Let's Talk about CBT- Research Matters

In this episode of Let’s Talk about CBT- Research Matters, Steph speaks with clinical psychologist Katherine Wakelin about her recently published clinical guidance paper, Cognitive therapy for moral injury in post-traumatic stress disorder: integrating religious beliefs and practices, in The Cognitive Behaviour Therapist. Together, they explore how therapists can compassionately and effectively incorporate clients' religious beliefs into cognitive therapy when working with moral injury. Katherine shares the motivation behind writing this paper, guidance on involving spiritual leaders in treatment, and practical tips for therapists who may feel apprehensive about discussing religion in therapy. Read the full paper here Explore more from the Cognitive Behaviour Therapist Find our sister podcasts and all our other episodes in our podcast hub here: Have feedback? Email us at podcasts@babcp.com Follow us on Instagram & Bluesky: @BABCPpodcasts If you found this episode helpful, please rate, review and subscribe so more people can discover these important conversations. Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF Transcript: Steph: Hello and welcome to Let’s Talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT. In this episode, I am joined by Katherine Wakelin. Katherine is lead author of the paper Cognitive therapy for moral injury in post-traumatic stress disorder: integrating religious beliefs and practices which was published in the cognitive behaviour therapist Hi, Katherine Welcome to the podcast. Katherine: Hello. Thank you for having me Steph. Steph: Thank you for coming. So just before we start, would you please tell the listeners a little bit about yourself and the areas that you work? Katherine: Sure. My is Katherine, Katherine Wakelin, I'm a clinical psychologist. I did my training at the University of Surrey and since then have always part of training and after training worked in a range of different specialist trauma services, so I guess certainly work in PTSD has been a specialist interest of mine for quite a few years now. I currently work in a community mental health team in Hampshire, and I guess my role within the team is in a specialist trauma place there as well. And by the time this airs I'll also be working at the University of Southampton as part of their doctorate programme as well. So that's a bit of my background and yeah what I'm currently doing. Steph: Great. And congratulations on your new role then. That's exciting. So I probably collared you about this paper this time last year, maybe we were at the conference, because it was in progress. And I really wanted to chat to you about it, because I thought it was a really interesting paper. And I was like, if it gets published, do you want to come on the pod? You very, very kindly agreed. So often on the podcast, we often talk to people about research papers, what they did, why they did it. This is slightly different because this is a clinical guidance paper where you’re giving actually practical guidance for CBT therapists on how to work with this client group. So was there any particular motivation behind writing this paper, how did this come about? Katherine: Definitely. Well, I guess it probably brewed over a few years. I think the first case I worked with, which was a PTSD case using cognitive therapy for PTSD, where moral injury was a big component in it, was when I was working at the Traumatic Stress Service in South West London with my colleague Sharif, who co-authored the paper with me. And I guess that certainly was a really exciting piece of clinical work where I drew, with lot of Sharif's encouragement and support, but drew on the client's religious beliefs that were largely underpinning and driving the moral injury that initially we'd overlooked that aspect. And then I guess as time has gone on, worked with similar cases across different religions and different religious backgrounds, but really clearly seeing this theme, particularly when working with moral injury, actually the real value if religion is a key part of somebody's identity, then the real relevance to their PTSD and their distress and that ongoing maintenance, unless that's considered. So that's something that over time kept coming up and with Sharif’s encouragement, he'd been saying all along, we should publish a paper on this. And I was like, yeah, yeah, sure. But then I guess when, over time when that kept coming up, we thought, okay, this is an idea actually that I think is a key part of the missing puzzle that perhaps didn't seem to be written about or widely talked about within the PTSD world or CBT world either. Steph: So I'm sure that many people will be familiar with the term moral injury, but just in case for anyone who isn't, would you mind just saying a little bit about what we mean by moral injury and how this might present when working with clients with PTSD? Katherine: Definitely. So I guess the paper or the definition our paper drew on throughout was Litz's definition of moral injury, which is sort of the leading in the field generally and how it's defined is the profound psychological distress that arises from very extreme events which violate somebody's very deeply held morals. This could involve somebody maybe perpetrating acts or failing to prevent acts or even bearing witness to acts that really violate their own moral code. So that could be for example somebody, it's really common in the veterans I've worked with, perhaps who've been part of events whether it be civilians are injured or killed or unintended consequences of actions, accidental car crashes or accidents where others are hurt or harmed or even where you've been a bystander of events and you've been unable to intervene and you've watched something very horrific play out. Or I guess even being subjugated to other people maybe betraying you or treating you in ways that  severely violate your own moral code. So I guess that's the definition that's talked about in the paper, consistently refers to you throughout. But certainly Hannah Murray, has written a very fantastic paper on moral injury in cognitive therapy PTSD so I would certainly read that and our paper definitely leans on that a lot as a foundation and introduction to work in moral injury which was I think Hannah's paper was one of the first I think really clearly and explicitly laid out conditions of how you might be able to routinely be working with this for PTSD and then I guess mine and Sharif's paper expand on that and think particularly in the realm of working with clients with religious beliefs and that's a part of the identity. And actually the paper highlights the intro but Litz's actually original definition of moral injury, I guess defines it as profound as a whole list but profound psychological, biological but also like spiritual distress is named in that which I think the clues in the name, isn't it? If we’re not considering someone's spiritual religious beliefs as part of working with this deeply, deeply held distress that is very relevant to somebody's moral code, then we're missing an obvious piece of the puzzle. Steph: So in the paper, you offer several practical ways of incorporating religious beliefs into therapy in the context of moral injury. Would you be able to just talk through a few of those? Katherine: Yeah, definitely. I guess the paper tries to of walk readers through how they might consider religion at various different aspects of somebody's treatment. In the beginning, certainly holding that in mind when you're formulating distress with clients. And I guess the formulation is always a work in progress. So certainly I've been, I've certainly missed that to start off with somebody in our initial formulation. And as our work's progressed actually we've come back to formulation, added that in actually that perhaps maybe a fear of a higher order judgment or condemnation based on acts they've perpetrated perhaps is actually really fuelling that current threat in their PTSD that might have been missing initially. And I guess it’s been really I guess some of the guidance by Griffiths talks about listening out for the sacred but I guess the idea of clinicians more routinely listening out for sort of language that might imply religion or spiritual beliefs, people talking about maybe being deserving or mentioning prayer or religious communities at all. I guess really listening out for that in your sessions as natural points to then pick up on and just explore I guess, if religion is part of their identity. So listening out for religion, I think it's really important. But then certainly when you're getting into the work and when moral injury is a big theme of that, because that's not always necessarily obvious when you first begin. And I guess these are things that people may never have ever admitted or talked about before because the traumas and the shame and the guilt could be so profound. It might not be obvious you're going to be working with moral injury until you get into the work. I guess as you get into that that often feels an actual place also to just gently prompt and open up conversations around religion. I guess you can give really good psycho education around moral injury and Hannah certainly lays that out in her paper really nicely. But then sort of opening up and sort of thinking, I guess, very understandably when these types of events happen, people can be informed by their morals or things that govern their behaviours and actions and can hold a lot of shame. I guess I’m curious for you, whether or not religious or

