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.

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.

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.

‘Engaging’ well in psychological therapy is generally associated with more positive clinical outcomes. However, the literature shows little agreement on how to define, conceptualise and measure engagement. Few studies focus primarily on engagement, and those that include engagement measures within other designs rely mainly on single behavioural indicators, such as whether between-session tasks (e.g. ‘homework’ in cognitive behavioural therapy) were completed, or the number of sessions attended. Although pragmatic, I suggest these indicators do not capture the full sense of what engagement means and that taking a broader perspective is likely to be helpful in advancing research and clinical practice. I present a conceptual model of engagement in psychological therapy that aims to draw together relevant theoretical ideas and combine them with observations from clinical practice. This proposes that engagement can be understood as three distinct facets: engagement with the therapist, engagement with the therapy approach, and the practical, behavioural indicators of engagement. I suggest this offers a comprehensive way to conceptualise and understand engagement that may prove helpful for clinicians and researchers. I aim to advocate for further research in this area and for applying the ‘empirically grounded clinical interventions’ approach to therapy processes, not just therapy content. This could help further our understanding of the engagement process, which may play a critical role in driving successful therapy outcomes.

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.

Transition-aged youth (TAY) are vulnerable to experiencing mental health disorders, yet research is scarce on treatment outcomes for TAY receiving cognitive behavioural therapy (CBT), particularly for anxiety and related disorders. The present study aims to investigate whether there are differences in treatment outcomes for TAY relative to adults following completion of mixed-age disorder-specific CBT groups for social anxiety disorder (SAD), generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD). A sample of 844 participants, including 232 TAY (aged 17–25) and 612 adults were compared on symptom specific measures (i.e. SPIN, GAD-7, Y-BOCS), group cohesion, attendance, drop-out rates, and general symptoms of low mood, stress, and anxiety (i.e. DASS-21) pre- and post-disorder specific CBT group treatment using linear mixed effects models. Although there were significant reductions in disorder-specific clinical symptoms and general symptoms of depression, stress, and anxiety in both TAY and adults from pre- to post-treatment, there were no significant differences between age groups in terms of treatment response, suggesting TAY responded as effectively as adults in mixed age treatment groups. There were no significant differences in terms of drop-out or group cohesion across age groups. TAY individuals had marginally lower attendance compared with adults, although this finding was not significant. These findings suggest that treatment as usual is effective in yielding significant improvement in anxiety and related symptoms across age groups. While these findings are encouraging for TAY who seek treatment, further research evaluating whether age-specific group CBT could enhance treatment outcomes for TAY is critical.

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. (1) To understand what chemsex is, what motivates chemsex participation, and the distribution of potential risks.

2. (2) To understand the intersection of sexuality, chemsex, and co-occurring mental health difficulties, including the role of pleasure, identity, shame and community.

3. (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. (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. (5) To identify practical strategies to engage service users who participate in chemsex.

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. (1) To develop understanding of the evidence base for CBT-I for sleep and mental health outcomes.

2. (2) To consider the outcomes of CBT-I when delivered by Psychological Wellbeing Practitioners in an NHS Talking Therapies service.

3. (3) To evaluate clinical recovery rates in line with NHS Talking Therapies criteria.

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

1. Readers of this paper will be able to:

   1. (1) Identify factors influencing self-perception of CBT competence.

   2. (2) Understand how CBT training occurs as part of a Master of Clinical Psychology programme in South Africa.

   3. (3) Understand how the perception that CBT is rigid hinders CBT implementation.

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. (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. (2) To identify potential mechanisms in a structured group which may influence engagement and treatment outcomes in the treatment of alcohol use disorder.

3. (3) To reflect on differing ways to measure effectiveness of a group in community drug and alcohol services.

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. (1) Build awareness around the various misconceptions associated with microaggressions.

2. (2) Knowledge of why these misconceptions exist, where they came from, and why they are important to consider and refute.

3. (3) Refuting misconceptions with scientific explanations and evidence.

4. (4) Understand how CBT clinicians can better prevent and respond to microaggressions.