
J. of Benefit-Cost Analysis     Hybrid Journal   (Followers: 4)
J. of Biosocial Science     Hybrid Journal   (Followers: 4, SJR: 0.48, CiteScore: 1)
J. of British Studies     Full-text available via subscription   (Followers: 32, SJR: 0.246, CiteScore: 0)

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Similar Journals
Journal Cover
Cognitive Behaviour Therapist
Number of Followers: 14  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Online) 1754-470X
Published by Cambridge University Press Homepage  [387 journals]
  • A little less talk, a little more action: a dialogical approach to
           cognitive therapy
    • Authors: Matthew Pugh
      Abstract: Reappraisal strategies such as ‘thought challenging’ and ‘cost-benefits analysis’ are a hallmark of cognitive therapy, but sometimes fail to bring about lasting changes in the cognitive-affective structures underlying psychopathology. Modern theories of information processing suggest that experiential, action-based interventions such as chairwork may be a more efficacious route to cognitive modification. Based upon this hypothesis, a ‘dialogical’ approach to cognitive therapy is presented, which aims to bring about change through evocative, here-and-now interactions with parts of the self (self-to-self dialogues) and other individuals (self-to-other dialogues). Implementation principles and facilitation skills which guide this approach are outlined. To illustrate how dialogical interventions are utilized in clinical practice, chair-based strategies for socializing clients to the cognitive behavioural model, restructuring cognitions, facilitating emotional processing, resolving ambivalence, addressing distressing memories, building character strengths, and overcoming therapeutic impasses are described.Key learning aimsAs a result of reading this paper, the reader should:
      (1)Understand the limits of ‘standard’ cognitive techniques.
      (2)Appreciate some of the advantages of experiential methods of intervention, namely chairwork.
      (3)Learn how dialogical interventions are conceptualized, implemented, and facilitated in cognitive therapy.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000333
      Issue No: Vol. 12 (2019)
  • War, trauma and culture: working with Tamil refugees and asylum seekers
           using culturally adapted CBT
    • Authors: Meera Bahu
      Abstract: This study explores the mental health difficulties associated with severe trauma as experienced by refugees and asylum seekers, and issues related to psychological treatments. An evaluation was conducted of a culturally adapted cognitive therapy group programme for Tamil refugees and asylum seekers in the Wandsworth IAPT (Improving Access to Psychological Therapies) service. Data were examined from 16 Tamil participants who accessed the service between 2014 and 2015 and subsequently engaged in the group programme between 2015 and 2016. The IAPT minimum data set (PHQ9, GAD-7, Phobia scale and WSAS) and IES-R (Impact of Events Scale Revised) were used as quantitative measures. Qualitative feedback about the programme was also obtained. A positive change in the wellbeing of participants was indicated by a reduction in the severity of negative symptoms for all metrics and qualitative feedback provided additional evidence that participants had benefited from the programme. The implications of these findings are discussed.Key learning aims
      (1)To examine the difficulties experienced by refugees and asylum seekers and to provide a shared understanding of these themes for CBT practitioners.
      (2)To assist CBT practitioners to develop their confidence in using culturally adapted CBT treatment programmes for refugees and asylum seekers.
      (3)To inform service providers how culturally adapted CBT models can be used in developing specialist services for refugees and asylum seekers.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X1900031X
      Issue No: Vol. 12 (2019)
  • Which types of feedback do CBT students in training value most'
    • Authors: Alexandra Bonney; Sharon Pettit
      Abstract: Feedback is regarded as a highly important component in improving work and learning; despite this, there is a lack of research into what feedback types and characteristics cognitive behaviour therapy (CBT) students value. The aim of this current research was to identify which types of feedback are valued most by CBT students during training. Using a budgeting methodology, students were asked to ‘purchase’ feedback types they valued the most in their learning. This was achieved by using budgets of different sizes to distinguish between necessities and luxuries as part of an online study. Out of nine types of feedback provided during CBT training, the written feedback on full session video recordings of their own therapy was identified as most valuable to students’ learning. Written feedback on full session video recordings is highly valued by CBT students. This arguably justifies the workload involved for training courses in providing detailed formative feedback on therapy recordings.Key learning aims
      (1)To know which aspects of feedback are prioritized by CBT students during training.
      (2)To explore these preferences using a budgeting paradigm from broader educational literature.
      (3)To help supervisors and trainers know how to prioritize if time and resources are stretched.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000321
      Issue No: Vol. 12 (2019)
  • Cultural adaptation of cognitive behavioural therapy (CBT) for patients
           with depression and anxiety in Saudi Arabia and Bahrain: a qualitative
           study exploring views of patients, carers, and mental health professionals
    • Authors: Haifa Mohammad Saleh Algahtani; Abdullah Almulhim, Fatema Ali AlNajjar, Mazen Khalil Ali, Muhammad Irfan, Muhammad Ayub, Farooq Naeem
      Abstract: Western values influence cognitive behavioural therapy (CBT) as it was primarily developed and practised in the West. As understanding the cultural context has been linked to better therapy outcomes, it has been suggested that CBT might need modification to non-Western clients’ cultural backgrounds. Previously we developed a cost-effective approach to adapt CBT for clients in China and Pakistan. In this study, we applied the same methodology for local clients suffering from depression and anxiety in the Kingdom of Saudi Arabia and Bahrain. This study aimed to understand the views of patients with depression and anxiety, caregivers and mental health professionals about CBT to develop guidelines for culturally adapting CBT for depression and anxiety. We conducted semi-structured interviews with the patients (n = 42), caregivers (n = 11), and psychiatrists and psychologists (n = 16). The data were analysed using a thematic framework analysis by identifying emerging themes and categories. The themes emerging from the analyses of interviews by each interviewer were compared and contrasted with those of other interviewers. The results highlighted barriers of access to and strengths of CBT while working with these patient groups. Patients and their caregivers in both countries use a bio-psycho-spiritual-social model of illness and seek help from multiple sources. Therapists emphasized the need for using local idioms, culturally appropriate translation and minor adjustments in therapy. There were no thematic differences between the two sites. These findings will be used to culturally adapt a CBT manual, which will be tested in a randomized controlled trial.Key learning aimsAfter reading this article, readers will be able to:
      (1)Understand the need for cultural adaptation of CBT.
      (2)Identify the necessary steps to adapt CBT for the Muslim Arab population.
      (3)Understand the modifications required to deliver culturally adapted CBT for the Muslim Arab population.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X1900028X
      Issue No: Vol. 12 (2019)
  • LGBQ+ adults’ experiences of Improving Access to Psychological Therapies
           and primary care counselling services: informing clinical practice and
           service delivery
    • Authors: Amelia A.J. Foy; Daniel Morris, Vanessa Fernandes, Katharine A. Rimes
      Abstract: Lesbian, gay, bisexual, queer and other sexual minority (LGBQ+) people experience higher levels of psychological difficulties than heterosexual people. Evidence suggests that LGBQ+ treatment outcomes within England’s Improving Access to Psychological Therapies (IAPT) services are worse than the outcomes for heterosexuals, especially for bisexual people and sexual minority women. IAPT services provide evidence-based treatments like cognitive behavioural therapy (CBT), typically for anxiety or depression. This study explored LGBQ+ adults’ experiences with IAPT services and/or primary care counselling. LGBQ+ adults (n = 136) answered an online questionnaire (fixed-response and optional open-ended questions) about their access and treatment experiences. Descriptive statistics summarized multiple-choice responses. Qualitative data were analysed through thematic analysis. Before access, 41.9% of participants were concerned about experiencing LGBQ+ stigma/discrimination within psychological services. Only 13.2% of participants thought their sexuality negatively impacted their treatment, although prejudice/discrimination may be underestimated as 33.6% participants did not disclose their sexuality to practitioners and sexuality was not discussed in treatment for 44.0% of participants. Bisexual clients were significantly less likely to disclose their sexuality. The barriers LGBQ+ people described within IAPT or primary care services included: feared or experienced stigma in the services; reluctance to disclose sexuality; inconsistent discussion of sexuality in treatment; a lack of awareness and understanding towards LGBQ+ identities and community-specific challenges; and distrust, disillusionment and exclusion resultantly. Overall, 52.2% thought services could be improved for LGBQ+ individuals. This study identified multiple issues to be addressed in therapist training and service development.Key learning aims
      (1)The unique needs/experiences that LGBQ+ people bring to therapy, such as the need to disclose their sexuality and past experiences of stigma/discrimination, including how this differs within the community (e.g. bisexual people or LGBQ+ Black and minority ethnic people).
      (2)How these needs/experiences can result in barriers that make their treatment experience distinct from heterosexuals and influence their treatment outcomes.
