Abstract Despite empirical support for cognitive behavioural therapy in the treatment of eating disorders (CBT-ED), real world adherence to CBT-ED is poor. The current study assessed the extent to which clinicians’ intolerance of uncertainty and attitudes towards evidence-based practice (EBP) are associated with adherence to CBT-ED. Licensed mental health clinicians ( n = 221) who self-identified as having treated >4 patients with EDs in the past year completed the Intolerance of Uncertainty Scale (IUS), EBP Attitude Scale (EBPAS), and reported the percentage of patients with whom they used 15 CBT-ED techniques. Most clinicians (>55%) reported using cognitive-related techniques with >90% of patients, whereas less than half (<42%) reported using behavioural-related techniques with >90% of patients; only 7% reported regularly weighing >90% of patients. IUS was negatively and EBPAS was positively associated with adherence to CBT-ED techniques. There was a significant interaction between IUS and EBPAS, such that clinicians with favourable attitudes towards EBP reported high adherence regardless of their intolerance of uncertainty, whereas IUS was associated with lower adherence among clinicians with unfavourable attitudes towards EBP. Clinical training that fosters positive attitudes towards EBPs, particularly among clinicians with high intolerance of uncertainty, may improve CBT-ED adherence. Key learning aims (1) Clinicians indicated less adherence to behavioural than to cognitive components of cognitive behavioural therapy for eating disorders (CBT-ED). (2) Clinician intolerance of uncertainty was associated with less adherence to CBT-ED. (3) Clinicians’ attitude towards evidence-based practice buffers the association of clinician uncertainty intolerance with adherence to CBT-ED,
Abstract Emetophobia (a specific phobia of vomiting) is an under-researched and often poorly understood condition compared with other anxiety disorders. It is often regarded as part of obsessive-compulsive disorder. It is the most common type of specific phobia that presents for treatment. Practitioners may feel less confident in treating emetophobia than in treating other specific phobias with standard exposure therapy. This article updates an evidence-based CBT approach, including exposure and response prevention, for the treatment of emetophobia. There are new insights into how individuals with emetophobia struggle to tolerate not knowing whether they are going to vomit. It aims to be a practical ‘how to’ guide for therapists, drawing on theory and the authors’ experience in this area. This highlights the need to adapt the general principles of treating specific phobias through exposure therapy. This is particularly true when the presentation shares processes with obsessive-compulsive disorder or is complicated by avoidant and restrictive food intake disorder, or sensory sensitivity due to features of the autistic spectrum. We will also consider new developments in current evidence-based approaches to treating emetophobia, such as virtual reality technology and intensive treatment. Key learning aims This article assumes basic knowledge of key concepts in CBT with exposure using inhibitory learning and developing an alternative understanding of a problem (for example, Theory A/Theory B). By the end of this article, readers will be able to: (1) Understanding the epidemiology, clinical characteristics, co-morbidity, and cognitive behavioural model of emetophobia. (2) Assess and formulate the main presenting difficulties for a person with emetophobia. (3) Select appropriate cognitive, behavioural, and imagery interventions to help individuals with emetophobia.
Abstract Social anxiety disorder (SAD) in adolescence associates with impairment across several developmentally salient life domains. Treating adolescents’ SAD with school-based interventions has multiple benefits. We examined the preliminary feasibility and effectiveness of the brief Developmentally Oriented Cognitive Therapy for SAD (DOCT-SAD), among adolescents with SAD and their parents delivered in the school setting by school psychologists. Participants ( n =11, mean age 15.8 years, females 81.8%) were recruited from secondary schools in Tampere, Finland. K-SADS-PL was used to determine primary and co-morbid disorders, augmented with ADIS-5. All participants had primary SAD. Structured feasibility interviews were administered at post-treatment to young people, parents, and school psychologists. Primary outcome measures (SPIN, ADIS-5 based CSR) and secondary outcome measures (SAFE, PHQ-9, YP-CORE, CALIS-C, and CALIS-P) were collected at pre- and post-treatment. On a scale of 0–10, young people perceived the treatment as suitable for them (mean 8.7, SD =1.0). Parents’ general experience of the DOCT-SAD treatment was overall positive (mean 8.9, SD =0.7). Treatment providers rated their general experience of the treatment as good (mean 8.5, SD =0.6). All participants completed the treatment. Significant pre–post decrease in SAD symptoms measured with SPIN was found (mean reduction −8.4, p =.021, r= 0.7). Of participants, six (54.5%) were in diagnostic remission at post-treatment according to ADIS-5. The brief, 10-session DOCT-SAD intervention was accepted by young people, their parents and school psychologists. DOCT-SAD seems feasible and beneficial in treating adolescents with SAD in the school environment. Key learning aims (1) To gain knowledge of a brief 10-session school-based SAD intervention and its feasibility in the school environment. (2) To learn about the feasibility, acceptability and preliminary effectiveness of the DOCT-SAD intervention for young people, their parents and school psychologists. (3) To acquire information about the benefit of the school-based DOCT-SAD and its comparability to previously studied SAD treatments in the school environment.
