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First page: 1 PubDate: 2023-01-06 DOI: 10.1017/S1754470X22000630
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Authors:Airdrie; J.N., Lambe, S., Cooper, K. First page: 2 Abstract: When post-traumatic stress disorder (PTSD) co-occurs with obsessive compulsive disorder (OCD), symptoms of the former can interfere with evidence-based treatment of the latter. As a result, exposure-based treatments are recommended for both OCD and PTSD, potentially facilitating a concurrent treatment approach. This case study describes the application of concurrent cognitive behaviour therapy (CBT including exposure and response prevention; ERP) for OCD and narrative exposure therapy to treat a patient whose PTSD symptoms of intrusive images of memories and hyperarousal were interfering with standard CBT (including ERP) treatment for OCD. Following this concurrent approach, the patient’s symptoms of OCD reduced to non-clinical levels and showed reliable improvement in PTSD symptoms. Whilst further methodologically robust research is required, this case study highlights that this approach may be beneficial to the treatment of OCD where PTSD symptoms are impacting on treatment.Key learning aims (1) To explore the literature considering explanations of the co-occurrence of OCD and PTSD symptomology. (2) To consider how symptoms of two mental health conditions can maintain one another and attenuate the effectiveness of evidence-based treatment for the other mental health condition. (3) Consider the use of concurrent therapeutic approaches to treat co-occurring mental health conditions. PubDate: 2023-01-06 DOI: 10.1017/S1754470X22000605
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Authors:Dagnan; Dave, Taylor, Lara, Burke, Christine-Koulla First page: 3 Abstract: This paper is an introduction to adaptations to make cognitive behaviour therapy (CBT) more accessible to people with intellectual disabilities. It is intended to inform therapists who may work with people with intellectual disabilities in mainstream services.The paper describes adaptations that consider neuropsychological processes, such as memory, and executive functions, such as planning, problem solving and self-regulation, and identifies that these factors are not unique to people with intellectual disabilities. We describe adaptations based on a review of literature describing CBT for people with intellectual disabilities (Surley and Dagnan, 2019) and draw on clinical experience to give examples of adaptations where possible. The paper particularly emphasises the generalisability of adaptations used with people with intellectual disabilities to therapy with wider populations and suggests that CBT therapists working in mainstream services will have the skills to be able to adapt therapy for people with intellectual disabilities.Key learning aims (1) To overview the evidence base supporting the use of CBT with people with intellectual disabilities. (2) To describe the epidemiology of intellectual disability and discuss its implications for the generalisability of adaptations discussed in this paper. (3) To describe a range of adaptations to make CBT more accessible people with intellectual disabilities. (4) To consider whether such adaptations are part of the skill set of CBT therapists mainly working with people without intellectual disabilities. PubDate: 2023-01-10 DOI: 10.1017/S1754470X22000587
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Authors:Faheem; Afsana First page: 4 Abstract: Individuals from Black, Asian and Minority Ethnic (BAME) groups experience profound disparities in accessing mental healthcare, show poorer treatment outcomes, and high attrition rates when compared to their White British counterparts. Despite the national rollout of Improving Access to Psychological Therapies (IAPT) services, research exploring service users’ recovery narrative has been scarce. The aim of this study was to explore whether evidence-based psychological interventions are suitable to the needs of BAME communities. Semi-structured interviews were conducted with nine BAME service users who received evidence-based psychological treatment(s) from IAPT services. Reflexive thematic analysis (RTA) was used to analyse the data which included a six-phase process to produce a robust pattern-based analysis. Overall, three themes were generated. The first theme highlighted the importance of recognising cultural dissonance within therapy, which considered patient therapeutic expectations, therapeutic guilt, and conflicting cultural identities. The second theme identified the need for therapists to develop cultural competency. This included the importance of building therapeutic trust and exploration of patient culture within therapy. The final theme considered the road to recovery and highlighted challenges with therapeutic engagement and evaluations of therapeutic effectiveness. Overall, BAME service users felt that therapy was not a cure, but found it helpful. Clinical implications and future recommendations are discussed.Key learning aims (1) To briefly introduce cross-cultural theoretical models that may assist mental health professionals to think critically about whether Western notions of therapy are suited to the needs of ethnic minority communities. (2) To highlight cultural challenges that may impede therapeutic success for BAME communities. (3) For IAPT services and practitioners to consider cultural competency training needs that may enhance service user therapeutic experiences and outcomes. (4) To encourage IAPT services to enhance knowledge about psychotherapy and mental health by promoting culturally sensitive psychoeducation in ethnic minority communities. PubDate: 2023-01-11 DOI: 10.1017/S1754470X22000599