In this episode, Steph Curnow is joined by consultant clinical psychologist Dr Kerry Young to discuss the paper "How to Treat Someone Suffering with PTSD Following Rape in Adulthood", published in The Cognitive Behaviour Therapist. Kerry shares the motivation behind the paper and reflects on over two decades of clinical experience in trauma services. Listeners will gain insight into: Why evidence-based trauma-focused therapy for PTSD following rape is so effective Common myths that prevent therapists from engaging in this work Practical guidance for assessment and treatment using CT-PTSD The importance of addressing dissociation, self-blame, and shame Strategies therapists can use to protect their own wellbeing while doing this work The powerful impact this intervention can have on clients’ lives This episode also highlights the invaluable video resources linked to the paper, which show exactly how to put the guidance into practice. Kerry offers encouragement to therapists: if you know how to do CT-PTSD, you already have the skills to help survivors of rape and it’s some of the most rewarding work you can do Read the full paper here Explore more from the Cognitive Behaviour Therapist Find our sister podcasts and all our other episodes in our podcast hub here: Have feedback? Email us at podcasts@babcp.com Follow us on Instagram & Bluesky: @BABCPpodcasts If you found this episode helpful, please rate, review and subscribe so more people can discover these important conversations. Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF Transcript: Steph: Hello and welcome to Let’s Talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT. Today I’m talking to Dr Kerry Young. Kerry is one of several authors on the paper How to Treat Someone Suffering with PTSD Following Rape in Adulthood published in the Cognitive Behaviour Therapist. Hi Kerry, welcome to the podcast. So, it's so nice of you to come on and talk to us today about this paper. I think most people will probably know who you are already, but for any listeners that don't, would you mind just introducing yourself and telling everyone a bit about you and the areas that you work in? Kerry: Yes, hi. So I'm Kerry Young. I'm a consultant clinical psychologist and I've worked in specialist trauma services. I worked it out just now for 28 years. I'm a bit tired. And at the moment I run a PTSD service for refugees and asylum seekers in West London near Paddington station. Steph: So, the paper we are talking about today is How to Treat Someone Suffering with PTSD Following Rape in Adulthood. That's the title of the paper and it does exactly what it says on the tin. So, I really wanted to get you onto the podcast to talk about it because it's such a comprehensive and helpful paper. Would you mind just talking a little bit about where the motivation to write this paper came from? How did it come about? Kerry:  Yeah, so as I said, I've been working in trauma services since the late 1990s. And I think when you start out working in specialist trauma services, you really appreciate how treatable PTSD is. So we would be expecting, if we treat PTSD for someone really not to have any symptoms anymore. So it really is a wonderful thing to treat. And over the years, I've done more and more supervising in other services. And in fact, I've been part of the NHS England funded top up for NHS Talking Therapies to work with PTSD. And what I think all of our supervisors noticed doing this is that people are a bit sheepish about treating PTSD following sexual violence. There's lots of myths and there's lots of things that get in the way, but for good reasons, I think. But we were, all of us, I think, feeling really worried, not just in NHS Talking Therapies, but in other people we supervise that, you know, if someone has PTSD to rape or sexual violence, their chances of getting someone to treat it in an evidence-based way were quite variable, I think. And I just found that really upsetting really, because you'll hear all of these stories about people being raped, you know, maybe in their teens, in their twenties, and it changing the whole course of their life. And them going through the rest of their life really feeling to blame for what happened or feeling really bad about themselves. And this sort of one moment really kind of can change the course of someone's life and that's very particularly the case if they have PTSD. And so what I was noticing is that people are flashing back to being raped day in, day out, dreaming about it when they're asleep. And it’s reinforcing this, they're feeling really bad about themselves, feeling really responsible for what happened and then, making choices about their life on the basis of that. And I just sort of thought, I think we all thought, oh my God, you know, if we could just 10 sessions and the person will stop re-experiencing it, they'll be able to make choices about themselves and their lives that aren't based on re-experiencing rape. And we just thought, how can we get people to do this evidence-based therapy? And it's not just me that's written the paper, you'll see there's an enormous number of people who've written it. So don't think for a minute it was just me, but we thought, well, look, I think the problem is that people really just don't know quite how to do it. They don't know how to ask these questions about body parts and stuff. And there's lots of myths about what you should and shouldn't do. So we thought, look, we'll just tell them. We'll just tell them how to do it and show them how to do it. And so what's brilliant about this paper is this film showing you how to do it. And then hopefully people will just have a go. So that was what was behind it. Steph: Yeah, yeah. And that really nicely segues into my next question then, which was to say, in the beginning of the paper, you do talk about, about therapist fears and maybe some myths around working with sexual violence. I think it'd be really helpful if you could just take us through some of these and actually what might be barriers for therapists working with these clients. As you just said, you know, there are so many that are shy about working with this. Kerry: Yeah, and I just want to make it clear that we're all a bit shy of working with sexual violence. When they invent the thing that means we don't have to talk about it with people, I'll be the first to sign up but there isn't anything else that works as well as trauma-focused therapy. Please don't, I don't want people to think I'm thinking they shouldn't, you know, not want to talk about this stuff because I think it's very natural. There's lots of myths, I think. People often think that someone has to be stable to be able to do this work. They need to be in stable housing. They need to not be waiting for a court case. It all needs to be well in their life. And actually, so often that's the reason why people don't do the therapy. And actually, that is not the case at all. And there's very good evidence in fact, there was a great systematic review that came out last year by someone called Vanessa Yim that really looked into that and found out that actually even when you're in a war zone or even when you're still in a domestically violent relationship, you can still benefit from trauma-focused therapy. So the stability thing is a myth. Now obviously some people might not want to do it when they're unstable, but we shouldn't make that choice for them. In other myths, the things like you can't sort of on a similar vein, you can't treat people who've been raped and have PTSD if they're substance misusing. Again, that's one of those really kind of widely put about beliefs. And actually, again, the evidence not only doesn't back it up, but backs up the opposite, that people can benefit from trauma focused therapy while they're still actively substance misusing. And if you treat the PTSD, the substance misuse comes down alongside it. those sorts of things. So people don't have to be stable. They don't have to not be drinking or taking drugs. And then I suppose the main thing that people worry about is, because the therapy involves talking about the rape in some detail, people think it will be too shame inducing for the client. And on the surface, that makes perfect sense. You think, yeah, no, fair enough. But if you just think about it a little bit more, what the problem with rape is nobody can really tell anybody about the details of it. Not even your best friend, I don't think would you would say this happened and then this and then this. And so people tend to feel ashamed when they've been raped and they never really get the chance to tell anyone exactly what happened. And then, so if you actually, you're with a therapist and you tell a therapist exactly what happened and the therapist goes, oh no, I'm so sorry, poor you, that's just dreadful, what a horrible man. I'm so sorry that happened to you. And the therapist remains compassionate and caring and doesn't blame them and doesn't run out of the room horrified, the client learns that actually the person isn't judging them, and it actually reduces their shame. So the act of telling something that you're ashamed of tends to actually reduce the shame because someone reacts nicely to it. And indeed there's research that backs that up that actually talking about sexual violence reduces the shame associated with it, doesn't increase it. So I think that's the big one. And I suppose related to that, people often think as well that talking about sexual violence will be too much for the client and that they'll just

In this episode of Let’s Talk about CBT- Research Matters, Steph speaks with Dr Daniel Wilson, a clinical psychologist and researcher based in Brisbane, Australia. Dan is the lead author of the paper “CBT-E following discontinued FBT for adolescents with eating disorders: time for a more individual approach?” published in The Cognitive Behaviour Therapist. Steph and Dan explore key findings from the study, which compared the effectiveness of CBT-E (enhanced cognitive behavioural therapy) for young people who had previously discontinued FBT (family-based treatment) versus those who had not tried FBT at all. The research offers important insights into treatment options for adolescents with eating disorders and highlights the value of providing alternative pathways to recovery. Links & Resources: Read the paper: “CBT-E following discontinued FBT for adolescents with eating disorders: time for a more individual approach?” - https://bit.ly/3Eysxd0 Explore more from the Cognitive Behaviour Therapist Find our sister podcasts and all our other episodes in our podcast hub here: Have feedback? Email us at podcasts@babcp.com Follow us on Instagram & Bluesky: @BABCPpodcasts Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF Transcript: Steph: Hello and welcome to Let’s Talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT. In this episode, I’m talking to Dr Daniel Wilson. Dan is lead author on the paper CBT-E following discontinued FBT for adolescents with eating disorders: time for a more individual approach? Which was published in the Cognitive Behaviour Therapist. Hi Dan. Welcome to the podcast. Dan: Thank you very much. Thanks for having me. Steph: It's really exciting to have you on. Actually, you are our first guest from Australia. So would you like to tell the listeners a little bit about yourself, maybe where you work and your research areas? Dan: Yep. Sure. So I'm a clinical psychologist. I'm from Brisbane, Australia, and my work here in Brisbane, I do a little bit of a mix. So I am working at Children's Health Queensland at a specialist eating disorders clinic for our child and youth mental health service and I work clinically there as part of the CBT-E team. I'm on a research fellowship for the last two years and we're researching eating disorders generally and what factors contribute to treatment outcomes amongst adolescent eating disorders. And also do a little bit of work in private practice as well. Steph: Okay, brilliant, thank you. So I was really keen to get you on the podcast. It was Eating Disorders Awareness Week here in the UK a couple of weeks ago. And, as we just talked about off air, we also recorded a Practice Matters podcast with Rebecca Murphy, which you said you listened to as well for Eating Disorders Week, talking all about it. So I thought this would intersect really nicely with that. We don't actually get many eating disorders papers into the journal as well, so I thought it'd be really nice to showcase this one and talk about what you do. So could you tell us a little bit about how this paper came about? Was there any particular motivation for the research? Dan: Yeah, so I guess in part, it was