Let's Talk about CBT- Practice Matters

In this episode, Rachel Handley talks with Professor Ed Watkins, Professor of Psychology at the University of Exeter a world-leading expert in Rumination and its impact on mental health and wellbeing. Professor Watkins talks about Rumination-Focussed Cognitive Therapy, an evidence-based approach he has developed and trialled to target these specific processes in depression.   They discuss: What is rumination What might be the different between adaptive and maladaptive rumination How rumination can become a habit that can maintain low mood, anxiety and depression The development and application of Rumination-Focused CBT (RFCBT) to depression Practical techniques to shift clients from ruminative abstract, self-critical thinking into concrete, experiential, and compassionate approaches When RFCBT may be especially helpful, including with complex or chronic depression Resources & Further Learning: Find more information about Ed and his publications here Find out more about The Calming Minds Project here Stay Connected: Follow us on Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don’t forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let’s Talk About CBT and Let’s Talk About CBT – Research Matters for more discussions on evidence-based therapy. 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 edited by Steph Curnow

In this episode of Practice Matters, Rachel is joined by Professor Judith Beck, President of the Beck Institute for Cognitive Behaviour Therapy and one of the most influential voices in the field. Judith discusses her personal and professional journey into CBT, the legacy of her father Aaron T. Beck, and the evolution of cognitive therapy from its traditional roots to recovery-oriented cognitive therapy (CT-R). Judith also shares insights on the importance of the therapeutic relationship, strategies for validating clients, managing hopelessness, and adapting CBT across cultures and how therapists can look after themselves, continue learning, and stay connected. Resources and links mentioned in this episode: Beck Institute for Cognitive Behavior Therapy Subscribe to the Beck Institute newsletter Cognitive Behavior Therapy: Basics and Beyond (3rd edition, 2021) by Judith S. Beck Beck Institute social media channels: Facebook: https://www.facebook.com/beckinstitute LinkedIn: https://www.linkedin.com/company/beck-institute-for-cognitive-behavior-therapy/ X: https://twitter.com/beckinstitute YouTube: https://www.youtube.com/user/BeckInstitute   Stay Connected: Follow us on Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don’t forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let’s Talk About CBT and Let’s Talk About CBT – Research Matters for more discussions on evidence-based therapy. 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 edited by Steph Curnow Transcript: Rachel: Welcome to Let's Talk About CBT Practice Matters, the BABCP podcast for therapists using cognitive behavioral therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who will share insights that will help you understand and apply CBT better to help your patients. Today, I'm really delighted to be joined by Professor Judith Beck. Professor Beck is president of the Beck Institute for Cognitive Behavior Therapy and clinical professor of psychology and psychiatry at the University of Pennsylvania Perelman School of Medicine. She has published prolifically on CBT, including key texts that are to be found on the bookshelves of almost every CBT therapist with a desire to hone their craft. And they really do guide us through the basics and beyond. Judy, welcome to the podcast. Judith Beck: Thank you for having me. Rachel: I’m fortunate to have met you previously during a brief period of study at the Beck Institute many moons ago now. However, I imagine that I feel about spending time talking to you about CBT the same way normal people might feel about chatting to celebrities, given that of course your CBT royalty, your father being Aaron T. Beck, also widely regarded as the father of CBT and that you've worked so closely with him to develop the field. It might perhaps seem inevitable given that background that you would end up in this work, but you clearly could have chosen any number of career pathways. Can you tell us a little bit about your personal and professional journey to where you are now? Judith Beck: So I've always loved children. And when I was probably six or seven, I decided that I wanted to be a teacher. And so when I went to the University of Pennsylvania, I studied education to become a teacher, but I took a lot of psychology courses as well. And I taught kids with learning disabilities for a while and then decided that if I wanted to have a career or met my career as a teacher, I really had to go back and get a professional degree, a master's degree. And so I went back to school and got a master's in educational psychology. Then worked as a supervisor for a little while and decided that I should really probably get a PhD. And it was toward the beginning of my PhD program that I became more interested in psychology and in my father's work. And I really think that I must have been at least subliminally influenced by my dad when I was a teacher and when I was a supervisor. At the beginning when I started to consider going into this field, I had kind of a naive idea and it was an automatic thought. I thought, I just don't know if I'm cut out to be a psychologist because I've always been such an intuitive teacher. I didn't really need someone to teach me how to teach, especially when it came to teaching kids with learning disabilities. It was just quite natural for me to know how to take something that was complicated and break it down and speak to my young students in a way that they could understand. So I thought, how could I learn to be a psychologist? I'm not intuitive at all about how to do that. Rachel: So if it requires some learning, then it can't be for me. Judith Beck: That was my thought at the time. And fortunately it turned out to be wrong. And then I started to learn really in detail about my dad's work, and it all made so much good sense to me. And what's interesting is that I've really come full circle. For a while, especially at the beginning, I was primarily a CBT therapist. But then I really became a CBT teacher. And most of my activities now, or many of my activities at the Beck Institute have to do obviously with training and teaching other people to use CBT. Rachel: So you started by integrating psychology into your education and you've come full circle in now you're integrating education into your psychology. Judith Beck: That's right. You sometimes people draw interesting conclusions. More than a couple of people have said, well, you probably didn't go into psychology initially because that's what your father was doing. And I said, no, no, no, it wasn't a reaction to my father. It was just that I was always drawn to working with young children. And that's what I did as a teacher. Rachel: When talking about families, I've often spoken on this podcast previously about how as both a psychologist and a mother, I hope that my professional skills give me skills and insights as a parent that I might not otherwise have. But mostly it feels like I'm just more aware of the many, many ways in which I'm failing as a parent and setting my kids up with all kinds of dysfunctional assumptions about how the world works. I wonder how it was growing up in the Beck household. Was there lots of practice and reflection on CBT principles? Judith Beck: Well, I grew up in the late 1950s and 1960s and I didn't go to university until 1971. And it was really through the later 60s and into the 70s that my father was developing cognitive therapy. But my parents had a very traditional marriage. My father worked all of the time and my mother who actually went to, did something extraordinarily unusual. She went to law school when she had four kids under the age of 10. There were three women in her very large class. Women just didn't do that in those days. It was starting in probably 1961 or 62. Despite the fact that she was in school and then developing her own career, she really had probably 90 % of the care of the kids and the household and organization and so forth. We did have dinner every night, though, as a family. My father stopped work long enough to do that. But we didn't really talk about his work very much. There was one memory that I have that I've told a number of people about, that's when I was someplace around 10, 11, 12 years old. And my father said, Judy, I have a new idea I'd like to run by you. And then he described the cognitive model. That's not a situation that directly influences your reaction, but rather your interpretation of that situation, the thoughts that go through your mind. And so he told me that, and he gave me an example. And he said, what do you think? And what I said out loud to him was, well, yes, that makes sense. But in my own mind, my automatic thought was but that's so obvious. So I think I probably began thinking like a cognitive therapist fairly early on, although we really rarely discussed his work. I knew my both parents were unusual, my mother being in school and becoming a lawyer. And I knew my dad was unusual because he wrote books. And I didn't have any friends who's fathers or mothers wrote books. Rachel: To be fair, I think I've got teenage boys and most of what I say either seems extremely obvious to them or totally ridiculous. I mean, at the other extreme, but it's lovely to hear about your mother as well. Cause obviously we all know so much about your father's work, but obviously two very inspirational, hardworking parents who, you know, work with a love of learning and an interest in doing things in the world. So fantastic. Well, glad he got past you, Judy, because if you'd said it sounds like rubbish, maybe we never would have had CBT. So I'm glad you were one of the first audiences. Now, regular listeners to the podcast will by now be familiar with our podcast challenge. We love a good formulation here at Practice Matters in good CBT style, but because we're an audio podcast, it has to be done unlike almost everything we do in CBT without boxes or arrows or other visual aids. So here's your challenge. Can you give us a brief explanation of how the cognitive model explains psychological distress develops and is maintained without any of those aids. Judith Beck: Sure, so the first thing I want to say is that automatic thoughts do not cause depression. Depression is caused by so many different factors and it's important to take a biopsychosocial view of the development of depression. Automatic thoughts are probably an important precipitating factor among others that ultimately lead to the development of depression. I'm just gonna use depression as an example. But the automatic thoughts don't themselves cause depression. Okay, so the easiest way to talk about a formulation is by presenting a case. So I'

In this episode of Let’s Talk About CBT- Practice Matters, host Rachel Handley is joined by two leading experts in perinatal mental health- Professor Heather O’Mahen and Dr Sarah Healy. Together, they explore the unique challenges, adaptations, and opportunities that come with providing effective CBT for individuals during the perinatal period. Heather and Sarah draw on their clinical experience, policy work, and research to discuss why perinatal-specific approaches are needed, the prevalence and impact of perinatal mental health difficulties, and how therapists can adapt CBT to meet the needs of diverse parents and families. The conversation also covers access to care, the role of identity and stigma, supporting culturally diverse and neurodiverse parents, and therapist wellbeing when working in this emotionally heightened period. Whether you're working in NHS Talking Therapies, secondary or specialist care, private practice, or simply want to deepen your understanding of this vital area, this episode offers compassionate insights and practical strategies for helping parents during this transformative time. Resources & Further Learning: ·        Find out more about the Pearl Institute here ·        Access the Perinatal Positive Practice Guide here ·        Take part in the Jame Lind Alliance perinatal mental health survey here ·        Listen to the our previous episode on OCD in the perinatal period with Dr Fiona Challacombe Stay Connected: Follow us on Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don’t forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let’s Talk About CBT and Let’s Talk About CBT – Research Matters for more discussions on evidence-based therapy. 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 edited by Steph Curnow Transcript: Rachel:  Welcome to Let's Talk About CBT-Practice Matters, the BABCP podcast for therapists using cognitive behavioural therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who will share insights that will help you understand and apply CBT better to help your patients. Today, we have the pleasure of being joined by not one but two experts in perinatal mental health, Professor Heather O’Mahen and Sarah Healy. Professor O’Mahen is Professor of Perinatal and Clinical Psychology at the University of Exeter and world leading expert in treatments for depression and anxiety in the perinatal period. Her work focuses not only on improving treatments, but also on improving treatment access, for example, through digital delivery. Heather is also currently National Clinical Advisor to NHS England's Perinatal Mental Health Policy Team. And Dr. Healy is a leading perinatal clinical psychologist with over 20 years’ experience in the field. She co-led with Heather the development of the Talking Therapies perinatal competency framework and contributes regularly to the development of perinatal mental health policy. They've also founded together the Pearl Institute, which provides evidence-based training for clinicians working in the perinatal period. You're both so welcome. Thank you so much for making time in your busy schedules to come on the podcast. I think the fact that from the first planning to recording this podcast has taken us about 10 months is probably a good indicator of just how busy you are doing this brilliant work. Heather: Thanks for having us, Rachel. Rachel: Now, I know you're both hugely committed to working in perinatal mental health, and I'm wondering how you came to work in the field and what's kept you fascinated by it personally and professionally? Heather? Heather: Well, I came to it accidentally. I applied to do a post-doc at the University of Michigan when I was living in the States and it was in primary care. But they had rejigged things and then said, we have this other one in perinatal mental health, would you be interested? I had a long-standing interest in women's mental health so that sounded really great to me and I said, yeah, I'm definitely interested. Then I started doing therapy with women, parents from the perinatal period, and also doing research in the area, and I just couldn't stop. It's such an incredible, transformative period in people's lives. It's such a meaningful time to get to work with folks. There's so much that's going on, but there's so many opportunities to walk alongside people during this period of change. And then of course I had my own children and that fed it further. And so here I am. Yeah, yeah, yeah. Then you learn like, wow, it really, really, really, really is important. Rachel: You learn what it's really about. Fantastic. And how about you, Sarah? Sarah:  Yeah, I guess I came a bit of a roundabout way into perinatal. My early kind of career was more on the research side of things, but I started with a master's in the psychology of early development. I was really interested in that early mother-infant relationship. So I did my PhD in that area and I kind of been moving towards clinical psychology. Thought I would end up in CAMHS because I really liked working with children and that kind of parenting piece and then have the great fortune of having an assistant psychologist post in a mother and baby unit. And I just really found the work fascinating and as Heather kind of said, such a transformative time to be working with. So that kind of started me on my perinatal path. And since then, I've really just found the work so rewarding. And similarly having my own, my son, obviously now eight, he just turned eight. The perinatal period is a little bit a while ago, but I think I learned a lot from the work that really helped me as a parent and then being a parent really, I guess, added to my knowledge and passion for the area. Such an exciting, interesting area to work in and you get such variability in the type of difficulties people are having and the outcomes are so rewarding. I get emails from clients I saw years ago, of pictures of their children that are now eight, nine, ten, and you feel you've been really part of that process. Rachel: Wow. So it sounds like you both really have a deep commitment to women's mental health, to parents, to babies, to seeing kids develop and thrive. And that you've really enjoyed working in this joyous, but also incredibly vulnerable and challenging period with people where you can really make a difference. Now, certainly my experience, I've got three kids and experienced postnatal depression after two of them and I remember look back at it being such a precious, incredible time, really special time in my life despite that, but also all these challenges that are piling in. And yeah, at eight, the challenges continue don't they Sarah, but there's a little bit more sleep maybe. Sarah: The sleep is nice. Rachel: But it sounds like you also both had an excitement about bringing together research and practice around multiple areas like physical and mental health and adult and child developmental psychology in ways that can make a big difference and you both obviously live and breathe this work at home as well. But people who haven't worked extensively in the area might ask if we need a special approach to perinatal mental health, you know, can't we just apply what we already know about the evidence-based practice and approaches to depression and anxiety, for example, for the adult population and adapt those where we need them in line with our individual formulations. Heather: I think that's a really good point. And the evidence would suggest that we can adapt many of the interventions that we do have, but that it's really important to understand what's going on for perinatal parents during this period of their life and to be able to, in those formulations and in those adaptations, make sure that you're addressing the key issues that are important for them. I think this has been for some and maybe historically challenging to get their heads around maybe a little bit. Back in the day, back before there was this lovely investment in England in perinatal mental health care, it was certainly the case that I would talk to some clinicians or service leads and they go, ah, but we don't really see that many perinatal parents in our service. I don't think there's actually really much of a need- and nothing could be further from the truth. The need is just as great, if not greater and we know that we see an increased incidence around issues like say OCD during this time and also that there are real problems around birth trauma and issues around loss as well. So it is that parents do experience problems during this time. They do want support, but they want the support that's really family focused, that really understands that the baby is so integral in their lives at that point, and that can address it. And we can do that, but we need to get it right. And if we don't, we don't see the parents, just like the service leads said, we won't see them if we don't get them what they need and want. And I think we can compare this to other significant problems that people might be having and very intensive or transformative parts of their lives, like veterans, for example, or people with long-term medical conditions. And we definitely see the priority there that we need to adapt for those problems as well. So likewise let's do right by perinatal parents. Sarah: I think just to add to that Heather, I completely agree with all those points there, but also thinking about looking at services that are doing it well. And when you have services that really are adapting their interventions to be specific to clients in the perinatal period that are doing lots of outreach, that are liaising with other perinatal colleagues, oth