      (3)What steps should be taken in future research and clinical practice to ensure improvements in the psychological treatment experiences of LGBQ+ people, including in relation to therapist understanding and training in LGBQ+-related issues.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000291
      Issue No: Vol. 12 (2019)
  • Working alliance does not mediate the relation between outcome expectancy
           and symptom improvement following cognitive behavioural therapy for social
           anxiety disorder
    • Authors: Amanda A. Draheim; Page L. Anderson
      Abstract: A small body of research shows that the working alliance mediates the relation between outcome expectancy and treatment response, but this model has not been applied to the treatment of social anxiety disorder. The present study tests the hypothesis that the working alliance mediates the relation between outcome expectancy and symptom improvement within a randomized controlled trial testing the efficacy of virtual reality exposure therapy for social anxiety disorder. A sample of 54 individuals diagnosed with social anxiety disorder completed eight sessions of virtual reality exposure therapy or exposure group therapy. Participants completed standardized self-report measures of outcome expectancy at the first session, of the working alliance at each session, and three measures of social anxiety symptoms at pre- and post-treatment. The working alliance did not mediate the relation between outcome expectancy and symptom improvement across time points, dependent measures, and treatment type. Bayes factors were calculated for the relation between the working alliance and symptom reduction, while controlling for outcome expectancy and therapist effects. Results were inconclusive. These null findings are intriguing and urge further study of the mechanisms through which common factors relate to treatment response. Utilization of Bayesian analyses may help to clarify the nature of these relations.Key learning aims
      (1)Readers will consider the role of common factors in treatment for social anxiety disorder.
      (2)Readers will learn about how different common factors may interact with each other.
      (3)Readers will be encouraged to consider how the therapeutic relationship may manifest in a unique manner in treatment for social anxiety.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000266
      Issue No: Vol. 12 (2019)
  • The impact of a CBT-based bipolar disorder psychoeducation group on views
           about diagnosis, perceived recovery, self-esteem and stigma
    • Authors: Thomas Richardson; Lucy White
      Abstract: Previous research has shown that psychoeducation for bipolar disorder (BD) improves symptoms and reduces relapse risk, but there is little research on how this impacts stigma, perceived recovery and views about diagnosis. The aim of this study was to explore whether a cognitive behaviour therapy (CBT)-based 12-week BD psychoeducation group conducted in a community mental health team for adults impacted perceived stigma, diagnosis-related self-esteem, recovery and views about diagnosis. The case series pre- and post-group had 23 participants across three groups. The Brief Illness Perception Questionnaire, views on Manic Depression Questionnaire, Bipolar Recovery Questionnaire and author-constructed questions were completed pre and post. Twenty participants completed the group. An intent-to-treat repeated measures multiple analysis of variance showed significantly improved perceived recovery and improvements in sense of control and understanding around their diagnosis. Other specific questions such as understanding of triggers and impact of thinking patterns also improved. However, there was no change in the perceived stigma or self-esteem associated with living with BD. CBT-based psychoeducation groups may help improve perceived recovery and factors such as sense of control in BD. However, there appears to be no impact on stigma and self-esteem, and the role of non-specific factors needs to be examined further.Key learning aims
      (1)To raise awareness of the impact of stigma and self-esteem in bipolar disorder.
      (2)To understand the content and structure of CBT-based psychoeducation groups.
      (3)To consider the potential benefits of CBT-based psychoeducation groups beyond symptoms and relapse reduction on factors such as perceived recovery.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000308
      Issue No: Vol. 12 (2019)
  • Cultural adaptations of CBT: a summary and discussion of the Special Issue
           on Cultural Adaptation of CBT
    • Authors: Farooq Naeem
      Abstract: Cognitive behavioural therapy (CBT) in its current form might not be acceptable to service users from a variety of backgrounds. Therefore, it makes sense to adapt CBT when working with diverse populations. Contributors to this special issue of the Cognitive Behaviour Therapist have tackled the issues around the cultural adaptation of CBT from various perspectives, using a variety of methods, and have addressed topics ranging from cultural adaptation to improving access to CBT. Here, I briefly summarize and discuss the papers in this special issue. I start with a systematic review of CBT for social anxiety across cultures. Seven articles cover aspects of adaptation of therapies for people from different backgrounds. Three papers discuss the issues of gender and sexuality when using CBT, while another three papers focus on refugees, asylum seekers and the homeless, and two papers describe the application of CBT with religious populations. Finally, there are seven papers on issues related to service delivery, practice and training and supervision when working with a diverse population. Collectively, papers in this special issue provide us with sufficient evidence that cultural considerations play a vital role when using CBT, offer practical suggestions for improving cultural competence and most importantly, can catalyse future research. However, the full potential of culturally adapted interventions will not be realized until and unless access to CBT is improved. Therefore, there is a need to build robust evidence to convince funders, policy makers and service managers.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000278
      Issue No: Vol. 12 (2019)
  • A review of the relationship between intolerance of uncertainty and threat
           appraisal in anxiety
    • Authors: S. Milne; C. Lomax, M. H. Freeston
      Abstract: The development and conceptual relationship of the constructs of threat appraisal (TA) and intolerance of uncertainty (IU) are explored in the context of anxiety disorders. A narrative review tracking the development of these constructs and their relationship is undertaken. There is some evidence to suggest that the interaction between the components of threat appraisal (probability × cost) may partially account for or provide a theoretical framework which explains presenting levels of anxiety. Furthermore, research suggested that IU is a construct which contributes to a broad range of anxiety disorders. It was concluded that distinctive cognitive biases linked with IU – such as interpreting ambiguous and uncertain (both positive and negative) information as highly concerning – suggests that IU is interpreted negatively independent of threat appraisal. These findings mean a number of issues remain unclear, including whether IU in anxiety-provoking situations is sufficient in itself – independent of threat appraisal – in eliciting high levels of anxiety. Additionally, it is unclear whether threat appraisal and IU act as independent constructs, or more in an interactive manner in anxiety. To achieve further clarity on these issues, methodological recommendations for future research are made.Key learning aims
      (1)To understand the conceptual foundations of TA and IU in the cognitive model of anxiety.
      (2)To understand the empirical evidence supporting the role of both TA and IU in anxiety.
      (3)To appreciate the potential relationship between these concepts in anxiety.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000230
      Issue No: Vol. 12 (2019)
  • Real-world evaluation of digital CBT for insomnia in the primary care
           setting – many should not log on to doze off
    • Authors: Zheyu Xu; Kirstie N. Anderson
      Abstract: Cognitive behaviour therapy for insomnia (CBTi) has emerged as the first-line treatment for insomnia where available. Clinical trials of digital CBTi (dCBTi) have demonstrated similar efficacy and drop-out rates to face-to-face CBTi. Most patients entering clinical trials are carefully screened to exclude other sleep disorders. This is a case series review of all those referred to a dCBTi within an 18-month time period. Those initially screened, accepted after exclusion of other sleep disorders, commencing and completing therapy were assessed to understand patient population referred from general practice in the UK. 390 patient referrals were analysed. 135 were suitable for dCBTi with a high rate of other sleep disorders detected in screening. 78 completed therapy (20.0%) and 44.9% had significant improvement in sleep outcomes, achieving ≥20% improvement in final sleep efficiency. dCBTi can be used within the UK NHS with good benefit for those who are selected as having insomnia and who then complete therapy. Many referrals are made with those likely to have distinct primary sleep disorders highlighting the need for education regarding sleep and sleep disorders prior to dCBTi therapy.Key learning aims
      (1)The use of unsupported digital cognitive behavioural therapy for insomnia (dCBTi) requires proper patient selection.
      (2)There are many insomnia mimics and also previously unrecognized sleep and psychiatric disturbances that are under-diagnosed in the primary care setting that are contraindications for unsupported dCBTi.
      (3)The use of a stepped care approach similar to the UK’s Improving Access to Psychological Therapies (IAPT) model using dCBTi could be feasible in the public health setting.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000242
      Issue No: Vol. 12 (2019)
  • The unified protocol for anxiety and depression with comorbid borderline
           personality disorder: a single case design clinical series
    • Authors: Michelle E. Lopez; Steven R. Thorp, Matthew Dekker, Andrew Noorollah, Giovanna Zerbi, Laura A. Payne, Emily Meier, Jill A. Stoddard
      Abstract: This study used a single case experimental design to investigate the use of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) among a sample of individuals with depression and anxiety who also presented with borderline personality disorder (BPD). Eight women received individual treatment with the UP over the course of 14–16 treatment sessions, and were assessed for anxiety and depression severity on a weekly basis over a 2–6 week baseline period and throughout treatment. Three of the eight participants demonstrated reliable pre- to post-treatment clinical improvements on depression and stress scales, and one participant demonstrated a reliable reduction on an anxiety scale. Two participants demonstrated a reliable improvement in overall anxiety. The results indicate that the UP applied to individuals diagnosed with primary BPD may lead to clinical improvement in depression, stress and anxiety for some individuals. However, the majority of individuals with BPD in our sample did not show strong improvement, and this suggests the need for additional sessions of UP or an intervention that focuses on the symptoms of BPD specifically for some women.Key learning aims
      (1)To describe the applicability of the Unified Protocol in the treatment of individuals with borderline personality and co-occurring anxiety or depression.
