Let's Talk About CBT

Ever heard of low Intensity CBT and wondered what it was all about? Or what it would be like to receive it? In this episode of Let’s Talk about CBT, Helen talks to Laura Stevenson-Young, a cognitive behavioural therapist and Director of Low Intensity CBT Clinical Training at Newcastle University and Emily who shares her lived experience of low intensity cognitive behavioural therapy. Together, they explore what low intensity CBT is, what it’s like to receive it, and how it can empower people to take control of their mental health. Emily talks candidly about the challenges that led her to seek help, including grief, anxiety, fertility concerns and low self-esteem. She describes the impact of low intensity CBT on her life, and the practical tools she still uses today. Laura explains how this type of therapy works, who it’s for, and why it can be so effective. Resources & Support Find an NHS Talking Therapies service: https://www.nhs.uk/nhs-services/mental-health-services/find-nhs-talking-therapies-for-anxiety-and-depression/ More about CBT and BABCP: https://www.babcp.com Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts Have feedback? Email us at podcasts@babcp.com Follow us on Instagram & Bluesky: @BABCPpodcasts Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This episode was produced by Steph Curnow Transcript: Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't.  I'm Helen Macdonald, your host. I'm the Senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies. Hello and welcome. Today, I've got Emily and Laura with me and we're going to be talking about low intensity CBT, what that is and what it's like to be on the receiving end. But first, I'm going to ask you both to introduce yourselves. Emily? Emily: Hi, yeah, thank you for having me. I'm Emily, I live in Yorkshire with my fiancé. And in November 2022, I reached out to my local mental health service for a number of reasons, which I'm sure we'll cover in this podcast. I began with a four-week introduction to CBT program, which was in a group setting online. That was in December. And then by January, I began my CBT therapy and yeah, it was one of the best things I've done. Helen: Thanks, Emily. And Laura. Laura: Hi, Helen. Thanks for having us and Emily. So, I'm Laura Stevenson-Young. I'm a cognitive behavioral therapist and Director of Low Intensity CBT Clinical Training at Newcastle University. So this means that I train practitioners to deliver low intensity CBT interventions for many different types of mental health problems, namely depression and low mood, generalized anxiety disorder, panic, OCD and some other problems that can really affect the quality of people's lives such as stress or sleep difficulties and long-term health conditions. So I trained as a low intensity CBT therapist, mostly known as a Psychological Wellbeing Practitioner or PWP for short, well over a decade ago. And I then went on to further CBT training and became a clinical trainer in low intensity CBT. So this is probably really going to come out today, but I'm a real advocate for low intensity CBT, the practitioners who deliver it. I'm so passionate about the work that they do and how they empower people to manage their own mental health within NHS Talking Therapies. Helen: Thanks Laura. So Emily, you said there were a number of things that led to you reaching out to the local mental health services. And I wonder if you're willing to tell us a bit more about what was going on? Emily: Yeah, of course. Yeah. I mean, kind of looking back, I should have done it a lot earlier than I did. It was kind of a lot of things building up over probably a couple of years. My mood definitely was low after losing my granddad and then with different job roles, kind of things to do with that, it was an ongoing thing. And then in 2022, that's when I'd gained a lot of weight, I was losing a lot of confidence, and I was letting a lot of stress at work get on top of me, which then had an impact on my relationship. And then obviously we were just coming out of lockdown as well. So I think that had a massive impact on my mental health. It was definitely, there was a lot of low mood and also anxiety around all I wanted to do was see friends and family, but the thought of doing that was actually making me incredibly anxious and busy places were making me anxious, new surroundings were causing kind of panic attacks. We'd gone on a trip and we were getting on a plane kind of in 2022 and I had a full panic attack getting on the plane. And there was nothing within my brain that was pinpointing what exactly it was. But I think...overriding the kind of that sadness and that anxiety there was a lot, it was around, I looked in my notes when I knew that we were doing this podcast and on the 12th of January I'd written in my notes as I was about to start my CBT I'm scared because I might not have control over what the future will bring and that might in my head was asserting so health wise I'd had some news regarding I was diagnosed with PCOS and an underactive thyroid, which both have a big impact on fertility and kind of me and my partner were trying to conceive and every single month it was like you were failing at being a woman really because it wasn't happening for us. That’s still an ongoing thing now, that's not kind of changed but my mindset has changed off the back of...having CBT and I kind of went into counselling after that as well. And my mindset then has started now. I'm learning to deal with different things in a more logical way instead of going with them thoughts and thinking that that's it kind of thing, if that makes sense. Helen: Thanks, Emily. And it sounds like there was a combination of all sorts of really difficult things going on. I mean, you've talked about your physical health, you've talked about what was going through your mind, you were talking about the way that you were feeling. There's an awful lot that was going on for you there. And thank you for sharing that with us. And I'm just sort of really curious to hear about what it was actually like having that low intensity CBT? I'm going to come back to Laura and ask her to explain a bit more about what that really means. But from your experience of being on the receiving end, what was it like? Emily: Yeah, I think it's so, you're thinking ahead and a lot of my thoughts was always, I kept thinking, I shouldn't be doing this, I'm taking that away from someone else who needs this more than me. I could go and talk to my friends and family about this, of how I was really feeling or my partner, even. And there's only so much I think that you're comfortable to open up and tell your friends and family and speak about and but actually talking through everything and kind of making them thoughts in my head a lot more logical and combating them unhelpful thinking styles that I was doing, what just helped me so much and kind of rationalizing everything in my brain. And I think with my CBT therapist, she spoke a lot about negative automatic thoughts with me. It's every time there was something that was happening my immediate thought was the complete, the most negative response to it. So combatting that was a big thing for me and speaking about that. Helen: Thanks, Emily. And I mean, if I can just come to Laura now, Emily's just spoken really clearly about lots of stuff to do with thinking, negative automatic thoughts, thinking logically and so on. Can you say a bit more about that from the perspective of somebody who delivered those kind of interventions? Why is that helpful? What's that about? Laura: Hmm, it's a good question I guess. So in Emily's case the therapist was working with her on how she was thinking about herself and her difficulties and there lots of ways to work with thinking and negative thoughts in CBT. So you can work on the content of thinking, what our thoughts actually are and what they're saying or the process of thinking which is how we engage with the process of those thoughts. And I guess the most common way a low intensity therapist will engage with negative thoughts, particularly in low mood presentations and people with confidence issues is content, usually through means of reality testing or a CBT therapist might call it cognitive restructuring. Because for many of us, and we'll all resonate with this, is that we can make assumptions of what others think about us, we can have untrue and negative appraisals about ourselves and our situation. So, for example, others think badly of me or I'm terrible at my job or like Emily said, I'm failing as woman and things will never get better. And our mind can really convince us of these things that aren't true. And even sometimes if there is some truth to our negative thoughts and maybe things aren't going so well, still having all or nothing thinking or having a hundred percent conviction in these negative thoughts is really unhelpful. So it's more helpful to balance our negative thoughts with evidence sort of against their truth, if you like. And this is really important because in any CBT format, whether low or high CBT, we're trying to help the person feel emotionally better through cognitive and behavioral change. If we could tell ourselves to stop feeling sad or anxious, well, I guess we would simply do it and I probably wouldn't have a job. But because that's not possible, we have to relieve our distress and emotions through how we're thinking and what we're doing that are worsening those problems. So cognitive therapy and working with thoughts can really help people pay attention to alternative facts and information that challenges t

In this episode, Helen Macdonald speaks with Chris Frederick- advocate, suicide survivor, founder of Project Soul Stride, and self-described "Mental Health Jedi." Chris shares his deeply personal journey, from childhood trauma and racial adversity to becoming a mental health advocate and what helped his recovery- and the things that didn’t. Resources & Support: If you or someone you know needs urgent help, reach out to Samaritans at 116 123 (UK) or visit samaritans.org Brent Recovery College- https://www.cnwl.nhs.uk/services/recovery-and-wellbeing-college The Listening Place- https://listeningplace.org.uk/ James’ Place- https://www.jamesplace.org.uk/ Find more information about CBT- www.babcp.com Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts Have feedback? Email us at podcasts@babcp.com Follow us on Instagram & Bluesky: @BABCPpodcasts Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This episode was produced by Steph Curnow Transcript: Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't.  I'm Helen Macdonald, your host. I'm the Senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies. Today I'm speaking with Chris Frederick. I'm absolutely delighted to have him here with me in the studio. He's going to share about his personal history and some difficult experiences that he had in his earlier life. How he ended up looking for help with his mental health and some of the things that helped as well as some of the things that were less helpful and how he's then started using his lived experience to help inform professionals, services and members of the general public about what helps and what helps people to access the kind of support that they need. He's also going to tell us how he ended up being known as the mental health Jedi. Chris, would you just like to introduce yourself and tell us a bit about who you are? Chris: So my full name is Chris Frederick. Born and bred in London, currently living in northwest London. I guess I like to introduce myself. Firstly, is I'm a suicide attempt survivor. I think it's important to get that out there. I'm an advocate and founder of Project Soul Stride, which we'll touch on a little bit later. And, also I'm a mad Star Wars fan. Helen: Oh, fantastic. And you've just mentioned a couple of things, really important things about your background and who you are. Is there anything else that you'd be happy to tell people listening today about your background and challenges or barriers that you've experienced? Chris: I mean I guess if I backtrack to the story that, that brought me to that point, very quickly in the barriers, because they might be things that listeners would identify with. I'm a twin, I'm 55. Growing up for us in the early seventies was a tough time. We lived as a small family of four in a flat in a council estate in Wembley and due to the pressures that my father and my mother who were very young, they were only 19 and 18, and they'd not long been in the UK from the Caribbean. So they themselves were carrying their own baggage, their own trauma, their own legacy and that transferred, I guess, onto us as young children. My father was a very strict, sort of military type figure. A beautiful looking man- if you put a picture of Muhammad Ali at his prime and my father at his prime, they could almost be twins, brothers, because that's how you know, he was tall, statuesque, beautiful green eyes, but on the downside, he had a heavy hand. And you know what I mean by that Helen, he had a heavy hand. He was quite, he was an intimidating character. And that manifested itself in negative behaviour in the house, physical abuse of various descriptions. And we grew up watching and witnessing and being victim of that as we grew up, and this is all within a black community. And then we moved at the age of 11, we upped sticks and moved to Chislehurst, which was a suburb of Kent. So imagine now we've moved from an all sort of majority ethnic community to now an ethnic minority community where we were the only black family on the street. Elms Street Avenue number 60, remember it well. Went to Kenmore Manor, and I remember for the first three years we were two of only five non-white pupils in the entire school. So without going into too much detail, you could also now begin to identify with the certain trends, the recurring themes, the racism of course, the pressures from my family. My parents eventually split up and divorced. My relationship with my twin eventually split. And so we ended up the complete, the family was completely fractured and still is today. And you bundle all that up. I started to experience mental ill health probably at the age of 19. And I'll tell you what it was, it was alopecia. Because I used to have, I used to have, if you could see me now, I've bald hair. and I started to feel there were bald patches appearing in the back of the scalp. So I went to the doctors and you said, oh, you've got alopecia. we could inject you with steroids, give you some cream. I said, well, what's the underlying reasons? And he goes, oh, it's stress. you. What can we do? What can I do to overcome that? And again, that was in the late eighties so talking about counselling and therapy again wasn't really part of the dialogue back then. Right. And then at the alopecia came back 10 years later. So I was beginning to realise I had some problems. And then I took off to Asia, lived there for 20 years, had an amazing time, an amazing experience. Again, suffered racism, but of a completely different type in China, Beijing, Singapore, Hong Kong as a black man, very few in number, but I didn't let that deter me. I had a very good career. I had a lot of experience and beautiful people, travelling a lot. But it all came to a head. It all came to head, and it's something that I called the ripple effect because it almost as if there was an author I spoke to last year, he when he heard my story, he said, I'm sorry to say this, Chris, but it almost sounds as if it was inevitable that you would reach breaking point and attempt to take your life, based on everything that you told me and that ripple that had gone through, the desperation for wanting to find love, family, belonging, identity, all the things that have become so precious to me now manifested itself when I lost my last job in Singapore in 2018, and I tried to commit suicide later that year. And then that was the time for me to leave Asia. After nearly 20 years, I realised that I needed to close the book on that era of my life. And I moved to Los Angeles and then a few months later moved to London, and then I attempted suicide again a couple of years later during Covid. So, you know, I've looked into the precipice, I've looked into the darkness, and twice I wanted to disappear from the world. Helen: And Chris, I'm really grateful to you for sharing so openly about what's happened to you and just such, such a combination of difficult life events and the circumstances that you were living in. And I mean, I will say that the show notes will have links to help and more information for people who may experience similar things or be concerned about risks and safety. But I'm really grateful for you to sharing so openly and you've said that all of these things really have brought you to where you are now. Tell me a bit about how you went from what sounds like a real, you said looking into the abyss, to accessing something that made a difference to you, or how you got the right kind of support, the right kind of help. Chris: So I mean, if I tell you, Helen, that when I got admitted into Ealing Hospital after my second attempt, at that moment in time, it was like, oh, finally I'm about to get some help. Finally, I'm about to be recognised as an individual who needs support from the NHS. And then through that whole process of being in the hospital, the psychiatric team at the hospital were very good, they were very helpful. The clinical psychologist came to see me. She spoke to my mum separately and said, okay, we need to help your son. And when I got discharged, I got put into the hands of the community mental health team, the Brent Community mental health team, and they were smashing. They'd come around two, three times a week. They'd make sure I was taking my medication. And then I started to ask them, okay, where do we go from here because I've got you guys for about a month. I'm really concerned what happens then. I just don't want to keep falling back into these bad habits. So they started to say, okay, firstly we're going to start to give you some information, some literature and then we're going to start to talk to you about what was then, Helen, IAPT, now Talking Therapies. I said to them, look, I don’t know if I'm ready to go into therapy quite yet. I'd like something just to, just as a teaser, just to start giving me a little bit of confidence, a little bit of awareness of even how to talk or be around people who might have experienced this stuff. So they said, we've got the solution for you, the Brent Recovery College, the CNWL Brent Recovery College. I said, oh, that sounds interesting what do they do? Oh, they've got a curriculum of courses, and you go online, and they've been facilitated by lived experience, peer support trainers. You are going to be in classrooms of about 12 people, they've all got experience of mental illness. They're all there like you. They want to see other people on the screen. They want to connect with people whilst learning new skills. And I said, I've been a lifelong learner this sounds just a ticket for me to get things going. And when I spoke to the admissions clerk, sh

