Cognitive behaviour therapy (CBT) requires baseline skills and knowledge that people possess to varying degrees. This includes the ability to accurately identify thoughts, feelings, and behaviours; interactions between these; and an understanding that change in one area may bring about change in another. Assessing these skills could help clinicians discern whether adaptations to CBT are required early in treatment. We report two studies about the development and validation of a novel measure, the CBT Skills Task (CBT-SKI). Study 1 investigates the internal consistency and convergent validity of a four-vignette paper-and-pencil version of the task with 72 neurotypical adolescents. Study 2 examines the factor structure of a two-vignette online version of the CBT-SKI with 300 young adults aged 18–30 from neurotypical and neurodivergent populations. Across studies, the task demonstrated adequate internal consistency. Relevant task items converged well with a validated self-report measure analysing one’s own emotions. Exploratory factor analyses indicated a three-factor structure for the CBT-SKI, which was supported by confirmatory factor analysis. However, the third factor had below-threshold internal consistency, indicating potential issues with its composition and that further refinement may be required. The CBT-SKI shows promise as a psychometrically sound measure of baseline CBT skills and clinical applications are discussed.

Key learning aims

1. (1) To understand the need for a standardised task-based measure of baseline CBT skills.

2. (2) To provide information about the development of the CBT Skills Task.

3. (3) To provide information about validation of the CBT Skills Task.

Contemporary literature suggests that cognitive behavioural therapy (CBT) is an effective intervention for substance use (SU) and for psychosis. However, research investigating the effectiveness of CBT for SU in people with psychosis is sparse. This study used a single-case experimental design (SCED) to evaluate the outcomes of CBT for cocaine use in an individual with a history of psychosis. It was predicted that he would show reductions in substance use, urges and cravings, alongside improvements in broader psychosocial domains. After conducting a cognitive behavioural assessment, the client received CBT focused on psychoeducation, formulation, relapse prevention, relationships and sleep. Non-parametric tests were used to examine whether his scores changed significantly between the baseline and intervention phases. Progress was tracked using idiographic measures based on the client’s goals, including targets linked to SU and secondary lifestyle factors. Across therapy, statistically significant improvements were observed in the client’s self-reported urges to use drugs, feelings of emptiness, openness with his partner and sleep. Also, trends towards significant improvements were identified in his self-reported risk of SU, cocaine abstinence, cocaine cravings, connection with his partner and feelings of shame and loneliness. No significant differences were observed for his self-reported confidence or exercise. This case study offers tentative evidence that CBT is an effective intervention for SU in individuals with psychosis.

Key learning aims

1. (1) To understand the potential effectiveness of cognitive behavioural therapy for substance use in individuals with psychosis, specifically regarding cocaine use.

2. (2) To utilise single-case experimental designs and idiographic measures to robustly evaluate therapy outcomes in complex clinical presentations.

3. (3) To describe a cognitive behavioural approach that utilises longitudinal formulation and interventions targeting sleep and relationships, as well as substance-focused work to support recovery.

Homelessness affects approximately 567,715 individuals in the United States, and its prevalence is increasing over time (Greenberg and Rosenheck, 2010; National Alliance to End Homelessness, 2020; Tsai, 2018). Cognitive behavioural therapy (CBT) is commonly used to treat depression, requiring few intervention sessions (Center for Substance Abuse Treatment, 1999). Few studies have been conducted to establish CBT’s efficacy in treating depression in individuals experiencing homelessness which was the goal of the present meta-analysis. Inclusion criteria included experimental studies with English publication, participants experiencing homelessness, validated depression measures, and recent publication. PsycInfo, PsycArticles, SocINDEX, MEDLINE, ProQuest, Taylor & Francis, PubMed, and Scopus were used to identify articles, and the most recent search was conducted in August 2025. Results identified a total of 11 studies with a total of 14 effect sizes and found that the pooled estimate suggested a small, non-significant difference in depression symptoms between CBT and comparison conditions (g = −0.356, p = .079; 95% confidence interval of [−0.75, 0.04]). Significant moderating variables included intervention setting, the format of therapy, participant age group, type of control utilized, and the specific CBT subtype being provided. Limitations included reliance on previously published articles, low power, and the use of one data coder. The researchers received no funding for this study, and the study was not pre-registered.