      (2)To understand the value of utilizing a transdiagnostic approach as an alternative to diagnosis-specific approaches to treatment.
      (3)To identify the four core modules of the Unified Protocol and describe the general format for individual treatment.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000254
      Issue No: Vol. 12 (2019)
  • Writing the ‘self’ into self-practice/self-reflection (SP/SR) in CBT:
           learning from autoethnography
    • Authors: Craig Chigwedere
      Abstract: Self-practice/self-reflection (SP/SR) allows cognitive behavioural therapists (CBT) to self-experience the techniques they use clinically. However, it is difficult to find published first-hand accounts of CBT therapists’ SP/SR experiences. This may be because CBT research is primarily positivist and objective, while SP/SR is intrinsically subjective. Borrowing from the principles of autoethnography may offer a subjectivist qualitative methodology, allowing CBT therapists to write up their SP/SR experiences as rich, first-hand research material, potentially impacting theory and practice. This novel personal case study of SP/SR borrows from autoethnography, adapting it to analyse the self-practice of the CBT model of worry, in order to understand my own experience of worry as well as the model itself.Key learning aims
      (1)To develop an approach to the research that is applicable to first-hand SP/SR material.
      (2)To demonstrate how therapists can continue SP/SR practice post-CBT training.
      (3)To illustrate how, with the aid of autoethnographic principles, SP/SR practice can influence not only the practitioner’s personal and therapist-self, but also theory development.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000217
      Issue No: Vol. 12 (2019)
  • Cognitive behavioural therapy for worry in young individuals with at-risk
           mental states: a preliminary investigation
    • Authors: Andrea Pozza; Sandro Domenichetti, Davide Dèttore
      Abstract: Cognitive behavioural therapy (CBT) is a first-line strategy in reducing or delaying risk of transition to psychosis among young individuals with at-risk mental states (ARMS). However, there is little knowledge about its effects on other outcomes associated with ARMS. No study on CBT for ARMS has assessed worry, an important process associated with this condition. The present study investigated changes in worry at immediate post-treatment and 14-month follow-up after CBT for young individuals with ARMS seeking psychiatric care in mental health services. Thirty-seven young individuals (mean age = 26 years, SD = 6.07; 22.20% female) seeking psychiatric care in mental health services and classified as reporting ARMS through the Comprehensive Assessment of At-Risk Mental States were included. The Positive And Negative Syndrome Scales (PANSS) and Penn State Worry Questionnaire (PSWQ) were administered at baseline, post-treatment, and follow-up. CBT consisted of 30 weekly individual 1-hour sessions based on a validated CBT for ARMS manual enriched with components targeting worry [psychoeducation, problem-solving, (meta)cognitive restructuring, behavioural experiments]. Seven participants (18.91%) at follow-up had cumulatively made transition to psychosis. Repeated measures ANOVA with post-hoc pairwise comparisons showed significant changes in PSWQ scores from baseline to post-treatment and from baseline to follow-up; PSWQ scores remained stable from post-treatment to follow-up. This is the first study investigating changes in worry after CBT for ARMS, which appears to be a promising strategy also for this outcome. Future research with a larger sample size and control group may determine whether changes in worry are also associated with reduced transition risk.Key learning aims
      (1)To understand CBT evidence and procedures for young individuals with ARMS.
      (2)To reflect on the current limitations in the literature on CBT for ARMS.
      (3)To understand the importance and clinical implications of assessing worry in ARMS.
      (4)To focus on changes in worry as an outcome after CBT for ARMS.
      (5)To reflect on future research directions on the role of worry in CBT for ARMS.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000229
      Issue No: Vol. 12 (2019)
  • An evaluation of predictors of dropout from an Emotional Coping Skills
           programme in a community mental health service
    • Authors: Shalini Raman; Thomas Richardson
      Abstract: Drop-out from mental health services is a significant problem, leading to inefficient use of resources and poorer outcomes for clients. Adapted dialectical behaviour therapy (DBT), often termed Emotional Coping Skills (ECS) programmes, show some of the highest rates of drop-out from therapy recorded in the literature. The present study aimed to add to the evidence base, by evaluating predictors of drop-out from an ECS programme in a UK-based Community Mental Health Team (CMHT). An existing data set of 49 clients, consisting of clients’ responses on a number of questionnaires, was evaluated for predictors of drop-out. Predictors of drop-out included symptom severity, substance use and client demographics. Independent-samples t-tests and chi-square cross tabs analyses revealed no significant differences between drop-outs and completers of therapy on any of the variables. This suggests that contrary to common assumptions and previous findings, clients using substances, who are highly anxious, or who experience a greater degree of emotion dysregulation, are not more likely to drop out from ECS programmes compared with other individuals. The clinical implications of these findings and future research are discussed within the wider context of the evidence base.Key learning aims
      (1)To be familiar with common predictors of drop-out from psychological therapies, as indicated by the literature.
      (2)To understand the theories underlying factors that impact drop-out and the associated consequences for mental health services.
      (3)To understand the potential impact of staff assumptions of factors that affect drop-out on client retention.
      (4)To have an understanding of initiatives and strategies that may improve client-retention and engagement in services.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000151
      Issue No: Vol. 12 (2019)
  • Psychotherapists’ reports of technique use when treating anxiety
           disorders: factors associated with specific technique use
    • Authors: Zachary J. Parker; Glenn Waller
      Abstract: Cognitive behavioural therapy (CBT) is the most efficacious and effective psychological intervention for treating anxiety disorders. Behavioural techniques, in particular exposure-based techniques, are fundamental to positive outcomes. However, research suggests that these techniques are either not used or are under-used when treating anxiety disorders. This study assesses therapists’ reported use of CBT techniques in the treatment of anxiety disorders, and explores which therapist variables influence technique use. A total of 173 CBT therapists completed measures on their demographics, routine therapy practices in treating anxiety disorders, and internal states (e.g. self-esteem). These data were analysed to see how often therapists employed particular techniques and the correlates of the use of those techniques. Behavioural techniques (e.g. exposure) were the least utilized set of core CBT skills, being used less often than non-CBT techniques. The under-utilization of these key techniques was associated with greater levels of increased inhibitory anxiety amongst therapists. Supervision and therapists’ self-esteem were both positively associated with the use of non-CBT techniques. While this study established what CBT therapists purport to use in routine practice with anxious populations, further research is needed to assess the association between adherence (or lack thereof) and client outcomes, and the factors that drive non-adherence.Key learning aimsAs a result of reading this paper, the reader should:
      (1)Learn about what psychotherapists report as occurring in routine care for individuals with anxiety and related disorders.
      (2)Know the potential therapist traits that influence the use of CBT techniques.
      (3)Gain knowledge to help explain to clients why previous therapy may not have been effective.
      (4)Develop a richer understanding of what factors may influence their own therapeutic practice.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000205
      Issue No: Vol. 12 (2019)
  • A test of the feasibility of a visualization method to show the depth and
           duration of awareness during Method of Levels therapy
    • Authors: Jakub Grzegrzolka; Warren Mansell
      Abstract: Many psychological therapies help clients to direct and sustain their awareness onto specific aspects of their problems to promote change. Yet, no theory-driven measure exists that can code moment-by-moment changes in awareness during a therapy session. It is known that awareness plays a crucial role in the process of change, but little is known about the underlying core processes. Perceptual Control Theory (PCT) offers a scientific explanation of psychological distress as loss of control and describes the role of awareness in processes responsible for restoring control by resolving any internal conflict. The Depth and Duration of Awareness Coding Scheme (D-DACS) was previously developed to capture the person’s current focus of awareness and its duration on the areas that from a PCT point of view are desirable in order to facilitate effective psychological change. The current research applies D-DACS to code three publicly available Method of Levels (MOL) therapy sessions delivered by an expert therapist and presents a visual representation of the client’s presumed attention in these sessions. The results showed that an average of 61.65% of the client’s attention was focused on the D-DACS areas, which is higher than the previous studies involving novel therapists. The produced visual representation of the clients’ presumed attention helps to examine the utility of this new coding scheme and further examine the validity of the underlying theory. Such work might help in examining effectiveness of therapy in meeting the underlying theoretical foundations of change. However, limitations and areas for improvement are also evident.Key learning aims
      (1)To provide a rationale for the use of observer-rated measures of within-session processes involved in therapeutic change.