In this episode, Rachel talks with Professor Barney Dunn, clinical psychologist and researcher at the University of Exeter, about his work on Augmented Depression Therapy (ADepT) a novel approach to treating depression that targets anhedonia (difficulty experiencing pleasure) and aims to boost wellbeing. Barney shares personal and professional insights into why and how traditional CBT might be augmented to actively help people rediscover joy and meaning in life. He explains how ADepT, based on systematic research, integrates cognitive behavioural principles with techniques from ACT, mindfulness, strengths-based CBT and more, all aimed at helping clients live well alongside depression rather than simply reduce symptoms. Whether you’re a therapist working with depression or simply curious about new directions in CBT, this episode offers a thought-provoking and inspiring conversation about what it really means to get better- and stay better. Resources & Further Learning: Find more information about Barney and his publications here Find out more about ADepT here Stay Connected: Follow us on Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don’t forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let’s Talk About CBT and Let’s Talk About CBT – Research Matters for more discussions on evidence-based therapy. 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 edited by Steph Curnow Transcript: Rachel: Welcome to Let's Talk About CBT Practice Matters, the BABCP podcast for therapists using cognitive behavioural therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who will share insights that will help you understand and apply CBT better to help your patients. Today, we're joined by Barney Dunn, a highly renowned research and clinical psychologist specialising in therapies to improve wellbeing and functioning in depression and related mental health conditions. Professor Dunn is based at the University of Exeter, and he has a finger in many interesting pies, but today he's here to talk particularly about his work developing and implementing treatment for depression with a particular focus on symptoms of anhedonia. Thanks so much for joining us, Barney. Barney: Thank you very much for having me, delighted to be here. Rachel: And just as a starter, we want to think about how you got into this area of research. And as I said, you're interested in lots of different things, but you've devoted a lot of your time and effort to thinking about anhedonia. There's so much to fascinate in clinical psychology. I wonder what got you interested in the field of depression and specifically this anhedonia area personally and professionally? Barney: Professionally, when I was doing clinical training and learning to cut my teeth with a lot of depression cases, hitting a point where I felt like I'd done quite a lot of work reducing the negative and reducing symptoms, but the job was only half done. And clients were saying things like, at the end of therapy, well, I'm not depressed anymore, but I'm still not quite sure what life's for and I'm not enjoying stuff. And I felt...Well, maybe I'm not doing CBT correctly, or maybe there's a bit of a trick missing about how we can do that stuff better. So that was the kind of professional route into it. The personal route into it was a bit more growing up with my dad. So I lost my mum when I was little and was very well supported by my family but seeing my dad in my eyes never quite get back to life, never rediscovering joy and connection and meaning and grinding through and turning the wheels, but not getting pleasure back and thinking there's a missed opportunity there. Even after the difficult, there's possibility for the good. And so that's the kind of personal motivation is thinking of clients like my dad, how could I help them get back to life when they've been through some difficulty and rediscover wellbeing and joy? Rachel So that really meaningful connection for you from your own lived experience with being alongside someone who never got that meaning back. Those are big questions. And I hear what you say, you working in depression, you get good results with your clients in terms of their symptoms improving, but you talked about a job half well done or half done. Currently, how well are these symptoms targeted in mainstream treatments? I mean, it's a brave man who takes on, you know, Beckian cognitive therapy and thinks, right, we need to do better. Barney: Well, I mean, we should follow the data. So if you do Beckian cognitive therapy and indeed any other evidence-based treatment for depression under ideal circumstances, really good therapists who are really well supervised, you basically get about 60 % of clients who will meet diagnostic remission at the end, half of whom will relapse within the next two years. So that's ultimately a 30 % proper response rate. And that means we leave a lot of people with a lot of distress afterwards, you know, 70 % of the people that are coming through our doors. If you look at NHS Talking Therapies reliable recovery rates for depression lag a bit behind anxiety recovery rates, and they're a bit below 40%. So more than 60 % of the folks coming through NHS Talking Therapies with depression will be depressed again within a couple of years. So there's definitely still a problem to solve and it feels like a really interesting and clinically important question to work on but one to be humble about because lots of really great minds and really hardworking people have thrown themselves at it, and what we've done is proliferated a lot of equally partially effective treatments but we haven't made any stepwise gains since Beck who did make that massive stepwise improvement in the late 70s. Rachel: Yeah. So it's great that there's evidence-based treatments are out there, but there's still a lot of people that find that there's something lacking at the end of therapy or even don't improve. So if we treat the sort of negative feelings, so there's negative symptoms of depression. Doesn't that automatically also address some of this anhedonia or positive valence system? And if not, why not? Barney:  So I think that's the assumption we all came from to start with, which is there's a continuum of affects, which you go from being really negative, you get to this middle point where you've been meh, and then you move to this position where you're feeling really positive. So if you bring down the negative, the positive will inevitably increase. But then there's been some interesting other ways of thinking about that and recognising that they're at least partially dissociable systems, which means positive affect can move when negative affect doesn't move and vice versa. And again, just to come back to my dad as a case example, when my dad was dying of cancer, there was a lot of distress and difficulty and pain. And there wasn't a way to make that go away. He was dying of cancer, but that didn't mean there weren't things we could do to find wellbeing within the midst of that. One of my favourite memories with my dad in the last few months was he wanted to drive his car again, but he was on too much morphine to drive safely. So we put him on the sit on mower and drove around the garden, kind of destroying my mum's prized flower beds and my stepmother's prized flower beds. And that's one of my favourite memories, like chuckling with my dad on morphine, driving badly around the garden, amongst a whole lot of negative affect. So I think it's quite useful to realise even in the midst of depression, you can find joy and pleasure. There's also an increasing basic science argument here, which is the systems of the mind and brain that regulate negative emotions and avoidance of threat are partially dissociable from the systems of mind and brain that regulate positive emotions and approach towards things. So you can move one without moving the other. And my view is you need to do both in therapy. Bring down the negative, push up the positive. Rachel: Does everyone experience, I mean, you've just spoken about an example of your dad experiencing lots of negative emotion, but still having that positive emotion. Does anhedonia develop for some people and not others in the context of depression? Barney: I think it's like most ways of thinking about depression, things fall on a continuum. Estimates of how many clients have clinically significant anhedonia ranges from 30 % of them having really severe and profound anhedonia to 70 % having significant anhedonia. It's one of the, along with elevated negative affect, it's one of the two cardinal symptoms you need to get a diagnosis of depression. So it's pretty prevalent, but it isn't there for everyone. And it isn't there for the people that have it all of the time. Its just sometimes people need to develop the skillset when anhedonia is with me, how can I step away from it and get back to wellbeing and joy? Rachel: And is there a differential pathway? I mean, will it be some people who are more likely to develop anhedonia than others or circumstances that are likely to lead to that? Or as you say, is it just likely to be there or not at different times than that pathway? Barney: Well, so my view again is like most symptoms, there are many ways into it and many ways out of it. So it's dangerous to put hard and fast generalisations onto it. But I would say there definitely is a kind of genetic, biological basis for your reward system to be more or less reactive for better or for worse. So some people are just born with a capacity that reward washes over them and they really enjoy it. Others have to work a bit harder. I'm increasingly struck that in people's deve

In the second part of this episode with Professor Steve Hollon, we go beyond theory into the heart of applying cognitive therapy for depression in real-world settings. Steve shares what therapy really looks like across the spectrum from relatively straightforward to deeply complex clients and how therapists can stay grounded and effective, even when things feel messy. Resources and links Cognitive Therapy of Depression (Second Edition) Find out more about Steve and his research here OXCADAT: A wealth of useful videos and therapist resources for social anxiety, PTSD and panic disorder can be found here: https://oxcadatresources.com/ Stay Connected: Follow us on Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don’t forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let’s Talk About CBT and Let’s Talk About CBT – Research Matters for more discussions on evidence-based therapy. 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 edited by Steph Curnow Transcript: Rachel Handley:  Welcome to Let's talk about CBT- Practice Matters, the BABCP podcast for therapists using cognitive behavioural therapy with me, Rachel Handley. Each episode we talk to an expert in CBT who will share insights that will help you understand and apply CBT better to help your patients. Welcome back to part two of our conversation with Professor Steve Holland, international expert in cognitive therapy of depression. In our last episode, Steve gave us some fascinating insights into the development of the cognitive model and how we can understand the development and maintenance of depression. In this episode, Steve talks in detail and with lots of examples about how to apply the therapy to really help people with all sorts of complexity in their lives without fear of getting it wrong. So let's dive straight in. Rachel Handley: And so, if you had to put in a sentence the main task of therapy, and I know asking any researcher to put anything into one sentence is a challenge, right? But what would you say is the purpose of therapy that we need to keep foremost in our minds to guide therapy? Steven Hollon: I'll say two things if I can Rachel Handley: I'll allow you two. Steven Hollon: Then I'll say two things. The first component is, when in doubt, do. If you're depressed, don't wait to feel like doing something. You're not going to feel like doing anything. Do the stuff you would do if you weren't depressed. And then the desire will come back, but don't wait to feel like it. And the second thing is don't believe everything you think. And the most powerful way to disconfirm an existing belief is to test it in a situation that your therapist can't control. Therapists get paid to tell people they're okay, or in some cases, dynamic, tell people they're not okay and if you've got kids to put through college, that's a nice, long term life lifestyle. But, what I'll do with the client when we start out and I learned to do this with Tim Beck and Maria Kovacs and others is in the very first session say, look, we can do this a couple of ways. There's some things I'd like to teach you how to do. And I can either do them for you or I can teach you how to do them. My goal is to make myself obsolete. Is that okay with you? And usually then people say, yeah, I’d prefer that. Usually, occasionally they won't, but usually they'll say that. And I’d say, now, if we were going to help you learn how to do these things, how can we do that? Say, well, can I work on this stuff between sessions? That's a great idea! So let people reinvent the therapy each time coming through. Then you'll end the session and have something for them to do between this and the next session. And by the way, every major study that has shown an efficacy for cognitive therapy has always seen people who are clinically depressed at least twice a week in the beginning. If I have to wait seven days to meet somebody, to work with somebody who's deeply depressed, they're going to forget who I am. I mean, their hippocampus is turned over. It's a, you have to reintroduce yourself. I get a little momentum going over that first session. Give me two or three days later I can keep the momentum going like Sisyphus pushing the rock up the hill. I don't know what things are like in the UK, but I would always want the depressed client to have twice weekly sessions in the beginning. It doesn’t have to be an office, one could be over the internet and then I'll space it out later on. Maybe we get a couple of weeks in, then we'll drop back to every other week. Rachel Handley: And certainly that kind of frequency of therapy is one where we have fallen into habits of, the routine is once a week for an hour on the same day and not one that a one that services often struggle with implementing logistically in terms of this, but certainly, looking at the evidence and the good clinical practice, it seems to be a point that bears reiterating. Steven Hollon: Its for the benefit of the convenience of the therapist, not for improving clients. Rachel Handley: So in terms of therapy, then it's don't think about it, do it. And don't believe everything you think. Steven Hollon: Well, yeah, in terms of the behavioural components, don't wait to feel like it. Do it. But when you do, do a test that tests your beliefs when you do it. With the sculptor, if you don't think anybody's going to hire you, then put applications in. Let's see if you're right. You might be, in which case work on a career change, but don’t your problem is right now not that you're incompetent. You might be. Well, we don't know that yet. What we do know is you're not sending out your portfolio and until you send your portfolio out, we don't know how competent you are. So let's find out. Rachel Handley: So let's test the strategy. So keeping in mind that you've said in the manual, which is a brilliant revision, the second edition of Cognitive Therapy for Depression, that therapy is not just a set of strategies or techniques, however, it's helpful to know what a typical course of therapy might look like. Can you tell us what an episode of therapy might look like for someone coming in for cognitive therapy for depression Steven Hollon: I mean, yeah, that’s a great question. I think it depends very much on what the client walks in the door with, like the sculptor, nothing much going else going on for him, except he had lost his job, probably no misfortune of his own, but he was going about getting the next job the wrong way. I mean, he was working, but something he didn't consider work and it was just a relatively simple matter of pitting his Theory A, which is I'm incompetent versus Theory B, which is he's going about it the wrong way, which is take a big task, break it into small steps, take it one step at a time, rather than getting overwhelmed with the magnitude of the task. Easy for him. Another client that I talk about is a woman that came into one of our trials that Rob DeRubeis and I were doing, and she ended up drawing me as a therapist. She knew some of the graduate students already. She'd done her training at Vanderbilt several years earlier. And when she got back to town at this point, on the way to getting divorced, real things have blown up for her in her personal life. She's absolutely devastated. Gets back into town, talks to some of her graduate student colleagues, hears about this study, decides I'm going to be in that, goes on clinicaltrials.gov, looks up what the inclusion-exclusion criteria were, sees that we were referring out people with borderline because they could get DBT in Nashville, they're going to do better with that than with what we had to offer. She borrows a copy of DSM, looks up what criteria are for borderline, knows what to deny when she comes in for interview, gets screened into the trial, gets me as a therapist, to her misfortune. In the first session, I start the thing about saying what I prefer to do is teach you how to do this as opposed to simply do it for you. And she said no, you don't understand. I am flawed. I am deeply flawed. Something happened to me as a teenager. I don't want to talk about it. I don't think we need to, but it changed me forever. I tear up anybody I get close to. I would like to have relationships with people that I care about. But anybody I get romantically involved with, I just tear them to shreds. I become this dragon lady, tiger lady. And she said, no, don't worry about that cause I'm 29. I turn 30 in six months and I don't plan to live past 30. And the third thing she said was now I'm an incorrigible liar and you can't believe a word I say, will be a problem for therapy? And of course it won't be, and it won't be a problem for therapy because no matter what story she makes up, it's going to have coherence. Evolution constrains that if she comes and tells a story about something that got her angry, then she's going to have cognitions that are consistent with somebody did something they shouldn't. The physiology is going to be aroused, and the behaviour is going to be want to attack, which is what she did in context of her relationships. So you can work with all that stuff. I never worked with somebody quite like her before, we were 3 years and in the beginning, because she was able to coerce me into it, we were meeting daily and we're meeting pretty much daily for the 1st year. And then we drop back to a couple of times a week in the 2nd year and then spaced out beyond that time. She made a marvellous return recovery, but it was slogging and I didn’t know what we were doing half the time, so we're making it up as we go along, more complicated minds are going to take longer. Now, I know from some of the training with IAPT folks, th