on behalf of our young people, on behalf of the treatments that we offer as well. I think unfortunately still with all the evidence we've got with treatment with eating disorders, sometimes they can get a bit of a bad rap. Not so much within our service, but they can be perceived as people that are hard to treat, or the treatments don't work, or people don't recover, despite there being like really good evidence for outcomes. And so what in particular we noticed as well was with family-based treatment, it's a treatment that a lot of people have heard of. It's probably the most well studied treatment for adolescent eating disorders and when it's not going well or it hasn't completely worked, then that kind of perception that, oh, they're not going to recover, can be even worse. And sometimes when family-based treatment doesn't go well, it can not look too good. There can be a lot of distress, there can be a lot of like argumentativeness so that the perception- this is very much anecdotally- is well, if they haven't been able to recover with full family support, what hope is there? And that they're not suitable for an individual treatment. But within our service, what we noticed was that when we'd had sort of some young people that hadn't done quite so well with FBT and we gave them a chance for CBT-E, a good proportion of them did really well and engaged really well on the treatment. So we thought that was really important to be able to demonstrate to give the families and to also clinicians hope that, even if their family-based treatment hasn't worked, then the young people can still achieve full recovery through a treatment like CBT-E. Steph: That's probably a really good point then to just talk about the two treatments a little bit. Would you be able to just sort of talk a little bit about the differences between the two for those who might not be so familiar, and actually maybe why family-based treatment might not work as well? I'm quite intrigued to some of the reasons why. Dan: Yeah, sure. I think that's, that's a really important distinction between the two treatments to make. And I think that's also a really great, to have two treatments that contrast quite differently. I think a lot of times in psychology there's a large overlap between the treatments and it's like one hasn't worked then the other one maybe is also quite similar. But with FBT and CBT-E, there's some really striking differences there, which I think might give some rationale for why if one doesn't work, the other one might work. So with FBT to start off with, the theory behind the two treatments are quite different. With FBT, they take the medical model, the disease model. So with that model, the eating disorder is conceptualised as an illness that the young person has, they don't have any control over, and the symptoms of the illness are the eating disorder behaviours, which might be the concerns overeating, the concerns over weight and shape and the desire to restrict. So according to that model, if you've got the disease, it's something that's external to you that you have no control over. It's a little bit like having covid or something, you don't choose to have a sniffly nose, you don't choose to have a cough, you don't choose to feel awful. It's an illness that you’ve contracted so you need some form of external medicine, external control to recover from the illness. So when you've got covid, you take whatever medicine's going to help you recover from that. According to the FBT model, it's the eating disorder that is causing these symptoms. It's not something that the young person's chosen to have, but they need some sort of external force to regain control. And according to FBT, the food is the medicine, and the family is that external support that's required to help the young person regain control from their illness and achieve recovery. So there's a lot of advantages to that model, in that because it's conceptualised an illness like no one's to blame. It's no one's fault. It's something that's happened. So the young person isn't to blame the families aren't to blame. And according to that model, you can garner the resource of the whole family to, to help the young person recover. So it's a good model and the evidence is that it works but it's also quite different to the CBT-E model where we take that psychological approach. So rather than it being an illness that you've got no control over, we think according to the CBT-E model, that there's reasons why this young person might be really concerned about their weight, concerned about their shape and want to engage in eating disorder behaviours. And it's not because they've got an illness or got something that's external to them. It's according to the CBT-E model we usually conceptualise it as being a maladaptive schema of achieving self-worth. So it's a way that the young person has learned to feel good about themselves. And if they can control their eating, if they can control their shape and weight, then they feel really good about themselves and they feel in control and they feel great and that's why they want to engage in the behaviours, and that's why they're so concerned. But there's also mechanisms that maintain it and can make it a problem. So according to that model, it's the road to recovery isn't through an external force being required. It's the road to recovery is understanding what the mechanisms are that the maintaining the eating disorder as a problem. Making the decision, okay, I want to explore other ways of achieving my self-worth. Other ways of feeling better about myself that don't rely on just controlling eating, weight and shape and then applying the strategies to be able to change them. Steph: Yeah. So it sounds like it gives them more autonomy. Dan: Yeah. Yeah definitely. And, yeah, in that early on in the stages of FBT, it's very much kind of parents are in control and that they need to be, because according to that model, the young person doesn't have any control. Whereas with CBT-E, it's all about autonomy from the very first session, it's like you are in control here, you are making the decisions through treatment and it's your decision to, to literally sit down in session one and talk about what's going on. And then if you want to hear more and make the decision to engage and it's your decision to go on from that. So, yeah, a lot of difference in the role of autonomy the

In this episode of Research Matters, host Steph Curnow talks to Dr. Alex Lau-Zhu, lead author of the paper “Flashforward Mental Imagery in Adolescents: Exploring Developmental Differences and Associations with Mental Health,” published in Behavioural and Cognitive Psychotherapy. Alex discusses his research into flashforward mental imagery—vivid mental pictures of future events that can be intrusive and emotionally powerful. We explore how these flashforwards relate to anxiety in adolescents, why mental imagery isn’t always a focus in CBT, and how young people may benefit from imagery-based interventions. Guest Bio: Dr. Alex Lau-Zhu is an MRC Clinician Scientist Fellow at the University of Oxford's Department of Experimental Psychology and a clinical psychologist supporting young people affected by trauma. His full list of publications and research areas can be found here: https://www.psy.ox.ac.uk/people/alex-lau-zhu Links & Resources: Read the paper: “Flashforward Mental Imagery in Adolescents: Exploring Developmental Differences and Associations with Mental Health” - https://bit.ly/3Eysxd0 Explore more from Behavioural and Cognitive Psychotherapy –https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts Have feedback? Email us at podcasts@babcp.com Follow us on Instagram & Bluesky: @BABCPpodcasts Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF Transcript: Steph: Hello and welcome to Let’s Talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT. Today, I'm talking to Dr. Alex Lau-Zhu, Alex is lead author on the paper “Flash Forward Mental Imagery in Adolescence: Exploring Developmental Differences and Associations with Mental Health” which has been published in Behavioural and Cognitive Psychotherapy. I really enjoyed this chat with Alex. We talked all about his paper, and we also talked about maybe why mental imagery isn't explored so much with adolescents, or even in CBT in general. It's a really interesting listen, so I hope you all enjoy. Hi Alex. Welcome to the podcast. Alex: Hi Steph, thank you for having me. Steph: You’re welcome. So, before we get into talking about your paper, would you mind introducing yourself to the listeners and telling us a little bit about who you are and the areas you work in? Alex: Yeah, of course. I'm currently an MRC clinician scientist fellow at the Department of Experimental Psychology at the University of Oxford, and I also work as a clinical psychologist in our local county in Oxfordshire, supporting young people who are affected by trauma. Steph: Thank you. So we're talking today about the paper that was published in the last issue of Behavioural and Cognitive Psychotherapy, which is about flash forward mental imagery in adolescents. So could you tell us a bit about how this paper came about? Was there any particular motivation for the research? Alex: Yeah so I work with a lot of young people in my clinical work and often find that they sometimes struggle with expressing themselves, sometimes around identifying what goes on in their minds in particular, which is really a key part of doing CBT, for example. And speaking to other clinicians, also working with young people, it seems like actually sometimes they do find thinking on mental images perhaps a bit easier to thinking about, for example, using visual mediums or drawings to express how they feel and what they think, but sometimes it goes to be around talking about mental images that they experience inside their mind, just describing what is it that they see, what is it that they hear, as a way to then better understand some of those thinking processes or what we might call as distortions in CBT. And that led me to think kind of more broadly around how much do we know about these sorts of processes in young people. And actually, we know incredibly little. There's some really I think exciting work that has happened in the last 20 or 30 years in working with adults and doing CBT with adults around thinking about mental images, not just verbal thinking. But that knowledge somehow hasn't really trickled down to working with young people as much. So I'm really curious more generally in, in understanding mental imagery in young people and whether that can help us improve our treatments. Steph: And would you mind just explaining what flash forwards are for anyone who might not be aware of the term? Alex: Yeah, I think it's probably a term that if once I explain what it means, then you might realise it's something that you're familiar with, you just perhaps haven't used this term to describe that before. So, the simplest way to think about it is the opposite of what a flashback would be. So a flashback is, you know, often a mental picture, often very visual, of the past, of a stressful, traumatic past