In this latest episode of Let’s Talk About CBT, host Helen Macdonald is joined by two international guests- Tafi Mazikana and Sherrie Steyn who share their journey from CBT service user and therapist to CBT innovators. Tafi, originally from Zimbabwe, opens up about his experiences with anxiety while working in a high-pressured job in finance and how a digital CBT intervention through IAPT (now known as NHS Talking Therapies) changed his life. He talks candidly about the cultural stigma around mental health, what it was like to try therapy for the first time, and his realisation that CBT is about learning practical, empowering skills. We also hear from Sherrie, a clinical and community psychologist from South Africa and co-founder of the Vimbo Health app along with Tafi. She reflects on her friendship with Tafi, the surprising conversations that sparked their collaboration, and the importance of culturally adapted therapy. Together, they describe how Vimbo Health was developed to meet the unique challenges and needs of people in South Africa, particularly in terms of language, cultural metaphors, accessibility, and affordability. They explore how therapy can be made more relevant and relatable, from replacing metaphors like “three-legged stools” with potjie pots to tackling barriers like mobile data costs and mental health stigma. Whether you’re a therapist or someone curious about accessing help in a different way, this conversation shines a light on how CBT can be tailored, inclusive, and transformative. Resources & Links: Learn more about Vimbo Health: https://www.vimbohealth.com/ Information on CBT and how to find a therapist If you or someone you know needs urgent help, reach out to Samaritans at 116 123 (UK) or visit samaritans.org Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts Have feedback? Email us at podcasts@babcp.com Follow us on Instagram & Bluesky: @BABCPpodcasts Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This episode was produced by Steph Curnow Transcript: Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't.  I'm Helen Macdonald, your host. I'm the Senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies. I'm absolutely delighted today to have some international guests for you. And in a moment, I'm going to ask, Tafi and Sherrie to introduce themselves. We're going to be talking with them about the experience of having CBT and then some really exciting developments that have happened since. But first, let's start with some introductions. Tafi, would you like to tell people who you are? Tafi: Yes, definitely. Thank you, Helen, really a pleasure to be with you today on this podcast. So I'm Tafi Mazikana and I'm Co-founder and CEO of Vimbo Health, a metal health app that's operating mostly out of South Africa. My background as I've shared, is not as a practitioner. My background is as a patient, of CBT who became very curious, perhaps too curious. So I was living in the UK working in banking and finance, and I was just very lucky to come across the services of IAPT which allowed me to self-refer in this area of mental health. I never knew that one could actually reach out and do something, so that was game changing in itself. But I was offered to have a digital CBT intervention, which was very transformative for me but obviously just left question marks as someone born and raised in Africa to say, well, who's thinking about the African context? Because, as I'll share later, there are things and ways of thinking and speaking that are different and I was just curious about who is going to think about that. And so became more and more involved, in this area of CBT, and in particular digital CBT. Helen: Thank you so much, Tafi. There's lots that we're going to talk about there. Before we start that though, Sherrie, can I ask you to introduce yourself please? Sherrie: Hi Helen. Thank you for having me. My name is Sherrie Steyn and I am from South Africa. I'm actually very fortunate to be from the East coast, so the sunny side, and my background is in clinical and community psychology. I tend towards the behavioural types of psychology. So I've done some ABA or as we call it VBA now and of course a special interest in CBT. So having done that clinical and community psychology, I then went on to do one of the allied CBT training courses through UCL. So I was very fortunate, to have done that. And that's a little bit about my background and, yes, I'm also the co-founder and CSO of Vimbo, I like to say I'm the science, because it sounds cool and yeah, just very happy to be here and share some of our experiences with you today. Helen: Thank you so much. So if I can come back to you, Tafi, I wonder if you would be willing to just tell our listeners a little bit about what it was that made you actually reach out to access CBT. Do you mind telling us a bit about what was happening for you that meant that you were seeking some help? Tafi: Yeah, absolutely. I think what I with hindsight realise is that it was difficulties that built up gradually over time and came to a point where they sort of caught me off guard. At the time that I reached out for help, I was working in the banking sector there in London on very stressful, large projects, which brought on a lot of anxiety, but I traced back my difficulties to over 10 years ago in terms of when those little moments of a negative self-talk, which started as innocent, and then grew into something of its own life, sort of started to happen and without the right tools then entering into that professional world, I do think I was at a disadvantage. I had some great tools in terms of being quite active and taking part in sports and exercise. So that's amazing but definitely what I came to realise is that I was actually lacking other tools that could have helped me to not get into a situation where I'm feeling like I'm in a lot of difficulty. So yeah, so I always describe it as, for me, in my case, not one thing in particular, but I feel like a gradual buildup of life just happening or that negative thinking pattern becoming something of its own. Helen: And I think it's quite important to notice that, that it doesn't have to be some one particular dramatic event or something key that changes. It might be a combination of things or a buildup over time. So can I ask you a bit about when you did access the CBT, what did you actually get? What happened in CBT for you? Tafi: Yeah, so I think for me, I grew up in Zimbabwe in Africa, and there isn't a tradition of seeking help. So for us, therapy is something that we saw in movies, we know that movie characters in Hollywood have therapists and get help. Or we associated it with people who we knew in the community who are undergoing inpatient care. And those are the forms of help that we knew to be there. Things that are not related to us in terms of early intervention, it is more something that happens when you are at the stage of acute care, which is inpatient. So essentially when I reached out for help, I was a bit sceptical of what was offered because it didn't fit the moulds of what I thought help looked like. And when I chose the route of going for the self-guided digital option that I was given there. I was, again, sceptical because it was not what I thought therapy looked like.  I chose it because it was, it felt like a lower barrier because I was still quite afraid to talk about my feelings and to talk about my thoughts and experiences. But yeah, but, needless to say, I was actually shocked and quite impressed at how effective it was. And so that, that introduced me into the idea that help is something you don't have to wait until you are at that acute phase of need. But also, it taught me that CBT is about, in my opinion, I guess I'm not a practitioner, so please take it with a bit of salt, but it taught me that CBT is about building skills, which is quite a positive thing. It's actually quite empowering is what I learned then, and I think that's what resonated the most with me and got me hooked onto this form of help. Helen: Thank you. And I just wanted to emphasise that there's several things that you've said there. I mean, firstly, you're coming from perhaps a cultural context that's less familiar to some of us. I suspect a lot of our listeners will be in the UK, although there are people from elsewhere. But that experience of really not being used to talking about feelings will be very familiar to a lot of our listeners, that sense that it's got to be really bad before you seek help, I think will also be something that people out there might feel. And yet what you've said, it was an earlier intervention, and it wasn't nearly as bad as it might have been.  So I just wondered if I can talk to Sherrie for a moment and ask about what it was like for you, getting to know Tafi and,from the CBT therapist's point of view. Sherrie: Well, I think what the first thing that strikes me is that Tafi and I socialised fairly regularly. We were a bit younger in those days. So the socialising honestly did tend to focus on large groups, at the pub, at a museum, at a place, and even when we do have dinner time, so if Tafi would come over and just hang out and have a meal, you are still so preoccupied with the day to day that unless someone brings something to you, you might not actually know what's going on. Whilst all this was going on, I had no clue what Tafi was going through. So the first time we actually really got talking about this was when he was visiting me, so after he had completed his treatments and we were hanging out on the balcony that I'm looking at, and we were just talki

In this episode of Let’s Talk About CBT, Helen Macdonald speaks with Phil Cooper, mental health nurse and co-founder of the charity State of Mind Sport, and Ian Knott, former professional rugby league player and State of Mind presenter. Phil shares how State of Mind was born out of tragedy and developed into an award-winning mental fitness programme, now reaching thousands of athletes across the UK and beyond. Ian talks candidly about his experience of severe injury, depression, and suicidal thoughts after retiring from sport, and how CBT helped him to rebuild his life. We hear how sports settings are being used to break down stigma, encourage conversations, and promote mental health support—particularly among men—and how brief interactions and powerful personal stories can save lives. Resources & Links: State of Mind Sport website Information on CBT and how to find a therapist If you or someone you know needs urgent help, reach out to Samaritans at 116 123 (UK) or visit samaritans.org Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts Have feedback? Email us at podcasts@babcp.com Follow us on Instagram & Bluesky: @BABCPpodcasts Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This episode was produced by Steph Curnow Transcript: Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't. I'm Helen MacDonald, your host. I'm the senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies Today what we've got for you is an episode about mental health, mental fitness and sports, and I've got Phil and Ian here to talk to me today. Phil, will you just introduce yourself? Phil: My name's Phil Cooper. I’m a mental health nurse by background. I used to work as a nurse consultant in mental health and drug and alcohol misuse. I love sport. And, for some strange reason or quirk of random chaos, I became to be one of the co-founders of State of Mind Sport charity that focuses on mental fitness. Helen: Thank you, Phil. Ian, please, will you introduce yourself? Ian: My name's Ian Knott. I'm a former rugby league professional and I currently am a presenter for State of Mind. I talk about my story, my lived experience of having to retire through a serious injury and then developing mental illness. So I talk about that. Helen: Thanks very much, Ian, and I'm sure our listeners will want to hear more about that later in this episode. Firstly though, can I ask Phil to tell us a bit more? Phil, will you tell us about State of Mind and how it came to be and what it does? Phil: Sure State of Mind Sport began unfortunately on the back of a tragedy within the sport of rugby league, where a Great Britain Rugby League international called Terry Newton, unfortunately took his own life in September, 2010. Sent great shock waves, I think, through the whole sport for such a high profile player. At the time there was relatively little support or mental health support for players at that time. I suppose as a mental health nurse who loves rugby league and sport, I read a league paper on a Monday morning, somebody wrote an article saying how the NHS and the sport should get together to try and prevent suicide. Also, somebody also wrote a letter, again a mental health professional, called Malcolm Rae and Ernie Benbow had written the article and I saw this and thinking, wow, this is Monday morning, I shall write these two individuals- checked with my chief exec, of course, because obviously you have to be doing all these things- and then invited them to a meeting we were going to have in good old health style a conference, that soon changed when we invited a couple of players such as Ian, and they suggested, why didn't we ask the governing body for a round of fixtures to promote mental health at that time or mental fitness. I then found myself in the strange position being ferried to Hull Kingston Rovers Ground to be presented before all the chief execs of all the top divisions with clubs to say, this is a really good idea. It's free. So the sport love that bit and, we’ll deliver a session to your players before the season and then a round of fixtures themed around that. So we had a State of Mind round in 2011 and player bought into it. There was very little support, as I said, and they began to talk about it on social media. They wore t-shirts in the warmup before the round of fixtures, but crucially, they knew what it was about, and they were all bought in. Things have grown massively since that time, which has been great for us. And also promoting mental fitness in rugby league, one of the toughest sports on the planet. Helen: Thank you Phil. So can you tell us a little bit more about what you really mean by mental fitness? Phil: Certainly, okay. I think language is crucial, as I'm sure all your members will realise and will think about on a regular basis. So for me, to get into a situation of encouraging men or engaging men into something that will help them, if I say, if I used to say, well, we'll come in and deliver a mental health session for you into a local grassroots sports club. I can imagine the reaction would be flipping heck, I'm not going into that. However, when you can make the case that actually you are going to go to training for physical fitness, what a lot of athletes will tell you that the mental fitness is perhaps the most important aspect of being a professional sports person or being the best sports person you can be. So therefore, if we go in and say, well, we're going to try and improve your mental fitness, men tend to sort of buy into that, especially if you go to them in their grassroots club, they wouldn't come to me in a community mental health team, but they would certainly go training two nights a week in their local club. And you have a captive audience potentially, especially when the weather's bad and they can't train on the pitch. And the coaches will want something different to either entertain or, keep the players focused on what they want to achieve. So State of Mind deliver mental fitness sessions so we look at anxiety and depression using a GAD-7 and a PHQ-9, as I'm sure your members will be very familiar with and again, we deliver that in a style that's not sat down in front of somebody asking them to fill in a questionnaire with a pen or online or whatever. So we'll do that. We will have two presenters usually. So Ian being one of those, I might have been the clinical dude once or twice with Ian, of course, and I'll ask him about how he's been feeling over the last few weeks using a PHQ-9 or a GAD-7. He'll tell me some strange answers, which he never used to tell me what they were going to be, I would then ask the audience how anxious or how low in mood Ian was based on those answers. So you keep all the information away from your audience, but you involve them to use all the different learning styles, so audio visual, kinaesthetic, all of those learning styles to get to as many of those people as possible. So we've been doing that for 10 years. Hundreds of thousands of people have attended sessions, which is ridiculous when I think back, but also numerous people have told us that they changed their mind about taking their own life and that's the sort of thing that keeps you going every week. And going to wherever we're going of a Tuesday or a Thursday evening, or even as I found myself in a dressing room last Saturday, so before a football match, just talking to players. So all of those things, we do mental health first aid. You can look on stateofmindsport.org if you really want to know. I don't want to want too much about that, but that's what we do. And we go to people where they are. We try to engage people where they are. Helen: And I'm hearing you are reaching a huge number of people, probably people who wouldn't easily go and look for help, like perhaps men in maybe more traditional settings where we don't talk about mental health or mental fitness as you put it. That's really important. But also this work is saving lives and that seems to me as a really important piece of work that's happening here. And I wonder if I can ask Ian to come in now. And Ian, you said, about your lived experience and that's what's brought you into working with State of Mind Sport. Can you talk a bit about your experiences? Ian: So my kind of story started in 2004 while playing for Leigh Centurions. At the time I probably had about 12 years I think at professional rugby. I played at the highest-level barring international level, and after 12 years of playing at the highest level, I dropped down division to play for Leigh Centurions And at the time, Leigh were making a massive push to get into Super League. I never played in Super League before, and halfway through the season, I can remember we played against Halifax away from home, and I ran with the ball, and I got tackled and there was nothing wrong with this tackle at all, but I felt these god awful pains in my lower back and it felt like my leg was, I don't know, it's like tingling and my foot was in like a bucket of water or something like that. So it felt, which was strange because we are really hot summers day. So obviously I came off reluctantly, because we are a bit stupid, old rugby players, we do play with injuries. But I did come off, and then a couple of days later the pain got worse, so I got sent for a scan. And I got told in no certain terms had a very large disc prolapse at the bottom of my back. So they said you can't play, you need to obviously get treatment and then you'll be okay for the next season. So I went back and had a meeting with the club, and we all came to the sensible conclusion to ignore the surgeon and playe

In this special episode celebrating World CBT Day 2025, we explore this year’s theme: CBT: A Solid Return on Investment. Host Helen Macdonald, Senior Clinical Advisor at BABCP, is joined by a range of voices reflecting on the impact, value, and future of CBT. We hear from: Dr. Adrian Whittington, National Clinical Lead for Psychological Professions at NHS England, about the rollout and outcomes of NHS Talking Therapies. Dr. Stirling Moorey, BABCP President, on the historical development of CBT and its increasing relevance and recognition over the decades. Nic, a former CBT client, who shares how therapy helped him manage anxiety linked to a long-term health condition. Dr. Saiqa Naz, past president of BABCP, who discusses her personal journey into CBT and her commitment to inclusion, diversity, and working with underrepresented communities This episode offers a rich blend of lived experience, clinical insight, and future vision, showing how CBT continues to be a wise investment for individuals, services, and society as a whole. Further information and links: Visit BABCP to learn more about CBT Find support via NHS Talking Therapies Discover more about World CBT Day Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts Have feedback? Email us at podcasts@babcp.com Follow us on Instagram & Bluesky: @BABCPpodcasts Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This podcast was produced by Steph Curnow Transcript: Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't.  I'm Helen Macdonald, your host. I'm the Senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies. Welcome to this special episode of Let's Talk about CBT celebrating World CBT Day. World. CBT Day takes place every year on the 7th of April, and this year's theme is CBT: A Solid Return on Investment.  In this episode, we're exploring just what that means- I will be speaking with Adrian Whittington, who's the National Clinical Lead for Psychological Professions at NHS England and with Stirling Moorey, who's our current BABCP President about how CBT has developed over time and the importance of continued investment in it. We'll also hear a personal story from Nic, who is a former client of Stirling's, who shares how CBT helped him manage anxiety and improve his quality of life.  Finally, I sit down with Saiqa Naz who is past president of BABCP to talk about her journey into CBT from starting out in the Improving Access to Psychological Therapies services, to completing a clinical psychology doctorate, and how she embodies the idea of CBT being a real return on investment. We hope you enjoy this episode and the range of voices reflecting on the impact and value of CBT.  Let's get started! Here's my conversation with Adrian and Stirling…. Adrian, would you introduce yourself please? Adrian: Yes. Hi. I am Adrian Whittington. I'm National Clinical Lead for Psychological Professions at NHS England, which means within England I'm the professional lead for psychologists, psychological therapists, and psychological practitioners. Helen: Thank you, Stirling, please introduce yourself. Stirling: Hi, I'm Stirling Moorey. I am currently the president of the BABCP and I'm a retired psychiatrist and really have been around in the CBT world since 1979. So, Adrian is speaking about CBT today and in the UK particularly and I'll just give a bit of a view of what it's been like to be in the CBT world for this length of time. Helen: Thank you very much. And so Stirling, if we come to you first, that’s a long career- you must have seen a lot of developments over the years. Tell us a bit about what you've seen and how things have developed. Stirling: Indeed, I mean, so right at the very beginning when I was a medical student, cognitive therapy was just being invented. And so we had BT, Behaviour Therapy, but not the CBT that we have today. And so it was quite sort of revolutionary. The behaviour therapists look down their nose a little bit at it, the psychoanalytic therapists very much looked down their nose, and I remember at one point talking to a psychoanalyst who told me that being a CBT therapist was a bit like playing a tin whistle compared to being a concert violinist. I think things have changed since then. So, over the years, what's happened is that really from the work of pioneers like Isaac Marks in behaviour therapy, Aaron Beck in cognitive therapy, for the first time psychotherapists started to actually address what evidence do we have that this works? And using randomised control trials. And this has been really powerful. It was revolutionary at the time because people thought you couldn't manualise therapy but Beck and others managed to do that. I think that's been the legacy of that, is that the services that are recognised to be really effective and are spread out across the UK that Adrian will talk about, have resulted from us gathering evidence that CBT works. The other thing that's happened is that really up until the early 2000s, we were using CBT in a lot of contexts in the UK, evidence accumulating that it was effective for anxiety disorders, depression, but other things like eating disorders, psychosis, long-term conditions, various things but they were all being delivered within a hodgepodge of services really. And I remember when the IAPT services that Adrian will be talking about, were about to be developed, my chief executive in my trust said this is amazing, it's like moving cognitive therapy from being a cottage industry into therapy mills as he called them. So, we have therapy mills across the UK, which are proving very effective in helping people with anxiety and depression. And it was that revolutionary input of David Clarke and Lord Layard who said, actually, we can work this out as a way to deliver therapy effectively and efficiently, not just in these services here and there, but across the whole country. So there's been so much change and now CBT is there for everyone. I suppose just finally thinking about what its impact in public consciousness has been, although people maybe have heard of it and maybe witnessed people who've received it, there've been some subtle changes, I think in our perspective on the world that have been influenced by CBT. I think people from the behavioural side now are recognising that a lot of our behaviour is learned in our everyday life. We have habits and people notice they have bad habits and go to podcasts to try and get them to rid them of their bad habits. And people are really aware of cognitive bias- it's there in the media all the time, that recognition that our thinking is not always that rational and straight, for good or ill. And then the third thing is there's a new wave of CBT that's come along that's called the third wave of CBT is really looking at how we can look in and just be aware and notice our thought processes. And so the whole field of mindfulness is very popular these days. So CBT, I think even if people aren't aware of what CBT is as a therapy, it has perfused our consciousness. Helen: Thank you very much, Stirling. That sounds like a whole symphony orchestra, not just a tin whistle from what you've been saying during your career. And thank you because that perspective of many years in the field and how things have developed, it leads us nicely to speaking with Adrian about, you mentioned IAPT, which stood for Improving Access to Psychological Therapies. I'm going to hand over to Adrian to ask him a bit about that project, how it came about and what happened. Adrian: Absolutely. Thanks Helen. Well, of course I'm a relative newcomer to the field having been trained as a psychologist 30 years ago and done my additional CBT training, I think 19 years ago, including under Stirling's tutelage as one of my training supervisors. So, it's great to join this session today with Stirling. So, NHS Talking Therapies as it is now was called Improving Access to Psychological Therapies is really something we're very proud of and feel as a sort of world leading program in implementing psychological therapies at scale. As Stirling's mentioned, David Clark and Lord Richard Layard were instrumental in founding the service and arguing successfully for its initial funding and have really been sort of fundamental to its success ever since. It's received investment every year, under every government since 2008 in the UK and it is just an England service so it's important to also remember there's other parts of the UK that don't have the same sort of service at the moment. It really makes a public promise, which is that it will deliver NICE guided psychological treatments. So NICE are our evidence-based, practice guidelines in, in the UK and, sort of established by independent panels of experts for each type of condition. So it makes a public promise, it will only deliver NICE recommended treatments, psychological treatments, that the therapists that deliver them will be fully trained and properly supervised and that it will publicly reveal its outcome data, anonymised, of course, but for the whole country so that we can see at a national scale, but also locally, how the service is performing, and the service can learn and the best performers can show what they're doing that's being so successful, to produce the best outcomes and other services can, can seek to learn from that and implement some of the same strategies. So we now have a sort of situation where for a number of years, the service has met its objective of 50% of those who coming into the service, are recovering completely from anxiety or depression and about two thirds, improving reliably, during the course of