      (2)To describe the desired focus of the client’s awareness in order to facilitate effective psychological change as described by Perceptual Control Theory.
      (3)To use an earlier validated scheme to code the depth and duration of awareness of three clients in best practice videos of Method of Levels psychotherapy.
      (4)To present and test the feasibility of a visual representation of moment-to-moment changes in a client’s awareness in a therapy session.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000199
      Issue No: Vol. 12 (2019)
  • Cognitive Behavioural Therapy Suicide Prevention (CBT-SP) imagery
           intervention: a case report
    • Authors: Marie Carey; Catherine Wells
      Abstract: Very little clinical work or research to date has focused on the prioritization of suicidal imagery intervention in the stabilization of risk. Current Cognitive Behavioural Therapy Suicide Prevention (CBT-SP) does not specifically address suicidal imagery as a priority intervention. This paper prioritizes imagery modification as the central task of therapy with the suicidal client. This is a single subject case review describing specific imagery interventions used to destabilize the comforting component of suicidal images, de-glamourize the suicidal image as a problem-solving method and the reconstruction of new images to offset the emotional grasp of both ‘flash-forward’ violent suicidal images and suicidal ‘daydreaming’ rumination. It is hypothesized that when suicidal images become less emotionally charged, the desire to act upon suicide decreases. Focusing on imagery intervention as a priority aims to stabilize risk in a more clinically specific and targeted way. Rob is a 19-year-old depressed young man with chronic suicidal ideation/images with repeated suicide attempts. All GP referrals are of a crisis nature since the age of 16. He was referred to a CBT clinician with specific training and experience in CBT-SP who proposed the following brief imagery intervention. Socialization to treatment rationale was pivotal at the outset to help facilitate strong therapeutic alliance, ‘buy-in’ to the intended de-glamourization of suicide planning/daydreaming/rumination and the effects of intrusive ‘flash-forward’ images on emotional well-being. Therapy was facilitated weekly, supported by telephone contact, on an out-patient basis in the HSE (Health Service Executive) Irish Adult Mental Health service. The care plan and interventions were supported by access to the 24-hour acute Adult Mental Health services, as required. There was no requirement for direct client engagement with the acute services. Rob engaged with five treatments of CBT-SP imagery intervention and full stabilization of risk to self by suicide was achieved. At the time of writing, Rob is alive, has no engagement with the services and no further GP referral requests for intervention. Despite Rob leaving therapy before full completion, brief targeted suicidal imagery intervention was observed to stabilize the risk of suicidal behaviour. This young man has completed his schooling, engaged in ‘life’ planning rather than ‘death’ planning and has not required further intervention from this service. Further research is required to engage frontline clinicians on the merits of suicidal imagery assessment in routine clinical practice.Key learning aims
      (1)To assess for imagery and violent day dreaming in suicidal patients.
      (2)Conceptualizing suicidal rumination and daydreaming as being a maladaptive problem-solving technique in overcoming psychological pain.
      (3)Use of suicide-specific assessment.
      (4)Ask about the presence of suicidal imagery as part of routine mental health assessment with the suicidal client.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000175
      Issue No: Vol. 12 (2019)
  • Who am I without anorexia' Identity exploration in the treatment of
           early stage anorexia nervosa during emerging adulthood: a case study
    • Authors: A. Koskina; U. Schmidt
      Abstract: Emerging adulthood (age 18–25 years) is a distinct developmental phase, characterized by multiple life changes, transitions and uncertainties, associated with significant risk of mental ill health in vulnerable individuals. Identity exploration and development is key during this phase, and the development of an eating disorder during this time can significantly impact on this process. This single-case study details the treatment of an 18-year-old female outpatient with first episode, recent onset anorexia nervosa. Using the Maudsley Model of Anorexia Nervosa Treatment in Adults (MANTRA), focus was placed on identity exploration and development as a tool to reduce the dominance of anorexia nervosa and increase recovery focus. Outcome measures at end of treatment and 6-month follow-up showed significant sustained improvement in BMI and EDE-Q scores. The patient gave detailed positive feedback suggesting that this was a highly acceptable and effective intervention. The case study is discussed with reference to limitations and some reflections on the utility of incorporating identity work in the treatment of anorexia nervosa in emerging adulthood.Key learning aims
      (1)This case study is thought to have important clinical implications for tailoring the treatment of early stage AN to the emerging adult population.
      (2)Identity exploration is a key feature of this developmental stage, and incorporating this work into therapy allows for experimentation and formation of an alternative, healthy set of values, beliefs and behaviours.
      (3)This case also highlights the value of using role models in the construction of a non-illness driven identity, to support with behavioural change.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000187
      Issue No: Vol. 12 (2019)
  • Transdiagnostic CBT for adult emotional disorders: A feasibility open
           trial from Saudi Arabia
    • Authors: Yousra Alatiq; Omar Al Modayfer
      Abstract: Transdiagnostic cognitive behavioural therapy (T-CBT) provides potential for improving psychotherapy services in countries with limited resources. The primary aim of this study was to assess the feasibility and potential benefits of using T-CBT in Saudi Arabia to treat adult emotional disorders in a naturalistic open trial. A secondary aim was to measure the effect of this approach when delivered by junior psychologists as a low-intensity intervention. The overall sample consisted of 198 patients (160 in the low-intensity group). Only 33 (16.7%) patients had completed the treatment plan, 55 (27.3%) were still active in treatment, and 109 (55%) had disengaged from the treatment. The pre- and post-assessments for the clients who completed the treatment showed a significant decrease in all outcome measures. This result held true for the whole sample and the low-intensity group. This study provides initial evidence that T-CBT is suitable for clients with emotional disorders in Saudi Arabia. The study also provides support for the effect of T-CBT as a low-intensity intervention delivered by junior psychologists. However, one of the study limitations was the sample size for the group who completed the treatment and was properly discharged from service. Implications and recommendations are discussed.Key learning aims
      (1)To examine the feasibility and potential benefits of using T-CBT in Saudi Arabia.
      (2)To measure the effect of T-CBT as low-intensity interventions delivered by junior psychologists.
      (3)To establish evidence-based practice for T-CBT in Saudi Arabia.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000163
      Issue No: Vol. 12 (2019)
  • ‘Courses for Horses’: designing, adapting and implementing self
           practice/self-reflection programmes
    • Authors: Mark H. Freeston; Richard Thwaites, James Bennett-Levy
      Abstract: Self-Practice/Self-Reflection (SP/SR) has been proposed both as an adjunct to therapy training programmes, and also as a means for therapist development among experienced therapists. Research suggests it develops aspects of knowledge and skill that may not be addressed through other training methods. With increasing interest in SP/SR, a growing evidence base regarding both participant benefits and potential risks from SP/SR, and the development of SP/SR programmes across a range of therapeutic modalities, we argue it is timely to identify a set of principles that can guide the design, adaptation and implementation of SP/SR programmes. At this stage, there is little empirical evidence to guide trainers wishing to implement SP/SR in different contexts. Accordingly, these principles have been derived from reflection on developing, testing and implementing SP/SR programmes as well as on other training and supervisory experience. The first set of principles detailed in Section 1 draw on various theories of learning and development and frame the processes involved, the next principles speak to the content of SP/SR programmes, and the final principles address structure. Within Section 2, the principles are then considered for their practical implications. In Section 3, the sharing of what are initially private self-reflections is then considered together with some implications for SP/SR programmes, especially when there is assessment involved. We argue that SP/SR will continue to progress with well-designed standard programmes, careful implementation, thoughtful adaptation, ongoing innovation, and especially more evaluation.Key learning aims
      (1)To understand the principles for designing, adapting and implementing SP/SR programmes that are drawn from theory and from the authors’ experience of developing and implementing SP/SR programmes over the last 20 years.
      (2)To understand the possible factors that guide the processes, content and structure of SP/SR programmes.