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Authors:Howard; Maxine, Hembry, Pippa, Rhind, Charlotte, Siddall, Amy, Uddin, Mohammed Fahim, Bryant-Waugh, Rachel First page: 5 Abstract: Avoidant Restrictive Food Intake Disorder (ARFID) is a condition characterised by a disturbance in eating behaviour that leads to a significant negative impact on physical, social and nutritional health. The diagnosis of ARFID relies on a comprehensive, multi-disciplinary assessment to understand the individual’s history, physical, social and mental health risk, and any co-occurring mental health difficulties. Consensus guidance suggests that psychological treatment, alongside medical and dietetic input is delivered with consideration of any appropriate adaptions to accommodate developmental stage and/or common co-occurring presentations. This paper has been authored by clinicians working in an out-patient setting for children and adolescents with ARFID, and focuses on the presentation and assessment of ARFID and cognitive behavioural therapy (CBT) approaches that can help children, young people and their families. After an introductory section, the paper is split into four sections: assessment of ARFID; drivers of avoidant restrictive eating behaviour; multi-disciplinary formulation and intervention planning; and treatment. The treatment section provides an overview of the available research on CBT for ARFID, and a brief summary of the broader evidence base for CBT in children and young people with anxiety. Following a review of the evidence base, three case descriptions are provided to illustrate the clinical application of CBT where fear-based avoidance is the main driver. The paper concludes with practice points for clinicians to take forward when working with children and young people with ARFID.Key learning aims (1) To be aware of the international consensus for the use of psychological interventions as a component of ARFID treatment alongside medical and dietetic input. (2) To understand that ARFID is characterised as a disturbance of eating behaviour, and as such, psychological intervention should target the drivers of this disturbance to promote behavioural change. (3) To gain an overview of the multi-disciplinary team assessment as an important tool to understand the contribution of each of the three drivers proposed to underpin an ARFID presentation. (4) To recognise when a CBT approach might be indicated, the current best evidence base for CBT for ARFID and how to adapt CBT to accommodate developmental stage and/or common co-occurring presentations. PubDate: 2023-02-22 DOI: 10.1017/S1754470X22000629
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Authors:Faheem; Afsana First page: 6 Abstract: Cultural competency is a core clinical skill. Yet, psychological therapists may be inadequately trained to deal with the needs of service users from Black, Asian and Minority Ethnic (BAME) backgrounds. This can lead to dissatisfaction with mental health services, disengagement from therapy, and poorer treatment outcomes when compared to the White British population. The aim of this study was to explore whether practitioners working for Improving Access to Psychological Therapies (IAPT) services are culturally competent to deal with the needs of diverse communities. Semi-structured interviews were carried out with a range of practitioners, from early career psychological wellbeing practitioners (PWPs) to senior cognitive behavioural therapists (n=16). Reflexive thematic analysis (RTA) was used to analyse the data, guided by a six-phase process to produce a robust pattern-based analysis. Overall, three themes were generated: (1) encountering cultural dissonance within therapy; (2) challenges in making cultural adaptations to therapy; and (3) identifying cultural competency needs. Out of sixteen participants, only nine therapists received one-day formal training throughout their therapeutic career, whilst seven reported receiving no cultural competence training at all. Overall, it appears that there is an urgent need and desire for therapists to be offered cultural competency training so that they can better serve BAME communities. Clinical implications and future recommendations are made.Key learning aims (1) To briefly introduce cross-cultural theoretical models that may assist mental health professionals to think critically about Western notions of therapy and whether they are suited to the needs of ethnic minority communities. (2) To consider challenges IAPT practitioners encounter during therapy and identify examples of good practice. (3) To explore to what extent IAPT practitioners feel culturally competent to deal with the needs of BAME communities. (4) To encourage IAPT services and decision makers (e.g. training bodies and commissioners) to enhance cultural competence training so that practitioners can better serve ethnic minority communities. PubDate: 2023-02-27 DOI: 10.1017/S1754470X22000642
