Cognitive behavioural therapy (CBT) is a frontline treatment for a range of mental health problems and is increasingly offered as the psychological therapy of choice across the globe. Access to or benefit from this psychological therapy relies on proficiency in the dominant language of the area. However, to meet our clients’ needs in an increasingly mobile, multicultural, and diverse society, it may require adaptation through the use of spoken language interpreters. The benefits of interpreter-mediated CBT for mental health problems remains uncertain. The objective of this review is to systematically identify, evaluate, and integrate the existing empirical literature on interpreter-mediated CBT for mental health problems. A comprehensive search was conducted in July 2024 across CINAHL, MEDLINE, PsycINFO and Scopus. Studies meeting the inclusion criteria resulted in a total of eleven articles being included in the review. The included research shows promise in terms of feasibility and efficacy, but not conclusively. The narrative review enabled the synthesis of recommendations, which have been conceptualised as being at individual, service, and organisational levels. There is limited research and a need for further studies into the influence of other factors such as therapist proficiency, interpreter proficiency, complexity/co-morbidity and service context. Further evaluation should consider controlled trials of interpreter-mediated CBT, while also establishing its efficacy more robustly in regular practice. It should also further explore the experiences and perspectives of the client, interpreter, and therapist regarding the suggested recommendations.

Key learning aims

1. (1) Gain an understanding of the existing evidence on the effectiveness of interpreter-mediated CBT for various mental health problems across diverse populations.

2. (2) Learn about key recommendations emerging from empirical research on the implementation of interpreter-mediated CBT.

3. (3) Acquire clear, practical guidance that can inform the work of interpreters, practitioners, services, and healthcare systems to improve the delivery of interpreter-mediated CBT.

Social anxiety disorder (SAD) is one of the most prevalent co-occurring conditions amongst cognitively unimpaired autistic people. The evidence-based treatment for social anxiety known as cognitive therapy for SAD (CT-SAD) may to an extent be beneficial to autistic people, but adaptations for autistic people are recommended to increase its effectiveness. The present study aimed to co-produce and pilot an adapted SAD treatment protocol for autistic people based on the Clark and Wells (1995) model, including assessing its feasibility and acceptability. A bespoke 12-week CBT online group intervention was created to meet the needs of autistic people with a diagnosis of SAD. The treatment protocol was created collaboratively with autistic people. It was piloted with seven adult participants (three males, four females) with autism or self-identified autism who completed the group intervention targeting SAD symptoms. With regard to feasibility, we met our initial aims of recruiting our intended sample size of a minimum of six participants for the intervention with an attendance rate of at least 80% of sessions. The excellent completion and attendance rates, respectively 100% and 95%, indicate that the intervention was acceptable to our participants. These findings extend previous research and support the continued adaptation of CBT interventions for autistic people. Furthermore, the evidence of feasibility indicates that further study to evaluate the efficacy of this group intervention is warranted.

Key learning aims

1. (1) To reflect on social anxiety, autism and identify ways to improve the delivery of cognitive therapy for autistic people.

2. (2) To identify useful adaptations to cognitive therapy for autistic people.

3. (3) To learn how to deliver group cognitive therapy remotely for autistic people who present with social anxiety.

Behavioural activation (BA) is recommended for the treatment of depression but most research focuses on working age adults and there is a dearth of literature concerning the delivery of BA with people with co-occurring depression and mild cognitive impairment (MCI). This case study outlines a BA intervention with a male in his late 60s with depression and MCI and describes appropriate adaptations that were useful. Treatment consisted of psychoeducation of depression and BA, formulation, activity monitoring and scheduling, tackling self-critical thoughts and rumination, and relapse planning. The 12-session BA treatment resulted in a decrease in both depressive symptoms and psychological distress as well as an increase in the individual’s engagement with meaningful activities. This case study adds to the literature and strengthens the argument for the use of BA in the treatment of depression in older adults with MCI. Adaptations, conclusions and limitations are discussed.

Key learning aims

1. (1) To gain an understanding of the use of behavioural activation (BA) in the treatment of depression in older adults with mild cognitive impairment (MCI).

2. (2) To illustrate treatment of depression using BA with an older adult utilising the current evidence base.

3. (3) To outline adaptations that can be made to BA to help deliver this treatment with an older adult who has MCI.

The Senior Wellbeing Practitioner (SWP) postgraduate certificate is a new low-intensity psychological training intended to expand the Children and Young People’s mental health workforce. It builds on the skillset of qualified Child Wellbeing Practitioners (CWPs) and Educational Mental Health Practitioners (EMHPs), by providing training to work with a broader range of presentations including neurodivergence. The SWP Skills and Competency Framework (SWP-SCF) is a new tool developed in response to the need to operationalise and assess the skills necessary to work with the range of presentations SWPs are required to treat, whilst retaining fidelity to the low-intensity intervention approach. As training providers we have used the SWP-SCF with our first cohorts of SWPs as an aid for skill development and reflective practice, as well as for assessment of clinical competency within assignments. Students and tutors have reported good face validity and utility, and further assessment of the validity of this framework appears warranted.

Key learning aims

1. (1) To understand the role of the SWP and how this fits into the wider child and adolescent mental health workforce.

2. (2) To outline the key skills and competencies necessary for SWPs to deliver effective interventions at the low-intensity level.

3. (3) To present how the SWP Skills and Competency Framework was developed and how this can be used as a tool within training and supervision.