      (3)To understand how best to maximize effective engagement and learning (and limit harm) when planning or implementing an SP/SR programme.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000138
      Issue No: Vol. 12 (2019)
  • Impact of a brief worry-based cognitive therapy group in psychosis: a
           study of feasibility and acceptability
    • Authors: Helen Courtney; Lucy White, Thomas Richardson, Ben Dasyam, Jo Tedbury, Jane Butt
      Abstract: Previous research suggests that CBT focusing on worry in those with persecutory delusions reduces paranoia, severity of delusions and associated distress. This preliminary case series aimed to see whether it is feasible and acceptable to deliver worry-focused CBT in a group setting to those with psychosis. A secondary aim was to examine possible clinical changes. Two groups totalling 11 participants were run for seven sessions using the Worry Intervention Trial manual. Qualitative and quantitative data about the experience of being in the group was also collected via questionnaires, as was data on number of sessions attended. Measures were delivered pre- and post-group and at 3-month follow-up. These included a worry scale, a measure of delusional belief and associated distress and quality of life measures. Of the 11 participants who started the group, nine completed the group. Qualitative and quantitative feedback indicated that most of the participants found it acceptable and helpful, and that discussing these issues in a group setting was not only tolerable but often beneficial. Reliable Change Index indicated that 6/7 of the group members showed reliable reductions in their levels of worry post-group and 5/7 at follow-up. There were positive changes on other measures, which appeared to be more pronounced at follow-up. Delivering a worry intervention in a group format appears to be acceptable and feasible. Further research with a larger sample and control group is indicated to test the clinical effectiveness of this intervention.Key learning aims
      (1)To understand the role of worry in psychosis.
      (2)To learn about the possible feasibility of working on worry in a group setting.
      (3)To be aware of potential clinical changes from the group.
      (4)To consider acceptability for participants of working on worries in a group setting.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X1900014X
      Issue No: Vol. 12 (2019)
  • Addressing issues of race, ethnicity and culture in CBT to support
           therapists and service managers to deliver culturally competent therapy
    • Authors: Saiqa Naz; Romilly Gregory, Meera Bahu
      Abstract: Conversations around improving access to psychological therapies for BAME (Black, Asian and minority ethnic) service users have been ongoing for many years without any conclusion or resolution. BAME service users are often under-represented in primary care mental health services, and often have worse outcomes, leading to them being portrayed as ‘hard to reach’, and to deterioration in their mental health. They are over-represented in secondary care mental health services. The authors of this article argue that more resources are required in order to understand the barriers to accessing mental health services, and improve both access and recovery for BAME service users. This paper examines concepts such as race, ethnicity and culture. It aims to support service managers and therapists to develop their confidence to address these issues in order to deliver culturally competent psychological therapies to service users from BAME communities, with a focus on primary care. It is based on our experiences of working with BAME communities and the feedback from our training events on developing cultural competence for CBT therapists. The paper also discusses the current political climate and the impact it may have on service users and the need for therapists to take the wider political context into consideration when working with BAME service users. Finally, the paper stresses the importance of addressing structural inequalities at a service level, and developing stronger ethical guidelines in the area of working with diversity for CBT therapists in the UK.Key learning aims
      (1)To examine concepts such as race, ethnicity and culture and to provide a shared understanding of these terms for CBT therapists.
      (2)To assist CBT therapists and supervisors to develop their confidence in addressing issues of race, ethnicity and culture with BAME service users within the current political climate and to deliver culturally competent therapy.
      (3)To assist service managers to promote equality of access and of outcomes for service users from BAME communities.
      (4)To understand how unequal expectations of therapists in services impacts on CBT therapists from BAME communities.
      (5)To widen understanding of some of the structural inequalities at service level which the CBT community needs to overcome, including recommending stronger ethical guidelines around working with diversity in the UK.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000060
      Issue No: Vol. 12 (2019)
  • A protocol for managing dissociative symptoms in refugee populations
    • Authors: Zoe J. Chessell; Francesca Brady, Sameena Akbar, Adele Stevens, Kerry Young
      Abstract: This article describes a clinical protocol for supporting those presenting with post-traumatic stress disorder (PTSD) and dissociative symptoms, particularly dissociative flashbacks, based on a cross-culturally applicable model. The protocol is discussed from the perspective of working with a refugee and asylum seeker population, although many of the principles will be applicable to clients from any background presenting with these dissociative symptoms. The protocol addresses the assessment and formulation of a client’s dissociative symptoms. It includes guidance on sharing psycho-education with clients regarding the evolutionary function of dissociation and developing practical strategies to monitor and manage dissociative symptoms. The strengths and limitations of this protocol are also discussed.Key learning aimsAfter reading this article people will:
      (1)Be able to understand a cross-culturally applicable model of dissociation and how it applies to clinical practice when working with clients presenting with dissociative symptoms, particularly dissociative flashbacks, in the context of a diagnosis of PTSD.
      (2)Be able to assess and formulate dissociative symptoms as part of an overall PTSD formulation.
      (3)Be able to develop practical strategies for assisting clients in monitoring and managing their dissociative symptoms.
      (4)Be familiar with adaptations for using this approach with refugee and asylum seeker populations.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000114
      Issue No: Vol. 12 (2019)
  • Using the evidence base for social anxiety to understand and treat
           paranoia: a single case experimental design
    • Authors: Stephanie Hicks
      Abstract: Research suggests that paranoia and social anxiety can be understood as part of the same continuum, having shared processes such as the anticipation of threat, cognitive biases, poor self-concept, worry and safety-seeking behaviours. There is limited research on whether evidence-based interventions for social anxiety could be used with individuals who experience paranoia; however, an existing brief intervention study using techniques taken from cognitive behavioural therapy (CBT) for social anxiety has had promising results.This paper uses a single-case experimental design to explore whether using a clinical model of the maintenance of paranoia followed by CBT for social anxiety can be an effective formulation and intervention method in cases where social anxiety processes appear to be maintaining paranoid thoughts. This may be an effective formulation and intervention method, resulting in a reduction in anxiety and a reduction in the distress associated with paranoid thoughts. The clinical implications are discussed along with limitations and recommendations for further research.Key learning aims
      (1)To describe shared processes in social anxiety and paranoia.
      (2)To identify the benefits and limitations of using a clinical model of paranoia and CBT for social anxiety for formulation and intervention with individuals experiencing paranoia.
      (3)To identify areas where further research is warranted in treatment for individuals experiencing paranoia.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000126
      Issue No: Vol. 12 (2019)
  • Cognitive behavioural therapy training in Tanzania: a qualitative study of
           clinicians’ experiences
    • Authors: Lydia Stone; Megan A. Arroll
      Abstract: 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.Key learning aims
      (1)To identify what range of factors may influence clinicians’ perception of and learning about CBT when CBT training is delivered in a mental health setting in Tanzania, or to those with East African origins.
      (2)To consider the use of qualitative research approaches to inform the early stages of adapting CBT for use in new settings and applications.
      (3)To be able to apply knowledge about cultural differences to standard CBT in order to promote culturally sensitive practice.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000084
      Issue No: Vol. 12 (2019)
  • Delivering a culturally adapted therapy for Muslim clients with depression
    • Authors: Ghazala Mir; Ruqayyah Ghani, Shaista Meer, Gul Hussain
      Abstract: Inequalities in mental health treatment access and outcomes for minority ethnic and religious groups in the UK have been recognized for more than a decade; however, work to address these at an operational level is still emerging. In recognition of the need for culturally adapted therapies, researchers at the University of Leeds developed and piloted an adapted therapy for Muslim clients, based on behavioural activation (BA), an existing evidence-based psychosocial treatment for depression. Therapists and supervisors at Touchstone, Leeds have been trained to deliver the culturally adapted approach, which supports Muslim clients who choose to use ‘positive religious coping’ as a resource for health. This paper describes the key elements of the intervention and how it is being delivered in practice to increase service uptake and recovery in Muslim communities.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000059
      Issue No: Vol. 12 (2019)
  • Culture and therapist self-disclosure
    • Authors: Peter Phiri; Shanaya Rathod, Mary Gobbi, Hannah Carr, David Kingdon
      Abstract: Cognitive behaviour therapy (CBT) as a treatment for schizophrenia and psychotic-related disorders has been shown to have significantly greater drop-out rates in clients of black and minority ethnic (BME) groups. This has resulted in poor outcomes in treatments. Our recent qualitative study thus aimed to develop culturally sensitive CBT for BME clients. The study consisted of individual in-depth 1:1 interviews with patients with a diagnosis of schizophrenia, schizo-affective, delusional disorders or psychosis (n = 15) and focus groups with lay members (n = 52), CBT therapists (n = 22) and mental health practitioners (n = 25) on a data set of 114 participants. Several themes emerged relating to therapist awareness on culturally derived behaviours, beliefs and attitudes that can influence client response and participation in therapy. The current paper aims to explore one of these themes in greater detail, i.e. client-initiated therapist self-disclosure (TSD). Using thematic analysis, the paper highlights key elements of TSD and how this could impact on therapist’s reactions towards TSD, the therapeutic alliance and ultimately, the outcomes of therapy. The findings appear to show that TSD has significant relevance in psychological practice today. Some BME client groups appear to test therapists through initiating TSD. It is not the content of TSD they are testing per se, but how the therapist responds. Consequently, this requires therapists’ cognisance and sensitive responses in a manner that will nurture trust and promote rapport. Further investigation in this area is suggested with a recommendation for guidelines to be created for clinicians and training.Key learning aims
      (1)To develop a dialogue and practice with confidence when addressing issues of self-disclosure with diverse populations.