event that just popped back into mind. So we think of flashforward as the almost the opposite of that. So again, mental images that just pop back. They're depicting something stressful and threatening, but they are about the future rather than about the past. And so perhaps another term that have been used in the literature or in clinical practice is intrusive images that are specific around the future. So one example would be, let's say, perhaps, last night before coming to the podcast, I had a flash forward of being on this podcast and perhaps, I don't know, my, my voice breaking, the technology not working, you know, something happens and maybe it's going live and I could kind of see your face or the laptop running out of battery. That's what I can see in my mind. And naturally that if someone has a very sticky image like that, then it's going to be very anxiety provoking. But if we take that to clinical case, let's say with young people that I work with, they might have flash forwards of having to do a school presentation later in the week and feeling like people are not really paying attention because they find that presentation boring, maybe laughing at them for not really knowing perfectly what they're talking about. So that's perhaps that, that brings about in terms of social anxiety, for example, and we can think about different types of flash forwards of different content for a range of anxiety presentations. Steph: Yeah, it's interesting you saying that mental imagery hasn't been explored in adolescents so much because you would imagine the kind of flash forwards being quite prominent in clients with OCD, for example, you would imagine that they would often quite have flash forwards about what might happen if I don't do this or if I don't do that. So it's interesting that in adolescents has not been explored so much. Alex: Yeah, and I don't really know why exactly that's been the case. I think there's something about imagery work that, that, well, you know, by now we know that imagery can be really emotionally powerful, in our therapies. I’ve been reading actually some very old work by Aaron Beck, who was still developing CBT in the early 70s. And actually, I didn't know, maybe other people do know, but he had a psychoanalytic sort of background right before breaking into CBT. But a lot of his clinical work in the early stages of CBT used loads of imagery. So, asking his patients about imagery, finding ways to interrupt those images and manipulate those images, changing the ending of a lot of images, like the way you would do that in imagery rescripting, for example, for those who are familiar with that technique. He was doing a lot of that sort of, not typical kind of CBT techniques and somehow then that got lost as CBT became more developed and disseminated and other researchers, you know, expanded on that thinking. I don't really know why. I wonder whether there's something about imagery that, that it kind of feels like it has too many links to psychoanalytic thinking, thinking about dreams and fantasies and CBT was perhaps trying to move away from that, but I think Beck always said that cognition is not just verbal thinking, it can also be imagery. Somehow the verbal thinking took over as CBT expanded, and actually, it would be great to be able to talk to Beck about what he was thinking. But I think for young people in particular, imagery is helpful and powerful for all ages, I believe. But for young people, I think, particularly relevant because I think it could be really creative work, it could be really imaginative, it could be really playful and fun, and young people often like therapists that has that kind of greater sense of agency on what they can bring to therapy. Steph: So I imagine imagery work as well must be really subjective too, and so that must be really helpful for adolescents to be able to sort of think, oh my therapist isn't just going to tell me what to do, they're going to ask me, you know, how to describe something, and if I can't, imagery might be a really helpful way to kind of get this out and to explain myself. Alex: Yeah, exactly. I mean, how you might want to change the content of an image, you know, from a more negative to more positive ending, for example, that the young person can become the director of their own film and I think at an age where agency is quite important, to me, it feels like imagery techniques really lend themselves to that developmental sensibility. Steph: Yeah, absolutely. Okay, so we'll get into talking about the paper a little bit then. You very helpfully laid out some very clear hypotheses in your paper, which were very helpful to talk about what you were going to be

In this episode, host Steph Curnow interviews Vickie Presley, the lead author of a paper titled "Crossing the Reflective Bridge: How Therapists Synthesize Personal and Professional Development through Self-Practice/Self-Reflection (SP/SR) during CBT Training", published in The Cognitive Behaviour Therapist. Vickie shares her insights from the research, discussing the importance of reflective practice in CBT training and how it shapes therapists’ professional growth and personal awareness. If you enjoyed this episode, please rate, review, and subscribe wherever you get your podcasts. Follow us on Twitter at @BABCPpodcasts or on Instagram . Share your feedback or episode suggestions by emailing podcasts@babcp.com. Useful links: The full version of the article being discussed can be found freely available here The SP/SR book that Vickie mentions is “Experiencing CBT from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists (Self-Practice/Self-Reflection Guides for Psychotherapists)” by James Bennett-Levy, Richard Thwaites, Beverly Haarhoff, and Helen Perry. Foreword by Christine A. Padesky Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF Transcript: Steph: Hello and welcome to Let’s Talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT. Today, I'm talking to Vickie Presley. Vickie is course director for CBT training at Coventry university. She's also the lead author of the paper “Crossing the reflective bridge’: how therapists synthesise personal and professional development from self-practice/self-reflection during CBT training” which she co-wrote with Gwion Jones and is published in the Cognitive Behaviour Therapist. Hi, Vickie. Welcome to the podcast. Vickie: Hi Steph, thanks for having me. Steph: Thank you. It's lovely to have you here. I was wondering if you would mind telling everyone a bit about who you are and the areas where you work. Vickie: Yeah, of course. So my name is Vickie, Vickie Presley. I'm currently the lead for psychological therapies training at Coventry University and the course director for our CBT training programme. And I guess outside of my university role, I'm also a CBT therapist and supervisor in private practice. I guess for the purposes of today as well, it'd be important to say I am also Vickie. I am a lady heading quickly towards my 45th birthday. I am a mum. I'm a wife to a long-suffering husband. I'm a sister. I'm an auntie. I'm a great auntie, Lots of things outside of that sort of professional context. And I guess also I'm a nervous wreck today, if I'm honest. I guess just thinking about conveying things around this research, but it just seems important to say that given we're going to talk about sort of how therapists might synthesise their personal and professional development, there's bits about me that might come through today that are about my personal self, not just my professional self. Steph: Great. Thank you. And that's great that you've sort of brought in some of the personal as well. That's really nice. And I'm always nervous when we start doing podcasts as well. So it's fine. And I've been doing this for a while now. Vickie: Oh, that's good to know. Thanks, Steph. Steph: The paper we're going to be talking about today is about self-practice, self-reflection in CBT training but before we get into talking a bit about the paper, would you be able to tell me a bit about how this research came about? What inspired it? Vickie: Yeah, of course. I mean, I suppose the answer to that question is, one that takes me back, sort of, 15 years or so to my own CBT training. So, I trained at Coventry. Coventry's got quite a long-standing ethos of reflective practice as part of the training course. And for me, I think that allowed me to really think about the role of myself in my therapeutic interactions with clients. And I started to notice as part of my training that I was getting in the way sometimes. So sometimes my own stuff was getting in the way of my work with clients. There's this example that I always give where, I was working with a lady who was very, very depressed, and as part of that presentation she was very perfectionist and held herself to really high standards, which, is something that I have to manage myself. So, there's kind of this schema match, I guess, if you like, that we noticed, and we did some work around that. And technically it was really good. Technically we did this continuum exercise. It worked really well, it was really helpful for her in the session. But right in the last minute, I suggested to her that she took the worksheet home, and she rewrote it because mine was too messy. And I suppose the whole irony of that, that one statement, which, I mean, I suppose we look back at that and sort of laugh at the irony, but it really had the potential to undo a lot of good work in the session. And that was about my own stuff. So, I really do think that's the point where it started for me, and I started looking at some of the research that was around about therapist perfectionism in particular. I suppose as my career has gone on and I've supervised trainees and qualified staff and obviously I've worked at the university for many years now, we notice the same patterns that therapist’s own stuff will get in the way a lot of the time. So some of my previous papers have focused on areas like therapist perfectionism, like things like experiential avoidance and one of the things we always suggest at the back end of those papers is that therapists get involved in SP/SR so they can get to know themselves a bit better. And I guess that brings us to this paper where we wanted to know whether that was working as part of our own program. And if it is, how trainees experience that, how do they get to know themselves as part of SP/SR and as part of the training process? And how do they make sense of that in a professional context? What meanings and what the experience of synthesising those two parts of themselves is like. So that's how we got here and that's what this paper aims to elucidate in some way. Steph: And I think that's really important, isn't it? Because when you're really busy training and you're taking in all this new information and then you're putting it into practice, it must be really difficult actually to take that time to think about yourself and to really self-reflect and think about how that might be impacting you. Vickie: I think it's really difficult and I think, in some ways, it seems more difficult in the CBT model, I