In the first instalment of this special two part episode, Rachel Handley talks to Professor Steve Hollon, international expert on the prevention and treatment of depression and co-author of the second edition of Cognitive Therapy of Depression about how we understand and treat depression. Steve shares what first drew him to the field, his early encounters with Aaron T. Beck and the rise of cognitive therapy, and how insights from evolutionary biology, psychology and neurobiology can enrich our understanding of depression. Next time: In Part 2, Professor Hollon discusses how CBT can be applied to a wide range of presentations, from more straightforward to highly complex and even tries his hand at devising a brief intervention for the President of the United States. Don’t miss it! Resources and links Cognitive Therapy of Depression (Second Edition) Find out more about Steve and his research here OXCADAT: A wealth of useful videos and therapist resources for social anxiety, PTSD and panic disorder can be found here: https://oxcadatresources.com/ Stay Connected: Follow us on Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don’t forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let’s Talk About CBT and Let’s Talk About CBT – Research Matters for more discussions on evidence-based therapy. 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 edited by Steph Curnow Transcript: Rachel Handley:  Welcome to Let's talk about CBT- Practice Matters, the BABCP podcast for therapists using cognitive behavioural therapy with me, Rachel Handley. Each episode we talk to an expert in CBT who will share insights that will help you understand and apply CBT better to help your patients. My guest today is Professor Steve Hollon, who had so much fascinating information, theoretical and clinical insights and stories to share that we just had to produce a special two part episode. In this first part, Professor Hollon shares the reasons for his fascination with depression, the story of Beck's development of the cognitive therapy for depression model and insights from psychology, neurobiology and evolutionary biology that can help us understand the development and maintenance of depression. Professor Hollon is an international expert on the prevention and treatment of depression and co-author of the long awaited second edition of Cognitive Therapy of Depression, the definitive and groundbreaking psychotherapy manual, first published by Aaron T Beck and colleagues in 1979. Professor Hollon is professor of Psychology at Vanderbilt University in the US but is no stranger to us in the UK and supporting the dissemination of evidence-based therapies here as he regularly provides training to services in the UK and teaches on the Talking Therapies Program at the IOPPN annually. So welcome to the podcast, Professor Hollon. Steven Hollon: Thank you very much. And Steve, please. Rachel Handley: So Steve, you've been working in this field for quite some time now, you might not want to tell us how long, but can you recall for us who or what got you invested in the field of depression personally and professionally? Steven Hollon: Yeah, I can't tell you exactly why I got interested in depression, but that goes way, way back. We have some family history that I got my own personal history of episodes of depression, but to make a long story short, I was in graduate school in Florida State which was good, strong program, but I was reading Aaron Beck and Marty Seligman and Jerry Claremont, the fellow that generated IPT and I was showing up, in those days we had libraries, we had stacks. And I was looking at some of the same journals that my then graduate student colleague Judy Garber, now 50 years now we've been together looking at the same kind of things and we just decided that we weren't getting the kinds of training that we absolutely wanted, as good as the program was in Tallahassee, we want to work with some of the leaders in the field. So she wrote to Marty and cut a deal with him to run his research labs while he was off on sabbatical at the institute in London. And I was finishing up my dissertation collection data and I followed her up about six months later, with the notion that I would work for Beck. Of course, Tim Beck didn't know me from Adam and couldn’t get in to see him. And his cognitive therapy approach hadn't taken off yet, but we ended up seeing that his group was going to be presenting at a conference, Society for Psychotherapy Research in Boston. So we drove up the coast and went to the meeting there and I spent the next three days getting to know the other people in this research group and, talking with Maria Kovacs, really first rate psychologists who ended up becoming a leading figure in developmental psychopathology, Hungarian and wanted to go back to Hungary for an extended visit that summer and Tim was reluctant. They had a research grant going on. She was interviewing people that survived suicide attempts. I'm just hanging out on the fringe of the group, and I said, well, I'm a psychologist, I'll stand in for it. So I stood it on a volunteer basis and spent the next three weeks trying to make myself indispensable. We ended up negotiating my first year in Philadelphia as my clinical internship. Second year, with Tim's blessing, I went over to the psychiatry residency program, continued working with him, and then ended up going off to Minnesota for a job I was thoroughly unprepared for. Nonetheless, things went well, I got an offer and went out there. Judy graciously finished up her doctoral training at Minnesota and eight years later, we were left eight years and 16 winters later, we left for Nashville Vanderbilt and where we’ve both been on faculty for close to 50 years. Rachel Handley: Wow, that's quite a trajectory. I'm old enough to remember what it's like to go down into a basement of a library and roll the stacks along and actually have to find a physical journal paper, not just type it in on the internet. Right. But from there to working at the heart of the revolution, really, of cognitive therapy with Beck and his team must have been quite something. Steven Hollon: It was something, but it was not a thing yet. Tim Beck, Philadelphia Penn was heavily psychodynamic, he was heavily ostracized. He'd been dropped by the Philadelphia Psychoanalytic Society. Every year they'd have the various psychiatry faculty meet with the residents, and when he met with the residents, virtually nobody showed up. It became a thing with the publication of the first outcome trial, the Rush et al study that suggested that cognitive therapy not only held its own with medications, it was actually better than turns out. It only looked better than because we did a terrible job with the medication comparison, but everything since that's done a good job with cognitive therapy, done a good job with medication treatment suggested they're about comparably effective and cognitive therapy has an enduring effect that cuts subsequent risk by about half something medications can't do. Rachel Handley: And as you hinted there, that was the journey for Tim Beck as well. He came from this psychodynamic background training team, anyone with a passing interest in cognitive therapy now knows about or has started by training in the principles and practice of cognitive therapy for depression. But can you tell us a little bit about his story and the development of the approach? Steven Hollon: Yeah, he was, although he was marvellous fellow, a marvellous human being, but originally wanted to be a pathologist because you could get definitive answers, but he ended up getting diverted into psychiatry. And in those days, the late 40s, early 50s, everybody was trained dynamically. He was trained by some of the best. And of course, the dynamic explanation for depression was it was anger turned inward. These were unconscious motivations laid down in early infancy, to be angry with your parents about something, some kind lack of sexual gratification and the notion was you had to, the patient himself or herself couldn't be aware of what their true motives were because there were defence mechanisms that got in the way. So you had to sneak up on them. You had to rely on free association. People would take the couch and just say, first thing that popped into their head, or you would interpret dream content, and you might spend two or three years exploring the underlying motivations without ever approaching them directly. The therapist might go, certainly better part of a session without saying anything. So it was a very long term, expensive therapy form of therapy. Tim was interested with his interest being a pathologist was interested in doing some research as well. And he was struck by the fact that the things his clients to him and their free associates in their dreams, which is like what they told him when they were walking into the office. I'm an addict. I'm unlovable. I'm a loser. I never do anything right. As, and they weren't screens for underlying, sexual and aggressive drives, They were just what they believed. He did some research where he investigated dream content, investigated free associations, and as hard as he looked, he could not find evidence of anger turned inward. It just wasn't there. He did an experimental study with colleagues across the street in psychology at Penn where they manipulated outcomes on a performance task. And it turns out if you want to get somebody who's not depressed really activated and motivated to try harder the next time, give them a failure experience. Rig it so they don't win. If you want to get somebody who's depressed activated the next time, give them a success exper

In this episode of Let’s Talk About CBT- Practice Matters, Rachel Handley talks to two expert guests – Professor Kim Wright from the University of Exeter and Associate Professor Tom Richardson from the University of Southampton – about bipolar disorder and the role of CBT in supporting people with this diagnosis. Tom and Kim share their extensive clinical and research experience, alongside insights from Tom’s own lived experience of bipolar disorder. They discuss common myths, the importance of timely and accurate diagnosis, and how CBT can support people with bipolar in a meaningful and collaborative way. They explore what CBT for bipolar looks like in practice, including work on relapse prevention, mood stabilisation, routine regulation and addressing beliefs about mania. The conversation also covers important systemic issues such as gaps in service provision, barriers to access and the need for more widespread training and implementation. This episode is released to mark World Bipolar Day and aims to raise awareness and improve understanding of this often misunderstood condition. Resources & Further Learning: ·        Richardson, T. (Eds). Psychological Therapies for Bipolar Disorder: Evidence-Based and Emerging Techniques. Spinger-Nature, 2024. ·        Bipolar UK Commission ·        Find out more about Kim Wright’s research and publications ·        Find out more about Tom Richardson’s research and publications Stay Connected: Follow us on Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don’t forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let’s Talk About CBT and Let’s Talk About CBT – Research Matters for more discussions on evidence-based therapy. 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 edited by Steph Curnow Transcript: Rachel: Welcome to. Let's talk about CBT Practice Matters, the BABCP podcast for therapists using cognitive behavioural therapy with me, Rachel Handley. Each episode we talk to an expert in CBT who will share insights that will help you understand and apply CBT better to help your patients. Today I'm delighted to be joined by not one, but two expert guests, my wonderful friend Kim Wright, Professor of Clinical Psychology at the University of Exeter, and the equally wonderful Tom Richardson, Associate Professor of Clinical Psychology and CBT at the University of Southampton. Both of our illustrious guests specialise in researching, treating, teaching, and training others in psychosocial interventions for bipolar disorder. Welcome guys. Tom: Thanks for having us. Rachel: I know you've both been working in this field of bipolar for many years. Kim, when I first met you, you were doing a PhD in bipolar, even before embarking on your doctorate in clinical psychology. And Tom, I know you have personal as well as professional reasons to be so committed, and passionate about the area. Can you tell us a little bit about your pathways into this work? Kim: Yeah. Hello Rachel. It's really good to be here. So, I, started out quite a long time ago, when it was possible to finish your psychology degree and go straight into a research associate job and I was very fortunate to be able to do that and work with Dominic Lamb on his trial of CBT for people with bipolar, for relapse prevention. And that is at the, or was at, Kings College London and it was one of the early CBT trials in the area and it was really exciting to be involved in it and as part of that, again, this is a bygone era, it was possible to do a part-time PhD that was heavily subsidised for members of staff of the institution. So I did my PhD part-time with Dominic alongside my role, and that gave me the opportunity to meet hundreds of people with bipolar disorder and hear about their experiences. And then, after I finished, I did clinical psychology training and then worked in a community mental health team for a bit. And then I had a really wonderful opportunity to join the clinical research group at the University of Exter where I am now. And back then it was led by Willem Kuyken and Ed Watkins, who work in the area of depression. And they liked the idea of broadening out the team to include a focus on bipolar. So that was a great opportunity for me to return back to research in the area of bipolar and also to work in the research clinic that we set up in the university not long after. Rachel: What a brilliant opportunity to work with such amazing people, but also to be in there from the ground up, working on that first CBT trial in the area. Really exciting. How about you, Tom? Tom: Yeah. Well, as you said, my research interests really has come a lot from my own experiences because I have Bipolar disorder type I. I haven't always been completely open about that. It's taken a few years of qualified life for me to feel comfortable with that, but yeah, I ended up having a manic episode just after my A levels, just before I started my degree, my undergraduate degree. I ended up in a hospital with a manic episode, so that got me interested in it. And then, when I was doing my undergraduate degree, actually I started doing a little bit, I started doing some stuff for kind of student journals and my thesis was actually about hypomania and how it relates to impulsivity and risk taking in the general population. So I actually became hypomanic about my dissertation, about hypomania. So, and then I was working as a research assistant on sort of computer-based CBT at the University of Bath with children. But I did a little bit of stuff, a few bits of research and kind of papers around bipolar disorder, around like letters to the editor and reviews and that kind of thing. And then when I started my doctorate here in 2010, and that's when I started to get my kind of first real clinical experience, my first placement, I worked with a couple of people with bipolar disorder. And then, I was working in the NHS in Portsmouth community mental health teams for eight years. And that was a whole range of problems, but I did a lot of bipolar work there. I set up and ran a bipolar group, which was, which I really love doing. So it's gone from there. And then I joined the university in 2021, and this is a big part of my research here is about psychological therapies for bipolar. So influenced by my own experiences a lot of the time, as well as my service users. Rachel: And I know that's naturally and rightly a very personal choice to share that information about your own mental health, but incredibly helpful, I think, for other mental health professionals as well as I'm sure your research to de-stigmatise that area and to be able to think about it from the inside out. Tom: Thank you. Rachel: We've recorded a number of podcasts recently on unipolar depression, and in fact, we've got a whole series of podcasts on depression coming out. This will probably be the first one because we've got World Bipolar Day coming up, but those conversations really underlined to me how common unipolar depression is. And our listeners will be not only aware of that, the massive numbers of people suffering from depression, but also probably seeing them in their practice’s day in, day out. But bipolar is perhaps a little less well recognised and understood. So, can we start with some of the basics? How might we recognise bipolar disorder or bipolar spectrum disorders outside of sort of dramatic portrayals, like the likes of Claire Danes on Homeland? Kim: Yeah, so you're absolutely right. Bipolar is quite a lot less common than unipolar depression. I would say if you're seeing someone with recurrent depression and they report periods of consistently elated or irritable mood that go on for, say around four days or so, as well as some heightened energy and activation that's pretty persistent over that period, you could ask them a bit more about that time. A key thing is often sleep, people often talk about dramatically reduced need for sleep, but still feeling rested. They might also talk about that their mind's racing, that they're talking a lot more than normal and importantly, if they're around other people, noticing that they're different at those times and there isn't another obvious explanation like stimulating drugs or an overactive thyroid, for example. And I think it can be a tricky one because I think a lot of clinicians are quite reluctant to pursue diagnosis for the, supposedly the milder, subtypes of bipolar. But there is this concern in the prescribing community about the potential for SSRI drugs, antidepressants, to increase vulnerability to mania. So it can be important for people to know if they do have that tendency to periods of hypomania, in terms of treatment choice, in medication. Rachel: Why? Why do you think clinicians are reluctant to pursue those diagnosis? What do you think is driving that? Kim: I think it's partly to do with maybe concerns about people getting a stigmatising diagnosis, concerns about people being, particularly young people, being prescribed what are often seen as quite heavy medications with a considerable side effect profile. And also, the difficulty that there can be if people have quite a rapid cycling, mild or subtype of bipolar with distinguishing that from other potential explanations. So that can make people, some clinicians, maybe more reluctant to diagnose. Tom: I think it's also worth saying that it also just gets missed a lot of the time. I was part of the Bipolar UK Commission, so we wrote some reports as part of that and that one of the key, really shocking findings was it was nine and a half years average to diagnosis. And nine and a half years after you'd been in touch with a mental health professional. Most people are originally diagnosed wit