In this episode of Let’s Talk About CBT, Helen Macdonald speaks with James from the charity Gambling with Lives about the serious impact of gambling addiction, its links to mental health, and the role of CBT in recovery. What We Cover in This Episode: 🔹 How gambling has changed – From a backstreet niche to an industry making billions through addictive products. 🔹 Gambling addiction and mental health – How gambling harms go beyond financial loss and can lead to depression, anxiety, and even suicide. 🔹 The neuroscience of gambling – How gambling rewires the brain, making it difficult to stop. 🔹 Recognising the warning signs – What to look for in yourself or a loved one. 🔹 The role of CBT in recovery – How cognitive behavioural therapy is a key treatment approach in NHS gambling addiction services. 🔹 Breaking the stigma – Why gambling addiction is not just about personal responsibility and we need to talk about how it can harm people and the amount of gambling advertising that is out there. 🔹 Getting help – Resources for those affected, including training for healthcare professionals. Resources & Links: Find out more about Gambling with Lives: gamblingwithlives.org Visit Chapter One for training and resources: chapter-one.org NHS gambling support services: NHS gambling support If you or someone you know needs urgent help, reach out to Samaritans at 116 123 (UK) or visit samaritans.org Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts Have feedback? Email us at podcasts@babcp.com Follow us on Instagram & Bluesky: @BABCPpodcasts Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This episode was edited by Steph Curnow Transcript: Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't.  I'm Helen Macdonald, your host. I'm the Senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies   Welcome to today's episode. I'm really pleased to have James with me today. He's from an organisation called Gambling with Lives, and I will ask him first to introduce himself. Hello, James. James: Hi Helen, thank you for having me on. I'm James. I live in Stockport, originally from Norfolk, hence I haven't got a Northern accent, but I'm here today representing the charity Gambling with Lives. The charity was set up by bereaved families who'd lost loved ones to gambling related suicide and I now oversee our prevention work, which includes education, training, information, and resources. And a lot of that stems from my own lived experience of a 12-year gambling addiction, which started as a young person, and which I'm sure we'll touch on today. Helen: Thank you, James. And so I'm very aware that a charity that's been very much grounded in the experiences of bereaved families, there's going to be some difficult things to talk about here. And just to say for our listeners, there will be links to where to find help and support on the show page and as well as anything that we talk about during today's episode. So can I ask you just to tell us a little bit more about gambling? What is it? You know, how people might get themselves into trouble with it, maybe? James: Yeah, it's a big question. And the first answer that comes to my head is that gambling is not what it was. I think a lot of people have a perception of what gambling is, and that's a weekly bet at the horses or going to the bingo on a Thursday night, or the football pools. Gambling has absolutely transformed over the last 10, 20, 30 years. And it all really started from a point in 2005 when the Gambling Act was created by the Labour government at the time, which changed gambling from being this thing that was, you know, quite hidden, quite behind closed doors, wasn't promoted, was quite hard to go and do, wasn't that easy or available or accessible, and that Gambling Act changed that completely and allowed for relentless advertising, sponsorship, marketing, and allowed for bookmakers in the high street to have really addictive electronic machines in their premises. And they were things like the fixed odds betting terminals, which were roulette machines, which at the time were called the crack cocaine of gambling because they were that addictive. And that was not what gambling was. I remember when I was a child, in our town, I'm from a quite a sleepy, small town in Norfolk. And the bookies in our town used to be this like really dingy, horrible place to be honest behind in a back alley that I used to walk past it and think I'm never going in there, that is a place not for me. It's for old men, smoke coming out the doors, did not have any interest in that. But then when I was 16, which was a couple of years after this Gambling Act, it changed into a massive Ladbrokes in the middle of the high street, you could see through there, you could see the machines and you could see all the advertised on the outside of the windows. And that's what's happened to gambling. And the impact on society is huge. We now know that 2. 5 percent of the adult population are experiencing so called “problem gambling”. And just to note on that terminology, it's not a term that we like to use, but this is what the statistics say. And we don't like to use it because we don't like to put the problem with the person. There are many reasons why people experience gambling harms, which is what I'll come on to later. But that figure alone. So that's the very sharp end of gambling harms, but then you've got many more impacted by somebody else's gambling. You've got widespread harms happening to young people. So, a really important point here is that these harms aren't just financial. Again, I think there's a perception that gambling addiction is a financial problem, and the harm is felt through debt and long-term financial worries. Actually, this is a mental health condition. This is a diagnosable mental health condition. Gambling disorder is in the DSM manual since 2013, and it's a mental health harm first and foremost. And that then causes anxiety, depression, and suicidal thoughts as well, which again, we'll come on to based on the work we do at Gambling with Lives. Helen: Thank you, James. So, what I've just heard you describe there, that it's gone from being a bit of a backstreet, rather unattractive niche thing, to being sort of very attractive and perhaps more widely, I don't know, more people participate in it. And you mentioned gambling machines and I'm also aware that people can gamble on the internet as well. They don't have to go out to do it necessarily. And I'm also aware that you used words like addiction, which most people would associate with substances, perhaps alcohol or drugs or something. And I wonder if you could say a bit more about, perhaps the difference between what I might have thought of as a harmless flutter and something that's harmful. James: Yeah, another good question and potentially asking the wrong person because I, obviously I experienced a gambling addiction myself, but I'll try to answer based on my own experiences. And on your first point, actually, probably the thing I forgot to say, which is most important is that the biggest change for gambling is, as you say, the fact that all of these products that are now available on our phones, in our pocket. At the time when the legislation was written, there was concerns about super casinos in places like Blackpool and on the coastal towns of England. And actually what's happened is we all now have a super casino, but it's in our pocket and anyone can access it over the age of 18. There's very little safeguards and protections on there. And that's where the harm is felt most on online gambling. And that's sort of the answer to the second question as well is that gambling is not just one product, and some products are more harmful, risky and addictive than others. And that's not to say you cannot be harmed by, as an example, buying a lottery ticket. Because if you've only got 5 pounds to last you for food that week and you spend 5 pounds on a lottery ticket, you are experiencing gambling harms. But evidence shows and experiences from people who have been there and been harmed are that the quickest, more attractive, the things that are designed to be addictive products like online slot games, online casino games, online bingo as well. These are the things that are really causing the harm and causing addiction. And the difference is the indication someone is experiencing gambling harm is how often someone is spending on those products and how much money someone is spending on those products and how quick all of those things are, those products. That's why people can get harmed quite quickly. Back in the day, again, you used to have to go somewhere to place a bet on, and you maybe did that once, twice a week. Now, because of how quickly you can do that, that creation of addiction is so much quicker and instant, and it can happen really quickly. I can give you examples of times where I spent five, six, seven hours just in bed spinning online roulette tables on online casinos. And that time I, it didn't feel like five, six, seven hours. It felt like I was just trapped in this zone. And that's because it's deliberately designed that way. So what happens is, and this is very medical and I'm not a scientist or a medical person, but this is a physiological change in the brain. So when you play these really fast paced products, these intense products like slots, like casino games, your pathways in your brain are rewired and it becomes a dopamine driven urge to do this thing again and again. And what's really worrying and something for your listeners to look out for, is if this happens to a young person befo

In this episode, Helen talks with Lizzie, a beauty content creator and disability advocate, and Bex, a CBT therapist, about Lizzie’s journey navigating living with long term health conditions, trauma and the transformative impact of Cognitive Behavioural Therapy (CBT). Lizzie shares her experiences living with Crohn's disease, POTS (Postural Orthostatic Tachycardia Syndrome), and hypermobility spectrum disorder, alongside the emotional challenges of managing these conditions. She discusses her initial scepticism about therapy and how CBT helped her address anxiety, PTSD, and prioritising her own well-being. Bex offers insights into the therapeutic process, addressing common misconceptions about CBT, and highlights the importance of building trust and tailoring therapy to individual needs. Together, they discuss the interaction between physical and mental health and strategies for balancing driven lifestyles with well-being. Useful links: Explore Lizzie’s content on Instagram and TikTok (@slaywithsparkle). Listen to our sister podcasts: Let’s Talk About CBT - Practice Matters and Let’s Talk About CBT - Research Matters: https://babcp.com/Podcasts Find us on Instagram: https://www.instagram.com/babcppodcasts/ Learn more about CBT www.babcp.com Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This episode was edited by Steph Curnow Transcript: Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't.  I'm Helen Macdonald, your host. I'm the Senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies   What we've got for you today is a conversation with Lizzie and Bex. Lizzie's going to talk about her experiences of having CBT and living with a number of conditions that she'll tell us more about in the episode. We're going to talk to Bex, who is a CBT therapist, and she's going to talk with us about working with Lizzie as well. Welcome to you both. Lizzie, would you like to introduce yourself? Lizzie: Hello! Thank you so much for having me. So as Helen's just said, my name is Lizzie. I am also a beauty content creator known as @slaywithsparkle on Instagram and TikTok and a little bit of YouTube and I'm also a speaker that talks about disability awareness. And I try and raise awareness about the health conditions I've got and general sort of disability awareness and activism about that. Helen: Thank you Lizzie, and welcome. Thank you for coming to talk to us today. And Bex, would you like to tell our listeners about you? Bex: Hi. Yes, I'm Bex. I'm a CBT therapist and worked with Lizzie a little time ago, when I worked in a physical health service for IAPT at the time. And I currently work more with trauma in Sheffield both in the NHS and privately. Helen Thank you, Bex. And maybe I should just say, when you said IAPT, we're now talking about NHS Talking Therapies. Bex: That's right. Yes. Thank you for providing the update. Helen: So Lizzie, can I ask you a bit about what was happening for you? What was going on that meant you ended up having CBT? Lizzie: So for me, I really had quite a negative opinion about any sort of talking therapy and had very much been brought up with the idea that if you have some sort of mental health problem, you should be able to solve it yourself. And if you just think positively and carry on, then everything should be fine. Because of my health conditions, so I will just mention just briefly so people are aware what my health conditions are just for context. So I have, Crohn's disease, which I was diagnosed with when I was 21 and then later about 9- 10 years later, I was diagnosed with hypermobile spectrum disorder and also POTS, which is a condition that affects my blood pressure and heart rate. And when I had a first flare of Crohn's disease. I'd obviously had it a long time without realising, but when I first flared with Crohn's disease, I really struggled with the concept of having a physical health condition that I couldn't push through. So with my Crohn's, I ended up ignoring a lot of the doctor's advice because I had this idea that I should be able to cure myself. I really pushed myself to look at alternative therapies. And then, because of that, I ended up ignoring what the doctor said and becoming a lot more ill. Unfortunately, because of a combination of the Crohn's having been misdiagnosed for a long time as IBS, and then because of all of those sorts of ideas about that I should be able to cure myself, my Crohn's did get so bad that I ended up having to go to hospital and have emergency surgery on my bowel. Years later, so about two or three years later, I started having real panic attacks, which I'd never had before. I was anxious all the time and I couldn't sleep. I would sometimes wake up in the middle of the night at like 4am and get the urge to clean the entire house and was sometimes just up in the middle of the night pacing up and down. And my partner at the time said to me, you know, this is not normal. Something's going on. You really need to think about getting some help for this. And I was devastated at that concept because I obviously had this idea that I should be able to fix myself. And so that was the sort of wakeup call that I had to go and get some help and I applied to IAPT at the time and had my first round of CBT. Since then I've had three rounds of CBT and a course of EMDR as well but yeah, that was the first thing that sort of led me to CBT. Helen: Thank you, Lizzie. And it just strikes me what a difficult combination of things you experienced that not only were you having a number of quite complicated and long-lasting physical symptoms, also the experiences you'd had when you were younger meant that it was really difficult to seek help for the panic attacks and the anxiety and so on. Can I ask you just to say, in case anybody's not familiar with the terms, can you just say a little bit about what the symptoms of Crohn's disease are? Lizzie: Yes, absolutely. So Crohn's disease is different for everybody. For me, I really struggled with pain and one of the biggest symptoms that I had was pain. I also struggle with diarrhoea. It's not the most glamorous disease. It's quite embarrassing sometimes. Some people have a lot of nausea and vomiting. For me, that's not been as much of a problem. To me, the biggest problem has been pain. And it got so bad that when I was actually in my final year of university, I'd been told by the doctors repeatedly that it was IBS, and it was just stress related IBS and I just needed to make sure I watch what I eat, tried to up my fibre, which made me a lot more ill. And eventually it got to the point where I literally couldn't even drink water because my oesophagus was closing up. I was in absolute agony and I finally went back to the doctor and I was like, really, honestly, there's something seriously wrong here and then they finally sent me for the right tests and they found the Crohn's disease. The other big symptom with Crohn's disease as well is fatigue. So, most people actually say that fatigue is the most debilitating symptom of Crohn's disease. And for me, I mean, at the moment I am in a flare and I am sleeping 14 hours. And if I don't get that 14 hours, I cannot function and I need a full day in bed to recover. Helen: And again, you've said about some of the symptoms being a little bit similar to IBS or Irritable Bowel Syndrome but having a really far reaching impact on every area of your life, really. You also mentioned that you had POTS, which can affect your blood pressure. And if I have this right, it's Postural Orthostatic Tachycardia Syndrome? Lizzie: Yeah, so it affects your, for me, it affects my blood pressure. Not everybody has problems with their blood pressure all the time. But what happens is your heart isn't getting the right signals. And so you end up having a really high heart rate when you stood up and then that can lead to you passing out. It also leads to symptoms again, like nausea, fatigue and for me, it just feels horrible. Like, it's just that feeling of like sometimes the world's sort of closing in on you and when you're about to go you just feel really sick, really like something's pulling you to the floor. It's a very frustrating condition. I think out of all of them, Crohn's is the most dangerous and that one is the one that when that's flaring, I'm always a little bit nervous because mine is quite severe, but POTS is definitely the one that is the most infuriating. I've had to lie down in the middle of shops. I once had to lie on the floor in the middle of Poundland because I was passing out and honestly, it's just mortifying. It's really embarrassing. Helen: And I'm noticing there as well, Lizzie, that you've just said that the Crohn's disease because of the symptoms of diarrhoea and you know that can be embarrassing. We all know that the impact of eating a lot of fibre, which you were advised to do can be, can lead to embarrassing symptoms and then the POTS as well, that having to lie down somewhere public, more embarrassment. And in addition to that, you also said that you have hypermobility syndrome. And again, can you just say a little bit about what that's like? Lizzie: Yes, so for me, I have a late diagnosis of hypermobile spectrum disorder. There are a couple of things that are related, so similar, sorry. So there's hypermobile EDS and then there's also hypermobile spectrum disorder and they're very similar conditions. But the one that I have is hypermobile spectrum disorder and with that, it just basically means that my joints are too floppy. They extend past the natural point where they should extend because my collagen is built in a way that means it can stretch further than it should. So it was okay when