think, because lots of the things that we have to teach are quite technical and there's lots of demands on trainees to show technical flair and that they understand quite complex models and ways of working. But that can become, this whole reflection stuff can become sidelined and feel like it's less important. I think my view is that the technical stuff, the technicalities of CBT take place within a relational context, and they take place within the dynamic between two people and if the therapist isn't holding what's their own stuff in that dynamic, that can become problematic. Steph: Could I ask you to just explain a bit about what is self-practice/self-reflection for anyone who might not be, familiar with the term? Vickie: Yeah, of course. So, I mean, I suppose the simplest terms, self-practice/self-reflection is about practicing CBT techniques on oneself, so using, the interventions of CBT on oneself and then having time to reflect on what that experience is like. I guess there's a myriad of ways that people can get involved in self-practice/self-reflection but on our training course specifically, we use the text “Experiencing CBT from the inside out”. So that's a well-established text. It's an evidence-based text, and we provide one of our trainees with a shiny workbook at the beginning of the year, and that's what we use to scaffold the process of SP/SR. So, we find that's a really nice text that helps the trainees work through some of the stuff that SP/SR incorporates, but also helps our staff who are facilitating that process to keep some framework around the process. So for our trainees, we give them that book and actually SP/SR is a mandatory part of our training program, so all of our trainees will be given the book and have space to work through that, but they'll also meet 12 times across the training year with their group facilitator to have space to reflect with peers and to reflect with the group facilitator about the process of taking part in SP/SR.I suppose for us it's an integrated part of our training programme and we find that this huge benefits from for including that as part of the training program. So yeah, so each of our trainees would be working through the process and have a formal space to reflect on how that's going across the year. And then they're also asked to submit an assessed summary of their learning from SP/SR and how they're making sense of that in terms of their clinical practice. And I guess that last bit is the key point. That we don't want people just to do SP/SR. We don't want them just to experience what it's like to do CBT interventions. We want to give them space to make sense of that in a professional context so, bridging that professional arena and what those insights mean for their clinical practice and how it can help with their skills developmentment. Steph: Yeah. And that's a really nice segue into my next question, actually because we're going to dive into the paper now on what you did and it's that reflective piece of work was kind of the basis for how you recruited your participants really, wa

In this episode of Let’s Talk about CBT – Research Matters, host Steph Curnow speaks with Dr. Nick Grey, a consultant clinical psychologist with extensive experience in anxiety disorders and PTSD. Together, they discuss the paper “Ten Misconceptions about Trauma-Focused CBT for PTSD,” co-authored by Nick and published in the Cognitive Behaviour Therapist. The paper addresses common myths and challenges in trauma-focused CBT, offering insights for both therapists and researchers in the field. Key misconceptions discussed include: Misconception 1: “Trauma-focused treatments are not suitable for complex or multiple trauma.” Misconception 2: “Stabilisation is always needed before memory work.” Misconception 10: “Cognitive Therapy for PTSD is rigid and inflexible.” If you enjoyed this episode, please rate, review, and subscribe wherever you get your podcasts. Follow us on Twitter at @BABCPpodcasts or on Instagram . Share your feedback or episode suggestions by emailing podcasts@babcp.com. Useful links: The paper discussed is: Murray, H., Grey, N., Warnock-Parkes, E., Kerr, A., Wild, J., Clark, D. M., & Ehlers, A. (2022). Ten misconceptions about trauma-focused CBT for PTSD. The Cognitive Behaviour Therapist, 15, e33. doi:10.1017/S1754470X22000307 The full version of the article can be found freely available here: https://bit.ly/47KIwPL Transcript: Steph: Hello and welcome to Let’s Talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT. Today I am talking to Dr Nick Grey. Nick is a consultant clinical psychologist and has worked in the field of anxiety disorders and PTSD for many years. He is also one of the authors of the paper we are going to be talking about today which is titled “Ten misconceptions about trauma-focused CBT for PTSD” and is published in the Cognitive Behaviour Therapist. So Nick, welcome to the podcast. Nick: Thank you, Steph. It's nice to be here. Steph: It's great to have you. So before we get talking about the paper, I was wondering if you would just mind telling everyone a bit about who you are and the areas in which you work. Nick: Yeah, sure. So, I'm a clinical psychologist by professional background and a sort of a CBT therapist by sort of flavour of psychological therapy. And I work down in Sussex now, based in Brighton working across Sussex partnership and for many years I worked up in London at the Centre for Anxiety Disorders and Trauma and continue to work together with David Clark, Anke Ehlers and other members of the Wellcome Trust anxiety disorders team who are based in Oxford. And, and that's where a lot of the work that we're going to be talking about has originated in both London and Oxford and in particular the paper is pulled together by the Oxford team. What I should also say and just wanted to say up front is that the paper is lead authored by Hannah Murray, who sadly passed away after a long illness in December 2023 and her input, not just to this paper, but to us as a group has been unbelievably crucial and, both us as a team, but I know that the wider, sort of CBT community will really miss her. Miss her contribution. Steph: Absolutely. And thank you for mentioning Hannah. She was a great friend to the journals as well. She spent so much time contributing to both of our journals, mentoring people, reviewing for us. Yeah, we really miss her. So I really wanted to talk to you about this paper today, because not only is it one of our most widely read papers, which is brilliant, but the format of this paper was so popular, it's actually sparked a whole new series of papers for us. We're doing a whole new set of “10 Misconceptions” papers now that we're currently commissioning. I just wanted to ask how did this come about? What was the idea for this? Nick: The idea came around because we found ourselves, doing a lot of training, a lot of supervision over a number of years, particularly for the treatment that we provide Cognitive Therapy for PTSD, which is one of the types of trauma focused kind of CBT. And we found ourselves saying many of the same things again and again, really sensible questions that people would raise in training workshops, really sensible questions people would raise in supervision, and we thought it would be helpful for us and therefore for all the people that we are also sort of like supervising and training to have us almost perhaps a single resource. So like an FAQs, around some of the things in this line of work. Steph: Before we get into talking about the misconceptions themselves, you've worked in PTSD and trauma for a long time now. If you don't mind me asking, when you started out were there any myths or misconceptions that you held about working with clients with PTSD? Nick: Yes, all of the ones that are in the paper at some stage or other, I think this is a normal process that actually we hold all of these to one degree or other, until perhaps we've had the chance to test them out or we've had the chance to learn more. One of the key things for me, I think one of the key things that we're always trying to get across in the work that we do is there's a difference between having a history of traumatic events and having experienced traumatic events, and then the types of presenting problems that people may have, which will include, may include PTSD, but may not only be PTSD. And this really came through to me, the sort of where I started in, in sort of psychology and mental health in the NHS was a long time ago, working as a research assistant, actually at the Spinal Injury Centre at Stoke Mandeville Hospital and part of the project that I was working on, led and supervised by Paul Kennedy, a clinical psychologist, was around how do people cope following spinal cord injury. And my job involved speaking to lots and lots of people who had experienced a spinal cord injury and how they were coping and, how, what helped them, what was difficult and those kind of things. And one of the things that I was really struck by was just how varied their current presenting difficulties or lack of difficulties were, given many of the similarities in the experiences that they'd had which had resulted in life changing injuries for all of them, essentially. And a small proportion of those people who had a spinal cord injury also were having repeated unwanted memories, nightmares, waking in the night on the wards, reliving the experiences that had led to their injury. But it was only a kind of a proportion. And then there was differences in how they coped with, with those experiences as well. So one of the things that I really took from that is that firstly that not everybody who experiences a traumatic event is going to be negatively affected in the long term, that the types of impact and effects that people may have following a traumatic event may be very varied or be very personal to them and even for those people who are having like unwanted memories or nightmares, for many people those also reduce naturally over time. And then what we're working with, certainly thinking about cognitive therapy for PTSD, thinking about trauma focused therapies as a whole, we're working with people who have become stuck in that process of natural recovery. So, I think one of the first misconceptions for me in this area was that everybody who goes through a trauma is going to be affected and they're going to be negatively affected and they're going to have PTSD. And I think some of that, that sort of misconception that I certainly, I think, held before getting more experience, is still to some degree commonly held in health systems. I wouldn't say necessarily by CBT therapists or people working in mental health, but as a whole, if you've had a trauma, it's definitely going to affect you and you're definitely going to need a trauma focused therapy. And I think this is one of the things that certainly exercises me in the present day as well, when people talk about things like treating complex trauma. And this ties in a little bit with the first misconception in the paper about multiple traumatic events or prolonged traumatic events and the complexity of kind of memory presentations and for me complex trauma is a description of the history, is a description of what the person has experienced and it's not a description of the presenting difficulties that they may have if they do in fact have significant difficulties. So we're never, and I don't think it is just semantics, I think it's important about how we conceptualise reactions to traumatic events, how we conceptualise PTSD, and therefore, really importantly how we provide treatment, is that we need to make sure that actually when we talk about treating complex trauma, it makes no sense. We're not treating the history per se. Of course, the history is massively important in the formulation, in understanding what's going on, in the possibility of there being PTSD. But what we're talking about in this paper, what we're talking about with cognitive therapy for PTSD is helping people, that subset of people who have experienced traumatic events who do meet criteria for PTSD or complex PTSD. And crucially it's those people who have re-experiencing symptoms where they have unwanted memories or bad dreams, where when they have those experiences, it feels to some degree like those events are happening again in the present. Rather than being simply memories from the past, and it's definitely taken me time to, to really get my head around that, that it's just a small subsection of people that kind of we're working with, and, and actually that treating multiple traumas, actually what we're treating is the re-experiencing symptoms, perhaps, to people who may have had a whole range of traumat