In this episode of Let's Talk About CBT: Practice Matters, Rachel Handley is joined by Dr. Rebecca Murphy, a clinical psychologist and researcher specialising in Cognitive Behavioural Therapy (CBT) for eating disorders. Together, they explore the complexities of eating disorders, effective treatment approaches, and ways to improve accessibility to evidence-based interventions. Resources & Further Learning: Visit cbte.co for information on CBT-E, training, and resources. Learn more about Rebecca’s research at the Centre for Research on Eating Disorders at Oxford (CREDO). The CREDO Contributors' Group is for individuals who are interested in our work, including people with lived experience of eating disorders, members of the public, and professionals with an interest.  People in our Contributors' Group may be invited to participate in future research and consultation if they wish.  Join our Contributors' Group by emailing credoenquiries@psych.ox.ac.uk. Please contact: Lisa.debrou@credotherapies.com if your clinical practice is interested in using Digital CBTe Rebecca’s research ad publications can be found here: https://www.psych.ox.ac.uk/team/rebecca-murphy Follow Rebecca on Twitter/X: @rebeccamurphyox for updates on her work. Read Overcoming Binge Eating by Christopher Fairburn – a key resource on CBT for eating disorders. Stay Connected: Follow us on Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don’t forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let’s Talk About CBT and Let’s Talk About CBT – Research Matters for more discussions on evidence-based therapy. 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 edited by Steph Curnow   Transcript: Rachel: Welcome to Let's Talk About CBT Practice Matters, the BABCP podcast for therapists using Cognitive Behavioural Therapy with me, Rachel Handley. Each episode we talk to an expert in CBT who will share insights that will help you understand and apply CBT better to help your patients. Today, I'm really delighted to say we're joined by Dr. Rebecca Murphy, clinical psychologist and senior research clinician at the University of Oxford, specialising in CBT for eating disorders and its dissemination. Welcome, Becky. It's really lovely to have you on the podcast. Thanks so much for joining us. Rebecca: Thank you so much, Rachel. It's such a pleasure to be here, and to be part of this really interesting series that you've put together. Rachel: Becky, we go back a few years, right? We probably even unknowingly crossed paths in the psychology department when we were undergraduates overlapping. But ever since I've known you properly when we embarked on our clinical psychology training, you've been really interested and passionate about eating disorders. I'm wondering what got you interested enough in the field, personally, professionally to pursue this as essentially your life's work? Rebecca: Yeah, thank you so much, Rachel and it's lovely to be speaking with you, as we have known each other for such a long time. So, I guess my interest started with mental health generally, and probably I had an interest from a very early age compared to most people, because my father was actually director of a therapeutic residential community for people with severe and enduring mental health difficulties. And as a director, he actually had to live on site, so I actually grew up surrounded by people with various mental health problems, seeing the impact it had on people's lives and being able to observe the difference that support and care made. I carried this through and that's why I studied psychology as an undergraduate. And within my course, we looked at different areas of mental health and I was very interested in eating disorders and what I especially loved was their complexity and the multifactorial elements. So as with many other areas, they're sort of no single cause. Yeah, you're thinking about biological, psychological, social factors. But I think with eating disorders, it's a really nice example of how all of those elements come together. So that was kind of my early interest. And I wanted to do something that would really make a difference, and I felt as if eating disorders as a field is actually still relatively young compared to some other psychological disorders so I really thought, Oh, I've got an opportunity potentially to make a big difference, as a researcher and clinician, in terms of thinking about new approaches, new ways of understanding eating disorders. And when I started to work with people, I also loved seeing how much people could change. So I really felt that it was an area in which there's so much hope because most people do get better and that was really rewarding to be part of. So yeah. That's where it all started. Rachel: And do you think that desire to make a difference, and that sense of hope was rooted in those early experiences that you had of living in that community? Did you see people's lives change, impacted there? Rebecca: Yeah, I think I did. I suppose I saw two things. One, if it's part of your everyday environment, it's very de-stigmatising, so you just see how normal it is for all of us at some point in our lives to have various difficulties, and I think I didn't really see it as something separate or that it was something that made people fundamentally different. I just saw it as part of a sort of continuum, that maybe we're all on. And I did, I saw people change. I mean, not necessarily the parts of them which they appreciated and valued but I could see that when people were really suffering, that was something that if you provided people with care and support, they were able to come out of and then they were able to make changes in their lives in terms of what they wanted, in terms of living independently or no longer being in such a state of distress. Rachel: So you could say that mental health has been part of your experience in terms of your genetics, your social environment and your psychological interest yourself throughout your life then. Rebecca: Definitely. So for me it was an everyday conversation from a really young age. Rachel: And I know you're interested not only in the what or process of treatment for eating disorders, but you're also interested in how we deliver therapy to make treatment more accessible and widely available. And we'll get into some of the great work you've been doing in that area. But given this is a young field as you've alluded to and there's probably still a lot of work to be done, how easy is it for folk who need access to good evidence-based treatment for eating disorders to access that? Rebecca: It is such an important question and unfortunately there is, as is the case in other fields as well, but there's a huge treatment gap between the number of people who could really benefit from treatment and the number of people who actually receive it. And perhaps there are two, two major sources of this treatment gap. One is that often people with eating disorders, they feel a sense of stigma or shame surrounding the problem so people may delay seeking help or never seek help because they don't feel able to disclose it to someone and so that's sort of an internal barrier. And then externally other barriers include that there is really only a limited number of trained therapists to be able to help people with eating disorders. So even when people do come forward and seek help, there aren't enough specialists to meet demand. And I mean, that's true even in kind of wealthy developed countries, and we know that only a small percentage of people with eating disorders receive recommended treatments. Rachel: So it's that double whammy of actually, it's really hard to get yourself to therapy because of that stigma, because of those barriers, and then you get there and you might not even be able to access it, so a lot of work to be done there. Rebecca: Yeah, absolutely. So it's a really difficult journey for people. Another barrier is often that people might present for help, but due to a lack of training, quite often primary care staff, so people sort of GPs and other individuals at the first point of contact, they aren't trained well enough to easily be able to recognise eating disorders as well. So people can get missed, misdirected or dismissed and if they even make it through that barrier, they might have to wait years to get treatment if they're even offered any, many eating disorder services are so limited that they can only offer treatment to people that are considered to be at very high risk, so other people just get turned away. Rachel: And the term eating disorders covers a really wide range of clinical presentations. I wonder if you can tell us a little bit about maybe some of the unifying characteristics of eating disorders and also aspects that might differ diagnostically, and what we know about typical presentations our listeners might see day to day in clinical practice. Rebecca: Yeah, that's a great topic to consider and I really liked how you started with asking about unifying factors because it's something that our research group at the Centre for Research on Eating Disorders at Oxford, our position is that we're more interested in features or characteristics of eating disorders rather than diagnoses. And quite often you do have these shared or unifying characteristics, which are quite specific to the eating disorders, but are shared across the group. And one of those characteristics is what we call an over evaluation of shape and weight and eating, which is where people's sense of self-worth depends largely or exclusively on their ability to feel like they're doing well in the areas of eating, weight and shape. So often peopl

In this episode of Let’s Talk About CBT – Practice Matters, host Rachel Handley speaks with Andrew Beck, consultant clinical psychologist, CBT therapist, and author of Transcultural Cognitive Behavioural Therapy for Anxiety and Depression. Andrew is a leading expert in culturally adapted therapies and a former president of the BABCP. Together, they explore the importance of culture, language, ethnicity, and identity in therapy and how these factors influence mental health, therapy engagement and treatment outcomes. Andrew shares his personal and professional journey into transcultural CBT and he and Rachel discuss practical strategies for therapists to approach conversations about culture and difference in therapy, as well as the evidence supporting culturally adapted approaches. Andrew encourages therapists to engage with these topics, step outside their comfort zones, and take a flexible and collaborative approach to transcultural CBT. 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 Instagram, @babcppodcasts.bsky.social on BlueSky or email us at podcasts@babcp.com. Resources & Further Reading Transcultural Cognitive Behavioural Therapy for Anxiety and Depression: A Practical Guide by Andrew Beck The Cognitive Behaviour Therapist Special Issue on Being an anti-racist CBT therapist IAPT Black Asian and Minority Ethnic Service User Positive Practice Guide 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 edited by Steph Curnow Transcript: Rachel: Welcome to Let's Talk About CBT- Practice Matters, the BABCP podcast for therapists using Cognitive Behavioural Therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who share insights that will help you understand and apply CBT better to help your patients. Today I'm going to be talking to Andrew Beck, consultant clinical psychologist and CBT therapist. Andrew is a former president of the BABCP and author of the influential book, Transcultural Cognitive Behavioural Therapy for Anxiety and Depression. He's also a leading expert nationally and internationally on culturally adapted therapies. So we're so delighted to have you, Andrew. It's one of the great joys of hosting this podcast, having the opportunity to read and reread the work of world experts in different areas of CBT, like yourself, and to talk to them about their work and having dipped into your book a few years ago over the years, it's been wonderful to have an opportunity to read it from front to back as there’s such a rich, wide ranging and thought provoking and practical information in it. I'm also really curious, cause at first glance, not necessarily the obvious choice of a topic for a white British therapist to write. And I'm wondering how you got engaged in this work. What's motivated and informed your interest in it personally, professionally? Andrew: Yep, it's a really good question, Rachel. And first, thanks for letting me know that it was a helpful book to you and something that was readable. It's one of those really difficult things about putting a book out there that you never know how it's landed and how it's landing, really. Because people pick it up, but you seldom hear from people about what it was like as a resource. I mean, how I came to be interested in it was through a couple of strands, really. One was quite personal, going right back to, I suppose like my early political life. I was born at the end of the 1960s. By the time I was 12, 13, the National Front who were kind of overtly racist political party were quite active in the area that I was growing up. And I think I was probably 13 when I first went on a kind of anti-Nazi league march and was listening to The Specials who were a band who really articulated the need to push back against that kind of growing tide of racism. And that was really formative for me as were some of the friendships and relationships I had during my teens and twenties, and being close to people who'd experienced discrimination at the sharp end. Really, as you say, I'm a kind of white English man, I'd never really experienced any kind of discrimination or hardship as a result of my characteristics, but politically I was interested in getting alongside people who had. So that was where it came from a kind of values point of view, I think, but in terms of how I ended up doing that as part of my job as well, is, so I was quite late to psychology. I graduated when I was around 25 and one of the first jobs I had was a research job in Nottingham, looking at how and why people used acute psychiatric beds. I was really lucky in that part of the team who were doing that work was a trainee psychiatrist called Swaran Singh, who's now Professor of Social Psychiatry in Warwick, but at the time he was just sort of finding his feet as a psychiatrist. And he said to me one day, have you ever noticed how nearly everybody who comes into these wards on a section of the Mental Health Act is a young black man? And I said, no, I hadn't noticed because, you know, I was a young white man. I didn't need to notice things like that. I didn't need to recognise those inequalities because they didn't really affect me, but Swaran as someone from a minoritised background had noticed. And what he was able to do was tack onto the study that we were doing, an additional study, looking at the rates of sectioning and who got sectioned and why. And with the statistical help of Tim Croudace, we wrote a paper that showed that young black men were massively disproportionately admitted under sections, despite the fact that the severity of their presenting problems was no greater than anyone else's. So that got me really interested in inequalities in mental health care. So I was really lucky that I had someone who opened my eyes to that really at a formative stage in my career. And then I spent three years as an academic, a research assistant, research associate. The professor in charge of my department told me that I'd never be a very good academic, but I'd probably be okay as a clinician. So then I applied for clinical psychology and began to practice clinical psychology in East London, where the patient group we were working with was diverse. So from the moment that I began to learn how to be a therapist, it was learning how to be a therapist with people from different backgrounds to myself. So that's how I became interested in that quite early on in my career, really. Rachel: So it sounds like you found yourself in a time and place in your life where there are these movements going on around your natural interest and inclination to stand up against racism and discrimination. But then also these key figures that drew you in and were generous with their time and thinking and their experience to help you think about ways in which you could really enact that in your work. Andrew: Yeah, that's absolutely right. I was so lucky in that, that there were a number of people who took the time to kind of help my thinking develop really. And that was generally people from minoritised backgrounds themselves who could see I probably had some kind of enthusiasm or interest and who sort of put the time and effort into bringing me along. And I'm really grateful for that really, I was very lucky to have those experiences. Rachel: And it's evident from your own history of your involvement in this work. This isn't a new conversation. It's not something that we're arriving to just now in terms of a therapy community. However, the way in which we discuss these things often feels quite tentative and people are coming to it often quite new and without kind of fully formed ideas. One of the things that might be helpful to think about upfront as we're having this conversation is what kind of terminology we might use in this podcast and maybe more generally that is helpful, rather than alienating for folk as we talk about transcultural therapy. Andrew: Yeah, that's a really good question, Rachel. And it’s one of those things that I think when I think back about how we had those discussions, in the kind of mid to late nineties, the language that we use then was very different to the language that I would use when I first started writing about this in publications and the language that we use now is different again. And it's a constantly evolving language. And I think that's great because as therapists, we know that the way we describe the world helps us understand the world and so refining our language is really helpful. But there's a downside to that, which is, I think worrying about getting the language right can be a little bit paralysing for people and people can be so worried about saying the wrong thing that they say nothing. And I think one of the helpful positions to take is that if people are trying to do the right thing, trying to talk about things from a position of good intent, but whose language isn't quite up to date, what I think I've learned over the years is not to kind of really overtly correct them, but to just use language that I find more palatable and see if that kind of rubs off to give people that different opportunity to talk in different language about these kind of issues, because I would rather people had a go and got it a bit wrong than didn't have a go at all. But in terms of the language that we currently use, I mean, it's in a state of flux, I think, So, when I published the book Transcultural CBT, I used the term BME, Black and Minority Ethnic, because that was the most useful phrase around at the time. By the time it was published, that phrase was out of date and the preference was for Black Asian and Minority Ethnic. And so when we did the Positive Practice Guide, myself and Michelle, we used the term BAME because it seemed like the most useful

In this episode of Practice Matters, host Rachel Handley is joined by Dr. Eleanor Leigh, Clinical Psychologist and Associate Professor at the University of Oxford to discuss social anxiety disorder in young people. Eleanor shares her journey into this field, highlights the challenges of recognising and treating social anxiety in young people, and offers hope through emerging evidence-based interventions, including tailored cognitive therapy for adolescents. Resources Mentioned: OXCADAT Resources: Free therapy resources, manuals, and videos for cognitive therapy. CAMY Website: Learn more about Dr. Leigh's research group focused on young people's mental health. Overcoming Social Anxiety and Building Self-confidence: A Self-help Guide for Teenagers (Helping Your Child) Papers mentioned: Carruthers SE, Warnock-Parkes EL, Clark DM. Accessing social media: Help or hindrance for people with social anxiety? Journal of Experimental Psychopathology. 2019;10(2). doi:10.1177/2043808719837811. Evans, R., Chiu, K., Clark, D. M., Waite, P., & Leigh, E. (2021). Safety behaviours in social anxiety: An examination across adolescence. Behaviour research and therapy, 144, 103931. https://doi.org/10.1016/j.brat.2021.103931 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 and Instagram or email us at podcasts@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 podcast was edited by Steph Curnow   Transcript: Rachel: Welcome to Let's Talk About CBT Practice Matters, the BABCP podcast for therapists using Cognitive Behavioural Therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who share insights that will help you understand and apply CBT better to help your patients. Today we're joined by Dr Eleanor Leigh and we'll be talking about social anxiety disorder in children and adolescents. Eleanor is a clinical psychologist, an Associate Professor at the University of Oxford and Honorary Associate Professor at University College London. Her research and clinical work is focused on improving our understanding and treatment of adolescence anxiety disorders. Her particular expertise is in social anxiety and she's widely published in the area and has done some really fantastic work deepening our understanding of the application of cognitive therapy in this population. Welcome to the podcast, Eleanor. Eleanor: Hi, Rachel. Thanks for having me. Rachel: It'd be really great. just as a starting point to hear what got you interested in this area, how did you get into looking at social anxiety in young people? Eleanor: So I was very lucky to do my clinical psychology doctorate many moons ago at the Institute of Psychiatry at King's, and I had my final placement at the Centre for Anxiety Disorders and Trauma, and which sort of specialised in the treatment of anxiety problems in adults using cognitive approaches, which have been set up by David Clark and Anke Ehlers. And I remember being really nervous about being there because there's a great reputation. And I got there and I had the most amazing supervisor in Debbie Cullen. And I had this really exciting six months of going deep into a therapy and feeling like I was delivering treatments that seemed to make a real difference. I was treating adults with Post Traumatic Stress Disorder and Social Anxiety Disorder. And I found it just really fulfilling and I thought, wow, this is amazing. And then I went and did a placement in a service for young people with anxiety problems, which was equally dynamic and exciting. But also made me really aware of how much kind of further behind the curve the research was, and treatment development was, with children and young people. And I'm sure we'll come on and talk about this in a little bit, but I was particularly struck by how the treatments for young people with social anxiety, which seemed to be the bread and butter that was coming through the clinic, just weren't as useful or helpful. And that was, I suppose, the real catalyst for where I've gone. And where my career has taken me so far. Rachel: So you had this experience of seeing stuff that really worked, that was really satisfying, but then also seeing this gap in the market, if you like, this area that we were under helping folk with. And it makes sense that this was the bread and butter of what you were seeing because adolescence can be an excruciatingly self-conscious time for many, but not all young people. And I guess lots of young people must suffer from social anxiety, but what do we know about how many actually suffer from this as a disorder? What the sort of typical age and onset and course of social anxiety is at this stage of life? Eleanor: Yeah, I think you've just pulled out two really important things. One is about what tends to happen to most of us in our teenage years, and the other is about thinking about the scale of the problem of social anxiety. Maybe if we just start off by thinking about what happens in the teenage years. I don't know, Rachel, about you, but when I think back to my kind of progress into being a teenager, I have like a particular memory that I find excruciating, which is of going shopping. I always tell this when I'm doing teaching, of going shopping with my mum, and I remember asking her to walk slightly ahead of me so we could pretend that we weren't actually together because I didn't want to be seen by my friends hanging out with my mum. My dearest mother, though, still carried on and bought me a really nice pair of jeans, despite my like abominable behaviour. And I suppose what this really makes me think about in retrospect is how we all get very self-conscious during the adolescent years, and there are all these changes going on with our kind of social, emotional, cognitive processes in adolescence, and that's all I suppose in the service of trying to help young people shift away from their family unit and towards their peer group, learning how to make, break and repair relationships because that's what we need to do to be able to become independent adults, functioning ourselves. Rachel: So what you're saying is it's normal that my teenage sons want to spend all their time in their bedroom and not with me. Eleanor: I know, painful as it is, and I've got a, my daughter is moving into the adolescent phase, and I can feel her pulling away as I endlessly try and hug her, I realise that this is a very normal thing. And so what we see, the research seems to suggest that there is this very predictable uptick in social worries as you sort of pre adolescence move into the teenage years and that's based on both parent report and child self-report. For most kids what we then see is that sort of just eases down naturally without any particular intervention. Rachel: So I can really identify with that. I remember my teenage years feeling like a long tunnel of feeling dull and boring and generally socially unacceptable. But you're saying that part of this is normal as a process of kind of individuating, separating from our parents, wanting kind of work things out, feeling awkward, feeling uncomfortable, self-conscious, but how does it develop into a problem that impacts people like social anxiety? Eleanor: Yeah, and I think, so this is a really critical point, isn't it? It's that for most people, all of these processes are recurring and increase in susceptibility to peer influence, self-consciousness, and there's this kind of perfect storm that sets the stage for social anxiety or social concerns. But why is it that some young people will then go on to have this kind of much more distressing and problematic social worries compared to others. And I suppose there are a few answers to that. Most likely there are going to be genetic vulnerabilities. And so some young people temperamentally, but more sort of behaviourally inhibited, tend to hold back, tend to be those kids who take a bit longer to engage in a party or play or a game or something novel. But there's also likely to be sort of particular experiences that some young people have been through that might make them more likely. So we know that, for example, from twin studies it seems to be this combination of genetic factors, but also non shared factors. So environmental factors. So things most likely to do with what's happened to that young person that's not in their family home. So peer experiences might be the kind of best candidate we could consider. And one of my colleagues did a really lovely meta-analysis looking at the relationships between peer problems and social anxiety in young people and found really clear indication of a two way link. But so it does seem to be that problematic peer relationships and peer victimisation in particular, contributes to social anxiety over time. Rachel: So it's a significant problem then for young people is it? I mean, how many young folk actually do develop this as a disorder as opposed to a normal self-consciousness? Eleanor: Yeah, exactly. So estimates vary but lifetime prevalence rates suggest it's between sort of five and 8%. But when you think about that sort of around 90 percent of cases will have their onset before early adulthood, before about the age of 20 ish. So most cases will first occur in that kind of adolescent period. So if you think about an average classroom of about 30 kids, you could expect to see a couple of kids, one to two kids in the classroom. Yeah. And if you speak to clinicians, it is the most kind of common problem coming through the doors. Rachel: So it’s a really significant problem. We see it really frequently in services, thinking back to where you started with saying there was this gap in treatment for it and evidence-based treatment and treatments that really helped. How well recognised do you think