Key learning aims

1. (1) Readers will understand the need for established evidence-based interventions for individuals experiencing homelessness and the way in which treating this population differs from the general population.

2. (2) Readers will learn about the overall therapeutic effect of cognitive behavioural therapy in its treatment of depression in individuals experiencing homelessness.

3. (3) Readers will learn ways cognitive behavioural therapy can be adjusted to better meet the needs of the homeless population.

Demand for child and adolescent mental health support is rising, with long waits risking deterioration. The Lucy Project provides rapid, self–referral, low–intensity CBT (LICBT) within paediatric settings, with interventions taking place via video call. While previous work suggests good reach and outcomes, equity of access and acceptability across demographic groups requires evaluation. This paper examines whether socioeconomic status (SES) and ethnicity are associated with engagement with the service. Service records for 149 patients referred to The Lucy Project in Sheffield Children’s Hospital between December 2022 and December 2024 were analysed. Engagement (engaged vs not–engaged) was recorded, and this was analysed in the context of ethnicity (White British; other; unknown) and indices of multiple deprivation (IMD) decile. Binary logistic regression tested associations. The sample’s ethnicity was broadly similar to that of the general population where the service is based; 27.5% lived in the two most deprived IMD deciles (vs 34.2% citywide). Ethnicity did not predict engagement, whereas IMD decile was shown to be associated with engagement. Results suggested that the more affluent a patient, the more likely they were to drop out. In this video-based, self–referral LICBT service, engagement did not differ by ethnicity but was higher among children and young people from more deprived areas. Findings support the model’s potential to mitigate socioeconomic barriers post–referral, while highlighting the need to optimise engagement for more affluent families and to continue addressing pre–referral inequities and digital exclusion.

Key learning aims

1. (1) To Understand the context of the implementation of The Lucy Project, a self-referral low-intensity cognitive behavioural therapy service in a paediatric setting.

2. (2) To explore the relationship between experiences of deprivation and its impact on engagement with The Lucy Project.

3. (3) To explore the relationships between ethnicity and engagement with The Lucy Project.

4. (4) To explore potential pros and cons of a self-referral mental health service in a paediatric setting.

NHS mental health services continue to experience high demand and limited capacity, contributing to long waiting times and poorer outcomes for service users. Dialectical behaviour therapy (DBT) skills groups are an established intervention for emotion dysregulation, yet little is known about whether group size influences treatment outcomes. This comparative service evaluation examined whether larger DBT skills training groups (20 participants), delivered as a standalone intervention, produced outcomes and retention comparable to standard–sized groups (12 participants), to provide preliminary evidence regarding the feasibility of increasing service capacity. Routinely collected data were analysed for 206 adults who attended standalone DBT skills training groups, delivered in cohorts of either 12 participants (n = 103) or 20 participants (n = 103). Emotion regulation difficulties were assessed pre– and post–intervention using the Difficulties in Emotion Regulation Scale (DERS–18). Drop-out rates were used as an indicator of retention. Independent samples t-tests indicated no significant differences in treatment outcomes between smaller and larger groups (p =.300, d = 0.15). Drop-out rates were comparable across formats (36% vs 43%). Larger DBT skills–training groups produced comparable outcomes and retention to the service’s standard–sized groups. These findings offer preliminary feasibility signals that increasing group size may help expand access, although controlled research is required before wider implementation.

Key learning aims

1. (1) To evaluate the feasibility of delivering DBT skills‑training in larger groups within routine NHS practice by examining whether increasing group size affects clinical outcomes.

2. (2) To compare retention across 12- and 20-person DBT skills-training formats by comparing engagement and discontinuation rates as part of a comparative service evaluation.

Traumatic breastfeeding experiences can lead a subset of mothers to develop moral injury and subsequent clinical presentations such as depression, anxiety and post-traumatic stress disorder (PTSD). However, to date, no clinical conceptualisation has been utilised to formulate or guide treatment for breastfeeding trauma reactions, leaving a gap for clinicians. In this clinical guidance paper, we present a cognitive formulation of breastfeeding trauma, drawing from the cognitive model of moral injury in PTSD. The paper aims to support cognitive behavioural therapists to conceptualise breastfeeding trauma through the lens of moral injury where appropriate, and provide treatment guidance through an illustrative case study.