Let’s Talk about CBT - Research Matters is a brand-new podcast from the BABCP, hosted by Steph Curnow, Managing Editor for the BABCP Journals Behavioural and Cognitive Psychotherapy and The Cognitive Behaviour Therapist. In this episode, Steph talks with Sandra Krause a senior PhD student at Concordia University. Sandra is lead author on the paper “‘Things that shouldn’t be’: a qualitative investigation of violation-related appraisals in individuals with OCD and/or trauma histories” with her co-author Adam Radomsky published earlier this year in Behavioural and Cognitive Psychotherapy. Sandra explains what is known about the cognitive model for mental contamination and how her research builds on this to explore what her participants with lived experience of OCD or trauma define as violations and the implications of this for clinical practice. You can find Sandra’s full paper here: https://bit.ly/3YLyoUn If you enjoyed this episode, please rate, review, and subscribe to the podcast on your preferred platform. Follow us on Twitter @BABCPpodcasts for updates and join the conversation. Have feedback or suggestions for future episodes? We'd love to hear from you! Email us at podcasts@babcp.com. Useful links: You can follow Sandre and Adam Radomsky on Twitter for more updates about their work or follow their lab at the links below: @SandraKrause4 @AdamRadomsky Lab website: https://www.radomskylab.ca/ Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF   Transcript: Steph: Hello and welcome to Let’s Talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT. Today I am speaking with Sandra Krause. Sandra is the lead author on the paper ‘Things that shouldn’t be’: a qualitative investigation of violation-related appraisals in individuals with OCD and/or trauma histories published in Behavioural and Cognitive Psychotherapy. Steph: Sandra, welcome to the podcast. Sandra: Thank you. Thanks for having me. Steph: No problem. So before we begin, would you like to introduce yourself and talk a little bit about the research that you do? Sandra: Sure, my name is Sandra Krause, and I'm a senior PhD student at Concordia University, which is in Montreal in Canada. And all of my research that I've done as part of grad school has been in the anxiety and obsessive-compulsive disorders lab. So that's been under the supervision of Professor Adam Radomsky and really, yeah, we've been interested in trying to understand different cognitive mechanisms that are at play. I'm trying to kind of better understand different aspects of anxiety disorders, OCD. My particular interest is in kind of the crossover with trauma, ultimately, really, just so that we can improve treatments and better help people who are suffering from those kinds of issues, so that's kind of the broad strokes of what we do, and clinically kind of work to apply the knowledge that we learned from the research to evidence based approaches to working with individuals who are struggling with those concerns. Steph: Okay. Brilliant. Thank you. So we'll start talking about the paper that you've just had published in BCP. So can you tell me a little bit about what the aims of the study were, and were there any particular motivations behind the research? Sandra: yeah, so when I started grad school, my research interest was on trying to kind of understand, we know a lot about within OCD contamination related symptomatology, but there's kind of a sub section of those types of symptoms that we know less about, and it's called mental contamination. And so this is, we often see people wash excessively, feel dirty in response to kind of intrusive moral thoughts rather than in response to any kind of contact with physical germs or dirt. So, maybe having an intrusive thought about something like incest or paedophilia, or intrusive memories of past assaults, things like this that have happened to them and that that's the driver of kind of the contamination symptoms that they experience. And so coming into my PhD, I was really curious, there's a cognitive model of mental contamination that was proposed initially when sort of the symptom domain was newer, but there's a lot of aspects of the model that aren't super fleshed out. So, for example, a big part of the model is the fact that these feelings, this is feeling of dirtiness and the washing that comes up, comes up because of a perceived violation, but there's not a super clear definition of what is a violation? What constitutes a violation? What kinds of events are violating for people and why? And then also, as the name suggests, the cognitive model kind of proposes that it's the way that people appraise or think about those violations that lead to the symptoms of mental contamination, but there's not a ton of work yet too that's been done at, zeroing in on specific types of thoughts that are linked to mental contamination feelings after experiencing a violation, and kind of differentiating between the types of thoughts that lead to mental contamination versus other kinds of negative emotions that might come up after a violating experience. So things like shame or anger or sadness that you might expect someone to experience as well. And so that's kind of where my study came in was that I wanted to really start from the ground up and speak to people who have lived experience with either OCD or trauma histories and hear from them, how they define the construct of violations so that we could get a clear definition for the model. And then also walking through past instances of violation that they've experienced to understand different types of thoughts that they have, different appraisals that they make, and how those appraisals are linked to different kinds of negative emotions. So, again, kind of differentiating between those that were associated with those feelings of dirtiness, disgust, contamination, and the ones that are related to other kinds of negative emotional experiences like anxiety, fear, anger, shame, Et cetera. So that was really the aim of aim of the study. Steph: brilliant. Thanks so much. So, if we get into the paper then, I think that leads quite nicely onto your participants. I see from the paper that you interviewed 20 participants. Who were they and how did you recruit them? Sandra: Yeah, so, the inclusion criteria for the study. So in order to be able to participate, we were interested in interviewing people who either met criteria for OCD or who met criteria for, we call Criterion A and the DSM for PTSD. And so this is people who have experienced a serious trauma, so either actual or threatened death or serious injury or sexual violence that they experienced themselves or witnessed firsthand. And so, in order to get participants, we have a clinical registry as part of the lab. So there was at the time of my study, there was also a randomized control trial happening in the lab for treatment for OCD. So, we advertised through that study to see if anyone was interested in participating in the study as well. And then we also advertised on Twitter and online. And so really we were just looking for people who had these experiences or kind of experienced these types of symptoms who are adults, so over 18, and who spoke English. So it was pretty broad inclusion criteria. And yeah, anyone who was interested reached out and then I had a phone screener with them and just went over those kind of symptom, sections of the Mini-International Neuropsychiatric Interview and confirm that they were eligible. And then we conducted the interview over Zoom with them. But yeah, these were just kind of people in the community. Some were seeking therapy, and some were just kind of interested in contributing to research. Steph: And did you get many, people come forward from Twitter? I'm always intrigued when I see studies on Twitter and how much uptake they really have. Sandra: Yeah, there was a bit of, interest. I would say that there was a lot more screening that was required of the broad social media ads that there was, again, we were just sort of in the ads were just describing the symptoms pretty generally. Yeah, so people can interpret that in different ways so that we didn't actually end up with a ton of participants from the Twitter ads. But actually ran into another sort of new research hiccup that we hadn't anticipated was bots that there was, we got one day like 300 emails from different Gmail addresses, that were sort of automated, I guess. The bots that had reached out about the study. So just, I guess, a caveat for anyone doing social media recruitment for research that to be careful about. Steph: I hadn't even considered that. But yeah, I can imagine 300 emails is annoying. Sandra: yeah, I mean, luckily for us, there was a screening call, so I was able to weed out all of those people through that, but, yeah, for people I know who have been doing just online questionnaire studies via social media that people kind of just go on, I guess there's automated ways of, getting whatever compensation at the end. So they go in and submit a bunch of responses and it's hard to screen out. Steph: So going back to the interviews then, when you completed all the interviews, am I right in thinking that you did some analysis on the transcripts and then some apparent themes emerged from these interviews? Sandra: Yeah. So the, again, because it was like a pretty exploratory study and we were going in pretty open ended because again, we didn't have like really specific hypotheses of what we were expecting to find because we didn't really know a lot about this area from previous research.