This episode, Rachel talks to Dr. Stirling Moorey about the role of CBT in supporting individuals with cancer. Dr Moorey is a consultant psychiatrist and a leading expert in psycho-oncology as well as the new BABCP President. He has worked extensively in the field of CBT and cancer since the 1980s, contributing to research, clinical practice, and supervision. They discuss how not everyone with cancer will need r want psychological interventions but how CBT and learning coping strategies can be effective for those who do and how therapists can look after themselves when working in this emotionally demanding area. Useful links: Books: Moorey, Stirling, and Steven Greer, Oxford Guide to CBT for People with Cancer, 2 edn, Oxford Guides to Cognitive Behavioural Therapy (Oxford, 2011; online edn, Oxford Academic, 1 June 2015) Papers: Serfaty, M., King, M., Nazareth, I., Moorey, S., Aspden, T., Mannix, K., Davis, S., Wood, J., & Jones, L. (2020). Effectiveness of cognitive-behavioural therapy for depression in advanced cancer: CanTalk randomised controlled trial. British Journal of Psychiatry, 216(4), 213-221. https://doi.org/10.1192/bjp.2019.207 Serfaty, M., King, M., Nazareth, I., Moorey, S., Aspden, T., Tookman, A., Mannix, K., Gola, A., Davis, S., Wood, J., & Jones, L. (2019). Manualised cognitive–behavioural therapy in treating depression in advanced cancer: The CanTalk RCT. Health Technology Assessment, 23(19), 1-106. https://doi.org/10.3310/hta23190 Serfaty, M., King, M., Nazareth, I., Tookman, A., Wood, J., Gola, A., Aspden, T., Mannix, K., Davis, S., Moorey, S., & Jones, L. (2016). The clinical and cost effectiveness of cognitive behavioural therapy plus treatment as usual for the treatment of depression in advanced cancer (CanTalk): study protocol for a randomised controlled trial. Trials, 17(1), Article 113. https://doi.org/10.1186/s13063-016-1223-6 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 edited by Steph Curnow Transcript: Rachel: Today I'm so pleased to welcome Dr Stirling Moorey to the podcast to talk about CBT and cancer. Dr Moorey is BABCP president elect and a recently retired consultant psychiatrist who's been practicing CBT since 1979 when he visited Beck Centre for Cognitive Therapy in Philadelphia for a medical student elective. He's a highly acclaimed clinician, researcher, and teacher, and has specialised in several clinical areas, including psycho-oncology. Stirling is particularly known for his research and work on the application of CBT for individuals with cancer. So thank you so much and welcome Stirling. Thank you for joining us. Stirling: Thank you. Thank you very much for inviting me. It's great to be on the podcast and really lovely to be contributing to what is the growing CPD offer of BABCP to our members. Rachel: And on our agenda today is an understanding of if and how CBT can be helpful to individuals with cancer and how we might apply CBT in this context. To start us off, I wonder if you could tell us a little bit about your journey into this work and what got you interested personally and professionally in working with CBT and specifically CBT with cancer. Stirling: Well, it's interesting. I think that this all began in about 1986 when I passed my membership of the Royal College of Psychiatrists and was looking for what the next job would be as a Senior Registrar. And looking for what might be research opportunities and Dr Stephen Greer, who was a wonderful clinician, but also a pioneer of research in psycho-oncology had received a large grant from what was then the Cancer Research Campaign, is now, Cancer Research UK to look at the effectiveness of psychological treatment in cancer and so he developed, was developing, what he called Adjuvant Psychological Therapy, which was a bit of a mix of some emotional support and CBT type components. So, because I was interested in and had some experience of CBT at that time, he was quite keen for me to come on board and be a member of the team. So that's how it started and really led to us doing some research but also producing our book, which was originally Adjuvant Psychological Therapy. It's gone through I think three or four editions now and has become the Oxford Guide to CBT for People with Cancer. So I got into it through really a research interest and my time at the Royal Marsden meant that we were doing quite a lot of clinical work in the liaison service as well as the research project. Rachel: And just to ask, briefly, Stirling, some people might not be familiar with that term adjuvant. What does that mean? What does that refer to? Stirling: So he called it Adjuvant Psychological Therapy because at that time, adjuvant chemotherapy was a treatment, that is still used, alongside what might be say a surgical removal of a cancer, and alongside that people would have a chemotherapy treatment. So he said, well why don't we sell this in a way to the oncologists by calling it Adjuvant Psychological Therapy, might make it more acceptable. Rachel: And do you think the fact that you had a medical background rather than, a sort of psychological background in terms of a psychology degree, that sort of pathway into psychological therapies, prepared you, drew you in particularly into this kind of work? Stirling: Yes I think I agree. I think that, having a medical background, I think gives you some advantages. It doesn't mean that many psychologists can't be very proficient at working with people with physical illness, but it does give you a different angle. I mean, I think one of the things that perhaps is unfortunate in the CBT world is that I think that biopsychosocial approach that doctors can bring, and nurses can bring is perhaps undervalued a little bit. So yeah, I think that adds a component to the psycho-oncology. Rachel: Perhaps I wonder if you can go places with your patients that perhaps psychological therapists might fear to go for that the fear that maybe their patients might think there's telling them it's all in their mind or, you know, being reductionist about what's going on for them. Stirling: I think that's right. I think that, to some degree, I don't know that being a medic necessarily comes up that often as an issue for patients. I think where the areas where it can be helpful is that you perhaps speak the language of the medical staff, doctors and nurses. So sometimes actually sort of interpreting in both directions, interpreting for the patient what some of these things mean, and vice versa, helping the doctors to understand. And sometimes we would have joint meetings with the oncologist or the nursing staff and again, that, that translation can be helpful, which perhaps is a little bit more difficult from someone who doesn't have a physical, medical background. Rachel: So you had this interest in CBT, this training in CBT, there was this momentum behind this particular area, there was funding for research into cancer. And we know now as then, but increasingly so cancer is undoubtedly a huge global concern. It's one of the most incurable diseases with, I understand, the second highest mortality rate after cardiovascular disease. Macmillan Cancer Support estimated in 2022 that there were approximately 3 million people living with cancer in the UK alone, with that number anticipated to rise exponentially up to sort of 5 million by 2040. And the NHS reports that one in two people will develop some form of cancer during their lifetime. So in that context, the context of the high mortality rates and the high prevalence of cancer, can you tell us a little bit about why we would be thinking about psychological interventions with cancer? Stirling: Yeah, I think that the good news on the psychological front is that we know that about 60 percent of people who go through a cancer diagnosis are going to be coping pretty well. They don't meet criteria for anxiety or depression, and I think that's very encouraging that there's a lot of resilience that we have. But, you know, 20 to 30 percent of people will experience symptoms of anxiety, depression and adjustment problems and that's a significant burden, I think for themselves and for health services in the past was largely unrecognised, but I think it's much more becoming recognized. People experience a whole range of reactions to cancer. The thing about cancer that I think makes it differ from other long term medical conditions is the threat to survival, is, is in our culture, associated very much more with cancer than with other conditions. But someone, say, with heart failure may actually have a much poorer prognosis than someone with cancer but in terms of the psychological impact because of the way in which we stigmatise and see the disease, that threat is often very profound. So fear of recurrence and progression is a big component of the psychological burden of cancer but then alongside that, there's also the impact of physical symptoms. There may be side effects from treatment, such as going through chemotherapy and losing your hair, having nausea, side effects from surgery, which may be major physical changes impacting body image. And also, often in later stage disease, physical symptoms such as fatigue and insomnia really impairing your capacity to cope. And plus the social impact of cancer for people losing, say their, their livelihood, losing their role, and the stigma that is still around. People don't quite know how to talk to someone with cancer. So a whole range of biological, psychological, and social impacts of cancer, that, as I say, fortunately, most people don't need psychological interventions beyond the usual support that might be necessary for any physical illness. But some people really do benefit from having a bit more of a of a look into how they're coping and how we might help them. Rachel: And that figure, you sa

In this episode, host Rachel Handley sits down with Dr. Fiona Challacombe, a leading expert in perinatal anxiety and obsessive-compulsive disorder (OCD), to explore the impact of OCD on new and expecting parents. They discuss why new parents are particularly vulnerable to intrusive thoughts, how CBT techniques can effectively treat perinatal OCD, and the importance of dispelling myths around maternal mental health. Fiona also offers practical advice for therapists working with clients presenting with perinatal OCD, including how to approach and adapt exposure therapy sensitively during pregnancy. 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. 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 edited by Steph Curnow Useful links: Maternal OCD website- https://maternalocd.org/ Perinatal Positive Practice Guide can be found here: https://babcp.com/Therapists/Perinatal-Positive-Practice-Guide A list of all Fiona’s published papers can be found: https://www.kcl.ac.uk/people/fiona-challacombe Books: Challacombe, F., Green, C., & Bream, V. (2022). Break Free from Maternal Anxiety: A Self-Help Guide for Pregnancy, Birth and the First Postnatal Year. Cambridge: Cambridge University Press. Bream, V., Challacombe, F., Palmer, A., & Salkovskis, P. (2017) Cognitive Behaviour Therapy for Obsessive-compulsive Disorder. Oxford: Oxofrd University Press. Challacombe, F., Salkovskis, P. M., & Oldfield, V. B. (2011). Break Free from OCD: Overcoming Obsessive Compulsive Disorder with CBT. Vermilion. Transcript: Rachel and Fiona Challacombe Rachel: Welcome to Let's Talk About CBT Practice Matters, the BABCP podcast for therapists using Cognitive Behavioural Therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who share insights that will help you understand and apply CBT better to help your patients. Today we're joined by Dr Fiona Challacombe, lecturer and researcher at King's College London and Oxford University. Therapist, author and leading expert in perinatal anxiety and in particular obsessive compulsive disorder or OCD. Over 20 years, her research has examined the impact of perinatal OCD on women and children, including the first randomised control trial of CBT for postpartum OCD, and treatment effects on anxiety and parenting. She's developed and leads a service for parents with anxiety disorders at the Maudsley Centre for Anxiety Disorders and Trauma and is the author of a number of excellent books and manuals on CBT for OCD, and we'll put some links to those in the show notes for people later on. Welcome Fiona. Fiona: Thanks so much for having me. Rachel: It's really, really great to see you, genuinely great to see you, not least because we're long overdue as we've just been talking about pre-recording for a catch up. We go back quite a long way to our, our training days at the IOP with a bunch of brilliant people. Actually, I'm hoping to get some of the others on this podcast. Becky Murphy hopefully will come and talk to us at some point about eating disorders, but loads of great folk that we were really fortunate to train with. And then I feel a certain pride when I read all the things that you've done, it's not really justified, but it's just kind of like a family connection when you've trained together, isn't it? You feel that connection. So, it's just brilliant to have you here and you've been so committed to this work and I know you're really passionate about it. What got you hooked in this field of OCD, personally and professionally? Fiona: Well, I came to training, which does really feel like yesterday, having worked with Alan Stein on this incredible treatment trial for mums with eating disorders, so that really got me very interested in the early parenting field. And I was really lucky when we started training to train with Paul, I think the first person, one of the first people I ever saw had OCD. And, of course, applying the model as a new trainee, it was just miraculous. It works so well. And getting this understanding of the cognitive model and how responsibility works in this context, putting all of these things together has been an amazing journey really, so starting to understand more about OCD, how well the treatments work, and then thinking about parenthood in that context, it makes so much sense that it's a time of increased risk. So I was very lucky as a trainee to do my doctoral research with parents with OCD, and it was mums with OCD with slightly older children, and understanding a little bit from their point of view about the impacts on parenting and so on. But in talking to those mums, and doing their SCID, and asking them about how their OCD started, when it started, really, one after another had said, well, it started during when I had my baby, it started during the perinatal period. And after about the fifth person had said this, I really thought, this is very interesting. I hadn't really heard of perinatal OCD. It wasn't something that was kind of on the radar. Perinatal mental health services were at a completely different point. It just really was before all the transformation stuff. And whilst most of us were aware of postnatal mood changes and so on, the idea that other things could occur at this time was like a really a not well understood idea, but it was really striking. So that's really all of those things together, what kind of brought me to this topic. Thinking about this early stage, why would it be that this perinatal period would be such a time of kind of onset, really, and risk for this problem? Rachel: And you mentioned there, Paul Salkovskis, who I've just recently recorded another podcast with on OCD more generally, which will hopefully be available to folk at the same time as this. And he's been such a great figure in this field, hasn't he? And someone fantastic to work with in your training and we know from him that OCD is a really widespread problem. It's a smaller problem in sense, statistically, than maybe other, mental health problems that people experience, but nevertheless really significant. And when it afflicts women in that perinatal period, it comes at a really vulnerable time for them, doesn't it? And their children. Can you tell us a bit about how significant a problem it is in that period, how often people have that problem, how it impacts them. Fiona: Yeah, so again, we haven't had good data on this really until very recently, there just aren't those big studies, but it does make sense that it's a time of increased risk because I think if you had to make a sort of cocktail for anxiety problems, you would put in a high dose of kind of responsibility, uncertainty, feeling kind of de skilled, and it has all of those elements and all the physical changes and things that kind of make life a lot more challenging. But really the studies hadn't been done. So, we know OCD affects sort of one to two percent of people at any time, a bit more over a lifetime. But there was a fantastic study by Nichole Fairbrother, which gave full kind of diagnostic interviews to a whole cohort of people, as they went through pregnancy into the postnatal period. But what Nichole did was to be really kind of, specific about asking them not only about our common understanding of obsessions and compulsions, and do you check doors and taps and things like that, but also to ask them about infant specific perinatal thoughts, so are you kind of checking the baby excessively and so on. So that study found a very high prevalence, particularly postnatally, so over the whole perinatal period, the whole prevalence I think was about 7%. So, whilst there are, I think, really interesting issues about what's normal and adaptive over that period because most parents can relate to kind of a time of excessive checking and feeling uncertain about things, and all the things that we're very familiar with in terms of the concepts related to anxiety. For a proportion of those people, it clearly is very troubling and impairing and persistent. So, I think there is this genuine increase in prevalence around this time but it can be hard, very hard to sort of distinguish exactly what's what and I think health anxiety probably is fuelling that as well. But it's definitely a time of increased risk. I think we can say that quite confidently, and particularly in the postnatal period and particularly for intrusive thoughts of deliberate harm in that area really is quite distinct to OCD in the sense of it being a very common presentation. You do get in those horrible intrusive thoughts in the normal population in the context of other problems, but that's quite a common presentation postnatally. Rachel: So it sounds like, it's such an important area to be researching, to be thinking about and offering treatment in. And I can really identify with what you're saying about that anxiety around the perinatal period and becoming a parent. I mean, everything else that you have to step up to in life in terms of responsibility like that you normally have to do an exam or, you know, at very least go to a class or someone gives you a job interview and says, yes, you're competent to do this. Suddenly you've got this little person in your arms and you're thinking, who is crazy enough to trust me with this huge responsibility. And people like ourselves, who like to study, probably read lots of books and go to classes and do all of those things. And the advice is often conflicting, isn't I and challenging. And then you add in disturbed sleep and plenty of time to worry and ruminate while you're with this little person who doesn't talk back in the middle of the night. It's not hard to understand why people might be anxious and as you say, what might be norma