Key learning aims

1. (1) To increase awareness of the impact that negative breastfeeding experiences can have on an individual, including moral injury, and/or the development of mental health conditions such as PTSD and depression.

2. (2) To support mental health clinicians, perinatal health professionals, infant feeding professionals, and antenatal educators in their understanding of breastfeeding trauma.

3. (3) To propose a conceptualisation of understanding and treating traumatic breastfeeding experiences, drawing from an existing formulation model for moral injury in PTSD, using cognitive therapy.

4. (4) To emphasise the importance of individualised assessment, formulation and therapy when working with individuals who have experienced traumatic breastfeeding experiences.

Low-intensity cognitive behavioural therapy (LICBT) services are a key component of mental health provision for children and young people (CYP) in England. Given the elevated prevalence of mental health difficulties among autistic populations, these services are likely to receive referrals for autistic CYP. However, evidence regarding the suitability of LICBT protocols for this group is limited, and little is known about practitioners’ experiences supporting autistic youth. This qualitative study explored LICBT practitioner perspectives on working with autistic CYP, including what helps prepare or support them in this work. Semi-structured interviews were conducted with Children’s Wellbeing Practitioners and Education Mental Health Practitioners (n = 13) working in LICBT services across England. Data were analysed using reflexive thematic analysis. Two over-arching themes were generated: (1) Delivering LICBT on Unstable Foundations, and (2) Navigating Organisational Challenges. Practitioners described feeling under-prepared by core training and uncertain about the suitability of LICBT interventions for autistic CYP. Successful intervention was perceived to depend on autism-specific adjustments and wider systemic support that were not always available. Organisational pressures, unclear role boundaries, and limited alternative service provision contributed to ethical discomfort and emotional strain. Many practitioners reported independently seeking additional training and informally extending their roles to bridge gaps in care. Findings suggest a misalignment between the LICBT service model and the realities of supporting autistic CYP in practice. Addressing this requires strengthening the evidence for LICBT with autistic populations, closer integration between LICBT and autism-specific services, and flexibility within practitioner workplans to support equitable and appropriate care.

Key learning aims

1. (1) To explore Children’s Wellbeing Practitioners’ and Education Mental Health Practitioners’ perspectives and experiences of supporting autistic children and adolescents within low-intensity cognitive behavioural therapy (LICBT) services.

2. (2) To examine what works well and the challenges encountered in practice by these practitioners when supporting autistic children and adolescents.

3. (3) To identify what may be needed to sustainably meet the needs of autistic children and adolescents referred to LICBT services, including factors that may support the accessibility and effectiveness of LICBT for this client group.

CBT training programmes increasingly emphasise widening participation and workforce sustainability; however, limited research has explored how neurodivergent trainees and practitioners experience the academic and pedagogical structures through which CBT competence is developed and assessed. This study examined how neurodivergence, specifically the author’s dyslexia and dyspraxia, shaped engagement with CBT training, academic assessment, and pedagogical leadership, and considered implications for inclusive and authentic competence development. A critical autoethnographic approach was employed, drawing on reflective narratives situated within neurodiversity theory, experiential learning models, and Universal Design for Learning (UDL) frameworks. Four interconnected themes emerged: (1) academic norms functioning as structural barriers to competence demonstration; (2) the hidden emotional and cognitive labour of navigating academic systems; (3) neurodivergent strengths within experiential learning and clinical formulation; and (4) transformation of lived experience into inclusive pedagogical redesign within CBT training programmes. The barriers described here reflect systemic misalignment between traditional academic structures and experiential competence development rather than individual deficit; while grounded in dyslexic and dyspraxic experience, they may resonate across neurodivergence. UDL-informed curriculum design and diversified assessment approaches may enhance accessibility, authenticity of competence evaluation, and workforce sustainability within CBT education.

Key learning aims

1. (1) To understand how neurodivergent identity shapes experiences of CBT training and academic engagement.

2. (2) To recognise systemic academic barriers affecting neurodivergent CBT trainees and practitioners.

3. (3) To explore the role of experiential learning and inclusive pedagogy in supporting diverse learners.

4. (4) To identify implications for assessment design and curriculum development within CBT training programmes.