In this episode, Steph interviews Liz Marks about the upcoming special issue on climate change in the Cognitive Behaviour Therapist. They discuss the origins of the special issue and chat a bit about the Climate Change Special Interest Group (SIG) within the BABCP. Liz also gives an overview of all papers in the special issue, covering topics such as eco distress, transdiagnostic approaches, compassion-focused therapy, acceptance and commitment therapy, environmental identity, active hope, and climate cafes. Useful links: tCBT Special Issue - CBT in a Time of Climate and Biodiversity Crises Liz is part of the Bath Centre for Mindfulness and Community mission and an affiliate of CAST- The Centre for Climate and Social Transformations 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   Transcript: Hello. I welcome to let's talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT. Today, I'm talking to Dr Liz Marks. Liz is a Guest Editor for our upcoming special issue “CBT in a time of climate and biodiversity crises”, which will be published later this summer in the Cognitive Behaviour Therapist. Steph: Hi, Liz, welcome to the podcast. Liz: Hi Steph. Thank you so much for having me on your podcast today. Steph: You're welcome. So, before we get into the episode, would you tell us a bit about who you are and the work that you do? Liz: Yeah, sure. So, I'm a senior lecturer at the University of Bath and I'm also a clinical psychologist, so I teach clinical psychology, but I also do a lot of research into relevant aspects of psychology and particularly CBT. So I'm also an accredited CBT therapist, I'm an MBCT trained mindfulness teacher and my work sort of covers all of those different aspects, both clinically and in terms of research. Steph: So we're talking today, not just about one paper, but we're actually talking about several papers, which make the upcoming special issue in the Cognitive Behaviour Therapist. So this is a special issue on climate change, which you guest edit alongside Mandy Cole. Can you tell me a little bit about how the idea for the special issue came around? Liz: Yeah, it's, it's really, interesting journey. I guess it sort of started in 2022, at the London conference. I don't know if you were there or your listeners were there, it was in the middle of that blistering heat wave. I had put in a symposium about climate change with Mark Williams at Cardiff and some others. And Mandy, who I didn't know at this point, had put in a request to run an interactive table. BABCP suggested we link up and have a round table, which is what we did. And that's where I met Mandy and also Claire Willsher who had been looking for some guidance from the organization around activism so Mandy and Claire were engaged in a consultation, with the BABCP members at the conference about what they wanted in relation to climate change and so that was all going on. And one of the things that happened was, Richard, Thwaites, who's the editor in chief at tCBT, spoke to Mandy there and asked if she might be interested in guest editing a special issue on climate change and me and Mandy, who had, who'd been talking at the conference, talked about that, and she asked me to join her, and that's kind of where it started. Steph: Brilliant. Thank you. And did you want to talk a little bit about the climate change SIG? How many members do you have? What kind of goes on in the climate change SIG? Liz: Yeah, okay. So the, the, climate change SIG was another outcome from this conference in 2022. And Mandy put in an application for the SIG at that point. It hadn't been successful previously, but it was accepted then. And, we were a temporary committee until 2023 when we had our first AGM and that was a conference in Cardiff. And now we've got over a hundred people. Steph: Oh, wow. Liz: and we, yeah, it's great. It's really exciting. It's building. And, so they, the SIG supported this special issue and we also are running various events. So we are running an event on eco therapy and CBT in September, we're supporting that and we're also going to be supporting the running of some climate cafes, which I can talk about a bit later as well. One of the other really important things that came out of the conference and that goes beyond the SIG, in fact, is the climate statement that the BABCP have made about the organization's aspirations and guidance around climate change as a whole. I think it's really important to mention this. I'm not sure if your listeners will all be aware, but they made it really clear there that BABCP recognizes we're in a climate and ecological emergency and that we all need to take action on climate change, regardless of what our roles are. And recognizing that CBT has the tools to alleviate suffering, but that we also need to develop new ways of working. So I think that's really important and also is well aligned to what we're doing with the special issue. And one last thing that SIG has done that's really interesting that your listeners might be interested in is that people in the Climate SIG have been interviewing the leaders of the organization about what they think is important about climate change. So President Saiqa Naz, President Elect Stirling Moorey, and the CEO, Tommy McIllravey, and they all talk about feeling passionately about climate change as individuals, as well as for the organization. So there's a real energy around this at the moment. Steph: Okay. Brilliant. Thank you. So, if we get into talking about the special issue, then it's full title is CBT In A Time Of Climate And Biodiversity Crises. So it has eight papers in the issue, and it also starts with a really lovely introduction from yourself and Mandy, which really sets the context of the issue and how all the papers fit within it. Do you want to start talking a bit about some of the papers and why they're significant. Liz: If I could just start by setting all of the papers in a particular context, which is the recognition that we are living at a time where we're facing significant threats and losses from climate change and the biodiversity crisis. And we wanted these papers to drive forward our understanding, offering original and pioneering ideas about what CBT can do in this context. And I think we, we talk about the distress that people might experience when aware or experiencing the impacts of climate change and related issues, which I will probably refer to as eco distress as we go through. but I, I think it's really important that this isn't some sort of diagnosis. It's referring to the experience of challenging thoughts and feelings in response to what is really happening, so just as we might have an emotional response when we are living with a chronic or terminal illness, and reality cognitions about that, we see that we're living with a, in a planet, who is also facing a chronic health condition, a sort of planetary health crisis and it's really important I think that we recognize that the thoughts and feelings that people have aren't pathological. They're actually showing a real awareness of what we're all facing. Steph: The first paper that we were going to talk about was the paper with Mark Freeston and Claire Willsher. And this is quite an unusual paper in that it doesn't read as a research paper, but it is Claire's experiences as a climate change activist, and then Mark’s responses to her with the kind of academic evidence backing up her kind of personal insights. Do you want to talk a bit more about that and start us off? Liz: Yeah, this is a really unique paper. And I think it's really helpful to set the scene as well because it ties our understanding of people's emotional responses to climate change. And so something I think that we can all relate to as kind of a citizen of the world of somebody who is aware about what's going on. But Claire brings to it the perspective of somebody both with the lived experience and with a psychological understanding as a CBT therapist, so she's able to reflect on her thoughts and feelings about climate change and how that shaped her decisions to engage with activism as well. She's very brave and open about her personal journey with difficult eco emotions and I think what, what Mark does really well is to show how and why these experiences might arise by linking them to different aspects of the evidence base and it's, it's really clearly shows how therapists are not going to be immune to climate change or the emotions that they elicit. And I think something that's maybe really relevant to a lot of CBT practitioners and more broadly to therapists around the world is, many of us go into this because we're tuned into suffering. And we, we wish to alleviate that suffering in some way we wish to show compassion and care for others. And something that climate change does is it, it threatens people's health and wellbeing, particularly people who are more vulnerable. So it may well be that people who are working in this area could even be particularly tuned into the painful emotions that elicits for themselves as well as others. And I think what this paper really beautifully shows is how important it is to make sure that therapists have the support that they need, and that the tools they could use for that around self-reflection, self-practice, supervision, personal and community support are all going to help them navigate their own eco emotions. Steph: Brill