In this episode, Rachel talks to Professor Colin Espie about cognitive behavioural interventions for insomnia. They discuss the importance of sleep, common misconceptions about sleep and the importance of trusting in the body's natural sleep processes.  Colin highlights the high prevalence of sleep disorders and comorbidity with other mental health conditions that CBT therapists will commonly be treating. They discuss factors that maintain sleep problems and key evidence-based and effective approaches to addressing these obstacles that might help you and your patients to get a good night’s sleep! 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. 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 edited by Steph Curnow Useful links: Books: The Clinician’s Guide to Cognitive and Behavioural Therapeutics (CBTx) for Insomnia: A Scientist-Practitioner Approach (2024) by Colin A. Espie. Overcoming Insomnia and Sleep Problems: A self-help guide using cognitive behavioural techniques (2021) 2nd Edition, by Colin A. Espie. Papers: Espie, C.A. (2023). Revisiting the Psychogiological Inhibition Model: a conceptual framework for understanding and treating insomnia using cognitive and behavioural therapeutics (CBTx). Journal of Sleep Research https://doi.org/10.1111/jsr.13841 Link to further papers: https://www.ndcn.ox.ac.uk/team/colin-espie Training links https://www.scni.ox.ac.uk/study-with-us   Rachel: Welcome to Let's Talk About CBT Practice Matters, the BABCP podcast for therapists using Cognitive Behavioural Therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who share insights that will help you understand and apply CBT better to help your patients. Today, I'm going to be talking to Professor Colin Espie about Cognitive Behavioural Interventions for Insomnia. Professor Espie is a Professor of Sleep Medicine in the Nuffield Department of Clinical Neurosciences at the University of Oxford. Since qualifying as a clinical psychologist in 1980, he's accumulated decades of research and expertise in the relationship between sleep and mental health and the understanding and treatment of sleep disorders particularly using cognitive behavioural therapeutics, a term we'll return to later in the podcast. He's also internationally recognised as a leading expert in the field and his work has been disseminated widely, not only through his many journal articles, books, and training programs, but also through his Sleepio app, which has supported improved access to evidence-based help. So welcome Colin. It's brilliant to have you with us Colin: Rachel, thank you very much for inviting me. It's great to be here. Rachel: So, I'm going to start with a question that I've heard you say you always get asked in these interviews. So, we're going to get it right out of the way up front. You're an international sleep expert. How well do you sleep? Colin: It's the journalist question, Rachel, isn't it? They usually ask at the end of the interview just when you're finishing up, Oh, by the way, how do you sleep? I'm actually a pretty good sleeper. I wake me quite early in the morning, you know, so I'm not a late night person. Rachel: So, you haven't had to apply these techniques extensively to yourself, or is that something you do? Colin: Well, the interesting thing, Rachel, is that I, and I'm sure it's true for everyone who's listening to the podcast, thinking about your own life, never mind the life of your clients and your patients that we all at times have difficulty sleeping. It's a normal experience, just the same as we all at times feel a little bit worried or anxious or have a period of feeling a bit depressed. And in some ways, the techniques that we use with our patients are kind of similar to what we try and do ourselves. Except we just need to apply them particularly rigorously, to help to remove more reluctant problems, shall we say. So I try not to lie awake in bed, for example. I try to, I better get up and go back to bed when I feel sleepy again, although it's not the easiest thing to do. Rachel: So you've practiced what you preach Colin: I, well, I try. I try. Rachel: and you've been interested in sleep from very early in your career. So I believe you're only a few years qualified as a clinical psychologist when you organised your first international conference on sleep. And then later you carried out the first control trial in insomnia patients in 1989. Colin: Yes. Rachel: And so what got you interested in the field of insomnia personally, professionally? Colin: Well, I think like, as with most things in life, its curiosity, isn't it? I started work, qualified in 1980 and I worked in primary care, seeing patients referred by general practitioners. That was very new at the time, getting direct referrals from GPs. And after a few months, one of the GPs said to me, “Colin, don't suppose there's anything you can do to help these people who can't sleep?” And I said, I don't know. Because we've never been taught anything really about sleep or its relationship to mental health. I'd been seeing lots of anxious people with depression and so on. So I said, send me a few patients. And I went to a thing called a library. And read some books, and some papers. Rachel: libraries, what are they like? Colin: I know, I know, so I, I tried to just find out as much as I could and discovered there was an emerging literature on behavioural therapies for insomnia. But mostly they'd been conducted in student populations and not with patients. So, in the mid-80s, I designed, as you said, kindly, the first trial of referred patients, and of course CBT had never been invented as a term then. Rachel: So it was, it was all brand new and on many levels. Colin: yeah, what I looked at initially were relaxation-based therapies and therapies based on something called stimulus control, which is, it's a behavioural approach if you like to try and help reestablish a good pattern. And I looked at something called Paradoxical Intention, which is a cognitive therapeutic, designed to overcome performance anxiety, in other words, to stop you trying to sleep. So these are the three interventions, which when I looked in the papers I could find, these were the three approaches that seemed to have some evidence base but hadn't been tried with patients. And I mounted a placebo-controlled trial as well. Pretty bold stuff, really, I think, back in the day, Rachel. Rachel: Fantastic. And as you said, this is whole raft of interventions that you now have developed and gone forward to, and we'll talk a bit more about that as we go through this podcast today. I guess you're not the only person who was curious about sleep. I mean, it seems at the moment that we're all pretty obsessed with sleep. I can't scroll through my news app or a Sunday supplement without encountering at least one article on how to sleep better or on sleep problems, which does suggest that it's a problem, or at least a perceived problem for a lot of people. And anecdotally, my friends who work in higher education with undergraduates tell me that Gen Z is absolutely fixated on getting their eight hours sleep and they're in bed before their parents and their professors. So, so perhaps a good place for us to start talking about sleep problems is defining what good or normal sleep looks like, how we would define that, what it's for? Colin: Yes, absolutely right, Rachel, sleep's everyone's business, it's not just the business of professionals. And in many ways sleep is nature's medicine, its what nature has provided, for us to give us quality of life and we wouldn't be able to function at all without our sleep. And when one thinks about it, we imagine ourselves to be highly evolved species, which I think we are, but we haven't evolved to do without sleep. In fact, we need rather a lot of it. If we spend a third of our life asleep, that's in service of our quality of life. But then what is sleep? I think a lot of people think of it as a kind of oblivion. Yeah and that's what it should be, that you just kind of conk out kind of thing. And that's you for the night. Rachel: it's the switch off button. Colin: it's a switch off button, but it's actually really the switch on button. Because there's a lot of research evidence now that, if you were to ask the brain, what's your preferred state, they would say sleep. Because that's when I can go on with my work, when you're out of the way. Because during sleep, a lot of the repair restoration work is done in terms of regenerating cells, in terms of clearing toxic waste from the brain, in terms of infection control and signalling. We need sleep to recover and rest, of course, but there's all these much more sophisticated processes going on. And of course, as people interested in psychology, it's sleep that gives us cognitive recovery. It's during sleep that memories are consolidated, not during wakefulness, or not efficiently during wakefulness, much more efficiently during the night. And it's during sleep that emotions are regulated and reset. So, it's a very complex set of processes and phases and stages, and people will be aware to some degree of REM sleep, Rapid Eye Movement sleep, or dreaming sleep, which occupies about a quarter of a night. and then non-REM sleep occupies about three quarters of the night. And it’s all beautifully architectured if you like, across the night. Rachel: So those different types of sleep have different functions? Colin: Yeah, absolutely. And I think one of the difficulties nowadays when one buys some kind of smartwatch or whatever, and it's going to track my sleep and tell me how much sleep I've got, and then tell me how much sleep is in different bins. And yo

In this conversation, Professor David Clark discusses his work using Cognitive Behaviour Therapy to treat Social Anxiety Disorder. He and Rachel talk about the Cognitive Behavioural model of Social Anxiety Disorder, considering the factors that contribute to maintaining this debilitating problem experienced by many people and the evidenced-based approaches to treating it. The conversation also delves into the economic impact of evidence-based psychological therapies and the importance of delivering high-quality, evidence-based care. 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, babcppodcasts on Instagram or email us at podcasts@babcp.com. Useful links: Papers: David has published numerous papers in the field and a full list can be found here: https://bit.ly/3zjxcNy The paper mentioned authored by Emma Warnock-Parkes is published in the Cognitive Behaviour Therapist and can be found here: https://bit.ly/3XzVsEq Clark, D.M. (2018) Realising the mass public benefit of evidence-based psychological therapies: the IAPT program. https://pubmed.ncbi.nlm.nih.gov/29350997/ Clark et al (2023) More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder. https://www.cambridge.org/core/journals/psychological-medicine/article/more-than-doubling-the-clinical-benefit-of-each-hour-of-therapist-time-a-randomised-controlled-trial-of-internet-cognitive-therapy-for-social-anxiety-disorder/ED618AA69204AABD5C5691ABC454F5BE Ehlers et al (2023) Therapist-assisted online psychological therapies differing in trauma focus for post-traumatic stress disorder (STOP-PTSD): a UK-based, single-blind, randomised controlled trial. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(23)00181-5/fulltext OXCADAT: A wealth of useful videos and therapist resources for social anxiety, PTSD and panic disorder can be found here: https://oxcadatresources.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 podcast was edited and produced by Steph Curnow Transcript: Rachel: Welcome to Let's Talk About CBT Practice Matters, the BABCP podcast for therapists using Cognitive Behavioural Therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who share insights that will help you understand and apply CBT better to help your patients. Today, we're talking about Social Anxiety Disorder, and we're really privileged to be joined by Professor David Clark, who's devoted his long and distinguished career to cognitive approaches to understanding and treating anxiety disorders, and also to disseminating these treatments so that help can be made available to as many people as possible. In addition to his work in social anxiety, David's work has led to the development of effective NICE recommended cognitive therapy treatments for panic disorder and PTSD. David is well known for pioneering and tirelessly working to advise and steer the IAPT program in England, and he continues to work towards wider and wider dissemination of therapy through digitalisation and through his training, teaching, and political engagement worldwide. Welcome to the podcast, David, David: Oh, thank you for having me, Rachel. It's lovely to chat again as we've worked together so closely in the past. Lovely to see you. Rachel: and there can be a few therapists working in the field of CBT and beyond who aren't aware of the enormous contribution you've made to social anxiety, but not everyone will know about your journey. So, it'd be great to hear about what got you interested in psychology, psychological disorders, and specifically social anxiety, both personally and professionally. And as a starting point, is it true that as a young man, your choice of study might've had rather more to do with the gender balance on the psychology program rather than the subject matter? David: Well, that had an element to it. I think I've always been interested in mental health problems since I was a child, my mother was someone who people would come to when they were distressed, and she gave them obviously very supportive chats. But you often don't feel that just following your mother is the right way to go. And so I felt that maybe one could do better, and I was good at chemistry. So, I started really as an undergraduate as a chemist with the idea that we could develop some improved drug treatments for mental health. But I soon realised that drug treatments were quite limited and were likely to have pretty high relapse rates. I was also studying on a course where there were just four women in an intake of 200 first year students at Oxford, but I had bumped into a few members of the opposite gender at parties and one of them was wandering past chemistry one day and said, why don't you come down and have a cup of coffee in experimental psychology? where I found, it was a wonderful department, with lots of senior people just sitting down with the undergraduates talking through ideas over coffee, and of course, a much more even gender balance. So, I moved fairly quickly to the experimental psychology department. Rachel: So there was a real motivation to help others right from the beginning, but maybe a small iota of self-interest there amongst that. David: and an interest in social interactions of all sorts. Rachel: And social anxiety then, what took you in that direction? David: Well, the first sort of clinical problem we worked on is panic disorder, and that was at the time that we started working on it in the mid-1980s considered to be the most difficult to treat anxiety disorder. So, there's lots of research showing that those people with agoraphobia who also had panic attacks got least improvement from behaviour therapy. And similarly, those people with what we call generalized anxiety who had panic attacks also got least improvement. So it seemed a really good topic to work on. Of course, things worked out well for us in developing a cognitive model in the treatment. And I think nowadays people tend to think it's easiest to treat of all the anxiety disorders. So in the sort of mid 90s, we started looking around for another problem and social anxiety is the most common anxiety disorder in the community. But what really fascinated us was that it is also the one with the lowest natural recovery rate. It starts in childhood for most people, and in the absence of treatment, it is often lifelong and it really interferes with your life. So it seems a really good challenge Rachel: So an area where you could really make an impact in research and having had such success with the panic model and having such an elegant approach to that, that was really making a difference it felt like let's extend this, let's look where people are really suffering. David: Yeah, and there was already a very respectable, psychological treatment. Group CBT was the dominant modality, the gold standard. But when you looked at the sort of outcomes in the best trials, it was rarely the case that you got more than 40 percent of people fully recovering from their social anxiety and that seems a real sadness for a condition that's so chronic and so common. Rachel: And as you said, the largest, most widely prevalent problem in terms of anxiety disorders, but many of us can also identify with feelings of social awkwardness or shyness at some point in our life. But how does social anxiety develop then into a problem that impacts people more significantly as you've described? Who typically suffers from social anxiety and how does that come about? David: Yeah, so you're obviously right. Many of us feel rather shy in some new social situations. And there are some events which pretty reliably make us anxious, like job interviews, particularly if you want the job. But that's sort of normal so we only think of people having an anxiety disorder if the anxiety is out of proportion to the situation. So it's not just in job interviews, for example, and it also really holds you back in life. You have a lot of avoidance and you can't do the things that you would like to. And so that's a real distinction between normal social anxiety and Social Anxiety Disorder really how much it interferes with your life. Rachel: And I can reflect on my first job interview with you, David, and it gave me some insight, but also working with you subsequently gave me some insight into how those techniques that you have come across and developed have been, could be so helpful. So we have a bit of a challenge on this podcast, David. We love a good formulation in CBT, as you know, ideally with boxes and arrows and pictorial ways of describing things, but this is an audio podcast. So here's the challenge. Can you give us a brief explanation about how social anxiety develops and is maintained without repetition, hesitation, deviation, boxes, arrows, or other visual aids? David: Well, the development is like most anxiety disorders. It's a mixture of genetic vulnerability, social learning, and adverse life events. That's not the interesting point from therapy. The interesting point from therapy is what keeps it going. And there's a really big puzzle because modern life is such that we all have to meet other people more or less every day. And at least when in adulthood, people with social anxiety, when they're meeting other people are not getting unambiguous negative feedback from them. So they seem to be having naturalistic exposure and we know that exposure therapy is a sound principle. So, the big puzzle for us as therapists is to work out why don't people benefit from naturalistic exposure? And being a cognitive therapist, I think the answer lies in getting into people's heads. And so, Adrian Wells and I interviewed a lot of people with so