Abstract NHS Talking Therapies for anxiety and depression (NHS TTad) were established in 2008 to increase and improve treatment for anxiety and depression, with the intention of reducing inequalities through being particularly responsive to individuals from marginalised groups. However, racially minoritised clients are under-represented within NHS TTad services, and are more likely to drop out of treatment. A service evaluation was carried out at a central London NHS TTad service to explore the experiences of clients from the ethnic group that was most likely to disengage. The aim was to find ways in which the service could be improved to enhance the experiences of this group and increase the rate of treatment completion. A service audit revealed that clients with a Black background, regardless of their specific ethnicity, had the highest drop-out rate and were significantly more likely to disengage than the White British group. The service evaluation involved interviewing six clients from this group who had recently dropped out of or declined treatment. Interviews were structured and analysed using narrative inquiry, and pattern coding was used to reduce large amounts of data into four main themes. Overall, participants found accessing support relatively easy but had limited knowledge on the service. A lack of choice and flexibility around appointments were highlighted as key factors in not completing therapy. Based on their experiences, participants recommended incorporating community and cultural learning into therapists’ training, and giving clients the option to request a therapist from a similar background. Recommendations are provided for service delivery. Key learning aims (1) To identify which clients, based on ethnicity, are most likely to decline or discontinue treatment within an NHS TTad service in Central London. (2) To increase understanding of the treatment experiences of clients from the ethnic group with the highest drop-out rates. (3) To provide recommendations offered by these clients for service providers, aimed at improving engagement and treatment completion.
Abstract Microaggressions have been a topic of significant debate in the psychological and social sciences. Despite an extensive body of empirical evidence, numerous misconceptions persist. This paper deconstructs common misconceptions surrounding microaggressions and addresses their origins, underlying biases, and empirical refutations. We explain the mechanisms that cause and maintain microaggressions through a CBT lens. We examine widely propagated misconceptions, including claims that microaggressions lack scientific validity, are too subjective to measure, and are not indicative of racism or other forms of prejudice. Drawing on the substantial literature base, including validated psychometric scales, experimental studies, and cross-cultural analyses, we demonstrate that microaggressions are not only real but also have significant psychological and social consequences. Empirical evidence links microaggressions to outcomes such as depression, anxiety, and lower self-esteem, reinforcing their relevance in clinical, educational, and workplace settings. CBT models provide a useful lens for understanding how individuals navigate the psychological complexities associated with microaggressive behaviours, helping explain why some people resist acknowledging microaggressions and their consequences. Lastly, we highlight the importance of education for reducing the prevalence of microaggressions and mitigating their harmful effects. Our goal is to provide clinicians with correct information so that they may skilfully and empathetically help clients experiencing microaggressions, and to no longer accept microaggressions as a harmless, misunderstood, or dismissed phenomenon. By debunking these misconceptions, this work contributes to a more scientifically grounded understanding of microaggressions, emphasizing the necessity of continued research and intervention efforts to address the impact of discrimination in society. Key learning aims (1) Build awareness around the various misconceptions associated with microaggressions. (2) Knowledge of why these misconceptions exist, where they came from, and why they are important to consider and refute. (3) Refuting misconceptions with scientific explanations and evidence. (4) Understand how CBT clinicians can better prevent and respond to microaggressions.
