Dr Richard Thwaites is a Cognitive Behaviour Therapist (CBT) and consultant clinical psychologist working in Cumbria, UK.

He is currently Clinical Director of a large Improving Access to Psychological Therapies adult service and is involved in research into both anxiety disorders and training methods such as Self-Practice/Self-Reflection. He recently co-authored the first published SP/SR manual (Experiencing CBT from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists, 2015) and a book detailing the various roles of reflection in the world of CBT from training to therapy and supervision (Reflection in CBT, 2016)

Why are you a CBT therapist rather than practicing another form of therapy?

Although as a clinical psychologist, I initially received training in a range of therapies, CBT always made most sense to me and I went on to train as a CBT therapist as soon as I could. As a clinician I feel a strong sense of duty to provide treatments with the strongest evidence-base as a first line treatment, and in my area of interest (anxiety disorders) this is usually CBT in some form. I also really enjoy the collaborative style of working that CBT involves; there is a strong fit there with my personal style.

What developments in the world of CBT are currently exciting you?

I am currently involved in a research programme led by Professor Mark Freeston (in collaboration with global colleagues) looking at the role of intolerance of uncertainty across a full range of disorders and trying to understand to what extent this differs from actual perceived threat. It is still relatively new work in CBT terms but I find it really interesting to consider when working with patients with anxiety disorders even when delivering ‘standard’ CBT.

What do you think are the main challenges facing CBT?

CBT has developed a strong evidence-base across a wide range of patient groups and disorders. However, this brings with it a range of challenges. Firstly, there is an ethical and global argument for thinking about how we can deliver evidence-based therapy most cost-effectively, for example in developing countries where health funding can be significantly lower than average and scalability is much needed, secondly we need to better understand the mechanisms of change in CBT and thirdly we need to understand why some people (significant numbers of people) don’t benefit from CBT and whether we can improve or further develop our interventions.

What do you think is distinctive about the CBT as a journal?

Most CBT practitioners are incredibly busy and can struggle to keep on top of the latest research even when they are really keen to base their practice on evidence. The CBT is very much a practitioner journal and I would hope that we can get to the point where for busy CBT therapists in clinical practice, if they only have time to browse one journal – then it would be this one. Whilst it covers all patient groups, the aim is that every article will cause the reader to stop and reflect, and think about their own practice and what potential implications this might have for them and their patients.

The online nature of the CBT means that articles can be published as soon as accepted and also that there are less limits in terms of word counts and numbers of articles. We are in a position to publish innovative work, clinical reviews and what I would see as ‘clinical wisdom articles’ (such as the great piece by Murray, Merritt & Grey in 2015 on how to maximise clinical benefit of trauma site visits when delivering trauma-focussed CBT). While some readers want case studies or research studies, others just want to know what best practice is with relation to specific aspect of CBT interventions or supervision. The ultimate test of success will be whether the articles we publish leads to readers (including myself) changing our clinical, supervisory or training practice!

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