In this episode Rachel talks with Professor Paul Salkovskis about using CBT to treat people with OCD. They discuss the Cognitive Behavioural model for OCD and how OCD develops and is maintained, debunk some common myths about OCD and the effectiveness of CBT in treating OCD. Paul and Rachel also chat about some of the more unusual techniques they have used when helping patients with OCD… Whether you’re a seasoned therapist or new to the field, this episode offers a wealth of knowledge about OCD and its treatment. Paul’s decades of experience and his ability to explain complex concepts in a relatable way make this a must-listen for anyone interested in understanding OCD and improving their therapeutic practice. 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: Paul has published numerous papers on OCD and hoarding (amongst other things) all of which can be found listed here: https://bit.ly/4dIpBqi Books: Bream, V., Challacombe, F., & Salkovskis, P. (2011). Break Free from OCD: Overcoming Obsessive Compulsive Disorder with CBT. London: Penguin. Bream, V., Challacombe, F., Palmer, A., & Salkovskis, P. (2017). Cognitive Behaviour Therapy for Obsessive-compulsive Disorder. Oxford: Oxford University Press. Articles: Lomax, C. L., Oldfield, V. B., & Salkovskis, P. M. (2009). Clinical and treatment comparisons between adults with early- and late-onset obsessive-compulsive disorder. Behaviour research and therapy, 47(2), 99–104. https://doi.org/10.1016/j.brat.2008.10.015 Rhéaume, J., Freeston, M., Léger, E., & Ladouceur, R. (1998). Bad luck: an underestimated factor in the development of obsessive-compulsive disorder. Clinical Psychology & Psychotherapy, 5(1), 1-12. doi:10.1002/(SICI)1099-0879(199803)5:1<1::AID-CPP145>3.0.CO;2-J   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 edited by Steph Curnow   Transcript: Rachel: Welcome to Let's Talk About CBT Practice Matters, the BABCP podcast for therapists using Cognitive Behavioural Therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who share insights that will help you understand and apply CBT better to help your patients. Today we're talking about Obsessive Compulsive Disorder, or OCD, and we're delighted to be joined by world leading expert in the area, Professor Paul Salkovskis. His cognitive behavioural model and treatment for OCD is probably the most widely taught and applied in clinical practice. He's an expert in CBT for anxiety disorders and has a huge impact on developing interventions and improving therapy outcomes, not just in OCD, but also in panic, agoraphobia and health anxiety. Without him, we might not have the formalised concept of safety seeking behaviours or be nearly so unconcerned about the bizarre and intrusive thoughts that we all have on a frequent basis. All of which means that Paul is more likely to be found with his hand down a toilet or licking his shoe than washing his hands. So I'm really delighted to be welcoming you remotely, Paul, to this episode of Practice Matters to talk about OCD. Welcome. So clearly, Paul, you've got a really wide range of clinical and academic interests, other than a predilection for the taste of the sole of your shoe. Is there a reason you got particularly interested in OCD professionally and personally? Paul: By the way, the sole of my shoe is salty during the winter, but not during the summer. I can't tell you why. Why did I get interested? Well, well, I mean there are two intersecting reasons. One of which is that when I was training, I was trained with something called David Clark, you've probably heard of him and we had a mentor who's called Jack Rachman, who was professor extraordinaire, in just about everything, but particularly OCD. So that was part one. So Jack inspired me, and I've kind of followed his mould, or been in his mould for a very long time. And then the other thing is, having met a lot of people with OCD, just the fact that they were the most fabulously nice people. And I don't really have any OCD that I'm aware of anyway, but I really like and identify with people with OCD because they're so nice and that probably links to one of the reasons they, of course, have OCD. I think it is possible to be too nice. Rachel: So something about these figures in your career, which you've actually become for many people throughout your career. I know you've inspired loads of people to, to follow in your footsteps and do this kind of research, but that just real connection with the patients, with the folk that are struggling with these and that human connection has inspired you. So, to get us started, I have some true or false questions. First of all, true or false, everyone has a little bit of OCD. Paul: That's true and false. Because the kind of basis of OCD, intrusive images, thoughts, doubts, and so on, is there in everyone but not everybody suffers from OCD. So, so it kind of starts with something we all have. Rachel: Brilliant. Secondly then, OCD is simply about being a little too focused on cleanliness or organisation. Paul: 100% false. Rachel: The brains of people with OCD are different to those with normal brains. Paul: Brain is the organ of the mind. Therefore, in very small ways, different. But not in a way that you can detect in any kind of biological test or scanner or whatever. So, so they are, they work in the same way, but the workings can be different. Rachel: Okay, excellent. OCD is untreatable by psychological interventions? Paul: You're joking, right? Okay, no you're not. Okay, no, okay. So, so I think that I could reasonably say that's 100 percent false. Rachel: Just your life's work. In order to treat OCD, you need to start with the root causes in a person's childhood. Otherwise, it will just come back in another way. Paul: Yeah, the old symptom substitution myth. Completely false, but it's not that childhood is irrelevant. And we'll probably come back to that. Rachel: OCD is harder to treat than other disorders for which CBT is a recommended intervention. Paul: It's false, but it's also true again. And that's because a lot of people are not properly trained in how to treat it. So it's harder if you don't have the tools but it shouldn't be. It really shouldn't be. Rachel: Okay. So starting at the basics then, what is OCD and how big a problem is it for people living in the UK and beyond? Paul: Lots of discussions about how much it is. Everybody who specialises in problems says, My problem is more common than everybody else's problem. But that's not true. It's probably sitting about 1 percent lifetime prevalence. which is lower than a lot of places will tell you. How big a problem it is? It's as big a problem as any other severe mental health problem. There are people who have mild OCD, and people who have severe OCD, and people with mild psychosis, and severe psychosis, and so on. So, what is it, its obsessions which can be intrusive thoughts, images, impulses, or doubts, and compulsions, which are related to it to those in terms of the meaning, which should take you to things like cultural issues and clearly there are cross cultural differences in the way OCD, kind of sets itself up. But then there's the disorder and that's the living hell that many people with OCD have. It really is awful for many people. And it can completely destroy people's lives for year upon year, shortens lives for some people and soon. So it's a really big problem but it's not the most common mental health problem. But the thing that bothers me about it, what, why it being a big problem is that I regard OCD as an unnecessary illness, nobody should suffer from it. When I'm working with OCD, when I'm working with people with OCD, and I tend to work with people who are more severe, these days, they've had the problem for a long time. Treating the OCD is the least of what I do. And generally, I'm dealing with the thing that I've sometimes referred to as collateral damage, that the way in which the people's lives have been eroded, destroyed, stolen from them. And then, when you've dealt with the OCD, you're left with people whose lives have been devastated by it and then helping them rebuild and reclaim their life. Now that is not unique to OCD. It's just because of the chronicity, severity and the poor treatment that people are offered we see it particularly commonly. Rachel: So do you feel that treatment isn't accessible enough yet? Paul: Not by a long way and that takes us to the whole issue of parity of esteem. I was talking with some therapists the other day, and we're talking about the way that people are offered sort of like short terms of treatment, you know, sort of six sessions or whatever. And it just goes completely against the whole parity of esteem thing. The idea if you've got, if you've got cancer and you need chemotherapy they don't say, well, that's three sessions of chemotherapy, you should have 12 but we're going to give you three or we're going to give you a quarter of the dose because it'll help a little bit, and so on. And we would never do that. It would be an absolute scandal. And the idea that we can take people with severe OCD and then say, oh, here’s a stress management group, and then here's four sessions with somebody who probably isn't actually able to formulate because they're not trained in formulating because that's not done. And then that's it off you go. That's not good and it's not appropriate, in my view. Rachel: And at worst, I guess, it's not just getting less than the appropriate dose, it's actually doing harm. Bit more akin to doing half a heart transplant than half the medication. Paul: Yes exactly and the harm is palpable. One of the things you have to remember is as a cl

In this episode, Rachel talks with Professor Myra Hunter about the role of CBT in addressing some of the troublesome symptoms of menopause and the evidence base supporting its use. The conversation emphasises the need to engage women and acknowledge their unique experiences of the menopause, as well as the importance of an evidence-based, biopsychosocial understanding of these experiences. It highlights the opportunity for women to revisit positively their sense of self and identity during this stage of life. 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: A full list of Myra’s publications can be found here: https://www.researchgate.net/profile/Myra-Hunter Hickey, M., Hunter, M.S., Santoro, N. & Ussher, J. (2022) Normalising menopause, British Medical Journal. BMJ 2022;377:e069369 Brown, L, Hunter, M.S., Chen, R., Crandall, C.J., Gordon, J.L, Mishra, G., Rother, V., Joffe, H., & Hickey, M. (2024), Promoting good mental health over the menopause transition, The Lancet, 403: 969-83 DOI: 10.1016/S0140-6736(23)02801-5 “The slow Moon Climbs: the Science, History, and Meaning of Menopause” by Susan Mattern, Princeton University Press, 2019 Hunter MS and Smith M. Managing hot flushes and night sweats: a cognitive behavioural self-help guide to the menopause. Routledge (2014). 2nd edition (2020) https://www.routledge.com/Managing-Hot-Flushes-and-Night-Sweats-A-Cognitive-Behavioural-Self-help-Guide-to-the-Menopause/Hunter-Smith/p/book/9780367853037   Hunter MS, Smith M. Living Well through the Menopause. Overcoming Series, Robinson UK (2021). https://www.littlebrown.co.uk/titles/myra-hunter/living-well-through-the-menopause/9781472148384/ 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: Rachel: Welcome to Let's Talk About CBT Practice Matters, the BABCP podcast for therapists using cognitive behavioural therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who share insights that will help you understand and apply CBT better to help your patients. Today I'm so pleased to welcome Professor Myra Hunter to the podcast to talk about CBT and the menopause. Our agenda today is what is menopause and why is CBT relevant? The evidence base for CBT for menopause symptoms, adaptions to CBT in this area, common challenges and solutions, and what we can learn more generally from this work. But first, to introduce Professor Hunter. Professor Hunter is Emeritus Professor of Clinical Health Psychology with King's College London. She's published over 200 journal articles and eight books and her research on menopause has established her as an international expert in the field. She was expert psychology advisor for the NICE guidelines on menopause in 2015. She's developed and trialled cognitive behavioural interventions for hot flushes and night sweats and conducted research aimed at improving the experience of menopause for working women. Welcome Myra. Myra: Hi Rachel, hello to everyone and thank you for inviting me today to speak about CBT for menopause. Rachel: We'd love to hear a little bit about your journey into this work Myra and what you got you interested personally and professionally in working with women in the perimenopause. Myra: Interesting question, so I qualified as a clinical psychologist way back in 1977 and after that I went to work at the Institute of Psychiatry doing studies on pain, managing pain, headache pain at that time. So I've always been interested in the relationship between emotional problems and, physical health problems and emotional problems. And after that I went to work at King's College Hospital, basically as a clinical health psychologist working within the general hospital and taking referrals from psychological medicine departments. And, it happened that, I got quite a lot of referrals from the women's health, obstetrics and gynaecology, and at that time there was one of the first menopause clinics developed, and that, this was really unusual to have a menopause clinic in a hospital, I think there were only about two, two or three, during that period. And linking with your question, I was referred to women who often were depressed, anxious, going through the menopause. And I'd be asked this question by the gynaecologist, Is this woman depressed because of her hormones, or is it her? Something like that. And so, looking into this, and it was really fascinating, as a topic in general, I think, you know, especially for a psychologist to look at, because it's something that happens to everyone, every woman, more or less and it can be appraised in so many different ways. It can be a problem or not a problem. So the sociocultural aspects. So the psychosocial aspects are very important. And so I looked into this and then decided as I wanted to do a PhD at the time too, to do my PhD on that, which was looking at what symptoms are actually menopausal and what aren’t. And I got hooked to be honest thereafter. looking at really the psychosocial aspects of menopause and looking quite early on, really, at trying to develop. Looking at the factors that made the experience of menopause more problematic for women and then trying to find ways to help women to negotiate menopause transition, in the particular symptoms. So that, that's taken many, many years. And, and here we are. Rachel: So it sounds like the work really came to you and, and drew you in as you say, and part of that was the fact that this here's something that happens to all women who live long enough and it's a, a really, significant issue for a lot of women. But at that time, it was a relatively taboo subject I would imagine in terms of general conversation, but it's changed a lot, hasn't it? It has become quite a hot topic in the media in recent years Myra: Very, very much. I was thinking back to I was quite young, obviously, when I started to study this, and I'd go to parties, and people would say, Oh, what do you do? what's your PhD on? And I would hesitate, actually, to say menopause, because it wasn't, it was quite unusual to talk about it, indeed. And I think there's a dramatic change, actually, just in the last few years, really, in terms of awareness, talking about menopause. A lot of interest and in many ways it's a really good thing that people, women are becoming more aware of it. but it's a complex issue. Rachel: yeah, it's complex, isn't it? And despite the fact that we are talking about it more and maybe in part because of how much is said about it, people are still unaware or a bit confused about what menopause is and how it might affect women. Are you able to define menopause for us and the common symptoms that are associated with menopause? Myra: And just to say, I will do that, but just to say, I think half the confusion is there's more talking about it, but there's the focus on actual research has got drowned out by people's stories. So it's that balance I think that that that's often is tricky. So as an academic, I'm keen to really focus on the evidence that we have. So, the menopause literally means the last menstrual period, which happens I'm told now in the UK the ages of 52, 53. There is different stages, if we define this sort of biomedically, in terms of premenopause, and then there's perimenopause, when menstrual periods become irregular in lots of different ways they can become more frequent, or gaps between them and that's sometimes when the main symptoms of the menopause happen, which are hot flushes, night sweats. This can last, again, all aspects of the menopause are very variable between women, so it's really hard to, to actually generalise. So there's a big range of how long that lasts, the perimenopausal period. But then that leads to the last menstrual period. In the 12 months after the last menstrual period, it's said that a woman is postmenopausal. Now most of the more dramatic hormone changes, and this is really a drop in oestrogen levels and there are changes in progesterone too. Hormones fluctuate quite a lot during the perimenopause before they decrease. And obviously the menopause is triggered by the ovaries stopping producing eggs or there being no eggs left gradually, and the body tries to, goes into kind of overdrive to produce the eggs, and it's the rate of change of oestrogen during the perimenopause and early postmenopause that's associated with the hot flushes and night sweats. I mean, it's a big topic here, but those are the main symptoms. However, other symptoms are associated with it sleep problems, some joint pains, some, vaginal dryness can happen. That's a little bit later, usually, loss of libido, but a lot of this, the other symptoms that are associated with menopause also have other causes too and can interact with lifestyle, and I think that's when we talk about it, I always want to not just focus on physical symptoms but view the menopause in its broader biopsychosocial context. And I think as, you know, CBT therapists, that's something that is always helpful, isn't it, in an assessment situation. But the menopause, there's different kinds of menopause. Some people have early menopause, about 1 percent of women have it before the age of 40, which has other implications, doesn't it? And then you can have menopause because ovaries, by surgery, ovaries are removed or you have one exacerbated by chemotherapy after breast cancer. So again, the basic message is here, such variation, take time to ask the woman what she's experiencing and then help her to make sense of it in terms of where she's at. And you have to be a kind of detective to look at time frames to understand. Rachel: And it was interesting what you were saying, Myra, about often what we