Abstract Insomnia disorder is highly prevalent and frequently co-exists with other mental health conditions. Evidence suggests that targeting insomnia may improve overall mental health. Although the effectiveness of cognitive behavioural therapy for insomnia (CBT-I) is well established, it is rarely offered to patients as a discrete treatment. This study aimed to evaluate the outcomes of CBT-I delivered at Step 2 for reducing symptoms of insomnia, as well as anxiety, depression, and impaired functioning, following its implementation within an NHS Talking Therapies service. We examined routinely collected pre- and post-treatment outcomes from 35 patients (median age 60 years, interquartile range 44–68, 63% female) who received CBT-I. Insomnia severity was assessed during the first and last session using the Insomnia Severity Index, while secondary outcomes, including depression, anxiety, and impaired functioning were completed at each session. Intention-to-treat analyses demonstrated significant improvements in insomnia symptoms from pre- to post-treatment, with a large effect size ( d = 0.85). Significant improvements were also observed across all secondary outcomes, with large effect sizes for depression ( d = 1.01) and anxiety ( d = 0.89), and a medium effect size for functioning ( d = 0.58). The complete case analysis yielded larger effect sizes across most outcomes. These findings provide preliminary support for the potential benefits of CBT-I as a primary treatment for symptoms of insomnia, with secondary benefits for anxiety, depression, and functioning in patients presenting with mental health difficulties within an NHS Talking Therapies service. Implications for the service and future service evaluations are discussed. Key learning aims (1) To develop understanding of the evidence base for CBT-I for sleep and mental health outcomes. (2) To consider the outcomes of CBT-I when delivered by Psychological Wellbeing Practitioners in an NHS Talking Therapies service. (3) To evaluate clinical recovery rates in line with NHS Talking Therapies criteria.
Abstract Individuals with co-occurring mental health and substance use disorders present considerations often requiring interventions from multiple services. This paper describes the development and implementation of an integrated service pathway, emphasising collaborative processes and inter-professional relationships. The model, implemented in partnership between an NHS Talking Therapies service and a local substance use service, aimed to improve care coordination and service delivery for adults with co-occurring disorders. This paper provides a description of the pathway, outlining the challenges that prompted its development, the processes involved in its establishment, the roles and responsibilities of professionals, and the mechanisms for ensuring continuity of care. A small service evaluation, employing a mixed-methods approach, examined the outcomes of nine patients who engaged with the one-to-one integrated pathway within the first 10 months of its inception. The implementation of the model resulted in enhanced inter-service collaboration, with improved communication protocols and a shared understanding of service user needs. Clinicians reported that the reciprocal consultative approach facilitated knowledge exchange and skill development across teams. Initial outcome data from a small sample suggests positive trends in patient wellbeing and substance use, with seven of nine patients discharged in recovery. This model, characterised by a reciprocal consultation approach and an emphasis on inter-professional collaboration, demonstrates potential to improve the care for co-occurring mental health and substance use disorders. While the patient outcome data are limited by the small sample size, the findings offer insights for service re-design and future research. Key learning aims (1) To gain a clearer understanding of the development and implementation of an integrated care model for co-occurring mental health and substance use disorders. (2) To recognise the impact of collaborative approaches on the professionals involved, including influences in communication protocols, knowledge exchange, and skill development across teams. (3) To learn about the initial outcomes of the integrated care pathway and to recognise the potential for improving care in patients with co-occurring disorders.
Abstract Despite religion being an important part of some patients’ identity and value systems, therapists report finding it challenging to discuss religion in therapy. Avoiding religion for these patients can have detrimental effects on the therapeutic alliance, treatment outcomes, and parity of access for minoritised groups. Therefore, this clinical guidance paper aims to support therapists to bring religion into the therapy room by addressing six key concerns: (1) difficulties raising the topic, (2) ‘getting it wrong’ when discussing religion, (3) therapist and patient differences, (4) managing negative or ambivalent beliefs about religion, (5) perceptions of insufficient knowledge, and (6) a lack of time for meaningful discussions. These barriers are explored by drawing on empirical evidence, clinical experience, and illustrative case examples. The paper aims to provide suggestions and next steps for how therapists can reflect on and address these concerns, aiming to enhance confidence and competence in integrating religion into CBT. Key learning aims (1) To support therapists to overcome commonly held concerns around discussing religion in therapy. (2) To provide practical guidance, tips, and suggestions for how therapists can discuss religion with patients. (3) To help therapists to take responsibility for bringing religion into the therapy room where it is relevant.