      (2)To appreciate the impact therapist self-disclosure has in early stages of engagement, in particular when working with patients from BME communities.
      (3)To understand the impact and role of self-disclosure as initiated by patients.
      (4)To increase therapist awareness on cultural differences in self-disclosure and develop ways to address this in therapy.
      (5)To challenge therapists to adapt psychological therapies to diverse cultures and be cognisant that ‘one size does not fit all’.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000102
      Issue No: Vol. 12 (2019)
  • Inflated sense of responsibility, explanatory style and the cognitive
           model of social anxiety disorder: a brief report of a case control study
    • Authors: Matthew Jones; Sarah Rakovshik
      Abstract: We sought to investigate situation-specific inflated sense of responsibility and explanatory style in social anxiety disorder (SAD) according to the cognitive model. Participants aged 17–68 years (mean = 31.9, SD = 11.1) included waiting list patients referred to a primary care mental health service for cognitive behavioural therapy for SAD (n = 18) and non-anxious control participants (n = 65). A battery of psychometric measures, including a bespoke measure of responsibility beliefs, was used. Compared with controls, participants with SAD were more likely to demonstrate an inflated sense of responsibility (p ≤ 0.001), and to adopt a negative explanatory style specific to social interaction (p ≤ 0.01). Inflated sense of responsibility was found to correlate with SAD symptomatology (r = 0.47, p ≤ 0.05), and with increased usage of safety behaviours (r = 0.47, p ≤ 0.05). Caseness (β = 1.45, p ≤ 0.01) and stability of causal attribution (β = 0.25, p ≤ 0.001) were found to predict inflated responsibility in our sample. To our knowledge this study represents the first attempt to investigate inflated responsibility within the context of SAD. Our results support the notion of inflated responsibility as a feature of SAD.Key learning aims
      (1)To understand the cognitive behavioural components of Clark and Wells’ model of SAD, and their bi-directional nature.
      (2)To understand what the term ‘inflated sense of responsibility’ refers to, and how it relates to CBT.
      (3)To understand what the term ‘explanatory style’ refers to, and how this concept can also relate to CBT.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000047
      Issue No: Vol. 12 (2019)
  • Reviewers
    • PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000072
      Issue No: Vol. 12 (2019)
  • Working with gender and sexual minorities in the context of Islamic
           culture: a queer Muslim behavioural approach
    • Authors: Khashayar Farhadi Langroudi; Matthew D. Skinta
      Abstract: There has been a large increase in the migration of Muslim populations towards the western world and the USA in the past decade. Many have migrated in the hope of finding a safe home away from war, persecution, or a better economic situation, with many coming from Afghanistan and Syria. Gender and sexual minorities (GSM), or individuals who are not heterosexual and do not identify with their sex assigned at birth, are disproportionately over-represented within migrating groups. While most of these individuals will not have received psychotherapy in their home countries, it is likely they would receive or be required to obtain psychological services as part of the asylum process or through psychoeducational services as a requirement to receive assistance. In exploring the specific needs of Muslim GSM individuals, we highlight the diverse impacts of minority stress, shame, and how these might be mitigated through the integration of acceptance and commitment therapy (ACT) and compassion-focused therapy (CFT). ACT and CFT may provide a helpful framework for a culturally adapted therapy that targets the needs of those experiencing intersectional Muslim and GSM identities, and can foster the cultivation of a meaningful life that can include all aspects of their identities.Key learning aims
      (1)To understand the context within which Muslim GSM individuals experience shame.
      (2)To learn to adapt an acceptance and compassion-based approach in working with GSM Muslim clients.
      (3)To describe how culturally competent hypotheses might inform case conceptualization with GSM Muslim clients.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000096
      Issue No: Vol. 12 (2019)
  • Evaluating response to group CBT in young children with autism spectrum
    • Authors: Deanna Swain; Haley G. Murphy, Tyler A. Hassenfeldt, Jill Lorenzi, Angela Scarpa
      Abstract: Many children with autism spectrum disorder (ASD) exhibit difficulties with negative affect. Cognitive behavioural therapy (CBT) has been successfully adapted for individuals with ASD to treat these difficulties. In a wait-list control study, for example, group analyses showed promising results for young children with ASD using a developmentally adapted group CBT approach. This report examined response to group CBT in terms of individual-level change in young children with ASD. Eighteen children with ASD, aged 5–7 years, and their respective parents participated in treatment. Parents completed pre- and post-treatment measures of negative affect and related behaviours. Treatment responders and non-responders were grouped based on significant treatment outcomes as assessed by statistically significant change for lability/negativity and 20% decrease in intensity, duration or frequency of emotional outbursts. Results indicated that 67% of children met criteria as a treatment responder, showing meaningful improvement in at least two outcome measures. No significant group differences emerged for initial characteristics before treatment. Wilcoxon signed rank tests determined pre-/post-treatment change in parental confidence for each treatment responder group. Results indicated statistically significant increase for the treatment responder group in parent-reported confidence in their own ability and in their child's ability to manage the child's anger and anxiety, but these results were not significant for the treatment non-responder group. Results provide additional evidence that CBT can significantly decrease expressions of anger/anxiety in children with ASD as young as 5 years, yet also suggest need for further improvement.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000011
      Issue No: Vol. 12 (2019)
  • Cognitive behavioural therapy for psychosis targeting trauma, voices and
           dissociation: a case report
    • Authors: Laura McCartney; Maggie Douglas, Filippo Varese, Douglas Turkington, Anthony P. Morrison, Robert Dudley
      Abstract: Trauma and dissociation may be important factors contributing to the experiences of distressing voice hearing. However, there is scant mention of how to target and treat such processes when working with people with psychosis. This case study reports on an initial attempt to work with dissociation and trauma memories in a person with voices. A single case approach was used, with standardized measures used before, during and after 24 sessions of cognitive therapy, and at 6-month follow-up. In addition, session-by-session measures tracked frequency and distress associated with voices and dissociation. The participant reported significant improvements in terms of reduced frequency and distress of dissociation, and voice hearing, as well as improvement in low mood at the end of treatment. At follow-up there were enduring benefits in terms of dissociation and trauma-related experiences, as well as broad recovery but not of change in voices. This case illustrated the potential benefit of targeting dissociation and exposure to trauma memories in producing general symptom improvement and specific reductions in dissociation and voice hearing at end of treatment.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000035
      Issue No: Vol. 12 (2019)
  • The importance of using reflective practice when working with refugees,
           asylum seekers and survivors of torture within IAPT
    • Authors: Michelle Brooks
      Abstract: There is a very high prevalence of post-traumatic stress disorder (PTSD) within refugee populations and survivors of torture. Refugees, asylum seekers and survivors of torture who access IAPT (Improving Access to Psychological Therapies) can present with unique clinical challenges for cognitive behavioural therapy (CBT) therapists. The use of reflective practice can be beneficial particularly when there is added complexity in the client's clinical presentation. The aim of this paper is to provide an overview of how reflective practice can improve clinical work with this patient group and to identify some of the challenges that refugees, asylum seekers and survivors of torture may present with during therapy. The paper sets out how the use of the critical incident analysis model and clinical supervision can assist to develop reflective practice skills and improve the clinical practice of IAPT CBT therapists who work with diverse populations.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X19000023
      Issue No: Vol. 12 (2019)
  • An evaluation of the transition from BAME community mental health worker
           to IAPT low intensity psychological wellbeing practitioner
    • Authors: Naheem Hakim; Andrew R. Thompson, Gail Coleman-Oluwabusola
      Abstract: The Improving Access to Psychological Therapies (IAPT) programme started in 2008, but it contained little provision for specifically meeting the needs of Black, Asian and minority ethnic (BAME) groups. The purpose of this evaluation was to describe the experience of transition from BAME community mental health worker (CMHW) to IAPT low-intensity psychological wellbeing practitioner (PWP) in order to identify possible gains and losses for the former communities served, and the factors that might contribute to successful training of people with BAME expertise. Four former CMHWs who had transitioned into working as PWPs were interviewed. Semi-structured interviews were used. The data were analysed using thematic analysis. Six major themes were identified with the benefits of training emerging as an important factor for the participants in enhancing their role. Three of the themes interconnected and focused on the impact for BAME communities in terms of access to service and barriers. Evident in the interviews were descriptions of adaptations that were made as a result of CMHW having access to both new and old skills. Finally, two themes focused on the participant recommendations as to how IAPT services might become more culturally responsive. The findings suggest that there can be significant benefits for services to provide IAPT training to people already providing culturally specific services. The participants reported that low-intensity cognitive behavioural therapy (LICBT) was effective, but only when cultural sensitive adaptations were made. The evaluation has some clear recommendations as to how IAPT services might seek to offer culturally responsive CBT. Suggestions for carrying out further practice-based evaluations are made.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000296