In this episode of Let’s Talk About CBT, Helen Macdonald speaks with Pete Moore, author and creator of The Pain Toolkit, about his journey of living with long-term pain. Pete shares his experiences of how he was able to move from being overwhelmed by pain to learning CBT techniques and strategies which helped him learn to manage it effectively, regain control, and even help others do the same. Useful links: The Pain Toolkit website Live well with pain website Listen to our sister podcasts: Let’s Talk About CBT - Practice Matters and Let’s Talk About CBT - Research Matters: https://babcp.com/Podcasts Find us on Instagram: https://www.instagram.com/babcppodcasts/ Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This episode was edited by Steph Curnow   Transcript: Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't.  I'm Helen Macdonald, your host. I'm the Senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies   Today, I'm speaking with Pete Moore, who'll be sharing with us his journey living with long term pain.  Many years ago, Pete took part in an inpatient pain management program, which among other things uses cognitive and behavioural techniques to learn how to manage long term symptoms of pain.  Pete will tell us about his journey and where he is today in not only managing his own pain and staying active, but also how he helps other people to learn key ways of living successfully with long term pain.  Pete, would you like to introduce yourself to our listeners? Pete: Yes, well, hi everyone. My name's Pete Moore and I'm the author and originator of the Pain Toolkit. I just want to say, Helen, thanks very much for inviting me along to do this podcast and I'm really looking forward to having a chat with you. Helen: That's great. Thank you very much, Pete. I think a good place to start would be if I ask you just to tell me a bit about how you ended up living with long term pain. Pete: Yeah, it's, such a familiar story actually that of mine. Back then in the early nineties, I had back pain and such and I used to sort of manage it by taking over the counter medication, et cetera, or just having a rest. But I didn't really do a lot to help myself. I didn't really know what to do with it. I just, you know, it's like most people just get on with life. But I think it was about 92, back then I was a painter and decorator, and I was painting a house over in Windsor Castle. Anyway, I went home that night and the next day I couldn't get out of bed. I found out later on that I'd prolapsed some discs in my back, I think, two in the lower, and one in the middle. And I was pretty scared, really frightened, et cetera. And I found it difficult even going to the GP, really. And anyway, long story short, I was given medication and anti inflammatories but little was I to know that back then there was, you know, managing back pain or managing pain itself was like being put in something called the medical model. And I wasn't really given any guidance around what I could do for myself. It was just, “take these pills. If they haven't worked, come back and see me”. So I wasn't quite on Christmas card terms with the GP, but, you know, I was around there every month or so. Anyway, I had to stop working et cetera. And for me, movement was more pain. So I stopped moving. I was sent to the physiotherapist, but back then I don't think that they was quite well up to speed with managing pain or back pain and I was given exercises to do and which say do 10 of these, 10 of these, 15 of those and, and as you know yourself, when you've got subacute pain, as I did, then, I've got up to five or six repetitions and the pain went up so much I thought this can't be right. So, to me, I learned that, back then the exercise equalled more pain. So I just stopped moving. Helen: So I'm hearing you got lots of back pain. You did what most people would do, which is go and see your GP and you got prescribed medicines. And you said, medical models. So it's very much, you go and see somebody and they're going to prescribe some treatment and you expect to get better. But what you're telling me is that the medicines, the physiotherapy actually ended up probably not helping very much. And actually you were still struggling with the pain. And you also said that you were really scared as well. Pete: I guess I couldn't see any future for myself really and I was getting depressed and I just, I had no plan, you know, that was it and at the time I was only I think in my mid-forties, something like that back then. And I thought what's my future? I couldn't see any future for myself, and I went through a pretty, pretty sticky time really, you know. People that used to call and say how you doing, or they would pop around, but it was the same old story and then even people stopped ringing me, stopped calling me because all I could talk about was my back pain really. And they probably got their own problems to deal with, you know? And I did look around for seeing people privately, you know, the osteopaths and chiropractors and all them sort of guys and, and all in all I spent, I did actually spend all my savings really and, I was a doctor shopper, I was a therapy shopper and looking for something to fix me, and little was I to know that I had to learn how to fix myself. Helen: So I'm hearing it was having a huge impact on every area of your life. It changed, you know, sort of whether you could go to work. It was changing whether you could see your friends. It was changing how you felt about yourself and your mood went down. You felt angry, anxious, all of those things. So tell me how you started to change how you approach trying to manage this, and moved away from, what did you say? Being a therapy shopper? Pete: Yeah, therapy shopper, doctor shopper, serial shopper, serial health care. I was just looking for someone to fix me because as a child, you know, you don't feel well. So you go to the doctors, the doctor gives you something or do something. And then after 10 days or so you feel better, and you get on with your life. But, when it comes to long term, this back pain, it wasn't. I had a couple of turning points, really. One was, I thought, well, I'm not getting anywhere with the healthcare professionals. So, I always remember a little saying I learned years ago that, if you want to learn something to teach it, and I thought, I need to be around people like me, you know? So, I started up a back pain support group and I was quite surprised. I was contacted a local newspaper and said I'm starting this up, can you publicise it for me? And, I was quite surprised, the hall I booked, it was only, I think it's supposed to hold about 20 people, but I think it was over 50 people showed up, like, you know. They was all like me, you know, struggling, looking for answers and that's the thing we wasn't, none of us were getting answers. Anyway, someone told me about a woman in Norwich or Norfolk who'd been on a pain management program in London called Input and it really worked wonders with her. And so I contacted them asking if someone can come along to speak to the group about what they did, et cetera. Well that was, that was the turning point and a really nice lady called Amanda Williams. She was a clinical, she is a clinical psychologist. And she'd come along and spoke to the group about, you know, learning how to pace the activities, about graded activities, moving will actually help your pain, et cetera. Really positive, information. I thought this is, this is right up my street. This is for me. And so I applied to go on the course and sadly it was the NHS so I had to wait till, 96, but in between that time, I was really getting depressed as well. And, on the, I always remember the date as it’s my birthday, 31st December 94. I got so down with my pain, I had some friends wanted to come and take me out for the night, being New Year's Eve and my birthday and stuff like that. And that day I had my full quota of medication. I said, I just can't go out like, you have to go on your own. And that night I did actually consider ending my life really, because I just couldn't see any future for myself, you know. I think the only thing that kept me going really was knowing that I was on a waiting list to go to the Input program. And the program gave me the, not only the tools and the skills, but it gave me the confidence to manage my pain myself. Helen: So, what you were saying there, Pete, about reaching a point where really you almost lost hope. Even though you'd done everything you could and you'd started a support group even, and found other people with similar experiences, you were trying everything you could, and then you did find something that you've described as a turning point for you, but you still had to wait a long time for that. I mean, I'm very pleased that you're still with us and I'm particularly pleased that you've got this opportunity to tell our listeners about, you know, how you did reach that turning point and how it helped you. So please do tell us what happened when you went to the Input pain management program. Pete: Well, it was an inpatient program. So, it was spread over two weeks I think the very, the first day, it was the best day for me because, Charles Pyler, who was the medical director at a time, he went around all the people in the group. There was 18 of us there, I think. And, and we were split into two groups of nine and, but he went around to everybody in the group asking them how long they'd lived with pain. And I think for memory, it was nearly 400 years. You know, of the 18 people. But he said, he said something really profound and it still sticks with me. He said,

In this episode of Let’s Talk About CBT, host Helen Macdonald speaks with Sarah, Sally, and Leanne about Sarah’s experience of having Cognitive Behavioural Therapy (CBT) after giving birth. They explore how CBT helped Sarah regain control during a challenging postnatal period, addressing struggles such as insomnia, anxiety, and adjusting to new motherhood. Sarah shares her journey of balancing therapy with the therapeutic benefits of movement and time spent in nature. CBT therapists Sally and Leanne discuss the powerful combination of therapy, physical activity, and connecting with nature for improving mental health.  Useful links: NHS Choices- Insomnia-https://www.nhs.uk/conditions/insomnia/  NHS Guidance on feeling depressed after childbirth: https://www.nhs.uk/conditions/baby/support-and-services/feeling-depressed-after-childbirth/ MIND information on how nature can help mental health: https://www.mind.org.uk/information-support/tips-for-everyday-living/nature-and-mental-health/how-nature-benefits-mental-health/ For more on CBT the BABCP website is www.babcp.com Accredited therapists can be found at www.cbtregisteruk.com Listen to more episodes from Let’s Talk About CBT here. Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This episode was produced and edited by Steph Curnow   Transcript: Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't. I'm Helen MacDonald, your host. I'm the senior clinical advisor for the British Association for Behavioural and Cognitive Psychotherapies Today I'm very pleased to have Sarah, Sally and Leanne here to talk with me about having CBT, in Sarah's case, when you've recently had a baby and also the value of getting more active and getting outside into nature and how that can help when you're also having CBT. Sarah, would you like to introduce yourself, please? Sarah: Hi, I'm Sarah. I'm, 37 from Sheffield and like I said, just recently had a baby, and she's absolutely wonderful. She is a happy, loud little bundle of joy. I ended up having CBT though, because the experience of having the baby wasn't what I thought it was going to be, I think is the reason. And I, just went a little bit mad, so I got some help. Yeah, I'm normally a very happy, positive, active person. Lots of friends, very sociable, always like to be doing things, always like to be in control and have a plan. I like to know what I'm doing and what everyone else is doing. And all that changed a little bit and I didn't really know what to do about it. So yeah, got some therapy. Helen: Thank you Sarah. So, we'll talk with you a bit more about what that was like. And first, Sally, would you like to just briefly say who you are? Sally: Yeah, so I'm, my name's Sally. I am a Cognitive Behavioural Therapist, working both in the NHS and in, in private practice at the moment. Helen: Thank you. And Leanne, Leanne: Hi, I'm Leanne. and I'm a cognitive behavioural therapist as well. And I also work in the NHS and in private practice with Sally. Helen: Thank you all very much. What we're going to do is ask Sarah to tell us a bit more about, when you use the term mad, perhaps I could ask you to say a little bit more about what was happening for you that made you look for some therapy. Sarah: Wel the short answer to that is I developed insomnia about 12 weeks postnatally, didn't sleep for five days. Baby was sleeping better than most, you know, so it was equally frustrating because there was no real reason I didn't think that I should be awake. And sleep obviously is very important when you've had a baby. As I said, I like to be in control, like to prepare, like to know what's going on. So I did hypnobirthing, I prepared, I planned, I packed the biggest suitcase for this birth of this baby that I was really excited for and I thought I'd prepared mentally for every eventuality- what kind of birth, what would happen afterwards, but all very physical because they're the sorts of things that I could understand and imagine. And basically I ended up having an emergency C section, which in the moment I was fine with and I didn't think I was bothered by it, but the level of pain afterwards, that then again affected my level of control over looking after the baby. And the level of debilitation it created that I wasn't expecting- this is the key thing, I wasn't expecting it. That meant that I wasn't able to be me, really. I wasn't able to not least look after a baby, but get myself dressed, get myself showered, walk to the shop, drive a car, play netball, walk my dog. And I wasn't able to do any of that. I didn't appreciate that I was struggling with that, with accepting that. And because it went on for so long, and of course with this comes the baby blues that everyone talks about, but that's meant to only last apparently a couple of weeks. I, you know, you kind of just think, oh, well, I feel all this. I feel pain. I feel sad. I can't stop crying. But all that's meant to happen, all that's normal and it's sort of became the norm. So I was like, well, this is normal. This is how I'm going to feel forever. At this point I didn't have insomnia. I just could not stop crying. And I mean, like I couldn't, I didn't talk to anyone for two days at one point, because I knew if I opened my mouth to say anything, I would start crying. Like literally anything, I would just start crying. What the clincher for me was when I spoke to a doctor, I thought they were going to say get out and about, do some therapy, which at the time, I'm going to be honest, I thought, I can't sleep. I need a fix now. What I now know is I was doing a lot of behaviours that over time culminated in my body going, you're not listening to me, you're not well. Right I need to do something physical so that you wake up and do something about it. And that was the insomnia. So, I went to the doctor fully expecting them to say, do some mindfulness, do this, do that. And at that point I was just, you need to fix this now. I need to sleep. I need drugs. And yes, that's what they gave me, but they did say you need to do CBT- but what they did say what the first thing the doctor said was, you need antidepressants. Now, as a nurse working in GP surgery for them to jump all the self-help stuff and go take these tablets was like, Oh, right. I'm not okay. and it gave me that like allowance to say, I need to take tablets. But I already had said to myself, but I want to do not just mindfulness and helpfulness for myself. I want to do structured CBT because that way it is something I'm doing to give me back my control and I've got a plan. And because I already knew CBT was wonderful. Yeah, I didn't really understand what it was, how it worked, the structure of it. And I get that there's different types for different problems. but I knew that's what I wanted to do, once I had tablets to help me sleep and knew the antidepressants were going to work eventually, which did take a while. I was at least doing something myself that would help me forever. And I just thought, what have I got to lose? I need to do something. And until I started CBT, basically, I just felt like I was running around in circles in the dark. And the CBT gave me control and focus and, right, this is what we're doing going that way. Because until I started CBT, you know, I was Googling everything. Right, I'll try this. Right, I'll try that. And because it didn't work within 24 hours, I'd then try something else and try something else. Now it was making it worse, obviously. So, to have the CBT and have my therapist say, do this one thing for a whole week. I was like, all right, okay. That's quite a long time, but there's obviously a reason. Helen: Sarah, thank you for telling us all about that. What I'm hearing is that you had a combination of massive changes in your life, which will happen when you've had a baby, all sorts of things about the kind of person that you are, kind of added to all your really careful and sensible preparations for having this baby and then really being taken by surprise almost by all the other impact that it had on you and taking a while really to look for help and to look for a very specific kind of help then. And I'm just wondering in the context of all that, what it was like when you first went to see Sally for therapy? Sarah: Well, like I say, it was brilliant. It was like having someone turn the lights on and point me in the right direction and say, right, head that way and don't turn off and don't go any other direction. Just keep going that way. And it will eventually result in this. It's like if you go to the gym and you're running on the treadmill and you're thinking, well, is this going to achieve what I want it to achieve? And until it does start to, you've not got that positive reinforcement, to keep going. So quite often you stop, and that's what I was doing. I was trying one thing, trying the next, because I was so desperate for it to just go away, this insomnia. Which obviously at the time was one thing, but I understand now there was a whole other problem going on but the insomnia was what I needed fixing. I found CBT for insomnia, but Sally said, do you want to do a more generic anxiety control type approach and I said, yeah, because that's what if before this, you know, five, six years ago, little things would happen. And I think, Oh, I should do CBT for that. So it's clearly the same thing. So yeah. Why don't we just tackle it as a whole? And that was definitely the best thing to do. Helen: It sounds as if one of the things that was really helpful was looking at the bigger picture, as well as focusing on taking enough time to make changes. Okay. Can you tell us about the specific things that you did in therapy that you saw as particularl

We’re back! Let’s Talk about CBT has been on hiatus for a little while but now it is back with a brand-new host Helen Macdonald, the Senior Clinical Advisor for the BABCP. Each episode Helen will be talking to experts in the different fields of CBT and also to those who have experienced CBT, what it was like for them and how it helped. This episode Helen is talking to one of the BABCP’s Experts by Experience, Paul Edwards. Paul experienced PTSD after working for many years in the police. He talks to Helen about the first time he went for CBT and what you can expect when you first see a CBT therapist. The conversation covers various topics, including anxiety, depression, phobias, living with a long-term health condition, and the role of measures and outcomes in therapy. In this conversation, Helen MacDonald and Paul discuss the importance of seeking help for mental health struggles and the role of CBT in managing anxiety and other conditions. They also talk about the importance of finding an accredited and registered therapy and how you can find one. If you liked this episode and want to hear more, please do subscribe wherever you get your podcasts. You can follow us at @BABCPpodcasts on X or email us at podcasts@babcp.com. Useful links: For more on CBT the BABCP website is www.babcp.com Accredited therapists can be found at www.cbtregisteruk.com Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF   Transcript: Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't. I'm Helen Macdonald, your host. I'm the senior clinical advisor for the British Association for Behavioural and Cognitive Psychotherapies. I'm really delighted today to be joined by Paul Edwards, who is going to talk to us about his experience of CBT. And Paul, I would like to start by asking you to introduce yourself and tell us a bit about you. Paul: Helen, thank you. I guess the first thing it probably is important to tell the listeners is how we met and why I'm talking to you now. So, we originally met about four years ago when you were at the other side of a desk at a university doing an assessment on accreditation of a CBT course, and I was sitting there as somebody who uses his own lived experience, to talk to the students, about what it's like from this side of the fence or this side of the desk or this side of the couch, I suppose, And then from that I was asked if I'd like to apply for a role that was being advertised by the BABCP, as advising as a lived experience person. And I guess my background is, is a little bit that I actually was diagnosed with PTSD back in 2009 now, as a result of work that I undertook as a police officer and unfortunately, still suffered until 2016 when I had to retire and had to reach out. to another, another psychologist because I'd already had dealings with psychologists, but, they were no longer available to me. And I actually found what was called at the time, the IAPT service, which was the Improving Access to Psychological Therapies. And after about 18 months treatment, I said, can I give something back and can I volunteer? And my life just changed. So, we met. Yeah, four years ago, probably now. Helen: thank you so much, Paul. And we're really grateful to you for sharing those experiences. And you said about having PTSD, Post Traumatic Stress Disorder, and how it ultimately led to you having to retire. And then you found someone who could help. Would you like to just tell us a bit about what someone might not know about being on the receiving end of CBT? Paul: I feel that actual CBT is like a physiotherapy for the brain. And it's about if you go to the doctors and they diagnose you with a calf strain, they'll send you to the physio and they'll give you a series of exercises to do in between your sessions with your physio to hopefully make your calf better. And CBT is very much, for me, like that, in as much that you have your sessions with your therapist, but it's your hard work in between those sessions to utilize the tools and exercises that you've been given, to make you better. And then when you go back to your next session, you discuss that and you see, over time that you're honing those tools to actually sometimes realising that you're not using those tools at all, but you are, you're using them on a daily basis, but they become so ingrained in changing the way you think positively and also taking out the negativity about how you can improve. And, and yeah, it works sometimes, and it doesn't work sometimes and it's bloody hard work and it is shattering, but it works for me. Helen: Thank you, Paul. And I think it's really important when you say it's hard work, the way you described it there sounds like the therapist was like the coach telling you how to or working with you to. look at how you were thinking and what you were doing and agreeing things that you could change and practice that were going to lead to a better quality of life. At the same time though, you're thinking about things that are really difficult. Paul: Yeah. Helen: And when you say it was shattering and it was really difficult, was it worth it? Paul: Oh God. Yeah, absolutely. I remember way back in about 2018, it would be, that there was, there was a fantastic person who helped me when I was coming up for retirement. And we talked about what I was going to do when I, when I left the police and I was, you know, I said, you know, well, I don't know, but maybe I've always fancied being a TV extra and, That was it. And I saw her about 18 months later, and she said, God, Paul, you look so much better. You're not grey anymore. You know, what have you done about this? And it was like, she said I was a different person. Do I still struggle? Yes. Have I got a different outlook on life? Yes. Do I still have to take care of myself? Yes. But, I've got a great life now. I'm living the dream is my, is my phrase. It is such a better place to be where I am now. Helen: I'm really pleased to hear that, Paul. So, the hard work that you put into changing things for the better has really paid off and that doesn't mean that everything's perfect or that you're just doing positive thinking in the face of difficulty, you've got a different approach to handling those difficulties and you've got a better quality of life. Paul: Yeah, absolutely. And don't get me wrong, I had some great psychologists before 2016, but I concentrated on other things and we dealt with other traumas and dealt with it in other ways and using other, other ways of working. I became subjected to probably re traumatising myself because of the horrendous things I'd seen and heard. So, it was about just changing my thought processes and, and my psychologist said, Well, you know, we don't want to re traumatise you, let's look at something different. Let's look at a different part and see if we can change that. And, and that was, very difficult, but it meant that I had to look into myself again and be honest with myself and start thinking about my honesty and what I was going to tell my psychologist because I wanted to protect that psychologist because I didn't want them to hear and talk about the things that I'd had to witness because I didn't think it was fair, but I then understood that I needed to and that my psychologist would be taken care of. Which was, which was lovely. So, I became able to be honest with myself, which therefore I can be honest with my therapist. Helen: Thank you, Paul. And what I'm hearing there is that one of your instincts, if you like, in that situation was to protect the therapist from hearing difficult stuff. And actually the therapist themselves have their own opportunity to talk about what's difficult for them. So, the person who's coming for therapy can speak freely, although I'm saying that it's quite difficult to do. And certainly Post Traumatic Stress Disorder isn't the only thing that people go for CBT about, there are a number of different anxiety difficulties, depression, and also a wider range of things, including how to live well with a long term health condition and your experience could perhaps really help in terms of somebody going for their first session, not knowing what to expect. As a CBT therapist, I have never had somebody lie down on a couch. So, tell us a little bit about what you think people should know if they are thinking of going for CBT or if they think that somebody they care about might benefit from CBT. What's it like going for that first appointment? Paul: Bloody difficult. It's very difficult because by the very nature of the illnesses that we have that we want to go and speak to a psychologist, often we're either losing confidence or we're, we're anxious about going. So I have a phrase now and it's called smiley eyes and it, and it was developed because the very first time that I walked up to the, the place that I had my CBT in 2016, the receptionist opened the door and had these most amazing engaging smiley eyes and it, it drew me in. And I thought, wow. And then when I walked through the door and saw the psychologist again, it was like having a chat. It was, I feel that for me, I know now, I know now. And I've spoken to a number of psychologists who say it's not just having a chat. It is to me. And that is the gift of a very good psychologist, that they are giving you all these wonderful things. But it's got to be a collaboration. It's got to be like having a chat. We don't want to be lectured, often. I didn't want to have homework because I hated homework at school. So, it was a matter of going in and, and talking with my psychologist about how it worked for me as an individual, and that was the one thing that with the three psychologists that I saw, they all treated me as an individua