Abstract Chemsex is a pattern of using specific drugs with the intent of enhancing the sexual experiences of men who have sex with men. Chemsex participation is often motivated by a desire for community connection or enhanced sexual pleasure. Many individuals who participate in chemsex can mitigate much of the associated risk and report limited, if any, harm. However, for some, chemsex can be problematic, precipitating or exacerbating mental health issues. Despite increasing amounts of research into chemsex, there is no consensus about how to best support people who participate in chemsex when they present for psychological therapies. In the absence of specific clinical guidelines, this paper explores the intersection of chemsex and mental health problems. Principles of affirming and non-stigmatising, assessment, formulation, and intervention strategies are discussed, and recommendations are made throughout. Drawing on contemporary evidence, we present cognitive behavioural approaches to supporting service users who participate in chemsex with anxiety, depression, and post-traumatic stress disorder. By enhancing cultural safety and tailoring existing evidence-based treatments, therapists can improve engagement and outcomes for individuals who engage in chemsex. We recommend an inclusive approach that champions service user choice, paired with a sensitive, sex-positive, and trauma-informed perspective. Therapists within Talking Therapy services are well placed to support service users who participate in chemsex and have co-occurring mental health difficulties. Key learning aims (1) To understand what chemsex is, what motivates chemsex participation, and the distribution of potential risks. (2) To understand the intersection of sexuality, chemsex, and co-occurring mental health difficulties, including the role of pleasure, identity, shame and community. (3) To identify the key barriers experienced by people who participate in chemsex when accessing mental health services, such as negative staff attitudes or fear of stigma. (4) To explore cognitive behavioural approaches to working with people who participate in chemsex, and associated common mental health difficulties (anxiety, depression, and post-traumatic stress disorder). (5) To identify practical strategies to engage service users who participate in chemsex.
Abstract With alcohol use disorder rising in England, evaluating the impact of interventions used in services is important. This evaluation was conducted in a third sector drug and alcohol service within South England. It aimed to explore the association of a structured cognitive behaviour therapy (CBT) group and engagement for service users in early recovery from alcohol use disorder, comparing outcomes with a previously unstructured psychosocial group. A mixed-methods approach compared the groups. Both groups lasted 12 sessions. Self-reported alcohol consumption, psychological health, physical health, and quality of life were measured using the Treatment Outcomes Profile (TOPs; Marsden et al ., 2008). Quantitative data were analysed from 47 service users in the unstructured group and 43 in the structured CBT group. Qualitative analysis explored four service users’ feedback from the structured CBT group through interviews, using thematic analysis. Significantly more participants completed the structured CBT group (93.02% vs 74.47%). Structured group participants, on average, attended 50.97% of sessions, compared with 25.53% in the unstructured group. Mixed-model ANOVAs (repeated measures and between subjects) showed an improvement in psychological health, quality of life, and physical health regardless of the intervention type. Both groups also reduced alcohol consumption. Qualitative analysis identified two emerging themes, accessibility and a sense of belonging, alongside several subthemes. While both groups improved treatment outcomes, findings suggest a structured CBT group may be associated with more engagement and facilitate greater retention in treatment. Key learning aims (1) To understand how engagement and treatment outcomes differ between a structured CBT group and an unstructured psychosocial group in the treatment of alcohol use disorder. (2) To identify potential mechanisms in a structured group which may influence engagement and treatment outcomes in the treatment of alcohol use disorder. (3) To reflect on differing ways to measure effectiveness of a group in community drug and alcohol services.