Let’s Talk about CBT has a new sister podcast: Let's Talk about CBT: Practice Matters with a brand-new host Dr Rachel Handley, CBT therapist and Consultant Clinical Psychologist. Each episode Rachel will be talking to an expert in CBT who will share their knowledge, experience, research and professional and personal insights to help you enhance your practice and help your patients more effectively.  Whether you are a novice or a seasoned clinician we hope you will find something to stimulate thought and encourage you in your work.  This episode Rachel is talking to Prof. Ken Laidlaw, a leading expert in aging about Cognitive Behavioural Therapy for older adults. He debunks myths and misconceptions about CBT with this population, highlights the evidence base for its effectiveness and discusses interventions, adaptions and challenges. Ken shares his personal journey into clinical psychology and his passion for working with older people. He emphasizes the importance of defining older people in the context of mental health and challenges ageist stereotypes 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. 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 Useful Links: Ken Laidlaw (2015), CBT for Older People, SAGE Future Learn online course on CBT with Older People https://www.futurelearn.com/courses/cbt-older-people NHS talking therapies positive practice guide: Older People https://babcp.com/Therapists/Older-Adults-Positive-Practice-Guide A Clinician’s Guide to: CBT with older people https://issuu.com/thecbtresource/docs/laidlaw___chellingsworth_cbt_with_older_people_iap British Society of Gerontology https://www.britishgerontology.org Professor Ken Laidlaw publications: https://www.researchgate.net/profile/Ken-Laidlaw   Transcript: Rachel: Welcome to Let's Talk About CBT Practice Matters, the BABCP podcast for therapists using cognitive behavioural therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who share insights that will help you understand and apply CBT better to help your patients. Today, I am delighted to welcome Professor Ken Laidlaw to the podcast to talk about CBT with older people. On our agenda today is the evidence base for CBT with older people, including myths and misperceptions, adaptions to CBT with this population, common challenges and solutions, and what we can learn more generally from work with older people. But first, to introduce Ken, Professor Ken Laidlaw is a clinical psychologist with world leading expertise in the psychology of aging, CBT for older people and attitudes to aging. Ken has published and developed a multitude of research papers, treatment manuals, books and guidelines, including leading on the NHS Talking Therapies Positive Practice with Older People Guidelines recently updated and hosted on the BABCP website. Ken retired from his role as Professor of Clinical Psychology and program director of the clinical psychology doctoral training program at Exeter University in 2022 because of caring responsibilities. Thankfully, as things have improved, he's returned to part time clinical practice working with NHS Scotland, and he remains Emeritus Professor in psychology at Exeter. Over and above all those wonderful qualifications. I'm particularly thrilled to welcome you Ken as a friend, mentor, and former colleague. Through working with you closely in clinical training, I learned that your values align really closely with those of this podcast. You're a committed educator who invests enthusiastically in the development of psychological professionals, you're committed to excellence in research and research led practice. And despite working in the most demanding of leadership roles, you've always maintained your clinical practice within the NHS and your passion for working with older people. Ken, you're also a humble person and you won't like all those nonetheless factual accolades. But I suspect you might like to tell us a little bit about your journey into clinical psychology before you had all these professional achievements under your belt and how this has shaped your practice and approach to your work. Ken: Well, thank you first Rachel for such a privilege and such an honour to be invited to speak to you on this and especially given we have such a good friendship and I've been very privileged to have your friendship and your professional collaboration. There's lots of things at Exeter recently in recent years that I couldn't have achieved if we hadn't worked together. And so thank you first for doing this. And you're right. I do kind of think it's important to try to be humble and have humility by what we do, and I recognize that in you as well. So we've got shared values on similar ethos and similar approaches to working hard and trying to do the best we can. I got into clinical psychology training through an interesting, odd route, I suppose. So I left school at 16 and, I didn't really know what I wanted to do. I stayed on, did a few O levels, O grades in Scotland at the time. And then, as was traditional in my family, went to work for the National Coal Board and I did an apprenticeship. It was a four-year apprenticeship. And it was really there that education started to click for me. I started to really enjoy education partly it was to do with, I was going out with this girl at the time who later became my wife, and she was studying at university and just to keep her company, I would just study with her. And then I got the bug for education. And when I was at day release college, everything just started to click into place for me. Clearly, I was a late developer. And because I was working for British Coal and the National Coal Board, there was a strike in 1984, I was involved in the strike, and it was round about that time I decided I needed to think of what I was going to do for the rest of my life, because I wasn't going to be able to work in this place for the rest of my life, and didn't want to be working in that place for the rest of my life, but, I then got interested in in perhaps taking my college education further and, and perhaps going to university. And I was the first person in my family to go to university and I went later in life. I was about 26 when I went to university and so I took this vocational course. It was a nursing degree at Edinburgh University. And when I was there, we had to do clinical work alongside our training. And that was great. And I was doing psychology as an outside option from a degree. And I started when I was doing my clinical work, I started meeting these clinical psychologists. And I thought, that's the job I'd really like to do. And I was very fortunate, there was a, there was a couple of clinical psychologists, there was Ian Robertson, Nigel North, and Bob Lewin, at the Astley Ainslie Hospital. And they were really kind to me, and they helped me, and supported me, and eventually, weirdly, I got on clinical psychology training. That, that's, that's how I got to be a clinical psychologist. I had to give up my nursing degree, switch over to psychology. I was advised against doing that. I did it nonetheless, and I did my psychology degree, got on clinical training, and A whole new world opened up for me. It was fantastic. And at the time, I was really fortunate. When I trained at Edinburgh, there was a woman called Ivy Marie Blackburn. And it was Ivy Marie Blackburn who brought CBT to the UK. It was Ivy Marie Blackburn who, as one of the pioneers of CBT, really lit a fire for me around CBT. So before, when I first set out to do clinical psychology training, I wanted to do it because I wanted to be a neuropsychologist. And I was particularly interested in stroke, so always interested in older people, but I was interested in stroke. But then I met Ivy and I just got inspired by Ivy, and I just got captured by her evident passion for CBT, and just the ideas, and it was like, this was just like, amazing new world of possibilities has opened up for me, that the way we think about something affects our behaviour and affects how we feel, and because our psychological and physical state are not disconnected if you change one thing you change everything and let's start with thoughts. I mean it was like "this is amazing”. So that was really when I got really interested in CBT but I couldn't have, I couldn't have predicted, even when I started being interested in clinical training, that I'd be interested in CBT Rachel: And you said that you were interested in working with stroke initially, you always had an interest in working with older people and CBT with older people. What was it that, that got you interested personally, professionally in that population in particular? Ken: For someone who works with older people, I find that a really interesting question. And I've spoken to other older adult psychologists, and a lot of older adult psychologists, they'll tell you that they didn't necessarily plan or intend to train with older people, but in their background they've always had maybe contact with older people. So when I was growing up, I had a lot of contact with my grandmother and my grandfather and my grandmother on my father's side and my grandfather on my mother's side. And I had a lot of contact, particularly with my grandfather, and I used to love listening to their stories, and I was just really interested in people's lives. When people ask me what I do, if I ever say I'm a clinical psychologist, I'll also say “that's a professional nosy parker, by the way, that's, that's what my job is”. I've just been interested in people's lives and I've had an abiding interest in that, and I think there's, I think there's something really important about the fact that we value

Let’s Talk about CBT has a new sister podcast: Let's Talk about CBT: Practice Matters with a brand-new host Dr Rachel Handley, CBT therapist and Consultant Clinical Psychologist. Each episode Rachel will be talking to an expert in CBT who will share their knowledge, experience, research and professional and personal insights to help you enhance your practice and help your patients more effectively.  Whether you are a novice or a seasoned clinician we hope you will find something to stimulate thought and encourage you in your work. This episode Rachel is talking to Prof. Richard Meiser-Stedman, a leading expert in PTSD in children and adolescents, about Cognitive Behavioural Therapy for PTSD in young people.  The episode covers the CBT model for the maintenance and treatment of PTSD, adaptions for working with young people, evidence, challenges and complexities, getting good treatment to the young people who need it and how to survive and thrive as a PTSD therapist. 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: Link to Prof Richard Meiser-Stedman’s publications including RCTs on CT for PTSD in children and adolescents: https://www.researchgate.net/profile/Richard-Meiser-Stedman UK Trauma Council website: https://uktraumacouncil.org NICE guidance: Post-traumatic stress disorder NICE guideline [NG116], 2018, https://www.nice.org.uk/guidance/ng116 Materials hosted by UK trauma council – videos: https://uktraumacouncil.org Books: Post Traumatic Stress Disorder: Cognitive Therapy with Children and Young People (CBT with Children, Adolescents and Families), Patrick Smith, Sean Perrin, William Yule and David M. Clark: Routledge, 2009 Working with Complexity in PTSD: A Cognitive Therapy Approach, Hannah Murray, Sharif El-Leithy: Routledge, 2022 Treating Trauma and Traumatic Grief in Children and Adolescents, Second Edition, Judith A, Cohen, Anthony P. Mannarino, Esther Deblinger: Guilford, 2017   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 Podcast produced by Steph Curnow for BABCP.   Transcript: Rachel: Welcome to Let's Talk About CBT Practice Matters, the BABCP podcast for therapists using Cognitive Behavioural Therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who share insights that will help you understand and apply CBT better to help your patients. Today, I'm really pleased to be joined by Professor Richard Meiser-Stedman.  Richard is a professor in clinical psychology at the University of East Anglia and a leading expert in PTSD in children and adolescents, having completed research in the area for over two decades. One of his earliest research papers, published in 2002, was entitled Towards a Cognitive Behavioural Model of PTSD in Children and Adolescents. And since that time, he's contributed enormously to research led clinical progress and published a multitude of papers in the area.  He led the ASPECT study, looking at the early natural course of traumatic stress reactions and early treatment for PTSD in children and adolescents, for example, and the DECRYPT trial evaluating cognitive therapy as a treatment for PTSD in UK Child and Adolescent Mental Health Services. So welcome Richard. We're really delighted to have you here. Richard: Thanks for inviting me. Rachel: And I'd just like to add to all of those accolades, that as a clinician whose passion is working with adults and PTSD, I have been a long-time admirer of your really important work, which can really stem the tide of a lifetime of suffering for children exposed to trauma. And as a friend, I also greatly admire the fact that you've been so prolific and productive while somehow effectively parenting four children of your own with your equally impressive wife, Caroline. Can you tell us a little bit, Richard, as we start about what got you interested in the field of PTSD in children and young people professionally and personally? Richard: Yeah, so, I studied psychology as an undergraduate degree at the University of Nottingham and it was a really good training in psychology, and I really enjoyed cognitive psychology. I really enjoyed thinking about how it might be applied to understanding mental health difficulties. I had some interest in being a clinical psychologist even before I went off to study at university and I thought that that sounded like the career for me. And, just things came together around, yeah, the science around PTSD, this condition. And I thought, oh, this is something I'd like to explore further. I felt like I'd got just a kind of, a flavour of research and what it could offer in terms of understanding really difficult mental health problems as an undergraduate student. And I thought, well, let's, let's keep going. Let's see if I can do a PhD. And so, you know, there's just so many things going on in PTSD, just from my initial studies. I just remember thinking, this is absolutely fascinating. There's so many aspects of how the brain is working and how our cognition is functioning that that are dysregulated. And there was this wonderful paper by Chris Brewin, Stephen Joseph and Tim Dalgleish back in 1996 that had come out just before I started university, which was really drew me in. During university, I got involved in a few things and it's just hearing about people's lives as you do. People start to tell you more things and I did a bit of work on something called Nightline and you started to hear people's stories. And it was clear that trauma can have such a, such a powerful impact on people. And I just felt this, this is something I'd love to know more about. I'd love to see if this is something I could contribute to and I thought, well, maybe if I did some work in this, maybe that'd be a good springboard to a career in clinical psychology, Rachel: And why kids in particular? Richard: because Bill Yule and Patrick Smith were happy to supervise me. Rachel: So, it's the right people in the right place at the right time? Richard: I mean, only an idiot would do child PTSD research because it's way more complicated than doing adult PTSD research. I mean, adults, they come in and they can say, yes, I'll do your study, I'll do your questionnaire And, it's straightforward and you tend to assume that adults have a reasonably good understanding of things and, you know, they've met all the major developmental milestones. I have no idea how I ended up doing child PTSD. I would have been much happier working with adults. But, no, I really enjoyed working with children. It's obviously more complicated. There's just a lot more going on, but I managed to get a PhD place funded at the Institute of Psychiatry, as it was then called and Bill Yule who passed away last year, and Patrick Smith, who's now a professor down at King's were happy to, supervise me, and it's just been a huge pleasure to work with them for over 20 years. Rachel: And as someone who works with adult PTSD, I always think that the really smart and creative people are doing exactly that work. Cause as you say, it's so much more complex to apply this work, with kids who maybe have a lot less autonomy over their system and, and how they can, effect change in their lives. So, you've been researching the impact of trauma on children and young people for more than 20 years then? Richard: I started in 2000 doing a PhD, and so, yeah, I was working with Bill Yule and Patrick Smith, and I was an ambulance chaser, so I was, I worked down at King's College Hospital working with children and teenagers, so 10 to 16 year olds who'd been involved in some sort of road traffic collision or an assault, some sort of physical assault. We recruited over a hundred children and young people who'd come through King's and we followed them up and we were trying to understand what was their initial reaction to that kind of experience and then what happened to their reactions over time? At that point, I think Anke Ehlers had done one study with children and Paul Stallard over in Bath had been doing some work with children, but this is our first London study and, Yeah, it was an important piece of work, it was a real eye opener. I know we were learning lots of things about how you can do research with this population, it was a different era in terms of research governance, but we were learning lots and, yeah, it was an important project. We got some good papers out of it. We were understanding a lot about, more about how, what happens to children and young people in terms of their mental health over time after trauma. And, and why is it that some children, mercifully only a minority, but some children would go on to have chronic difficulties as a consequence, so more persistent PTSD. Rachel: And that's the puzzle that people like Anke Ehlers and others have started with really, isn't it? Why some people recover from these awful events and, and others don't. And I wonder what you've learned about the factors that shape responses to trauma and how those differ perhaps in children from those shaping adult responses to trauma. Richard: I get asked this question from time to time. I'm still not convinced we found a massively different mix of factors that drive PTSD in children compared to adults. A lot of the things that come up in this, say the cognitive model of PTSD that Anke Ehlers and David Clark proposed, they still seem to be really important. So, the kind of key planks would be to give people a reminder of sort of the nature of the memories that children develop for trauma, traumatic experiences, what the trauma and their reactions to the trauma mean? So how do they see themselves in particular, but also other people in the world after the trauma? How do they see their own mind and brain and body after the trauma? T