The British Association for Behavioural and Cognitive Psychotherapies, the lead organisation for cognitive behavioural therapy (CBT) in the UK and Ireland, is 50 years old this year. In this episode Dr Lucy Maddox explores how CBT has changed over the last 50 years. Lucy speaks to founding members Isaac Marks, Howard Lomas and Ivy Blackburn, previous President David Clark, outgoing President Andrew Beck and incoming President Saiqa Naz about changes through the years and possible future directions for CBT. Podcast episode produced by Dr Lucy Maddox for BABCP   Transcript  Dr Lucy Maddox:        Hello, my name is Dr Lucy Maddox and this is Let’s Talk about CBT, the podcast brought to you by the British Association for Behavioural and Cognitive Psychotherapies or BABCP. This episode is a bit unusual, it’s the 50th anniversary of the British Association for Behavioural and Cognitive Psychotherapies this year. And I thought this would be a nice opportunity to explore some of the history of cognitive behavioural therapy, especially the last 50 years.                                     Some of the roots of CBT can actually be traced way back. Epictetus, an ancient Greek Stoic philosopher wrote that man is disturbed not by things, but by the views he takes of them. This is pretty close to one of the main ideas of cognitive behavioural therapy, that it’s the meaning that we give to events, rather than the events themselves which is important. But actually, cognitive behavioural therapy started off without the C. To find out more, I made a few phone calls. Isaac Marks:               Hello, Isaac Marks here. Dr Lucy Maddox:        Isaac Marks was one of the founding members of BABCP and a key figure in the development of behavioural therapy in Britain. I asked him if he could remember what CBT was like 50 years ago. Isaac Marks:               Originally it was just BT and a few years later the cognitive was added. At the time, the main psychotherapy was dynamic psychotherapy, sort of Freudian and Jungian. But just a handful of us in Groote Schuur Hospital psychiatric department, that’s in Cape Town, developed an interest in brief psychotherapy. And I was advised if I was really interested in it and I was thinking of taking it up as a sub profession, that I should come to the Maudsley in London. Dr Lucy Maddox:        Isaac and his wife moved to London from South Africa and Isaac studied psychiatry at the Maudsley Hospital in Camberwell. What was it about CBT that had interested you so much? Isaac Marks:               Because it was a brief psychotherapy, much briefer than the analytic psychodynamic psychotherapy. We were short of therapists and there wasn’t that much money to pay for extended therapy, just a few sessions. Six or eight sessions something like that could achieve all what one needed to. They had quite a lot of article studies. Dr Lucy Maddox:        And I guess that’s still true today, that those are some of the real standout features of it, aren’t they? That it is a briefer intervention than some other longer-term therapies and that it’s got a really high quality evidence base. Isaac Marks:               I think that’s probably true, yes. Howard Lomas:          There was a group that met at the Middlesex Hospital every month. And that was set up by the likes of Vic Meyer, Isaac Marks, Derek Jayhugh. Dr Lucy Maddox:        That’s Howard Lomas, another founding member of BABCP remembering how the organisation got set up 50 years ago from lots of different interest groups coming together. Howard Lomas:          These various groups that got together and said, “Why don’t we have a national organisation?” So that was formed back in 1972. Dr Lucy Maddox:        Howard’s professional background was different to Isaac’s psychiatry training, but he found behaviour therapy just as useful. Howard Lomas:          I’d originally trained well in social work, but I was a childcare officer with Lancashire County Council. Dr Lucy Maddox:        And how were you using CBT or behaviour therapy in your practice? Howard Lomas:          Well, as a general approach to everything, thinking of everything in terms of learning theory. How do we learn to do what we do and maintain it with children? Things like non-attendance at school and other problems, behavioural problems with children and then later problems with adults. But I suppose when I moved to Bury in 1973, I was very much involved in resettlement of people with learning disability from the huge hospitals that we had up here in the north. We’d three hospitals within sight of each other, each with more than 2,000 patients. Dr Lucy Maddox:        Wow. Howard Lomas:          They’re all closed now long since, but yeah, the start of that whole closure programme of trying to get people out into the community. You learn normal behaviour by being in a normal environment, which people in institutions clearly aren’t and weren’t. So it’s trying to create that ordinary valued environment for people. And simply doing that would teach them ordinary behaviours, valued behaviours. It was evidence-based, it was also very effective.                                     It looked at behaviour for what it was rather than what might be inferred. I suppose I saw psychology as more of a science (laughs). I’m still in touch with some of the people that are resettled from way back. People who had been completely written off as there’s no way they could ever live in their own home are now thriving, absolutely. Dr Lucy Maddox:        Now, Howard’s and Isaac’s memories of CBT 50 years ago highlight that an important route of CBT is behavioural learning theory. This includes ideas of classical conditioning, where in a famous experiment which you’ve probably heard of, Pavlov, taught his dogs to salivate in response to the bell that he rang for their dinner rather than the dinner itself. And operant conditioning, where animals and humans learn to do more or less of a behaviour based on the consequences which happen in response to that behaviour. Howard Lomas:          Half a dozen of us sitting with Skinner, chatting for three hours. So that was quite influential (laughs). Dr Lucy Maddox:        Skinner was another of the early behaviourists, and Howard has memories of being lectured by Skinner at Keele University. The formation of BABCP was important for therapists at the time because behavioural therapy back then was quite a niche field. Howard Lomas:          It was publicly very unpopular indeed. Behaviour therapy was known very much as behaviour modification, which has got an involuntary feel about it, even the name that it was being thrust upon people. And even at that time, aversion therapy was being used for trying to change homosexuality in people, aversion therapy then. Which is quite topical now with the whole debate on conversion therapy. Dr Lucy Maddox:        Absolutely. We’ve signed up to the memorandum of understanding against conversion therapy. Howard Lomas:          The aversive is horrible. And there was a big scandal at I think it was Napsbury Hospital about their clinical programme, which was allegedly based on behaviour modification, more aversive techniques. So there was a big scandal and that led to a major government inquiry, and they asked for anyone to offer, submit evidence on the whole question of behaviour modification, which BABP did. And that then formed the basis of our guidelines for good practice. Dr Lucy Maddox:        Just a note, if you’re listening to this as a cognitive behavioural therapist, please do read the memorandum of understanding against conversion therapy online at www.babcp.com.  It makes it clear why we’re opposed to conversion therapy in any form. I’ll put the link in the show notes, too. Like Isaac, Howard remembered that shift from behaviour therapy to cognitive behavioural therapy. Howard Lomas:          Well, I was always against adding the C. I was always taught that behaviour has three components to it: motor behaviour, cognitive behaviour, and affective behaviour. So behaviour included cognitive, so why did you have to have it as a separate thing? Although in those early days I used to get told off if I spoke about thoughts and feelings. Dr Lucy Maddox:        Did you? Howard Lomas:          Yeah, because you can’t see them. You can’t measure them. Dr Lucy Maddox:        Yeah, interesting, although there’s still a lot of measurement, isn’t there? But maybe it’s like you say what we think we can measure has maybe changed. Howard Lomas:          That’s right, yeah. Yeah, I think the measurement and the evidence is so important. Ivy Blackburn:             We actually changed the name when we started it was called the British Association for Behaviour Psychotherapy. So at one of the conferences we passed a motion and added the C. Dr Lucy Maddox:        That’s Ivy Blackburn, another founding member of BABCP. Ivy Blackburn:             At that point well, I was a qualified clinical psychologist. I’d just finished my PhD, I trained in Edinburgh. And I was working in a research set up, an MRC unit called the Brain Metabolism Unit. Dr Lucy Maddox:        And so, CBT at that time was quite a new thing? Ivy Blackburn:             Very, very new. I actually had just discovered Beck as it was, while I was going the research for my PhD, which was in depression. And I used to correspond with him and he used to send me his early papers and things like that. Dr Lucy Maddox:        Ivy’s talking there about Aaron Beck, also sometimes known as Tim Beck. Also sometimes called the father of CBT. Ivy Blackburn:             With Aaron Beck I always signed I M Blackburn. And the story he used to tell at conferences was he always thought I M Blackburn was an old Scottish man. (Laughs) So once he came to Edinburgh, he was on a sabbatical, and we were sitting at I think it was a case conference. He was sitting next to my boss, who was somebody called Dr Ashcroft, a

In this bonus episode of Let's Talk About CBT, hear Dr Lucy Maddox interview Dr Tom Ward and Angie about SlowMo: digitally supported face-to-face CBT for paranoia combined with a mobile app for use in daily life. Podcast episode produced by Dr Lucy Maddox for BABCP   Transcript Dr Lucy Maddox:        Hello and welcome to Let’s Talk about CBT, the podcast from the British Association for Behavioural and Cognitive Psychotherapies, BABCP. This podcast is all about CBT, what it is, what it’s not, and how it can be useful. In this episode, I’ll be finding out about an exciting new blended therapy, SlowMo, for people who are experiencing paranoia. This digitally supported therapy has been developed over 10 years with a team of people including designers from the Royal College of Art in London, a team of people who have experienced paranoia. And a team of clinical researchers, including Professor Philippa Garety, Dr Amy Hardy and Dr Tom Ward. The design of this intervention really prioritised the experience of people using the therapy in what’s called a design led approach. To understand more I video called Tom Ward, research clinical psychologist based in Kings College London, and I had a phone call with Angie, who’s experienced using the therapy. Here’s Angie’s story. Angie:                          I mean, I’ve had psychosis for many years. About 20 years ago I was really poorly, I was in and out of hospital. Going back about 20 years ago they kept giving me different diagnoses and I expect everybody else had the same thing. Anyway, then I met a psychiatrist and I was with him for over 20 years until he retired. And he really helped me a lot, I was actually diagnosed with schizophrenia. Part of me was really scared and another part of me was sort of relieved that I knew that I was dealing with. I get voices, sometimes I see or feel things that aren’t really there. But part of my diagnosis is I also get very depressed. And when I get very depressed, that’s when the voices are at their worst because I haven’t got the strength to sort of fight them off, if you like. If I’m having a good day, then I can use the skills I’ve learnt in the past to not listen to the voices and to have a reasonably good day. If I’m having a bad day and it’s a duvet day, then that’s when I really suffer with the voices. Unless you can actually accept that you have this issue, and you actually accept that you need the help, it doesn’t matter what they do to help you, you’re just not going to take it on board. Dr Lucy Maddox:        Angie wanted some help, specifically with paranoid thoughts she was experiencing about people looking at her or laughing at her. She found out about the SlowMo trial and applied to be a part of it. And ended up being one of the very first people to try the therapy. Tom led on the delivery of therapy in the trial. Dr Tom Ward:              I’ve worked and have worked for the last couple of years trying to develop and test digital interventions for people experiencing psychosis. So I’ve been involved in developing interventions that help people who are experiencing distressing voices. And been involved in work in a therapy called avatar therapy and more recently I’ve been working with colleagues to develop an intervention designed to help people who are experiencing fear of harm from others, which we would sometimes refer to as paranoia. Dr Lucy Maddox:        In case listeners wonder what avatar therapy is could you just briefly say what that is? Dr Tom Ward:              So in avatar therapy, digital technology is used with the person to create a representation of the distressing voice that they hear. So we work with the person to create an avatar which has an image which matches the image the person has of their distressing voice. And which comes to sound like the voice that they hear. And we use this avatar direct in dialogue. Very much with the rationale that many people who are experiencing distressing voices have relationships with their voice where they feel disempowered and lacking power and control. And we try to use the work with avatars and the dialogue with avatars to provide an opportunity for the person to reclaim power and control. And so we’re very much working directly with the experience in quite a potentially powerful way for people. Dr Lucy Maddox:        Could you tell me about the current project you’re working on, so SlowMo? Dr Tom Ward:              Yeah, so the first thing to say is that SlowMo stands for slow down for a moment. And so, it’s a therapy which is a targeted therapy for people who are experiencing paranoia. And it’s based in the idea that’s been popularised by Daniel Kahneman and other people that human thinking can be sort of thought about in terms of two different types of thinking. There’s fast thinking where we approach situations and we go with our first impression. We go with our intuition and gut feeling and we don’t take time to think it through. And slow thinking is more around taking a step back from situations and weighing things up and considering different ways of looking at situations. So one of the things to say is that fast thinking is part of human nature, we all do it and in many different times in our lives. But what we know from research into the experiences of people with psychosis is that people who worry about harm from other people, people who have significant paranoia can often be very likely to engage in this fast thinking. And find it difficult to feel safe in situations and to slow down and consider what else might be going on in the situation. So the therapy is designed to help people build an awareness of this fast thinking which is a part of human nature but can be particularly difficult if we’re feeling unsafe. And it’s designed to support people to be able to slow down and feel safer in their lives. And managing situations so they can really engage and enjoy their lives in a way that perhaps in the past has been difficult. Dr Lucy Maddox:        Fast thinking I guess that’s something like you were saying that we all can get into a bit. Dr Tom Ward:              The first message that we try to get across within the therapy is that fast thinking is part of human nature, it’s natural. And there are times when thinking fast is actually very helpful for people, sometimes we need to react to situations, and we need to recognise where we are unsafe and there’s danger. But in the context of when people are feeling unsafe throughout so much of their life, and in situations where perhaps the danger isn’t quite as much as the fear suggests it is, fast thinking can leave people feeling unsafe in situations where it might start to be a barrier to people living their lives. And slow thinking is something that we’re all capable of, but all human beings find it difficult and people experiencing psychosis and worrying can find this difficult as well. But we’re really trying to find ways to support people to do that, to feel safe in their lives. Dr Lucy Maddox:        And how does the therapy work? What does it look like? Dr Tom Ward:              We would describe it as a blended digital therapy. And it’s important to explain what that means. The blending aspect of this is that we try to take the best of face-to-face therapy and the building of a relationship with someone. But we try to improve the therapy through using, through blending digital technology into what we do.                                     So the therapy involves eight face-to-face sessions, but each of these sessions is supported by an easy to use website effectively, an interactive website. So within a session, you’d be talking to the person or the person would be talking with the therapist but also interacting with a touchscreen laptop. And this provides information, it provides interactive ways that the person can build a picture of their own worries about other people or situations.                                     And really visualise what’s happening in a way that in psychological therapy we talk about a formulation. A formulation, an understanding of somebody’s difficulties. But the digital technology in SlowMo is trying to really bring the person into that process of understanding what’s going on and making it very engaging and interactive and visual and memorable for the person.                                     In order to try to support the person to make changes in their daily life, there’s also a mobile app that comes alongside the therapy, which is very much aimed at taking what the person has learnt in the therapy and applying it into their daily life. Dr Lucy Maddox:        Here’s Angie on what she remembers this digitally supported therapy being like. Angie:                          You could choose pretty much where you wanted to do the therapy, you could have it at home, or you could have it in a café or somewhere else where you felt comfortable. So I did it in a café, a local café, with a lady called Alison. And what it consists of the clinician, Alison, she had a laptop. My heart sank originally because I thought oh no, I’m no good on computers. And I explained to her that I wasn’t very good on a computer. And she was so lovely, so patient, she said, “I can do most of it for you.” So that was fine. What the therapy was it did what it says on the tin, really. It taught you to slow your mind down, and to break things up into little pieces, like for instance I used to be terrified of getting on the bus because I thought people were talking about me and laughing at me. Dr Lucy Maddox:        That’s a horrible feeling. Angie:                          Yeah, yeah. And this sort of therapy taught me to break it up. To say myself, “Well, hang on a minute, these people aren’t looking at you. They’re talking to their friends, they’re on their phone.” Just take it easy. And it’s a very simple idea but it works because although you know in your heart of hearts that that i

