From a national service delivery perspective, low-intensity cognitive behavioural therapy (liCBT) came to prominence in England in 2008 as part of the NHS England Improving Access to Psychological Therapies (IAPT) programme. Now known as NHS Talking Therapies for anxiety and depression (TTad), liCBT resides at Step 2 of a mental health stepped-care service delivery model for the treatment of mild-to-moderate common mental health problems. It utilises supported liCBT written and digital interventions to provide scalability, improve access and promote patient acceptability by enabling choice.
Originally established through a consensus exercise involving multi-disciplinary subject experts (Baguley et al., Reference Baguley, Farrand, Hope, Leibowitz, Lovell, Lucock, O’Neill, Paxton, Pilling, Richards, Turpin, White and Williams2010), it remains important to maintain fidelity to the core principles and defining characteristics of liCBT of which evidence-based practice remains fundamental (Farrand, Reference Farrand2024). However, while fidelity to the evidence base is of utmost importance, liCBT must also remain responsive to developments in clinical practice and service delivery. These developments include changes in the role of the Psychological Practitioner workforce and the ways in which low-intensity interventions are delivered, supported and evaluated.
Attending to these developments is increasingly important as liCBT evolves beyond its initial implementation within TTad. There is growing interest in extending liCBT to new patient groups and settings, as well as applying and adapting the approach in international contexts. This expansion presents opportunities for innovation, while also raising important questions about how the core principles and defining characteristics of liCBT can be preserved.
Why this special issue matters now
Since demonstrating its utility, effectiveness and acceptability within TTad, liCBT has continued to develop as an important component of mental health service delivery. This special issue provides a timely opportunity to reflect on the current state of liCBT and to consider emerging issues and challenges to its practice, not only within TTad but increasingly beyond. The issue recognises the growth of liCBT as a developing new ‘wave’ within the broader CBT family where its influence increasingly extends beyond NHS TTad services. Together, the papers in this issue explore how liCBT can develop, while remaining grounded in its evidence base and responsive to the changing needs of practitioners, services and the people who use them.
What you will find inside
Following a substantial number of submissions, the guest editors have curated a collection of papers addressing several important aspects of liCBT. These include original research, clinical guidance, service-delivery, education and supervision articles, with implications for clinical practice, education, supervision, service design and commissioning. This breadth reflects the range of issues that will shape the future of liCBT. The special issue is intended to support practitioners, trainers and commissioners in strengthening and future-proofing liCBT in everyday practice, whether working in the UK or internationally. By bringing together evidence, clinical experience and service-based perspectives, the issue offers an opportunity to consider how liCBT can continue to grow while retaining the principles that underpin its effectiveness and accessibility.
Author Contributions
Paul Farrand: Conceptualization–Equal, Writing – original draft–Equal, Writing – review & editing–Equal; Patrick James Raue: Writing – review & editing–Equal; Amy Blakemore: Writing – review & editing–Equal.
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