Response prevention is an intervention that refers to deliberately abstaining from or blocking a compulsion that is normally performed in response to an obsession. This year marks the 60th anniversary of the publication in which response prevention, a behavioural intervention based on learning theory, was first described by Vic Meyer in 1966. Since then, the theory and practice of the intervention have been incorporated into inhibitory learning theory and cognitive behavioural models of obsessive-compulsive disorder (OCD). The theory and principles of resisting a compulsion by tolerating anxiety or uncertainty and testing expectations are straightforward. However, it may be poorly implemented; for example, it is not merely psychoeducation or encouragement as homework to resist a compulsion, but an active therapeutic intervention conducted collaboratively and testing a client’s predictions (Clark, 2020). Various approaches have been described and adopted by clinicians. However, there is remarkably little literature on the optimum approach to response prevention; for example, how it may differ in physical or mental compulsions, how it may be implemented with doubts, and how it may be conceptualised as habitual behaviour. This paper reviews the historical development of response prevention. This review provides clinical guidance on the theory and implementation of this approach and considers areas that require further research.

Key learning aims

1. (1) To understand the phenomenology of compulsions in obsessive-compulsive disorder (OCD).

2. (2) To formulate the function and termination criteria of a compulsion.

3. (3) To understand the learning theory and cognitive models to the maintenance of compulsions.

4. (4) To consider different ways of applying response prevention (response blocking, response reduction, response delay, exposure after a response and habit reversal).

Tic disorders are common neurodevelopmental conditions in children and young people. However, although evidence-based support and interventions exist, families often struggle to access these for their children, in part due to a lack of assessment and treatment pathways in UK healthcare services. This article describes a quality improvement project involving the development and implementation of a tics pathway in a generic children and young people’s mental health (CYP MH) service in the UK. This process included building appropriate knowledge, skills and confidence in the team; designing and implementing a pathway, including assessment/diagnosis, provision of psychoeducation/resources, as well as further group and individual treatment where needed; and reflecting on and adapting the process with the support of specialist consultation. The introduction of the tics pathway has resulted in reduced waiting times in all areas of the pathway for those referred to the service, including assessment, diagnosis and the provision of evidence-based support. Feedback from children, young people and families has been very positive. This paper demonstrates that with minimal training and consultation, it is possible for a generic CYP MH service to assess and provide evidence-based resources and support for those referred with tic disorders. It is hoped this paper will provide a model of service delivery that can be utilised by other services, enabling them to support families within their local communities and make a meaningful difference in the lives of children, young people and their families.

Key learning aims

1. (1) To raise awareness about the prevalence of tic disorders in children and young people, and the existence of effective evidence-based support and treatment.

2. (2) To highlight challenges faced by families seeking timely and local diagnosis and support.

3. (3) To provide a model of service delivery for the evidence-based assessment and treatment of tic disorders in a generic CYP MH service that can be utilised by other services.

4. (4) To demonstrate that the development and implementation of a tics pathway can be straightforward, cost-effective, and hugely beneficial to children, young people and families.

5. (5) To inspire other CYP MH services to provide support of this kind, thus increasing the provision of timely support for children, young people and families with tic disorders in their local communities.

Widening participation in psychological wellbeing practitioner (PWP) training by targeting mature candidates has the potential to bring greater diversity of life experience into the profession, as well as address retention challenges. This paper presents observations on recruitment interest, academic performance, and career aspirations among mature PWP trainees (aged 35 years and older), in comparison with those of traditional PWP trainees (aged under 35 years). Participants were recruited from pre-training events and training cohorts at the University of Surrey. The study utilised a cross-sectional survey to understand the age profiles of trainees recruited into training, an analysis of routinely held participation and academic attainment data, and a longitudinal survey to explore future career aspirations between mature and traditional trainees. The findings showed that mature candidates attended recruitment events in proportionally higher numbers, but this did not necessarily translate to securing places on training. Mature trainees achieved lower class awards and exhibited higher withdrawal and termination rates compared with traditional trainees. Mature trainees reported higher intentions to stay in a PWP-related role than their traditional counterparts; however, both groups expressed concerns about poor progression opportunities and the risks of burnout. The implications of these findings for clinical services and university providers, along with recommendations for future research, are discussed.