      Issue No: Vol. 12 (2019)
  • The need for service change and community outreach work to support
           trans-cultural cognitive behaviour therapy with Black and Minority Ethnic
    • Authors: Andrew Beck; Saiqa Naz
      Abstract: Recently there have been a number of developments in cognitive behaviour therapy (CBT) that have led to cultural adaptations of specific interventions and a greater awareness of how in general CBT might be adapted for Black and Minority Ethnic (BME) service users. These developments, however, involve change at the level of the individual therapist and particular treatment approach, but involve very few considerations of what needs to happen at the levels of teams or services in order to best meet the mental health needs of British South Asian and other BME populations. This paper summarizes the way that services need to understand how minority populations use services and how to involve those populations in developing services in order to ensure their needs are best met.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000016
      Issue No: Vol. 12 (2019)
  • Brief CBT group therapy for Mexican homeless girls
    • Authors: Susana Castaños-Cervantes
      Abstract: Homeless girls suffer labour and sexual exploitation, abuse, discrimination and social exclusion at a higher rate than the rest of the population. However, worldwide information on homeless girls and intervention programmes for this group are scarce. This study examined the preliminary efficacy of a brief cognitive behavioural group therapy tailored to Mexican homeless girls. The intervention targeted subjective well-being and these determinants: symptoms of anxiety, symptoms of depression, assertive behaviours and functional emotion regulation skills. Results revealed statistically significant differences in symptoms of anxiety and depression, assertiveness, emotion regulation strategies and subjective well-being with treatment effects that ranged from moderate to large. Symptoms of anxiety and depression, and dysfunctional emotion regulation strategies decreased. Assertive skills, functional emotion regulation strategies, and subjective well-being increased. Outcomes were clinically relevant. At 2-month follow-up, participants showed improvement from pre-treatment on all measures. The current study provides unique findings in terms of a promising preliminary intervention that helps restore homeless girls to a healthier social/emotional developmental path especially in the context of Latin American cities. As a result, the clinical implications of this research highlight the urgent need to design effective interventions based on the observed characteristics and identified needs among homeless girls.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000272
      Issue No: Vol. 12 (2019)
  • Schema Therapy and the use of Politeness Plural in Greek-speaking
           populations: a need for cultural adaptation or a quest for early
           maladaptive schemas/modes'
    • Authors: Konstantina Kolonia; Eirini Tsartsara, Ourania Giakoumaki
      Abstract: This paper is clinical practice-based, and examines the Greek cultural linguistic schema of Politeness Plural in the application of the Schema Therapy mode model. The philosophical principles of Schema Therapy and the importance the model ascribes on creating a warm therapist–client relationship as a pre-requisite for schema healing are discussed. We further explore the need for the therapist to be culturally sensitive to the linguistic use of Politeness Plural in Greek-speaking populations. We are looking into the reasons of why, whilst culturally sensitive, a schema therapist needs to remain inquisitive of potential maladaptive and/or internalized dysfunctional coping mechanisms of inter-relating that are masked by the use of the Politeness Plural linguistic schema. The implications the cultural linguistic schema of Politeness Plural can have in the therapy outcome are considered. Specifically, we argue that holding on to the Politeness Plural cultural linguistic schema may reinforce emotional distancing and compromise schema healing. The authors identify the need for more research to further understand the issues that are raised in this article. Although the focus of the article is on Greek populations, the matters under consideration may be valuable to other cultures.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000302
      Issue No: Vol. 12 (2019)
  • Patient experience of supported computerized CBT in an inner-city IAPT
           service: a qualitative study
    • Authors: Ramesh P. Perera-Delcourt; Gemma Sharkey
      Abstract: Computerized cognitive behavioural therapy (cCBT) has been developed to address economic and clinical issues around limited access to evidence-based therapy. Supported cCBT (variously termed iCBT or eCBT) has been developed to address issues with the effectiveness of, and engagement with, cCBT. There has been no in-depth qualitative exploration of the patient experience of eCBT within the UK, which might aid improving its effectiveness. The aim of this study was to explore patient experience of eCBT in one inner-city National Health Service (NHS) Improving Access to Psychological Therapies (IAPT) service using a semi-structured interview and Thematic Analysis methodology. Ten patients took part. Six main themes were identified: (1) Being Offered eCBT; (2) How eCBT Compares with Self-help; (3) The Patient's State of Mind; (4) The Relationship with the Supporter; (5) Preferring to Talk; (6) eCBT's Value as a Treatment. Participants in this study indicated a preference for face-to-face talking therapy, but were clear that they could form a therapeutic relationship via asynchronous messaging. They reported clinical benefit from the eCBT programme and online relationship, and acknowledged that accessing this immediately was valuable. Issues around the process of selecting patients for eCBT, including with regard to acknowledging or mitigating any negative emotional effects of eCBT, and how to offer and support users with it, are discussed.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000284
      Issue No: Vol. 12 (2019)
  • Under the hood: lay counsellor element use in a modular multi-problem
           transdiagnostic intervention in lower resource countries
    • Authors: Laura K. Murray; Emily E. Haroz, Michael D. Pullmann, Shannon Dorsey, Jeremy Kane, Jura Augustinavicius, Catherine Lee, Paul Bolton
      Abstract: The use of transdiagnostic mental health treatments in low resource settings has been proposed as a possible aid in scaling up mental health services. Modular, multi-problem transdiagnostic treatments can be used to treat a range of mental health problems and are designed to handle comorbidity. Two randomized controlled trials have been completed on one treatment – the Common Elements Treatment Approach, or CETA – delivered by lay counsellors in Iraq and Thailand. This paper utilizes data from two clinical trials to explore the delivery of CETA by lay providers, examining fidelity and flexibility of element use. Data were collected at every therapy session. Clients completed a short symptom assessment and providers described the clinical elements delivered during sessions. Analyses included descriptive statistics of delivery including selection and sequencing of treatment elements, and the variance in element dose, clustering at the counsellor level, using multi-level models. Results indicate that lay providers in low resource settings (with supervision) demonstrated fidelity to the recommended CETA elements, order and dose, and occasionally added in elements and flexed dosage based on client presentation (i.e. flexibility). This modular approach did not result in significantly longer treatment duration. Our analysis suggests that lay providers were able to learn decision-making processes of CETA based on client presentation and adjust treatment as needed with supervision. As modular multi-problem transdiagnostic treatments continue to be explored in low resource settings, research should continue to focus on ‘unpacking’ lay counsellor delivery of these interventions, decision-making processes, and the level of supervision required.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000144
      Issue No: Vol. 12 (2019)
  • Applying dialectical behaviour therapy to structural and internalized
           stigma with LGBTQ+ clients
    • Authors: Kim Skerven; Dane R. Whicker, Kelly L. LeMaire
      Abstract: Delivering research-supported intervention is increasingly important, given the growing emphasis on evidence-based practice in mental health treatment. When working with clients who hold marginalized identities, however, therapists may have questions about how to best tailor interventions, as treatments may not yet have demonstrated efficacy with under-represented populations. This paper describes potential strategies for using dialectical behaviour therapy (DBT) skills to help LGBTQ+ clients, guided by a theoretical model for understanding sexual stigma. Joining these two paradigms, suggestions are made for applications of skills that can help LGBTQ+ clients who are in DBT effectively interact with invalidating environments characterized by structural stigma. DBT-based strategies aimed at buffering clients from environmental invalidation and enhancing their skills in self-validation can help provide them with pathways towards affirming their own sexual orientation and gender identity. Examples from clinical cases are used to enhance understanding of skills application in practice.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000235
      Issue No: Vol. 12 (2019)
  • Exploring the cultural flexibility of the ACT model as an effective
           therapeutic group intervention for Turkish speaking communities in East
    • Authors: Aradhana Perry; Chelsea Gardener, Joseph E. Oliver, Çiğdem Taş, Cansu Özenç