Abstract Individuals with symptoms of mild personality disorder should be proactively provided with treatment to reduce the likelihood of long-term negative outcomes. Whilst there is encouraging evidence for dialectical behaviour therapy skills training (DBT-ST), the research focuses on individuals with complex presentations (e.g. borderline personality disorder) in specialist mental health services. It is unclear whether DBT-ST is effective for individuals with symptoms of mild personality disorder. The aim of this study was to evaluate whether a DBT-ST intervention is effective for people with symptoms of mild personality disorder. Participants were 82 adults with symptoms of mild personality disorder. Participants received a 24-week DBT-ST intervention through either face-to-face or online appointments. Several outcome measures were collected. There was a significant reduction on outcome measures post-intervention although drop-out rates were high (47%). DBT-ST led to similar recovery rates when it was delivered through online or face-to-face appointments, indicating that it may be effective for people with symptoms of mild personality disorder in either format. Providing DBT-ST in primary care may impact the individual’s longer-term use of specialist services, although further research is needed. Key learning aims (1) To evaluate the effectiveness of a 24-week DBT-ST intervention for individuals with symptoms of mild personality disorder. (2) To compare the effectiveness of DBT-ST when it is delivered via online versus face-to-face appointments (3) To review the individual’s use of healthcare services after receiving a DBT-ST intervention
This model proposes that clinical complexity is defined with respect to treatment complications, not just client characteristics. In complex cases, there are significant barriers in the working alliance between the client and the therapist, and this limits the gains the client can receive. In any course of therapy, client, therapist, healthcare and contextual factors interact to facilitate or complicate the therapeutic process. Each participant has facilitative factors that are therapy-enabling, and complexity factors that challenge the therapeutic process. Some clients have multiple complexity factors and it is helpful to specify them and try to mitigate them. However, identifying clients as complex cases can overlook facilitative factors and take attention away from therapist and service variables. Overcoming alliance barriers relies on bringing attention to them, reflecting on the various factors that influence them, and communicating explicitly about them in supervision and therapy. Practical applications are explored for clients, therapists and services using a case example to illustrate the key points.
Practice research networks (PRNs) have been proposed as a mechanism to support continuous service evaluation and improvement in the field of psychological therapies. In theory, PRNs could help to generate high quality practice-based evidence that has potential to inform and improve clinical care. However, in practice, many obstacles pose challenges to the sustainability and impact of such networks. The UK Northern Talking Therapies PRN is an exemplar that has generated over 20 scientific publications over a decade of successful clinical-academic collaborations. This article distils key lessons learned over that time, to guide and promote the wider adoption of PRNs in psychological services.
To reduce the burden of depression, it is important to ensure that adolescents have access to effective, early interventions. Limited research has explored psychological practitioners' views during the development of such interventions, despite the potential for this to improve implementation. A brief, imagery-based intervention (IMAGINE) has been co-developed to address issues in treatment provision for symptoms of depression in adolescents. Here, we investigate psychological practitioners' and supervisors' views about factors that may act as barriers and enablers to implementing IMAGINE. We used a qualitative interview study with (1) qualified low-intensity practitioners with experience of working in schools, and (2) clinical supervisors to these practitioners, working in England. Reflexive thematic analysis was initially inductive followed by a deductive mapping to normalisation process theory, a theory of how interventions become implemented and embedded in practice. Twenty-four participants (14 low-intensity practitioners and 10 supervisors) were interviewed. Six themes were identified: (1) 'We could be doing more for young people with low mood', (2) 'IMAGINE stands out while feeling familiar', (3) 'Which young people is IMAGINE for?', (4) 'Pushing the depth of low-intensity practice', (5) 'Getting everyone on board', and (6) 'A good fit for services, more or less'. The findings show enthusiasm for new interventions to address adolescent depression, with low-intensity practitioners eager to enhance their clinical skills. This was balanced with concerns about the demand for low mood interventions and whether some components of IMAGINE fit within low-intensity practice. These insights suggest barriers and enablers for developing psychological interventions.Key learning aims To identify implementation and contextual factors that may act as barriers and enablers to implementing imagery-based depression interventions in schools. To explore how an imagery-based psychological intervention for depression in adolescence is perceived from the perspective of psychological practitioners working in schools and their supervisors. To inform future research in the development of imagery- and school-based interventions for adolescent depression.