The evidence-based psychological therapy for obsessive compulsive disorder (OCD) is cognitive behavioural therapy (CBT) delivered by mental health professionals who are trained and regulated by a professional standards authority. In recent years, people with OCD have reported consulting unqualified and unregulated coaches. We aimed to explore the experience of people who sought unregulated coaching for OCD. Using semi-structured interviews, we explored the lived experiences of 13 people with OCD who have undertaken sessions with an unqualified individual (referred to as a ‘coach’). Thematic analysis was conducted. There were four coaches rated negatively and one rated positively. Four over-arching themes were identified in the coaches who were rated negatively: (1) Appealing content, (2) Vulnerability, (3) Cult-like experience, and (4) Complex peer relationships. There were some positive experiences of coaching described, such as positive peer support from others receiving coaching in group chats. Many of the experiences documented by people who received OCD coaching were negative. It was highlighted that unqualified coaches may increase vulnerability of people seeking OCD treatment, due to unprofessional conduct. We suggest that this unprofessional conduct may be investigated by a regulator. We suggest that people seeking OCD treatment seek help from qualified professionals and that clinicians are aware of the potential negative effects such coaches can have on people.

Key learning aims

1. (1) To understand the potential risks, vulnerabilities and potential positive aspects associated with unregulated coaching for individuals seeking OCD treatment.

2. (2) To discuss our findings to promote informed decision-making by encouraging individuals with OCD to seek treatment from regulated and qualified mental health professionals.

3. (3) Increase clinician awareness of the potential harms associated with unqualified coaching and equip them to guide patients towards evidence-based treatment options.

This study focused on the effect of the cognitive behavioural therapy (CBT) combined with aripiprazole on cognitive functions and psychological state of schizophrenia patients. Seventy-eight schizophrenia patients were divided into two groups. One group received aripiprazole with conventional nursing treatment for 3 months (control group, n = 39), and the other received aripiprazole with CBT for 3 months (observation group, n = 39) (1 session per week, each session lasting 60 min. In the two groups before and after treatment, the severity of symptoms was evaluated using the Psychiatric Symptom Rating Scale (BPRS). Cognitive function was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The Positive and Negative Symptom Scale (PANSS) was utilised to evaluate mental status, while the Generalised Self-Efficacy Scale (GSES) measured psychological state. Additionally, the quality of life was assessed using the General Quality of Life Inventory-74 (GQOLI-74). In the final analysis, post-treatment efficacy and complications for the two groups were counted. Both groups showed significant improvements: BPRS and PANSS scores decreased, while RBANS, GSES, and GQOLI-74 scores increased. The observation group showed greater improvements than the control group. The total improvement rate was 89.74% (35/39) in the observation group, higher than the 71.79% (28/39) in the control group. The complication rate was 33.33% (13/39) in the observation group and 38.46% (15/39) in the control group. The treatment of CBT combined with aripiprazole for schizophrenia has a significantly positive effect on the cognitive functions and psychological state of patients.

Moral injury is the profound psychological distress that can arise from exposure to extreme events that violate an individual’s moral or ethical code; for example, participating in, witnessing, or being subjected to behaviours that harm, betray or fail to help others. Given that the experience of moral transgression is inherent to moral injury-related post-traumatic stress disorder (PTSD), it is important to consider patients’ religious beliefs and formulate how these may interact with their distress. In this article we describe how to adapt cognitive therapy for PTSD (CT-PTSD) to treat patients presenting with moral injury-related PTSD, who identify as religious. Anonymised case examples are presented to illustrate how to adapt CT-PTSD to integrate patient’s religious beliefs and address moral conflicts and transgressions. Practical and reflective considerations are also discussed, including how a therapist’s personal beliefs may interact with how they position themselves in the work.

Key learning aims

1. (1) To understand the importance of patients’ religious beliefs in the context of moral injury-related distress.

2. (2) To understand how patients’ religious beliefs can be integrated into Ehlers and Clark’s (2000) model when working with moral injury-related PTSD.

3. (3) To offer practical adaptations for CT-PTSD to integrate patients’ religious beliefs and practices, including how to set up a consultation with a religious expert in therapy.

4. (4) To aid therapist reflection on how their personal beliefs interact with how they position themselves in therapeutic work with religious patients.

Demand for student mental health services is growing, as is the complexity of presentations to university student wellbeing services. There is a need for innovative service delivery models to prevent students falling in the gaps of existing provision, where outcomes from traditional talking therapies services have been shown to be poorer for students than non-student peers. In 2018, Newcastle University established a pilot in-house cognitive behavioural therapy (CBT) service to provide high-intensity CBT for students at the university, harnessing the expertise of qualified and training staff from the psychological professions. This subsequently expanded into the Psychological Therapies Training and Research Clinic, appointing additional clinical staff. Here we present the journey of the clinic, from inception to implementation and expansion. We also present a descriptive evaluation of the first three years of operation, reporting on clinical activity, clinical outcomes and client experiences of the service. Data are presented from 605 referrals. Over 70% of referrals were assessed and over 60% transitioned into treatment. The treatment completion rate was 50%, with an overall recovery rate of 47.3% [using the same definition of recovery as NHS Talking Therapies for Anxiety and Depression (NHS TTAD)]. Satisfaction, measured by the Patient Evaluation Questionnaire, was high. These outcomes are commensurate or better than seen in NHS TTAD services for students and young adults. Overall, the clinic has been a successful addition to the wellbeing offer of the university and has provided a number of positive further opportunities for both research and the clinical training programmes.