Let’s Talk about CBT - Research Matters is a brand-new podcast from the BABCP, hosted by Steph Curnow, Managing Editor for the BABCP Journals Behavioural and Cognitive Psychotherapy and The Cognitive Behaviour Therapist. In this episode, Steph talks to Dr Jake Camp a clinical psychologist and DBT therapist about their paper “Gender- and sexuality-minoritised adolescents in DBT: a reflexive thematic analysis of minority-specific treatment targets and experience” published in the Cognitive Behaviour Therapist. This study aimed to understand the experiences of GSM young people in DBT and what difficulties and dilemmas associated with their gender and sexuality diversity were thought by them to be important to target in DBT. Jake talks about what this study found and highlights some really helpful recommendations for clinicians working with young LGBTQ+ people. You can find Jake's ful paper here: https://bit.ly/45GhM1C 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 Transcript: Steph: Hello and welcome to Let’s Talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT? In this episode, I talked to Dr Jake Camp. Jake is a clinical psychologist and lead author of the paper “Gender and sexuality minoritised, adolescents in DBT, a reflexive thematic analysis of minority specific treatment targets and experience” which was published in the Cognitive Behaviour Therapist. Steph: Hi, Jake, welcome to the podcast. Jake: Hello, nice to be here. Steph: Thank you so much for joining us. So just to start off the podcast, are you okay to tell me a bit about yourself and the service that you work for? Jake: Yes, absolutely. So, so my name is Jake Camp. the pronouns I use are he/they. I'm a clinical psychologist, and DBT therapist. So my main area of work is at a national, DBT service for adolescents that's based at the renowned Maudsley Hospital. I also work academically, mostly with the department of psychology and the LGBTQ+ mental health research group. So that is at King's College, London. and I mostly work with young people who have experienced a ton of trauma, sadly, and have had a lot of difficulties that have led to, finding it very hard to sort of survive and thrive in the world. Often, young people end up being quite highly suicidal, sadly and my area of research that I'm particularly keen with, and of course what we're hopefully talking a bit about today, is mainly around how therapies work for minoritised groups and particularly LGBTQ+ groups as my sort of main area of research. So, it's great to have a chat about that. Steph: So yeah, that leads us really nicely into talking about the paper because we are talking about one of the minority groups that you have been researching. So do you want to tell us a bit about who they are and what the paper is that we're talking about today? Jake: Yeah. So, the paper that we are focusing on today is, one where I really wanted to spend some time privileging and I suppose, increasing the sort of voices of LGBTQ plus young people in DBT. For those who are not familiar with that acronym, although hopefully most people are, of course, that is usually people who identify with a minoritised or minority sexual identity, so that's like lesbian, gay, queer, etc and or a sort of minoritised or diverse gender identity, so that might be trans, non-binary, or so forth. So the paper really was to try and, you know, sort of give a platform to LGBTQ+ young people about their experiences of Dialectical Behaviour Therapy or DBT, because what we know from the literature is that, generally LGBTQ plus people experience quite a lot of barriers to accessing services. There's also some evidence of poorer experiences of services and even some of the poorer outcomes, particularly in the sort of adult literature. So we know that there's a bit of a problem with how we meet the needs of LGBTQ plus group generally across our services, and we know that LGBTQ plus groups usually are significantly more likely to experience mental health difficulties and particularly engage in self-harm and suicidal behaviours, sadly, which we think is associated with, societal oppression, what we call minority stress. So those are stressors unique to their sort of minority characteristics or identity. So, we think it's super important, you know, to sort of do more work in this area. And of course, sadly, there's not actually that much, particularly in DBT about this, but, I would say there's also not much robust work, across that sort of fields as well. So, so this is the paper. Steph: And I think one thing that really struck me when I was reading the paper, I've read a couple of iterations of it from when it was submitted to the published version, it's really about how much the lived experience of the young people you were researching in this was very important to, to the topic and to you. And so what motivated you really to look at this research area in particular and, and focus on this. Jake: Yeah. Yeah, good question. I think, it really stems, obviously, from early on, and I touch on this a little in the paper, I identify as LGBTQ+ so generally just describe myself as a queer/nonbinary psychologist and I think, you know, growing up in a societal context where we had the sort of echoes of what I now know was sort of Thatcherism, Section 28, which precluded, the sort of conversations around what was termed homosexuality in schools, which ultimately meant that, you know, things like bullying with content around this, things like talking about modelling good experience of this, showing you that you could be a queer young person and be okay and thrive, were just completely absent from my childhood, mixed in with, I think, you know, we certainly were coming out of the AIDS epidemic when I was growing up and a number of other social, cultural things, I think just meant that, you know, growing up as a queer kid really wasn't comfortable and from a very early age, starting to feel different from people and starting to feel that societal oppression was very heavy. Mixed in with, a number of other sort of areas of difficulty and trauma in my sort of familial environment. I think I was I've always been very keen to try and use my privilege to help people, help my kin almost, help people, help those queer kids, you know, to sort of grow up and thrive, because I really didn't feel like I had that. And so that sort of informed how I've ended up going down the route of LGBTQ mental health as my sort of main area of research. And, I think, of course, part of that is they're my tools, they're my tools for activism in some ways, is that, the area that I can use and the privilege I have is that I can focus my research energy into this and hopefully try and make the system better. So, they're the sort of overarching aims. The reason I ended up in this sort of project area specifically is firstly, because, I work in DBT and very passionate and keen about supporting people who have quite complex trauma that other sort of traditional services don't always quite meet their needs, you know, so the sort of the running theme for it, and I think DBT does that really nicely and when I started working in the National DBT Clinic, I was very surprised to quickly see that in this group of very highly suicidal young people, that about 60 to 70 percent of them were LGBTQ+ which of course is an outrageous over representation, compared to what should be if there was no health inequality there. And that sparked my interest because I thought, I need to work out what's going on here. And I need to try and make sure we're meeting their needs and make sure that other services are meeting their needs too, because I think what that potentially speaks to is that their needs are not being met sufficiently earlier in the treatment pathway before they end up needing DBT. And of course, DBT, you know, is really made for people where they're highly suicidal, high severity of difficulty usually been going on a long time. So this paper sort of squarely came out of that. I thought, where do I start? Well, I want to start, you know, with the young people and their voices, and I want to know what's working for them, what isn't working for them, and actually what is important about their experience as a minoritised individual that we need to be thinking about in therapies, in particular, of course, DBT. So that was the sort of inspiration for it, and it's part of a wider program of work, of course, to try and complement some of those questions that I had. But here it was squarely about, what do the young people think? what would they advise us to do, which I think is super important. Steph: Yeah, absolutely. And that really comes across in the paper, I think. Like I say, it's really nice when you can read papers that you know have been written with real thought and real compassion as well, that definitely comes across in the paper. Before we getting into talk about the paper itself, would you mind explaining a little bit about DBT for maybe listeners who don't know what it is, or maybe don't know that much about it? Jake: Yeah, of course, yeah. So DBT stands for Dialectical Behaviour Therapy. so, we usually describe it as a sort of third wave CBT approach. for those who are not familiar with that terminology, third wave, I usually think of as meaning standard sort of second wave CBT, which is the usual CBT you see out there for, you know,