Key learning aims

1. (1) To outline the rationale for widening participation in PWP training, specifically focusing on mature candidates.

2. (2) To outline interest for PWP training, academic attainment and career aspirations in mature PWP candidates and trainees.

3. (3) To consider the implications of these findings for Talking Therapies services and university training providers, with regard to recruitment practices, training support and retention.

Psychological Wellbeing Practitioners (PWPs) deliver high-volume, low-intensity psychological interventions for mild to moderate mental health problems within NHS Talking Therapies (formerly IAPT). However, anecdotal reports suggest they are working with clients presenting with more complex needs, including moderate to severe mental health difficulties, severe and enduring mental health problems, high-risk levels, and facing co-occurring social or systemic challenges. This qualitative study examines the experiences and perspectives of PWPs on working with complexity in clinical practice. An online questionnaire was completed by 104 PWPs working within NHS Talking Therapies services. Data analysis utilised qualitative content analysis. Seven themes were identified, highlighting a range of factors contributing to complexity, including psychological, social, physical, and systemic issues. PWPs also described the emotional toll of managing complex cases and emphasised the need for improved supervision, training, and leadership. The findings underscore a growing disconnect between the intended role of PWPs and the realities of clinical practice. PWPs are routinely expected to manage complexity, high level of risk, and co-occurring social problems. While some practitioners find ways to navigate these demands with adequate support, the overall picture points to significant strain on individuals and services alike. Future research should refine the conceptualisation of complexity, evaluate the proposed decision-making tools, and explore the perspectives of PWPs and clients to inform service development.

Key learning aims

1. (1) Gain insight into PWPs’ experiences and perspectives on managing complexity in clinical settings.

2. (2) Examine the impact of working with complex or inappropriate presenting problems or multiple needs on PWPs’ professional wellbeing and clinical efficacy.

3. (3) Contribute to the limited research on PWP and low-intensity psychological interventions by expanding understanding of its use, challenges, and the impact of complexity within TTad.

It has long been recognised that there is a cohort of service users who typically fail to meet criteria for specialist secondary mental health services, yet their needs are considered too complex for Talking Therapies services. As a result, new psychological practitioner roles, including mental health and wellbeing practitioners (MHWP), were introduced to support implementation efforts, including for newly commissioned Psychological Therapies for Severe Mental Health Problems (PT-SMHP) programmes. This study aimed to explore the impact of the newly commissioned MHWP role’s deliverance of low-intensity CBT-informed interventions on service user outcome measures across three time points during psychological intervention within a primary care-based PT-SMHP service in the East of England. Repeated measures-ANOVAs found significant improvement in all outcome measures, and further post-hoc pairwise comparisons generally found significant improvements in measures across each of the three time points. These preliminary findings provide initial evidence that the role of MHWPs are making a difference in community-based primary care services and positively impacting service user outcomes. Further studies are needed to investigate efficacy of the role with a larger sample, including across other mental health settings such as secondary care to ensure external validity.

Key learning aims

1. (1) To introduce the role of a mental health and wellbeing practitioner in a primary care-based psychological therapy service for severe mental health difficulties.

2. (2) To examine preliminary outcomes of mental health and wellbeing practitioners in the treatment of individuals presenting with a personality disorder.

3. (3) To consider what further research may be needed in relation to the mental health and wellbeing practitioner role.

There is recognition of the need to design wellbeing interventions in contextually sensitive ways, and report systematic, theory-driven approaches to intervention development. However, many intervention studies in the burgeoning literature on psychological professional trainee wellbeing do not include information on processes or theory surrounding the development of interventions tested. This theory- and stakeholder-informed intervention development study was guided by the MRC framework for developing and evaluating complex interventions and underpinned by the COM-B. Evidence and theory were used to support an initial intervention outline. Meetings were subsequently held to gather stakeholder perspectives, to address unknowns of intervention design, and to support development of a theory of change. Stakeholder (trainees and professional training staff) perspectives and relevant theory were used to inform the design of an acceptance and commitment therapy (ACT) based intervention, to address key stressors experienced by trainees. The intervention was delivered in a group setting, over the course of four sessions spaced 1–3 weeks apart. Collaboratively constructed COM-B analyses identified target behaviours and shaped intervention design. A comprehensive theory of change was developed, outlining key assumptions and setting out hypothesised pathways of change. An evidence-informed ACT-based intervention for psychological professional trainee wellbeing has been developed with key stakeholder collaboration. An acceptability and feasibility evaluation of this intervention is underway.