A long-term physical health condition (LTC) is one 'that cannot currently be cured but can be controlled with medication and/or other therapies'. Around 30% of people with an LTC have mental health co-morbidities. Systematic reviews suggest adapted cognitive behavioural therapy (CBT) produces positive outcomes for LTC clients compared with control conditions. However, limited research includes long-term follow-ups or the client's voice, preventing conclusions about mechanisms of change or sustainability. This qualitative study explored long-term health experiences of CBT for adults with LTCs in UK primary care, and what elements of CBT participants deemed responsible for change. The sample included 10 individuals with an LTC. Findings were constructed through inductive-deductive reflexive thematic analysis, integrating participant-led narratives with psychological theory. Four themes were identified: a validating and normalising therapeutic relationship, lack of therapist skill and knowledge of LTCs, adjusting to and accepting LTC, and de-catastrophising LTC-specific beliefs. Participants discussed the importance of both common and specific factors. A trusting therapeutic relationship was essential, while collaboratively applying techniques to promote adjustment and acceptance was necessary for long-term gains. The study highlights embedding health psychology theory and third-wave approaches within a process-based, transdiagnostic framework enhanced through LTC-specific training and supervision. By attending to identity disruption, illness representations, values conflict, and low self-efficacy, therapists can deliver interventions that consider the lived realities of LTCs.Key learning aims To explore how participants understood and described the emotional, cognitive, and identity-related changes that occurred following CBT, with particular attention to long-term adjustment and meaning making. To identify which therapeutic processes participants perceived as most helpful or unhelpful, including both CBT-specific strategies and common relational factors, and how these were thought to influence change. To contextualise participants' accounts within broader health psychology and process-based frameworks, considering how their narratives reflect mechanisms highlighted in models such as the Self-Regulatory Model, the Transdiagnostic Model of Adjustment to LTCs, and third-wave approaches.
Cognitive behavioural therapy (CBT) is a widely recommended, evidence-based modality. Cost-effective interventions such as CBT are particularly valuable in low- and middle-income countries, which typically have considerable resource constraints and service delivery challenges. Despite its benefits, CBT remains under-utilised by clinical psychology practitioners in South Africa, possibly due to poor perceived self-competence of practitioners. We employed a qualitative exploratory design to explore student clinical psychologists' perceived self-competence in delivering CBT in their first year of masters studies at one university in South Africa, using once-off individual semi-structured interviews (n=5). Data were analysed using reflexive thematic analysis, following an inductive-deductive approach. We identified two over-arching themes: (1) Training experiences shape perceived self-competence in CBT, and (2) Making sense of competence and readiness for practice. The findings suggest that perceived self-competence in CBT is shaped by training experiences, with supportive supervision, practical application, and positive client outcomes enhancing confidence. Limited prior exposure to CBT, rigid teaching approaches, and inconsistent feedback created challenges in developing self-competence which seemed to influence decisions about using CBT in practice. The findings provide important insights regarding the gaps in CBT training in South Africa, which may influence the use and uptake of CBT by future clinical psychologists. These findings highlight the importance of training environments that promote flexibility, experiential learning, expert supervision and constructive feedback in developing competence in evidence-based interventions. Further research is needed to establish whether these issues are shared amongst trainee students at other universities. Key learning aims Readers of this paper will be able to: Identify factors influencing self-perception of CBT competence. Understand how CBT training occurs as part of a Master of Clinical Psychology programme in South Africa. Understand how the perception that CBT is rigid hinders CBT implementation.
Misophonia is a condition characterised by intense emotional reactions to sounds that would not bother most people. Currently, there is no widely accepted and effective treatment for misophonia. Most published studies on treatment have used behavioural therapy, cognitive interventions, or audiological treatments; however, there is no comparison of the effectiveness of these approaches. This 6-week study aimed to compare the effects of brief, self-administered versions of exposure and tinnitus retraining therapy (TRT) in 58 adults with misophonia. The participants, randomly assigned to the two treatment groups and a wait-list group, were assessed at three time points (baseline, week 3, and week 6). The exposure group was given self-exposure homework assignments, where the patient was expected to self-expose to the live or recorded misophonic sound that was agreed upon during the week 0 assessment, for 20-40 minutes, three times a week. The patients in the TRT group were given a set of pre-recorded music pieces and asked to listen to any piece of their choosing for 20-40 minutes a day, three times a week. Self-report measures of misophonia severity (Misophonia Checklist), and interference due to symptoms were rated at each time point by the patients. The assessor also rated improvement at each time point. The study is registered in ClinicalTrials.gov (registration no. NCT05993286). The Intention to Treat (ITT) analyses revealed no difference between the three groups in terms of self-rated misophonia severity at week 6. The assessor-rated percentage of improvement favoured exposure, although the response rate was very low; only six out of 39 participants were rated as moderately or much improved, five of whom were in the exposure therapy group. The results underscore the need for finding ways to increase treatment response in misophonia.Key learning aims To become familiar with the concept of misophonia; i.e. hatred of sounds. To evaluate the potential effectiveness of existing interventions for the treatment of misophonia. To gain insight into adapting established therapy methods to novel settings.