Children don't come with a manual, and parenting can be hard. What is evidence-based parenting training and how can it help? Dr Lucy Maddox interviews Sue Howson and Jane, about their experiences of delivering and receiving this intervention for parents of primary school aged children.  Show Notes and Transcript Podcast episode produced by Dr Lucy Maddox for BABCP Sue and Jane both recommended this book: The Incredible Years (R): Trouble Shooting Guide for Parents of Children Aged 3-8 Years By Carolyn Webster-Stratton (Author) Sue also recommended this book: Helping the Noncompliant Child Family-Based Treatment for Oppositional Behaviour  Robert J. McMahon, Rex L.Forehand 2nd Edition Paperback (01 Sep 2005)  ISBN 978-1593852412 Websites http://www.incredibleyears.com/ https://theministryofparenting.com/ https://www.nurturingmindsconsultancy.co.uk/ For more on CBT the BABCP website is www.babcp.com Accredited therapists can be found at www.cbtregisteruk.com   Courses The courses where Sue works are available here, and there are similar courses around the country: https://www.reading.ac.uk/charliewaller/cwi-iapt.aspx   Photo by Markus Spiske on Unsplash This episode was edited by Eliza Lomas   Transcript Lucy:   Hello and welcome to Let’s Talk About CBT, the podcast from the British Association for Behavioural and Cognitive Psychotherapies, BABCP. This podcast is all about CBT, what it is, what it’s not and how it can be useful. This episode is the last in the current series so we’ll be having a break for a bit, apart from a cheeky bonus episode, which is planned for a few months’ time so look out for that. Today, I’m finding out about evidence-based parenting training. This is a type of intervention for the parents of primary school aged children. It draws on similar principles to cognitive behavioural therapy about links between thoughts, feelings, behaviours and bodily sensations and ideas from social learning theory. It also draws some ideas from child development such as attachment theory and parenting styles. To understand more about all of this, I met with Sue Howson, parenting practitioner who works in child mental health services and Jane, a parent who has experienced the training herself. Jane:  My name is Jane and I’ve got a little boy called Jack who is seven and he’s in Year 3. Lucy:  And you’ve experienced evidence-based parenting training, is that right? Jane:  Yeah, I have. It’s something called the Incredible Years. And there was a really nice lady called Sue and my school put us in touch to form a group to kind of help me manage Jack a little bit more at home. Lucy:  So, your journey into it was that the school let you know about it? Jane:  Yeah. Basically, I was having a few issues with Jack at home and I think it was kind of impacting on school as well. So, I was working with the special needs coordinator and she, obviously, had me, Jack and my family in mind as someone who might benefit from working a little bit with Sue.  I was a bit nervous at first, you know, like professionals coming in, getting involved. But she was really nice and it was really beneficial. Lucy: Is it okay to ask what sort of difficulties you were having at home, sort of what was going on? Jane:  Yeah, I can tell you now because it’s all changed, it’s much better. Lucy:  Oh good, that’s great to hear. Jane:    I mean, Jack’s a lovely boy. He’s my eldest and he’s really nice and just a bit of a joy – he is now. But I think one of the main things that I was struggling with, with him, was kind of difficulties with falling asleep. In the evenings, he would always want me to fall asleep either next to him or in his bed and that was kind of impacting on our evening, mine and my husband’s quite a lot. And it was taking up a lot of time and I think evenings are quite hard because you’re so tired and you just want to go to bed. So, that was one of the issues. And the no sleep was impacting on all aspects of our family life, really. I would just be really tired all the time and quite short, and end up shouting at Jack when I just wanted him to go to sleep and he wouldn’t. And shouting wasn’t ideal and doesn’t help but I’d just get frustrated, really and I think quite a lot of us were quite unhappy. Lucy: That sounds super hard. Jane: Yeah. I mean, he is seven but he’d kind of throw a massive wobbly if he didn’t get what he wanted, like, I don’t know, like an extra biscuit or chocolate finger or something from the cupboard, he would just kind of lose it. And that was really hard to deal with, particularly when you’re tired. I know you shouldn’t but you always kind of end up giving in a little bit, don’t you, because you just want the easy life. And you know that you shouldn’t but… Sue: It’s really hard when you’re being shouted at or when you’re exhausted like that. Jane: And I’d also feel like the path of least resistance, like sometimes it just easier to give in, even though I knew that I shouldn’t. So, I guess those are the main issues, really, kind of thinking about his behaviour. And there were a few concerns from school in terms of his behaviour. Obviously, he was tired at school and maybe not doing as much as he could be schoolwork-wise. It was kind of impacting everything, really. So, that’s where Sue came in. Sue: My name’s Sue Howson and I am a parenting practitioner and I’ve worked in CAMHS for many years, background in social work. I’ve been working with children and families for years and years and years. But I also have a role of teaching practitioners at the University of Reading. Lucy: And do you teach practitioners about evidence-based parenting training? Sue: Yeah, absolutely. So, I have trainees coming from various different parts of the country to Reading University where we teach two really strong evidence-based parenting interventions where the practitioners become super equipped to go out into the community and offer the support that the parents need. Lucy: Fantastic. And this is all extremely topical because BABCP have recently launched the evidence-based parent training accreditation pathway. Sue: Yes, which means that the parent training pathway is now on par with the CBT pathway, which is hugely exciting for all those people out there that are actually during parent training and offering parenting interventions. It’s a really great way to get those skills and practices recognised. So yes, I’m really excited by that too. Lucy: Could you say a little bit about what evidence-based parent training is? Sue:  It is a practice that is based in social learning theory and really focuses on the attachment relationships and building the relationships between parent and child and building on parental self-confidence and self-efficacy and trying to equip the parent and skill up the parent to notice particular behaviours in a child and them then feeling confident in applying a particular technique or a particular method in the moment which will make a difference to – fingers crossed – to the outcome of that little interaction between parent and child. Lucy: When we’re talking about social learning theory, by that do you mean the way that we all learn from what we see around us? Sue: Yeah. It’s learned from our environment and the things we see around us. Lucy: So, it’s kind of providing parents and carers with a different model of how to do things. Sue: Yes. So, perhaps in their upbringing, they were brought up with one particular style of parenting and parent training offers, perhaps, a selection of different ideas on how they may choose to interact with their child that’s different from the way that they were brought up. Lucy: Which is very interesting, actually, isn’t it? Because, you know, it’s not something that’s taught in school, is it, parenting? So, it’s very much something that people do quite intuitively or in the way that they’ve been brought up or that their friends are doing it. So, there’s a lot of social influence involved, actually, isn’t there? Sue:  A huge amount of social influence. And quite often, in homes, both parents don’t do it the same way. So, just because you do it one way, your partner might do it in a different way and you may never have even discussed that until you reach a point where you’re having challenges with your child. So, you may end up having to think about things and being much more consistent. Especially with children with ADHD and autistic spectrum difficulties, the consistency element is really, really important. Lucy:  I asked Jane what she’d expected from evidence-based parenting training. Jane: Oh, I was a bit nervous and apprehensive to begin with because, you know, it’s bit embarrassing, isn’t it? You’re the one with the naughty kid that doesn’t do what they’re meant to. Sue kind of made me feel super relaxed from the start. She’s really approachable and just like normal, like not too expert, not using all these words that I didn’t understand. And she was quite relaxed so that kind of made me feel quite relaxed and let me feel comfortable to ask questions, even though they might have been silly or they might seem obvious. So, that was really nice in the beginning. I liked how she said things about the group rules, like intense confidentiality and respect and that made me feel like it was okay to share, really. Lucy: That sounds really important. Jane: Yeah. And I think one of the biggest things, obviously, apart from the actual strategies she gave me, was being able to meet other parents in a similar situation who had a child like mine. And we kind of set up a WhatsApp group after, which is really nice. Now Sue’s worked her magic, that kind of keeps us going. Like if you’re having a bad day, you can still speak to someone who knows. Lucy:  I asked Sue to talk us through what evidence-based parenting training involves and she said there are two methods. The first is the group process, which Jane did. This is usually two hours a week minimum for 12 to 14 weeks on the

In this episode Dr Lucy Maddox speaks to Sharon and Dr Anne Garland, about CBT for depression. Hear how Sharon describes it, and how both group and individual therapy helped.  Show Notes and Transcript Podcast episode produced by Dr Lucy Maddox for BABCP Books Overcoming Depression by Paul Gilbert Podcast Episodes CBT for Perfectionism Compassion Focussed Therapy Websites www.babcp.com www.cbtregisteruk.com Image by Kevin Mueller on Unsplash Transcript   Lucy: Hello and welcome to Let’s Talk About CBT, the podcast from the British Association for Behavioural and Cognitive Psychotherapies, BABCP. This podcast is all about CBT, what it is, what it’s not and how it can be useful.   In this episode we’re thinking about CBT for depression. I spoke with Dr Anne Garland who spent 25 years working with people who experience depression and Sharon, who has experienced it herself.   Both Anne and Sharon come from a nursing background. Anne now works at the Oxford Cognitive Therapy Centre as a consultant psychotherapist, but she used to work in Nottingham, which is where Sharon had CBT for depression. Here’s Sharon.   How would you describe what depression is like?   Sharon: When I was going to school, when I was a little girl, an infant, we would have to go over the fields because I lived in the country, and go down. I could hear the bell of the junior school but couldn’t find it because of the fog. I walked round and round, I was five, walked round and round and round in those fields trying to get to the bell where I knew I would be safe and being terrified on my own. And that’s how it feels actually. Darkness, cold, very frightening.   Lucy: I asked Anne how depression gets diagnosed and she described a range of symptoms.   Anne: In its acute phase it’s characterised by what would be considered a range of symptoms. So, tiredness, lethargy, lack of motivation, poor concentration, difficulty remembering. Some of the most debilitating symptoms are often disturbed sleep and absence of any sense of enjoyment or pleasure in life and that can be very distressing to people. People can be really plagued with suicidal thoughts and feelings of hopelessness that life is pointless.   I think one of the most devastating things about depression as an illness is it robs people of their ability to do everyday things. So for example, getting up, getting dressed, getting washed, deciding what you want to wear can all be really impaired by the symptoms of depression. I try and help people to understand that the symptoms are real, they’re not imagined. Often people will tell me that they imagine these things or that they aren’t real and that it’s all in their mind.   Their symptoms are real, they exist in the body and do exert a really detrimental effect on just your ability to do what most of us take for granted on a day-to-day basis.   Lucy: And so it’s a lot more than sadness isn’t it?  Anne: Absolutely. It can be very profound feelings of sadness but often that’s amplified by feelings of extreme guilt, of shame, anger and anxiety is another common feature of depression.   Also, when people are very profoundly depressed they can actually just feel numb and feel nothing and that in itself can be very distressing because things that might normally move you to feel a real sense of connection. Say for example your children or your grandchildren, you may have no feelings whatsoever, and that in itself can be very alarming to people.  Lucy: The way that depression and its treatment are thought about can vary depending on who you speak to. Just like with other sorts of mental health problems. More biological viewpoints prioritise thinking about brain changes that can occur with depression while more social perspectives prioritise thinking about the context that people are part of.   Anne: As CBT tends to take a more pragmatic view of thinking about a connection between events in our environment, our reactions to those in terms of biology, thoughts, feelings and behaviour and how all of those things interact and that’s a very pragmatic way of thinking about things really. And I guess traditionally in CBT there’s the idea of making what is referred to as a psycho biosocial intervention. What that essentially means is that you can use medication plus psychological therapies – particularly CBT in this instance – and interventions that may influence your environment.   If you do those things altogether then you’re more likely to get a better outcome, which is really what our service in Nottingham is predicated on that idea. That if you think about all of those aspects in a practical, pragmatic way, then that may maximise your chances of seeing an improvement in depression.   And I think one of the challenges in depression, if you look at the research literature, is once you’ve had one episode of depression, you have a 25% chance of another. Once you’ve had two, a 50% chance. And once you’ve had three, a 95% chance of another episode. So the concept of recurrence becomes really important.   A lot of the work we do with people who have more persistent treatment resistant depression is really trying to help the person develop strategies for managing the illness on a long term basis. So it’s very much about trying to manage your mood and how you structure your day and your life and activities and that type of thing. I can be a very complex illness to work with.   Lucy: For Sharon, her first experience of depression was 20 years ago when depression suddenly had a huge effect on her and her life.   Sharon: And at the time the word they used was ‘decompensated’. Like a little hamster in a wheel and I just couldn’t keep going anymore and everything fell apart. I ended up being admitted to a psychiatric hospital for a few weeks.   Lucy: Ten years later, Sharon had another episode.   Sharon: I just couldn’t manage everything, working full-time, single parent, no family support and it just all imploded, I just couldn’t manage, I became really depressed again.   Lucy: This time she saw a psychiatrist who suggested she try CBT alongside medication. Although reluctant, she went ahead with it. At the time the therapy offered had little effect on her.   Sharon: I can’t describe it, it juts was an academic exercise to me.   Lucy: However, a few years later he doctor encouraged her to try CBT again.   Sharon: Because I like to please, not upset anyone, I went along to it. And it was a group CBT and it was compassion-focused, compassionate-based CBT and it was over about 20-24 weeks, something like that. We met every week, this small group.   Lucy: This time it was different, things started making sense for her.   Sharon: We went through that limbic system, the old brain, the new brain, the threat, soothing, drive, and all this explanation which for me, was a very good fit. Because suddenly, it was like a revelation, “So it’s not just me being weak then.” Even though people had told me, I didn’t really believe it.   So this information was important for me and from that we started to develop the discussions of, “Why do I think the way that I do?” Which was what the early CBT had done but somehow this meant more. It actually touched me.  And being in that small group and hearing other people talking and the two therapists that were there guiding, compassionate responses and, “What would we say to this person?” enabled me to see actually far more clearly the relevance of what they were doing.   Lucy: That sounds super helpful.   Sharon: You could offer a compassionate response and you could see the effect it was having and when they said to me I found it very hard to take, I couldn’t accept anybody being kind or compassionate.   Lucy: Sharon had a combination of group compassion-focused CBT which you can also hear more about in the episode on compassion-focused therapy, as well as individual CBT for depression. I asked Anne to talk us through how individual CBT for depression works.   Anne: Well, CBT for depression has two aspects to it really. The first aspect is the idea of symptom relief and really the purpose of that aspect of the treatment is really to try and help people re-engage with activities.   Say for example you feel too tired to get up out of bed, get washed and dressed and make your breakfast in the 30 minutes you normally would have done that, you might try and break that down into smaller tasks. So you might get out of bed and have a cup of tea. You then might get your breakfast and have another break and then you might get dressed.   So this idea that if you make an allowance for your energy levels, your concentration and try and approach tasks by breaking them down into manageable chunks, that will start to get you active again. So that’s really the first step of symptom relief.   The second aspect of symptom relief in depression is really trying to look at the role thoughts might play in the context of depressed mood. And what the research tells us in the cognitive science of depression is once mood becomes depressed, thinking becomes more negative in content. It also becomes more concrete and more over general, so it’s hard for us to be specific in our recall.   And another important factor, a thing that occurs once mood becomes depressed is our memory more readily recalls past unpleasant painful memories and actively screens out positive or neutral memories. The reason why this is important is that our ability to solve problems is really based on being able to retrieve information from the past about how we did that.   But once mood becomes depressed, you’re trying to do an everyday thing like say, I don’t know, mend a broken sink pipe, and you’re trying to do that, but because your mood is depressed and your concentration isn’t great, it’s harder to do. But also, all that’s coming back to you is all the times things have gone wrong, not the times when they’ve gone wel