Key learning aims

1. (1) To understand the processes through which a tailored wellbeing intervention for psychological professional trainees was developed in collaboration with key stakeholders.

2. (2) To consider how an acceptance and commitment therapy (ACT) based intervention was adapted to address specific challenges encountered by psychological professional trainees.

3. (3) To understand the pathways through which an adapted ACT intervention is anticipated to support trainee wellbeing.

Children and young people (CYP) living with long-term physical health conditions (LTCs) have a higher prevalence of mental health conditions but report barriers in accessing mental health interventions. One way to increase access to such interventions is through Children and Young Person Wellbeing Practitioners (CWPs) who deliver low-intensity cognitive behavioural therapy (LI CBT). This non-randomised study evaluates the effectiveness of LI CBT delivered by CWPs integrated in a specialist paediatric psychology service. Thirty-six CYP aged 3‒23 years receiving LI CBT interventions were included in the evaluation. Outcome measures included the Revised Children’s Anxiety and Depression Scale (RCADS) and goal based outcomes (GBOs), which were administered at the beginning and end of the intervention. Feedback from participants was also gathered to complement quantitative data. Analysis of pre- and post-intervention data highlighted a reduction in symptoms across all RCADS subscales with notably large effect sizes observed when comparing total RCADS scores (d = 0.86) and low mood scores (d = 0.99). GBO data similarly reflected progress towards personal goals with a large effect size reported (d = 1.44). Participants provided positive feedback, emphasising improvements in symptom control and emotional understanding. The integration of CWPs into paediatric hospitals demonstrated preliminary effectiveness in reducing anxiety and depression symptoms among CYP with LTCs and significant progress towards their personal goals. These findings suggest that LI CBT delivered by CWPs could fill a critical gap within paediatric settings, although further research with a larger sample size is warranted.

Key learning aims

1. (1) To understand the mental health needs of children and young people with long-term physical health conditions.

2. (2) To learn how low-intensity cognitive behavioural therapy (LI CBT) delivered by Children and Young People’s Wellbeing Practitioners (CWPs) can be integrated into paediatric healthcare settings to improve mental health outcomes.

3. (3) To explore the preliminary effectiveness of CWP-delivered interventions through clinical outcome measures and participant feedback, and consider implications for future service development and research.

There is a growing evidence base for the treatment of gambling harms indicating that cognitive behavioural therapy (CBT) is an effective treatment. However, limitations in research methodology raise questions about the effective mechanisms of change. Existing research has been inconsistent in the measurement of change, and it is not clear whether markers of recovery identified by researchers represent the treatment goals that are most important to those recovering from gambling harm. This study aimed to clarify these areas using a single-case experimental design for treatment seekers accessing a CBT intervention. Recovery trajectories were observed for eight participants attending a group CBT programme, identifying changes in measures of wellbeing and gambling severity through baseline, treatment and follow-up phases. Each participant’s recovery journey was illustrated through weekly measures of perceived closeness to achieving their self-identified treatment goal as well as daily reports of urge severity and presence of gambling behaviour. Findings indicated that all participants viewed abstinence from gambling as their treatment goal. Unexpectedly, half of the sample had already achieved abstinence prior to attending the CBT programme, suggesting that additional factors, including initial contacts with the service contributed to reductions in gambling. This finding also indicated that for individuals recovering from gambling harm, achieving abstinence is not the end of their recovery. Most participants demonstrated improvements in wellbeing and gambling-related cognitions that could be attributed to the CBT programme, with those gambling at baseline showing improvements in gambling urges and behaviour following treatment. The study highlights the need for service-user perspectives in measurements of recovery. Implications for clinical practice and future research are discussed.

Key learning aims

1. (1) CBT has good efficacy for treatment of gambling harm, established in trials.

2. (2) Establishing outcomes for individuals receiving CBT in NHS practice is important.

3. (3) Existing studies do not always identify the outcomes that are important to service users.

4. (4) Single case research is a valuable tool to explore outcomes in practice.