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Authors:Dessert; Ashton, Lynch, Aadila, McMillon, Ashley, Terrill, Madeline, MacNeil, Brad A. First page: 7 Abstract: Effective methods for training and education in the dissemination of evidence-based treatments is a priority. This commentary provides doctoral clinical psychology graduate student authors perspectives on common myths about cognitive behavioural therapy (CBT). Three myths were identified and considered: (1) CBT does not value the therapeutic relationship; (2) CBT is overly rigid; and (3) exposure techniques are cruel. Graduate students were engaged in a competency-based course in Cognitive Behavioural Approaches to Psychotherapy at an American Psychological Association (APA)-accredited doctoral clinical psychology program. The origins of common myths identified by graduate students included a lack of in-depth coverage of CBT and brief video segments provided during introductory courses, lived experience with CBT, and pre-determined views of manualized treatment and exposure techniques. Myth-addressing factors discussed by graduate students included holding space at the start of training for a discussion of attitudes about CBT, specific learning activities, and course content described in this commentary. Finally, self-reported changes in graduate students’ attitudes and behaviour following the course included a more favourable view of CBT as valuing the therapeutic relationship, as well as implementation of resources provided, and techniques learned and practised at practicum settings. Limitations and lessons learned are discussed through the lens of a model of adult learning that may be applied to future graduate training in evidence-based therapies like CBT.Key learning aims (1) To understand common myths about cognitive behavioural therapy (CBT) that doctoral students in clinical psychology hold prior to entering a course in CBT. (2) To understand the possible origins of these myths, factors that may address their impacts, and changes in attitudes and behaviour among graduate students as a result. (3) To examine the lessons learned that can be applied to future training in evidence-based therapies like CBT. PubDate: 2023-03-02 DOI: 10.1017/S1754470X23000016
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Authors:Marx; Robert, Menzies, Pippa, Symon, Richard, Turner, Sally, Pound, Amy First page: 8 Abstract: This paper reports on the experience of the first cohort of cognitive behaviour therapists completing the first delivery of a UK government-funded mindfulness-based cognitive therapy (MBCT) teacher-training. Trainees completed a new curriculum approved by NHS England and commissioned by Health Education England (HEE) that enabled them to teach MBCT in Improving Access to Psychological Therapies (IAPT) services in England and to meet the criteria for registration for the British Association of Mindfulness-Based Approaches (BAMBA). The components of the training are described. Mixed quantitative and qualitative methods were used to assess the experiences of those trainees who completed that training. High levels of satisfaction were reported and the ‘embodiment’ of the trainers and supervisors was flagged as particularly significant. The retreat was experienced as a core component of the training that helped deepen mindfulness practice. Various challenges were identified, including from the retreat, technical difficulties and challenges with completion for a minority of trainees. Learning from the difficulties and responses to them are reported.Key learning aims (1) To understand the experience of trainees on an MBCT training programme for CBT therapists in Improving Access to Psychological Therapy (IAPT) services in England. (2) To identify key features of a training for CBT therapists that were experienced as helping or hindering learning. (3) To understand the content and issues involved in delivering a mindfulness-based cognitive therapy training. PubDate: 2023-03-03 DOI: 10.1017/S1754470X23000028
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Authors:Naeem; Farooq, Sajid, Sana, Naz, Saiqa, Phiri, Peter First page: 10 Abstract: Culture plays a significant role in psychotherapy practice, with cultural adaptations being implemented more commonly as globalisation and cultural awareness increase. An abundance of systematic reviews, meta-analyses and randomised controlled trials exploring culturally adapted interventions have been published across the globe. In this paper, we present the historical background to cultural adaptation by summarising and evaluating previous frameworks, as well as reviewing current evidence for such adaptations and highlighting routes for further research. Around twenty cultural adaptation frameworks have been published, covering various population demographics and intervention types, providing general guidelines for the implementation of cultural adaptations to psychosocial interventions. Nearly all the frameworks used previous literature and research to develop models on culturally adapted interventions. Some even implemented stakeholder discussions, randomised control trials, and even pilot studies. A variety of cultural adaptation factors have been outlined and discussed; however, there is no agreement on which elements work and which do not. Existing evidence indicates that culturally adapted interventions are effective, regardless of intervention type or population. While cognitive behavioural therapy (CBT) was the most common intervention in trials, there are, at present, no high-quality comprehensive meta-analyses or systematic reviews on culturally adapted CBT which include all literature on this topic. This is needed in order to provide a holistic and detailed comprehension of where current understanding lies. We conclude our paper with recommendations for researchers, trainers and commissioners.Key learning aims (1) Current theoretical frameworks guiding the development of culturally adapted frameworks will be outlined. Gaps in current literature will be highlighted. (2) An overview of the current literature of culturally adapted psychotherapies, specifically CBT and its efficacy in improving outcomes for patients, will be provided. (3) The need for culturally adapted CBT and comprehensive guidelines for the development of these interventions will also be discussed, with clinical implications highlighted. PubDate: 2023-03-20 DOI: 10.1017/S1754470X2300003X