Anxiety is one of the most common mental health problems, but there's a good evidence-base for CBT as a helpful intervention. In this podcast, Dr Lucy Maddox speaks with Dr Blake Stobie and Claire Read, about what CBT for anxiety is like, and how anxious thoughts can be like the circle line.  Show Notes and Transcript Podcast episode produced by Dr Lucy Maddox for BABCP Websites BABCP https://www.babcp.com Accredited register of CBT therapists https://www.cbtregisteruk.com Anxiety UK https://www.anxietyuk.org.uk NICE guidelines on anxiety https://www.nice.org.uk/guidance/qs53 Apps Claire recommended the Thought Diary Pro app as being helpful to use in conjunction with therapy to complete thought records.  https://www.good-thinking.uk/resources/thought-diary-pro/ Books Claire recommended this workbook on Overcoming Low Self Esteem by Melanie Fennell https://www.amazon.co.uk/Overcoming-Low-Self-Esteem-Self-help-Course/dp/1845292375/ref=sr_1_2?dchild=1&keywords=self+esteem+workbook+melanie+fennell&qid=1605884391&s=books&sr=1-2 And this book by Helen Kennerley on Overcoming Anxiety is part of the same series https://www.amazon.co.uk/Overcoming-Anxiety-Books-Prescription-Title/dp/1849018782/ref=sr_1_1?dchild=1&keywords=overcoming+anxiety&qid=1605884437&s=books&sr=1-1 Credits Image used is by Robert Tudor from Unsplash Podcast episode produced and edited by Lucy Maddox for BABCP Transcript   Lucy: Hello and welcome to Let’s Talk About CBT, the podcast from the British Association for Behavioural and Cognitive Psychotherapies, BABCP. This podcast is all about CBT, what it is, what it’s not and how it can be useful.   In this episode we’re thinking about CBT for depression. I spoke with Dr Anne Garland who spent 25 years working with people who experience depression and Sharon, who has experienced it herself.   Both Anne and Sharon come from a nursing background. Anne now works at the Oxford Cognitive Therapy Centre as a consultant psychotherapist, but she used to work in Nottingham, which is where Sharon had CBT for depression. Here’s Sharon.   How would you describe what depression is like?   Sharon: When I was going to school, when I was a little girl, an infant, we would have to go over the fields because I lived in the country, and go down. I could hear the bell of the junior school but couldn’t find it because of the fog. I walked round and round, I was five, walked round and round and round in those fields trying to get to the bell where I knew I would be safe and being terrified on my own. And that’s how it feels actually. Darkness, cold, very frightening.   Lucy: I asked Anne how depression gets diagnosed and she described a range of symptoms.   Anne: In its acute phase it’s characterised by what would be considered a range of symptoms. So, tiredness, lethargy, lack of motivation, poor concentration, difficulty remembering. Some of the most debilitating symptoms are often disturbed sleep and absence of any sense of enjoyment or pleasure in life and that can be very distressing to people. People can be really plagued with suicidal thoughts and feelings of hopelessness that life is pointless.   I think one of the most devastating things about depression as an illness is it robs people of their ability to do everyday things. So for example, getting up, getting dressed, getting washed, deciding what you want to wear can all be really impaired by the symptoms of depression. I try and help people to understand that the symptoms are real, they’re not imagined. Often people will tell me that they imagine these things or that they aren’t real and that it’s all in their mind.   Their symptoms are real, they exist in the body and do exert a really detrimental effect on just your ability to do what most of us take for granted on a day-to-day basis.   Lucy: And so it’s a lot more than sadness isn’t it?  Anne: Absolutely. It can be very profound feelings of sadness but often that’s amplified by feelings of extreme guilt, of shame, anger and anxiety is another common feature of depression.   Also, when people are very profoundly depressed they can actually just feel numb and feel nothing and that in itself can be very distressing because things that might normally move you to feel a real sense of connection. Say for example your children or your grandchildren, you may have no feelings whatsoever, and that in itself can be very alarming to people.  Lucy: The way that depression and its treatment are thought about can vary depending on who you speak to. Just like with other sorts of mental health problems. More biological viewpoints prioritise thinking about brain changes that can occur with depression while more social perspectives prioritise thinking about the context that people are part of.   Anne: As CBT tends to take a more pragmatic view of thinking about a connection between events in our environment, our reactions to those in terms of biology, thoughts, feelings and behaviour and how all of those things interact and that’s a very pragmatic way of thinking about things really. And I guess traditionally in CBT there’s the idea of making what is referred to as a psycho biosocial intervention. What that essentially means is that you can use medication plus psychological therapies – particularly CBT in this instance – and interventions that may influence your environment.   If you do those things altogether then you’re more likely to get a better outcome, which is really what our service in Nottingham is predicated on that idea. That if you think about all of those aspects in a practical, pragmatic way, then that may maximise your chances of seeing an improvement in depression.   And I think one of the challenges in depression, if you look at the research literature, is once you’ve had one episode of depression, you have a 25% chance of another. Once you’ve had two, a 50% chance. And once you’ve had three, a 95% chance of another episode. So the concept of recurrence becomes really important.   A lot of the work we do with people who have more persistent treatment resistant depression is really trying to help the person develop strategies for managing the illness on a long term basis. So it’s very much about trying to manage your mood and how you structure your day and your life and activities and that type of thing. I can be a very complex illness to work with.   Lucy: For Sharon, her first experience of depression was 20 years ago when depression suddenly had a huge effect on her and her life.   Sharon: And at the time the word they used was ‘decompensated’. Like a little hamster in a wheel and I just couldn’t keep going anymore and everything fell apart. I ended up being admitted to a psychiatric hospital for a few weeks.   Lucy: Ten years later, Sharon had another episode.   Sharon: I just couldn’t manage everything, working full-time, single parent, no family support and it just all imploded, I just couldn’t manage, I became really depressed again.   Lucy: This time she saw a psychiatrist who suggested she try CBT alongside medication. Although reluctant, she went ahead with it. At the time the therapy offered had little effect on her.   Sharon: I can’t describe it, it juts was an academic exercise to me.   Lucy: However, a few years later he doctor encouraged her to try CBT again.   Sharon: Because I like to please, not upset anyone, I went along to it. And it was a group CBT and it was compassion-focused, compassionate-based CBT and it was over about 20-24 weeks, something like that. We met every week, this small group.   Lucy: This time it was different, things started making sense for her.   Sharon: We went through that limbic system, the old brain, the new brain, the threat, soothing, drive, and all this explanation which for me, was a very good fit. Because suddenly, it was like a revelation, “So it’s not just me being weak then.” Even though people had told me, I didn’t really believe it.   So this information was important for me and from that we started to develop the discussions of, “Why do I think the way that I do?” Which was what the early CBT had done but somehow this meant more. It actually touched me.  And being in that small group and hearing other people talking and the two therapists that were there guiding, compassionate responses and, “What would we say to this person?” enabled me to see actually far more clearly the relevance of what they were doing.   Lucy: That sounds super helpful.   Sharon: You could offer a compassionate response and you could see the effect it was having and when they said to me I found it very hard to take, I couldn’t accept anybody being kind or compassionate.   Lucy: Sharon had a combination of group compassion-focused CBT which you can also hear more about in the episode on compassion-focused therapy, as well as individual CBT for depression. I asked Anne to talk us through how individual CBT for depression works.   Anne: Well, CBT for depression has two aspects to it really. The first aspect is the idea of symptom relief and really the purpose of that aspect of the treatment is really to try and help people re-engage with activities.   Say for example you feel too tired to get up out of bed, get washed and dressed and make your breakfast in the 30 minutes you normally would have done that, you might try and break that down into smaller tasks. So you might get out of bed and have a cup of tea. You then might get your breakfast and have another break and then you might get dressed.   So this idea that if you make an allowance for your energy levels, your concentration and try and approach tasks by breaking them down into manageable chunks, that will start to get you active again. So that’s really the first step of symptom relief.   The second aspect of symptom relief in depression is really trying to look at the role thoughts might play in the context of depressed mood. And what the research tells

We tend to think about therapy as something that is helpful for individuals, but what about when you want to address problems which affect you and a partner or spouse? In this episode, Dr Lucy Maddox speaks to Dan Kolubinski about cognitive behavioural couples therapy, and hears from Liz and Richard about what the experience was like for them.  Show Notes and Transcript Podcast episode produced by Dr Lucy Maddox for BABCP Dan recommended the book Fighting For Your Marriage by Markman, Stanley & Blumberg https://www.amazon.co.uk/Fighting-Your-Marriage-Best-seller-Preventing-dp-0470485914/dp/0470485914/ref=dp_ob_title_bk Some journal articles on couples therapy are available free online here: https://www.cambridge.org/core/journals/the-cognitive-behaviour-therapist/information/let-s-talk-about-cbt-podcast The podcast survey is here and takes 5 minutes: https://www.surveymonkey.co.uk/r/podcastLTACBT The BABCP website is at www.babcp.com And the CBT Register of accredited CBT therapists is at https://www.cbtregisteruk.com Photo by Nick Fewings on Unsplash   Transcript Lucy: Hello, and welcome to Let’s Talk About CBT. It’s great to have you listening.   When we think about therapy, we often think of one-to-one conversations between one person and their therapist. But what about when the problems that we’re going for help with are related to how we’re getting on with a partner or a spouse? Cognitive behavioural couples therapy helps with these sorts of difficulties. To understand more about it I spoke to a married couple, Richard and Liz, and Dan Kolubinski, their therapist.   Richard and Liz did this therapy privately, but couples therapy is also available on the NHS to help with some specific difficulties. We hear more about that from Dan later on. For now though let’s hear what Richard and Liz thought of their couples therapy in this interview which I recorded with them remotely.   Richard: My name’s Richard. I’m 37 years old and I’ve been married to Liz for just over seven years now. I’m a postie at the moment, and kind of lived in Essex most of my life.   Liz: It’s like a dating programme.   Richard: It is, isn’t it? Yeah, a little bit. (laughs)  Liz: So I’m Liz and I make cakes for a living, and write about mental health. So that’s us.   Lucy: That’s great. So thanks so much for agreeing to speak with me about your experience of couples therapy, and specifically cognitive behavioural couples therapy. Would you mind telling me how you came across it and what made you think you might want to try it?  Liz: Yeah. So I think it’s something that we’ve spoken about in the past. And we’ve both had therapy separately, and I think we’ve both had various different types of therapy. So Richard has had CBT before, I think we’ve both done psycho-dynamic counselling.   So when we decided we were going to do it, we realised that for us it was more beneficial to almost do a crash course, as it were, together. So to do a whole weekend, rather than a little bit once a week. And that was how we discovered Dan, and were able to book in with him.   Richard: Yeah, I think we both understand the value or had both experienced and understood the value of therapy individually. So it was kind of an easy step for us then to decide there could be a lot of value in doing this together.   Lucy: That makes total sense. So you already had a bit of an understanding of what it might be like, or what it’s like on an individual level?  Liz: Yeah, definitely. And actually very early on in our marriage we had some couples counselling, which I don’t think was actually as successful, and it was after that that we had separate counselling. And I think it was after we were both able to get ourselves into better positions, as it were, that that’s when we were able to come back together and experience some therapy together.   Lucy: That’s really interesting. Do you think that helped you access the conversations together in a different way?  Richard: Yes, I think it did. I think we both had an experience of therapy, of CBT and of other therapies, and the structure they would take or how they engaged you and enabled you to talk safely, and the prompts that might be used.   When we did it together, it did make the conversations a bit freer, a bit more open. And I think we both felt it was a safe environment, which when we first had it I don’t think we did feel. And that made a big difference I think.   Liz: Yeah. And I think as with any relationship, until you’ve got a level of happiness with yourself, it’s very difficult to have a relationship with somebody else that involves vulnerability or trust.   And I don’t think we had that the first time we tried having counselling together. I think we were almost so reliant on our relationship to form who we were, that the first time around we put too much pressure on ourselves, on the relationship, and also on the counselling, and we expected some magic wand. Whereas now we’ve realised it actually does take a bit of work.   Richard: Yeah.   Liz: But obviously the pay-off is huge, so that’s brilliant.   Lucy: That’s so nice. Sometimes you see adverts for couples counselling, or couples conversations, when people are thinking of getting married. Was that something that was around for you?  Liz: (Laughs) Yeah, slightly ironically we started it and it was meant to be three sessions long, or four sessions long, and I think before the second or third session we had such a big argument that we never went back.   So yeah, again it’s something that I think in hindsight there were warning bells that both of us were probably having our own inner struggles, as it were. And that we weren’t really able to reap the benefits of that pre-marriage counselling. But I would definitely recommend it to any friends who were getting married.   Richard: Yeah, absolutely.   Liz: I’d definitely recommend it, even if it’s just to get the conversation started.   Lucy: Yeah, it’s interesting. So there are some conversations it feels like almost we don't quite have permission to have without somebody prompting it or some kind of structure around it.   Liz: Yeah, definitely. And I think it takes a certain amount of emotional maturity to have conversations like that, or the difficult conversations, and not to take something personally or get defensive. And I think that that’s something as a society we don’t necessarily encourage people to have those conversations, or to be able to freely explore things without there being some element of self-worth dependent on it.   Lucy: Liz and Richard went for therapy after experiencing a bit of a rocky patch in their relationship.   What was it like going for the weekend?  Richard: I think it was really beneficial. It’s certainly something that – hopefully we’ll never be in that similar circumstance again – but in a situation where we thought it was beneficial, doing it over… was it three nights?  Liz: Yeah, three nights.   Richard: Was really valuable, because it kept you in that space. So there were no distractions from, I don’t know, going to work, having to get back, get to the session.   Then inevitably when you finish the session you get home and normal life kicks in straightaway. So whether it’s cooking dinner or having to get ready for the next day, that’s unavoidable. But in this situation we were really able to take ourselves away from normality and the routine, and really focus on it. And I think it had a great impact doing it that way.   Liz: Definitely. And also I think that having – because the sessions each day I think ran from 10:00 till 1:00, and then 2:00 till 4:00. So having those extended sessions meant you could really get down to what was happening and really attack that. As opposed to when it’s say weekly, hour long sessions, having to almost get past the initial boundaries that you might have set up and break those down, and get into a place of being able to talk freely.   Lucy: And were there other people there as well? Were there other couples there or was it just you?  Liz: It was just us.   Richard: Yeah.   Lucy: And what was it like before you went? Was it frightening to think about going?  Richard: I suppose for me it was a sense of that nervous excitement. So I didn’t quite know what was going to happen. I knew what I wanted from it. And it was the kind of knowledge that this was going to be good for us, at least for me.   Liz: Definitely. And I think one of the first things, on our first evening there, we had the initial introduction session together. And Dan did say it was quite unusual to be dealing with a couple who were in such a good place. And that was quite nice actually, and we definitely subscribe to the idea that therapy isn’t just for when something goes wrong; it’s actually really useful to keep things right, as it were.   And I think it was funny because the things we thought we were going to end up talking about over the weekend, actually it all came down largely to communication, which I think is often the case with couples. And learning how to communicate with each other.   Lucy: Before we hear more about Richard’s and Liz’s experience, here’s Dan to give the bigger picture on this type of therapy.   Dan: My name is Dr Dan Kolubinski, and I am the clinical director of Reconnect UK, which is a CBCT based intensive retreat programme.   Lucy: And what’s your professional background?  Dan: My master’s degree is in counselling psychology, and a PhD in psychology as well. And I’ve been a CBT therapist for about 15 years now.   Lucy: Cognitive behavioural couples therapy might be something that people haven’t heard of before. Could you explain what it is?  Dan: Well, as in CBT, in cognitive behavioural therapy, there are these two different aspects; there are cognitions and there are behaviours. The ideas are that if you change those two things you might change how a pers

What is digital CBT? How does therapy work over the internet? Can it ever be as good as face-to-face? Dr Lucy Maddox hears from Dr Graham Thew and Fiona McLauchlan-Hyde about an internet-based CBT programme for PTSD. Fiona shares her experience of how this therapist-supported programme helped her through traumatic grief, and also has some helpful advice for people trying to comfort those who are bereaved.    Show Notes and Transcript Podcast episode produced by Dr Lucy Maddox for BABCP BABCP website is at www.babcp.com CBT Register of accredited CBT therapists is at https://www.cbtregisteruk.com BPS Top tips for psychological sessions delivered by video call for adult patients https://www.bps.org.uk/sites/www.bps.org.uk/files/Policy/Policy%20-%20Files/Top%20tips%20for%20psychological%20sessions%20by%20video%20%28adult%20patients%29.pdf Resource from OCD-UK on getting the most out of online CBT https://www.babcp.com/files/Therapists/Oxford-OCD-Making-the-Most-Out-of-Remote-Therapy-for-Patients-by-OCDUK.pdf Graham’s recent paper in the Cognitive Behavioural Therapist can be found on the podcast journal article page https://www.cambridge.org/core/journals/the-cognitive-behaviour-therapist/information/let-s-talk-about-cbt-podcast Information from Cruse about traumatic grief https://www.cruse.org.uk/get-help/traumatic-bereavement/traumatic-loss The Good Grief Trust https://www.thegoodgrieftrust.org Image is by Cassie Boca on Unsplash Transcript   Lucy: Before we get started, I want to remind you about the survey which I released at the beginning of August. I really would like to know more about who is listening to these podcasts and what you would like. The link to the survey is in the show notes and it takes about five minutes to complete. If you have time to fill it in I would be really grateful.   Hello, and welcome to Let’s Talk About CBT, with me, Dr Lucy Maddox. This podcast is all about CBT, what it is, what it’s not, and how it can be useful.   Today I am exploring digital CBT. I speak to a therapist who has been researching internet based CBT programmes that are supported by a therapist, and I speak to someone who has experienced this first hand.   The particular programme that we talk about is for PTSD, which we’ve heard about before in a previous episode. In this case PTSD was related to an experience of traumatic grief.   Fiona: I think I started last September and I finished just before lockdown, actually.   Lucy: Gosh, so in a way good timing.   Fiona: Yeah, it was great timing to finish just before lockdown. It put me in a good place I think, to be able to deal with what was going on, rather than if it had been six months earlier it would have been a very different experience I think.   Lucy: It took Fiona, who is based in Oxfordshire, a long time to find this type of therapy.   Fiona: It all started six and a half years ago, when my husband died of cancer.   Lucy: I’m so sorry.   Fiona: He was diagnosed in the June, and he died in the December, and it was really horrific. He was 49, I was 42 at the time. And so it was heartbreaking and I couldn’t cope. I couldn’t cope afterwards. We had a little girl, she was seven when he died. And my world was turned upside down.   And I got help at first. But then, as with all things, life goes on around you and everyone thinks you’re fine. And I was still putting my lipstick on, so therefore everyone thought I was okay. And I felt I was getting worse and worse, and no one would believe me.   And it wasn’t until I threw all of my toys out of the pram; after having therapy through my local GP – so this was last year, last summer – sitting in my car afterwards for about an hour just sobbing, because no one believed me that I was feeling as bad as I was.   And I asked to be put in touch with TalkingSpace. And they put me forward for a trial with Oxfordshire Mental Health, and it changed my life. It absolutely changed my life. Because I was drowning and no one believed me, it was awful.   Lucy: It sounds like such a dark time.   Fiona: It was a really dark time. And everyone just kept saying come on, you know, it’s been so many years. And I was functioning, but I think it was last year… So I suffered from panic attacks; I suffered from panic attacks from before my husband died, and they got worse. They’d gone away for years and then they came back when he was diagnosed.   And last summer, around this time last year, I had such a severe panic attack, I was driving my daughter and she had to call an ambulance. And that was when I decided that come what may I needed help.   But it was still quite some time after that. I still had to go through about six weeks of people going, “Come on, you’re fine. Take a pill.” And I didn’t want to take a pill. So yeah, I was lucky, eventually.   Lucy: It sounds like you had to be really tenacious to get access to the therapy?  Fiona: It was a real, real battle. And as much as I really liked my GP, and my GP was the person who was there when my husband was dying. So he knew what happened and how horrific it was. But in the end his last thing was, “No more therapy. You’re lonely. You need to go out and find yourself another man.” And that was when it just – that was when I sat in my car for an hour and a half and cried.   Because it wasn’t that, I knew it wasn’t that. I knew there was something really wrong, and that I really, really needed help. And TalkingSpace came in, and I had a huge amount of telephone conversations and meetings in person, just for them to try and work out which way to send me.   Lucy: Fiona was diagnosed with post traumatic stress disorder. Fiona’s experience of losing her husband was deeply traumatic; not only the death but the lead up to it.  Fiona: I mean obviously it didn’t just happen to me; a lot of us were affected by it. But it was a particularly brutal and nasty way to die.   And you see the other thing is I did most of the nursing when my husband was sick. I don’t know how it happened like that, but it just did. So all of a sudden I became a nurse, which is not on my CV.   Lucy: Super, super hard. Yeah.   Fiona: And for us, Paul’s death was so horrific. He had a lot of failed operations, there was a lot of emergency surgery, there was an awful lot of blood everywhere. There were ambulances called in the middle of the night. He didn’t just have cancer and pass away, he suffered every day for those however many months it was.   And all of those things that we did automatically; like he had a feeding tube, because he had oesophageal cancer. So with me setting up the feeding tube every night, and flushing all of the feeding tubes out in the morning. And all of those things that you do automatically, because you’re trying to keep your loved one alive, they hit you later.   So his death, apart from – it sounds terrible to say this – apart from his death being the trauma, his illness was a trauma too. Because I did everything I could, but I couldn’t make him better. And this is part of my therapy, just my guilt at not being able to save him.   Lucy: The therapy that Fiona was referred to was a trial based at the Oxford Centre for Anxiety, Disorders and Trauma.   Graham: My name is Graham Thew. I am a clinical psychologist. And I do a job that’s split between research and clinical work.   So my research work I do at the University of Oxford, at the Oxford Centre for Anxiety, Disorders and Trauma. And my clinical work I do at two different services that are part of the IAPT programme, the Improving Access to Psychological Therapies programme. So that’s the Healthy Minds service in Buckinghamshire and the TalkingSpace Plus service in Oxfordshire. And both my research work and my clinical work all focus on digital treatment and digital therapies.   Lucy: Graham wasn’t Fiona’s therapist, but he’s involved in the trial that she took part in. I asked him about what digital therapy is.   And when you say digital CBT, what do you mean?  Graham: Yeah, that’s a great question, because I think terms like digital CBT can actually cover a range of different things.   So as we’ve just mentioned, we might be referring to webcam sessions; so video conference sessions that would perhaps cover the same content as a face-to-face therapy session. So you would still be able to see your therapist on webcam, and you both agree to meet at a specific time.   But digital CBT and other online treatments can be broader and look a little bit different to that as well. So for example there are some forms of CBT that still take place online with a therapist at a specific time, but instead of seeing them and talking to them via webcam, you’d actually be typing; you and the therapist would be typing to each other live, in real time.   Lucy: Like a kind of Messenger chat?  Graham: Exactly, like a sort of instant messaging chat.   And then another different category altogether is more of a sort of internet-based CBT programme. So that would be where there’s a website or a programme that has a lot of the therapy content written, perhaps in the form of little treatment modules. So written texts, videos, that sort of thing. And you would therefore work through those in your own time, and perhaps have some support from the therapist every so often; maybe in the form of messaging or a phone call or something.   So it can be a bit confusing because terms like digital CBT can mean different things.   Lucy: Is your research looking at all of those types of digital CBT?  Graham: The work that I’ve done has mostly focused on the last category that I talked about; the forms where treatment is partly written down and put into an internet programme in a series of modules, but that there’s support from a therapist. In the programmes that I’ve worked with most closely, the therapist would communicate with you by telephone, by messaging, and also occasionally via webcam as