Imagery rescripting (ImRs) is a therapeutic technique that uses mental imagery to update the meanings associated with traumatic memories and reduce re-experiencing and emotional distress (Arntz, 2012). It is commonly used as a therapeutic technique for post-traumatic stress disorder (PTSD). The present study evaluates an ImRs intervention specifically developed to target somatic flashbacks. Somatic flashbacks can be understood as re-experiencing somatosensory sensations, such as touch or physical pain. The study aimed to investigate the feasibility, safety, and acceptability of the intervention. The study also explored if the intervention led to any differences in participants' experiences of somatic flashbacks and their global symptoms of PTSD. A non-randomised feasibility study design was used. Seven participants who reported experiencing somatic flashbacks at assessment were recruited into the study. The ImRs intervention consisted of a pre-intervention session to complete measures, two ImRs intervention sessions, and a 4-week follow-up session. Participants' experience of the intervention was measured at the end of the second ImRs session. Participants' somatic flashbacks and global symptoms of PTSD were measured pre- and post-intervention and at follow-up. ImRs was feasible, safe, and acceptable. Frequency, intensity, and distress of somatic flashbacks reduced, and sense of coping increased following the intervention. A brief ImRs intervention for somatic flashbacks is a promising intervention. Future research should explore the prevalence of somatic flashbacks, underlying mechanisms of ImRs, the optimal timing and content of the intervention, and whether this can be integrated into existing trauma therapies.Key learning aims To assess if imagery rescripting is a feasible intervention for somatic flashbacks. To assess if imagery rescripting is a safe intervention for somatic flashbacks. To assess if imagery rescripting is an acceptable intervention for somatic flashbacks. To assess if the imagery rescripting intervention led to any differences in participants' experiences of somatic flashbacks and their global symptoms of PTSD
Body dysmorphic disorder (BDD) is a common, often debilitating condition that frequently goes undiagnosed and untreated. Limited training for mental health clinicians may contribute to this gap, but no study to date has systematically mapped BDD teaching within professional training courses. The current study aimed to establish the extent of BDD training provided to psychological therapists in the UK, comparing it with obsessive-compulsive disorder (OCD), a related condition with a similar population prevalence and impact. A cross-sectional survey design was employed. Surveys were sent to all UK Doctorate in Clinical Psychology (DClinPsy, n=32) and Post-graduate Diploma in Cognitive Behaviour Therapy (PgDip, n=30) courses, initially as a general request and then under the Freedom of Information Act. All courses responded. Teaching on BDD and OCD in DClinPsy and PGDip courses was summarised descriptively, and differences were assessed using z-tests of proportions. Results indicated that BDD is taught less frequently than OCD (61.3% vs 96.8% of courses) and for shorter durations (7.9% vs 60.0% provide more than 1 day of training). DClinPsy courses offer BDD training less often than PgDip (40.6% vs 83.3%) and most BDD teaching occurs within the adult stream. The current findings highlight a significant gap in BDD training within UK psychological therapy programmes, particularly DClinPsy courses, potentially contributing to under-recognition and under-treatment of BDD. These findings call for better integration of BDD into core curricula for mental health professionals, alongside the development and evaluation of low-resource training solutions than can be rolled out among the existing workforce.Key learning aims To consider the barriers that individuals with BDD experience in accessing care. To recognise that BDD is under-represented in psychological therapy training courses. To consider ways of increasing BDD training, through curricula reform and through scalable, online programmes. To be aware of available BDD assessment measures and therapist CBT manuals, which clinicians can use to guide their practice.