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Authors:Chigwedere; Craig, Fitzmaurice, Brian, Thwaites, Richard First page: 11 Abstract: Personal practice (PP) is widely practised and a requirement across major psychology and psychotherapy organizations and modalities. However, one of the challenges for training institutions is how to assess the quality of such PP. The Reflective Essay Marking Scale (REMS) was developed to improve standardization of marking reflective essays in cognitive behavioural psychotherapy (CBT) training. A small sample of 16 expert CBT participants recruited by email used the REMS to rate two mock reflective essays in a within-subjects design. The internal consistency of REMS was acceptable (Cronbach’s α=.73) with excellent inter-rater reliability. Across the raters, it sufficiently differentiated quality (t12=4.91; p PubDate: 2023-03-31 DOI: 10.1017/S1754470X22000617
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Authors:Wild; Jennifer, Duffy, Michael, Ehlers, Anke First page: 12 Abstract: Traumatic loss is associated with high rates of post-traumatic stress disorder (PTSD) and appears to inhibit the natural process of grieving, meaning that patients who develop PTSD after loss trauma are also at risk of experiencing enduring grief. Here we present how to treat PTSD arising from traumatic bereavement with cognitive therapy (CT-PTSD; Ehlers et al., 2005). The paper describes the core components of CT-PTSD for bereavement trauma with illustrative examples, and clarifies how the therapy differs from treating PTSD associated with trauma where there is no loss of a significant other. A core aim of the treatment is to help the patient to shift their focus from loss to what has not been lost, from a focus on their loved one being gone to considering how they may take their loved one forward in an abstract, meaningful way to achieve a sense of continuity in the present with what has been lost in the past. This is often achieved with imagery transformation, a significant component of the memory updating procedure in CT-PTSD for bereavement trauma. We also consider how to approach complexities, such as suicide trauma, loss of a loved one in a conflicted relationship, pregnancy loss and loss of life caused by the patient.Key learning aims (1) To be able to apply Ehlers and Clark’s (2000) cognitive model to PTSD arising from bereavement trauma. (2) To recognise how the core treatment components differ for PTSD associated with traumatic bereavement than for PTSD linked to trauma where there is no loss of life. (3) To discover how to conduct imagery transformation for the memory updating procedure in CT-PTSD for loss trauma. PubDate: 2023-04-20 DOI: 10.1017/S1754470X23000041
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Authors:Riches; Simon, Hammond, Neil, Bianco, Marilla, Fialho, Carolina, Acland, James First page: 13 Abstract: The aim of this study was to investigate, from a lived experience perspective, specialist psychological therapists’ views on therapeutic adaptations to cognitive behaviour therapy (CBT) for autism that are most helpful for service users and enable best practice. Psychological therapist participants took part in semi-structured interviews led by a researcher with lived experience of autism. A thematic analysis was carried out. Participants (n=8) reported that challenges for service users were anxiety about the therapeutic relationship; communication difficulties with understanding and being understood; emotion recognition difficulties impeding trust and development of the therapeutic relationship; relationships with family interfering with the intervention; information processing impairments, necessitating a slower pace to the intervention; and avoidance of therapy due to anxiety. Goals were forming relationships and building social confidence and skills. Demographic differences were age, with older service users deemed less open to change and younger service users less mature and more often accompanied by family; and gender, with female service users deemed more socially able than males. Therapeutic adaptations were to increase collaboration; support emotional literacy, to help service users understand their own and others’ emotions; focus on special interests; use visual prompts, to improve communication and understanding; be consistent, to build trust and reduce anxiety; accommodate sensory needs, to reduce anxiety and build engagement; avoid metaphors, to reduce communication difficulties; and use role-play, to build and enhance social skills. Therefore, adapting CBT may support clinicians and reduce challenges for people with autism, while lived experience perspectives ensure adaptations meet service users’ needs.Key learning aims (1) To use a lived experience perspective to explore expert psychological therapists’ views of challenges and adaptations when delivering CBT for adults with autism. (2) To investigate the benefits of adapting CBT when working with adults with autism. (3) To understand the importance of involving people with lived experience in the development and co-production of psychological interventions. PubDate: 2023-04-25 DOI: 10.1017/S1754470X23000053
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