Let's Talk About CBT Survey Have you got 5 minutes to complete a quick survey about your experience of listening? It would really help us to know who is listening and what you would like from the podcast. Thank you! https://www.surveymonkey.co.uk/r/podcastLTACBT Podcast episode produced by Dr Lucy Maddox for BABCP   Photo by Emily Morter on Unsplash

  What does existing research tell us about the possible impact of the pandemic on children and young people's mental health? Dr Lucy Maddox speaks with Dr Maria Loades about Maria and colleagues' recent rapid review of the literature on isolation and mental health, and what CBT principles suggest can be helpful to head off problems, in particular with loneliness during the pandemic.  Show Notes and Transcript Podcast episode produced by Dr Lucy Maddox for BABCP Maria recommended lots of helpful resources on loneliness and social isolation which we've listed here: Books Together: Loneliness, Health And What Happens when we find Connection – Vivek Murthy https://www.amazon.co.uk/Together-Loneliness-Health-Happens-Connection/dp/1788162773 Overcoming social anxiety and shyness https://www.amazon.co.uk/Overcoming-Social-Anxiety-Shyness-Gillian/dp/1849010005 Overcoming your children’s social anxiety and shyness https://www.amazon.co.uk/dp/1845290879/ref=cm_sw_em_r_mt_dp_U_6p13EbZ0ER2XD Websites Mind - https://www.mind.org.uk/information-support/tips-for-everyday-living/loneliness/about-loneliness/ How to cope with loneliness during coronavirus – https://www.verywellmind.com/how-to-cope-with-loneliness-during-coronavirus-4799661 TEDx talk by Will Wright ‘Loneliness is literally killing us’ - https://www.youtube.com/watch?v=ruh6rN5UrME&feature=youtu.be Loneliness and isolation in teenagers – a parent’s guide https://www.bupa.co.uk/newsroom/ourviews/2019/05/teenager-loneliness As always if you want more information on BABCP check out www.babcp.com If you want to find a CBT accredited therapist check the register of BABCP accredited therapists https://www.cbtregisteruk.com/ Articles The rapid review we talked about is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267797/ Podcast That podcast episode with Shirley Reynolds on teenagers doing more of what matters to them is here: https://letstalkaboutcbt.libsyn.com/helping-teenagers-do-more-of-what-matters-to-them   Transcript Lucy: Hi and welcome to Let’s Talk About CBT with me, Dr Lucy Maddox. In this episode brought to you by the British Association for Behavioural and Cognitive Psychotherapies, we think about the possible effects of quarantine on children and young people’s mental health. I’ll let my guest for today introduce herself.   Maria: My name is Dr Maria Loades and I’m a clinical psychologist and I work at the University of Bath as a lecturer on the doctorate and clinical psychology programme.   Lucy: Maria and her colleagues have been especially interested in the effects of the pandemic on children and young people. She co-authored a rapid review of evidence to try to understand what this effect is likely to be.   Maria: What we wanted to do was to look at two things. One is the studies that have been done that have looked at social isolation in a pandemic context in children and young people and how that’s impacted on their mental health. Secondly, we were also interested in thinking, okay, if these measures mean that young people experience this increase in loneliness, what do we know about how loneliness might be related to mental health for children and young people.   Lucy: So obviously there’s not loads of pandemics to study, but you’re trying to work out from what’s been done before, how does loneliness impact on mental health problems for children and young people? You turned the review around really quickly didn’t you, because normally it takes months to do something like this.   Maria: Yes, we really felt like it was particularly important to pull this together as quickly as we could to inform policy and practice going forward.   Lucy: And what did you find?   Maria: As we expected, there isn’t much known about the impact of pandemics specifically. There was just one study that looked at mental health in children and young people in a pandemic context and it did find that there was significantly increased rates of mental health problems for those who had experienced disease containment measures like quarantine or social isolation. And the study focused on trauma symptoms and they found really much higher rates of trauma symptoms amongst those young people who had experienced those disease containment measures. But that is only one study.   More broadly though, there were over 60 studies that looked at loneliness and mental health. And we found that there is good evidence that loneliness increases the chances of developing mental health problems, both anxiety and depression, up to nine years later.   So there’s not only a loneliness and depression and anxiety linked when we measured them at the same point in time, but there’s good evidence that being lonely now will mean an increase in risk of mental health problems at a later date.   Lucy: Maria thought one study was particularly interesting. It looked at duration of loneliness compared to intensity of loneliness.   Maria: Now what we mean by that is how long the loneliness is going on for, as compared to how strong the loneliness is. And what this study found, and it was a big study, is that actually the longer we’re lonely for, the more closely linked that is with mental health problems than how strong the loneliness is.   Lucy: What are some things that might be helpful to head off these problems?  Maria: We know that loneliness is that feeling we get when our social connections are not what we would want them to be. In the current context, of course, socially connecting in the normal ways, like at school or at college, for young people, is curtailed. But we can still connect in other ways.   Lucy: Maria emphasised how important connecting for play dates over video calls can be, as well as meeting up for play now lockdown is easing, and using more old school ways of communicating as well, like sending friends cards or letters.   Maria: The other thing we can do is more broadly to think about how we promote activities amongst young people that support wellbeing in every which way we can. As well as making sure we’re providing a listening ear for young people and being open to hearing what they might be worried about or what they might be feeling sad about and problem solving that where we can. Actually giving them permission, this is a really unusual circumstance and it’s okay and it’s normal for it not to feel very good.   Lucy: Some things that we know promote wellbeing include regular exercise, good quality sleep, healthy eating and time spent on activities that young people enjoy and feel proud of.   Maria: As one goes for a walk you see rainbows in the windows and my little one looks and points and knows that those rainbows mean that there are other children out there. And I think that’s incredibly helpful in terms of feeling a sense of community, connectedness, which also helps to overcome that loneliness.   Lucy: So although there may be an increased risk of mental health problems as a result of the pandemic, there’s also lots and lots that we can do that would be protective.   Maria: Definitely. I think it’s really important too that we make a distinction between young people who might be feeling lonely now and during this context, but who were pretty well socially connected beforehand. And of course, other young people who might have been lonely beforehand and this has maybe made things worse, or that their loneliness is ongoing at this stage.   For those young people who have maybe been feeling lonely for a much longer time, we might need to do something more individualised and more specific in terms of helping them to think about how they can make social connections going forward, as we resume life to some degree.   Lucy: I asked Maria whether she thought that as we are able to see people more, there might also be some anxiety around socialising.   Maria: You know, the reality is, we haven’t been practicing socialising nearly as much as we’d normally do. So we might well feel rusty and we might well even be worried about connecting socially with each other again. Add into that, of course we’ve had a lot of messages in recent weeks about the risk of interacting with each other because of the risk of infection. And so I think anxiety about getting physically close to each other and interacting with each other is going to be really natural in weeks going forward.   And I think again, the CBT principles can really help us to deal with those social anxieties too. So the first principle that I think is really important to remember is: The first step to tackling fear is facing it.   Lucy: CBT principles suggest breaking down a scary situation into steps and gradually building the confidence to face the fear by conquering one step at a time. So starting with a text message to a friend and working up to meeting face-to-face, for example.   Another tip to help with social anxiety is trying not to focus on how we’re coming across to someone but to focus on what someone is saying rather than getting caught up in thoughts about what they think about us. Thinking about thoughts, just as thoughts rather than facts is one thing that can help with this too, both for children and adults.   Maria: There’s certain developmental reasons why children and young people may be struggling particularly and those are about the key importance of play and of social interaction to development at those ages. But actually this is something that everybody is experiencing.   I do think the majority of children and young people, and adults more generally, will have a few wobbles, but will manage and will bounce back as we go forward. But for some, I think it will be a little more difficult and they’ll need to maybe engage in a bit of self-help using some of these CBT principles or indeed actually to go on and get some more professional help.   Lucy: Maria’s review has implications for school policy.  Maria: What we’re really encouraging, both sch

How does doing more of what matters help teenagers with low mood and depression? And what can we all learn from this, particularly at the moment? Prof Shirley Reynolds speaks to Dr Lucy Maddox. Show Notes and Transcript Podcast episode produced by Dr Lucy Maddox for BABCP If you want to know more the following resources might be helpful. Books Shirley has written two books about depression in teenagers, one for teens and one for parents: For parents: Teenage Depression:  CBT Guide for Parents https://www.amazon.co.uk/Teenage-Depression-CBT-Guide-Parents/dp/147211454X For adolescents: Am I Depressed and What Can I Do About It? https://www.amazon.co.uk/Am-Depressed-What-Can-About/dp/1472114531/ref=pd_lpo_14_t_0/260-4076808-4951665?_encoding=UTF8&pd_rd_i=1472114531&pd_rd_r=bd1ea151-b4d3-40bc-99bc-583aa3824613&pd_rd_w=xtKq9&pd_rd_wg=CFBxI&pf_rd_p=7b8e3b03-1439-4489-abd4-4a138cf4eca6&pf_rd_r=MFANFKSAD9RE92R6XS65&psc=1&refRID=MFANFKSAD9RE92R6XS65 Websites BABCP website www.babcp.com Register of BABCP accredited therapists https://www.cbtregisteruk.com/ These resources about child and adolescent mental health might also be useful Young Minds https://youngminds.org.uk/ MindEd https://www.minded.org.uk/ Association for Child and Adolescent Mental Health https://www.acamh.org/ Other resources Shirley is running a course with Future Learn from 1st week in June about adolescent depression – aimed to help parents and professionals understand and help young people who struggle with low mood: https://www.mooc-list.com/course/understanding-depression-and-low-mood-young-people-futurelearn Have you seen the BABCP animation about what CBT is? Only 1 minute long and available here: https://www.youtube.com/watch?v=ZRijYOJp5e0 Photo by Daria Tumanova on Unsplash Podcast episode produced by Dr Lucy Maddox for BABCP Transcript  Lucy: Hi and welcome to Let’s Talk About CBT with me, Dr Lucy Maddox. This podcast is all about CBT, what it is, what it’s not and how it can be useful. Today I’m speaking to Professor Shirley Reynolds from the University of Reading about how doing more of what matters can help teenagers boost their mood, and how this might be particularly helpful for all of us to remember at the current time.   Shirley: The thing I’m really mostly interested in is understanding more about adolescent depression in order to help us really develop better treatments and better ways of preventing young people from developing depression. So that we can really try and divert them away from a path that can lead into a lifetime of problems with low mood.   Lucy: Fantastic. And at this time in particular when we’re all shutting doors a bit because of the pandemic and teenagers are shutting doors as well, what can your research tell us that might be helpful at this time in particular do you think?  Shirley: I think there are some general points and some more specific points. I think the general point is that one of the things we know, not just from our own research but from many people’s research is that when you’re a teenager, most teenagers are going to be incredibly attached to and reliant on having relationships with their friends, their peers.   The family becomes a bit less important, it’s not unimportant, but the importance of it becomes a little bit less and that’s replaced by a really, really strong focus on needing to be part of a social group. Being accepted by other people, contributing to things with your friends, being part of something bigger than yourself.   And so what that tells us then is that a period like now when young people simply cannot have those relationships in the normal ways, that this is a potential point of really massive stress for them and distress for them. And we need to try and support them; to maintain any relationships they already have, in whatever way is possible.   And what most parents are currently struggling with, but I think getting a handle on, is that currently that is going to be on a computer.   It’s not just young people, we all need these things. This is a lifelong thing for most people, but it’s a particular importance at that critical development period when we’re teenagers.   Lucy: So making sure that we’re supporting the young people in our lives to maintain contact with their friends in whatever way is possible.   Shirley: In whatever way is possible, absolutely. And accepting and understanding that it’s frustrating and difficult and anxiety provoking and that that’s true for everybody, parents, children, and everybody else.   There’s a degree to which we have to kind of let our normal expectations just be shifted around a bit and learn to live with that and be okay with that.   Lucy: Actually, just you talking about teenagers in particular made me think about that tension that can happen sometimes between teenagers really wanting to be independent and maybe family really wanting to comfort teenagers during this time. And sometimes that can be a really tricky balance to walk, can’t it, if you’re a parent who wants to offer comfort and your teenager is saying, “No, leave me alone.” Is there anything, from your point of view, that you would say about that?   Shirley: I think that’s absolutely right because the other task of being an adolescent or a teenager or growing up is to learn to be independent and to learn to do things on your own. And at the moment everybody is forced to spend 24/7 with their families and that exploration and getting out there and taking a bit of a risk and learning about yourself in the world is something, it’s very hard for teenagers to do at the moment. So they are going to need time to be separate and to be on their own.   And it is fine for them to tell you to back off and it’s inevitable that people will feel a little bit pushed away and maybe left out or maybe tempers will be frayed and there’ll be a bit more irritability. But again, I think that’s one of those inevitable challenges that there’s no right answer for this.   So I think that tension between needing support and also needing to be separate is really a massive struggle, especially for people who live in very small houses, don’t have outside space. So sharing bedrooms. I think trying to find a space for young people to call their own, for at least some of the time is going to be really important, if that’s at all possible.   Lucy: Yeah, really helpful. And helpful to remember that in the midst of trying to homeschool and all the rest of it as well actually, that to be somebody’s teacher and mum and seeing them all the time is not possible.   And some of the research that you’ve done that I found really interesting has been about valued actions. I wondered if you could say a little bit more about what valued actions are?  Shirley: Yeah, so this comes from the research we’ve done with teenagers with depression and low mood. What we see when somebody has depression or beginning to become depressed is that as we feel a little bit worse, what we tend to do – this is in normal life – is to take ourselves out of our normal social activities. So young people who have got problems with depression very often, nearly always, spend more time on their own than they would have previously.   And as they do that, as they take themselves further out, they get less reward from life. So fewer of the things that would have just happened in their normal daily life, a smile from somebody or a shared joke or something that you notice outside of the house that just made you feel good about yourself, those things just are less available to you. They happen less because you take yourself out of what’s happening in life.     As you withdraw what we see is you get less reward from life, or less of what we would call the ‘feel good factor’. And when you get less of the ‘feel good factor’, that makes you feel worse. And as you feel worse, you withdraw a little bit more and you get less reward and then you get less of the ‘feel good factor’.   So you find that young people with depression and adults with depression get themselves into this very hard to escape from cycle, this vicious cycle.   Lucy: Shirley’s research looks at ways of trying to break the cycle of low mood and doing less.   Shirley: So, we want to break the cycle and the way we turn it around when we’re working with young people is we help them to do more of what matters. More of what matters are things that are important to them and we help them decide what matters to them by talking to them about their values.   Lucy: Values are guiding principles in life, the things that show us the direction we want to go in. To work out what matters sometimes takes some real reflection on what it is that’s important to us.   Shirley: Now, they’re really big questions, why am I here? What am I doing? What is the point of it all? They’re massive questions, but they’re brilliant questions and lots of teenagers are sort of playing around with them anyway. So if we can tap into that need to work out why I’m here and what I’m doing and what my values are, it becomes a really exciting, interesting conversation.   Lucy: Shirley told me about three main areas that she tends to ask young people to think about. Values to do with themselves, like health or fun, values to do with things that matter, like education or politics and values to do with people that matter, like family and friends.   Shirley: And then the idea is that once we’ve helped them think about what their values are, which we can do in a very structured way, we then help them to do a little bit more of what matters. These are the valued activities.   So tiny little, small, easy to do activities that help them get a little bit more of that ‘feel good factor’.   Lucy: By increasing time spent on things that matter, that vicious cycle Shirley talked about before can be reversed.  Shirley: And as that reward comes back, we start to reverse the cycle.