      Abstract: This study describes a successful community-based partnership project between statutory and third-sector services in East London; The City and Hackney Black and Minority Ethnic (BME) Access Service [East London NHS Foundation Trust (ELFT)] collaborated with Derman, a local community organization supporting the well-being of Turkish-speaking communities, to explore the cultural adaptability of an empirically supported, third-wave cognitive behavioural intervention, Acceptance and Commitment Therapy (ACT). The aim was to develop a culturally acceptable group that was responsive to the therapeutic needs of participants from Turkish-speaking communities. The study implemented a mixed-method analysis with a one group pre/post-test design to examine the effectiveness of a 7-session culturally adapted ACT group intervention and a descriptive approach was implemented to assess usefulness, relevance and acceptability. Results demonstrated an overall positive effect of the culturally adapted ACT intervention in terms of both symptoms and patient-reported outcomes. Participants showed significant improvements on measures of depression (p = 0.014), anxiety (p = 0.041) and psychological distress (p = 0.003). The magnitude of these changes was categorized as large, with effect sizes from 0.90 to 2.03. Qualitative responses indicated that the group was experienced as enjoyable and useful and was considered to be an accessible and acceptable therapeutic format. Although a pilot within clinical practice, the findings provide preliminary support for the clinical utility of ACT as an effective, culturally acceptable therapeutic approach for Turkish-speaking communities living in an urban UK setting. The study highlights the importance of culturally appropriate service development and a need for further research within this area.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000041
      Issue No: Vol. 12 (2019)
  • Cultural aspects of vaginismus therapy: a case series of Arab-Muslim
    • Authors: Yosra Zgueb; Uta Ouali, Radhouane Achour, Rabaa Jomli, Fethi Nacef
      Abstract: Vaginismus in one of the most frequent causes of non-consummation of marriage, and of infertility, in Arab-Muslim societies. Cognitive behavioural therapy (CBT) proved to be effective, but it is important to consider the cultural context of the patient attending CBT for vaginismus. The aim of our study was therefore to draw attention to the belief systems and behaviours linked to female sexuality and couple relationship in the Arab-Muslim culture. We present a series of four patients representative of the local culture and show how treatment strategies were adapted to fit these behaviours and belief systems, as well as environmental factors. We found that excessive closeness of family members, allowing the family to be intrusive and exercising pressure on the couple, a strict education which highly values virginity, transmits fear of ‘the male’ and fear of sex, and which links sex with pain, were the common denominator of all patients of our case series. We adapted the classical CBT strategies for vaginismus to our cultural context. The educational component was enlarged. Cognitive techniques were used to modify specific traditional beliefs. The integration of the family, and not only of the partner, into the treatment process proved uniquely beneficial for the patients.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000119
      Issue No: Vol. 12 (2019)
  • Cultural adaptations of CBT for the British Jewish Orthodox community
    • Authors: Raphael Kada
      Abstract: There is a national drive to increase access to psychological therapies across England, with a specific focus on under-represented groups such as Black, Asian Minority and Ethnic (BAME) groups. Although prevalence rates for common mental health conditions such as depression and anxiety in Orthodox British Jews are less than those of the generic population in the United Kingdom, accessing services to help treat these conditions within this group are considerably less than other groups. This paper seeks to consider reasons for this, as well as what adaptations, both from a therapist and service perspective, can be made to increase access within the Orthodox Jewish community with lessons to be made to other BAME groups.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000120
      Issue No: Vol. 12 (2019)
  • Military cultural competence in the context of cognitive behavioural
    • Authors: Liza Zwiebach; Brittany K. Lannert, Andrew M. Sherrill, Lauren B. McSweeney, Kelsey Sprang, Jessica R.M. Goodnight, Shaun C. Lewis, Sheila A.M. Rauch
      Abstract: Current work in multicultural competency has emphasized factors such as race and ethnicity, age, disability status, socioeconomic status, sexual orientation and gender. For those clinicians who work with military and veteran populations, grounding in military cultural competence is also critical as a prerequisite for providing quality care. We believe that engaging these populations from a specifically cognitive behavioural orientation allows bridging of cultural gaps and that there is a natural alignment between cognitive behavioural therapy (CBT) and many aspects of warrior culture. This paper outlines several factors related to the values of military culture and strategies of the CBT therapist to better understand and use these values effectively in clinical practice, including lessons learned from an intensive outpatient program providing speciality care to veterans and military service members.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000132
      Issue No: Vol. 12 (2019)
  • Cultural modifications of cognitive behavioural treatment of social
           anxiety among culturally diverse clients: a systematic literature review
    • Authors: Maja Jankowska
      Abstract: The aim of this study was to conduct a systematic literature review to ascertain whether cognitive behavioural therapy (CBT) for social anxiety disorder (SAD) can be successfully used in non-Western contexts and demonstrate sufficient effectiveness. This area is largely under-researched with conflicting evidence presented in quantitative studies, with virtually no qualitative studies published. This review utilized realist review methodology and focused on qualitative case studies presented by clinicians. A systematic search of EBSCO HOST, The Cochrane Library Database, Google, Google Scholar and reference mining, using various combinations of terms relating to: (1) CBT, (2) social anxiety and (3) cultural diversity were employed. Seven case studies of cultural adaptations of CBT treatment for culturally diverse SAD sufferers were included. The treatment outcomes were generally promising in all cases (reporting significant decrease of SAD symptoms, maintained over time) and the success of therapy was often attributed to culturally specific modifications introduced. CBT can be an acceptable and effective treatment for culturally diverse SAD sufferers with ‘modest’ modifications, without major diversions from the original CBT models and protocols, but this finding must be treated with caution and more methodologically rigorous research (qualitative and quantitative) is needed to more fully understand what works, for whom and in what circumstances.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000211
      Issue No: Vol. 12 (2019)
  • Understanding Black and Minority Ethnic service user's experience of
           racism as part of the assessment, formulation and treatment of mental
           health problems in cognitive behaviour therapy
    • Authors: Andrew Beck
      Abstract: Experiences of racism can be a cumulative risk factor for developing mental health problems. Cognitive Behaviour Therapists working with Black and Minority Ethnic (BME) service users should be confident in their ability to establish the necessary rapport to ask about these experiences and be able to incorporate this information into longitudinal formulations and as part of maintenance cycles. This paper sets out guidelines as to how to do this as part of a wider engagement process.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000223
      Issue No: Vol. 12 (2019)
  • An evidence-based framework to culturally adapt cognitive behaviour
    • Authors: Shanaya Rathod; Peter Phiri, Farooq Naeem
      Abstract: Cognitive behaviour therapy (CBT) in its current form might not be applicable in non-Western cultures. Differences between Western and non-Western cultures have been reported widely. Most psychotherapeutic interventions have been developed in the West and are underpinned by the values that might be specific only to Western culture. To adapt CBT, we need to understand whether the concepts associated with CBT may conflict with cultural beliefs, identifying barriers to the success of the therapy using the views of experts by experience, public and practitioners. This paper discusses the process, foci and framework of cultural adaptation of CBT. We describe an evidence-based framework for adapting CBT for individuals from non-Western cultures that will benefit clinicians who practise CBT and individuals from different cultural backgrounds.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000247
      Issue No: Vol. 12 (2019)
  • Working with unaccompanied asylum-seeking young people: cultural
           considerations and acceptability of a cognitive behavioural group approach
    • Authors: Dorothy King; Glorianne Said
      Abstract: This paper outlines a psychological skills group for unaccompanied asylum-seeking young people with a focus on cultural adaptations in the context of a UK mental health service. Unaccompanied asylum-seeking young people have typically experienced multiple losses, traumatic experiences, significant disruption and psychosocial stressors. These experiences occur during a key developmental period and outside of the context of a supportive family environment. Mental health difficulties are estimated to be present in 41–69% of this population. Prevalence rates are higher than among children seeking asylum with their families or children who are not from refugee or asylum-seeking backgrounds. Cognitive behavioural approaches were considered to be applicable and useful when working with this client group. Group approaches may offer unique benefits for this population through peer support and normalization. The group described was planned around three key themes: physical health needs, emotional wellbeing and resilience-building. A number of adaptations were made to meet the needs of this population which included engagement, considering physical health needs, sleep, language needs, issues related to power, race and status, and thinking about the needs of the group as young people. Attendance ratings, session rating scale outcomes, preliminary effectiveness data and qualitative feedback from young people identified that this is an acceptable approach for these young people. Unaccompanied asylum-seeking young people require a broad package of care; however, making adaptations to routine practice allowed access to evidence-based interventions to support mental health and wellbeing.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1754470X18000260
      Issue No: Vol. 12 (2019)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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Fax: +00 44 (0)131 4513327
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