This paper outlines a prospective cognitive framework for understanding the intersectionality of gender diversity and neurodivergence (specifically being autistic). The framework aims to provide understanding of the overlap between being autistic and being transgender and gender diverse, where these two constructs intersect and where they are disparate. Within these two intersections, there is evidence that individuals may mask or camouflage parts of these intersections of their identity, which may in turn impact on emotional wellbeing. This framework aims to be supportive of staff and adult service users alike in understanding this intersectionality and to provide suggestions on how to use this framework within psychological therapy to support autistic transgender and gender diverse adults. Limitations, clinical implications and key messages are briefly included within the discussion. Due to the limited research in this area at present, it is likely that further research into this field is warranted and further evidence, service user feedback and trialling of the cognitive framework would be imperative to conclude its utility and efficacy in clinical practice.

NHS Talking Therapies for Anxiety and Depression (TTad) offers evidence-based psychological interventions for individuals with depression and anxiety disorders across England. Despite substantial progress in improving access to therapy, disparities remain, particularly for clients from diverse backgrounds. Given the increasing linguistic diversity across England and the reported preference among clients to engage in therapy in their first language, it is not yet known whether requiring or requesting an interpreter affects access to timely and appropriate therapy, or whether such needs contribute to disparities in treatment outcomes. This study, therefore, examined waiting times and outcomes for interpreter-mediated CBT within TTad. The sample consisted of 177,340 clients who accessed TTad services for the year 2022 to 2023 and received Step 3 CBT. Clients using an interpreter were significantly more likely to wait longer for treatment compared with those not using an interpreter. Treatment outcomes differed significantly; only 58.5% of clients using an interpreter showed reliable improvement, compared with 69.2% of those not using an interpreter. Similarly, reliable recovery was lower in the interpreter group (32.5%) versus the non-interpreter group (44.5%). Among those requiring an interpreter, the lowest reliable recovery was seen in clients using professional interpreters (28.8%). These findings highlight the need for targeted strategies to reduce delays and improve outcomes for interpreter-mediated therapy, ensuring more equitable access and effectiveness of psychological interventions within TTad. Further research is needed to explore the underlying factors contributing to these disparities and to identify best practices for delivering effective, culturally and linguistically appropriate therapy.

Key learning aims

1. (1) To examine whether a request or requirement for an interpreter is associated with increased or altered waiting times for Step 3 CBT within NHS Talking Therapies for anxiety and depression.

2. (2) To investigate differences in clinical outcomes, specifically reliable improvement and reliable recovery, for clients using interpreters compared with those who do not use interpreters.

3. (3) To compare outcomes across different interpreter arrangements, including professional interpreters, family/friend interpreters, others, and instances where interpreters did not attend, exploring any differences in outcomes.

Despite religion being an important part of some patients’ identity and value systems, therapists report finding it challenging to discuss religion in therapy. Avoiding religion for these patients can have detrimental effects on the therapeutic alliance, treatment outcomes, and parity of access for minoritised groups. Therefore, this clinical guidance paper aims to support therapists to bring religion into the therapy room by addressing six key concerns: (1) difficulties raising the topic, (2) ‘getting it wrong’ when discussing religion, (3) therapist and patient differences, (4) managing negative or ambivalent beliefs about religion, (5) perceptions of insufficient knowledge, and (6) a lack of time for meaningful discussions. These barriers are explored by drawing on empirical evidence, clinical experience, and illustrative case examples. The paper aims to provide suggestions and next steps for how therapists can reflect on and address these concerns, aiming to enhance confidence and competence in integrating religion into CBT.

Key learning aims

1. (1) To support therapists to overcome commonly held concerns around discussing religion in therapy.

2. (2) To provide practical guidance, tips, and suggestions for how therapists can discuss religion with patients.

3. (3) To help therapists to take responsibility for bringing religion into the therapy room where it is relevant.

Chemsex is a pattern of using specific drugs with the intent of enhancing the sexual experiences of men who have sex with men. Chemsex participation is often motivated by a desire for community connection or enhanced sexual pleasure. Many individuals who participate in chemsex can mitigate much of the associated risk and report limited, if any, harm. However, for some, chemsex can be problematic, precipitating or exacerbating mental health issues. Despite increasing amounts of research into chemsex, there is no consensus about how to best support people who participate in chemsex when they present for psychological therapies. In the absence of specific clinical guidelines, this paper explores the intersection of chemsex and mental health problems. Principles of affirming and non-stigmatising, assessment, formulation, and intervention strategies are discussed, and recommendations are made throughout. Drawing on contemporary evidence, we present cognitive behavioural approaches to supporting service users who participate in chemsex with anxiety, depression, and post-traumatic stress disorder. By enhancing cultural safety and tailoring existing evidence-based treatments, therapists can improve engagement and outcomes for individuals who engage in chemsex. We recommend an inclusive approach that champions service user choice, paired with a sensitive, sex-positive, and trauma-informed perspective. Therapists within Talking Therapy services are well placed to support service users who participate in chemsex and have co-occurring mental health difficulties.

Key learning aims

1. (1) To understand what chemsex is, what motivates chemsex participation, and the distribution of potential risks.

2. (2) To understand the intersection of sexuality, chemsex, and co-occurring mental health difficulties, including the role of pleasure, identity, shame and community.

3. (3) To identify the key barriers experienced by people who participate in chemsex when accessing mental health services, such as negative staff attitudes or fear of stigma.

4. (4) To explore cognitive behavioural approaches to working with people who participate in chemsex, and associated common mental health difficulties (anxiety, depression, and post-traumatic stress disorder).

5. (5) To identify practical strategies to engage service users who participate in chemsex.

Insomnia disorder is highly prevalent and frequently co-exists with other mental health conditions. Evidence suggests that targeting insomnia may improve overall mental health. Although the effectiveness of cognitive behavioural therapy for insomnia (CBT-I) is well established, it is rarely offered to patients as a discrete treatment. This study aimed to evaluate the outcomes of CBT-I delivered at Step 2 for reducing symptoms of insomnia, as well as anxiety, depression, and impaired functioning, following its implementation within an NHS Talking Therapies service. We examined routinely collected pre- and post-treatment outcomes from 35 patients (median age 60 years, interquartile range 44–68, 63% female) who received CBT-I. Insomnia severity was assessed during the first and last session using the Insomnia Severity Index, while secondary outcomes, including depression, anxiety, and impaired functioning were completed at each session. Intention-to-treat analyses demonstrated significant improvements in insomnia symptoms from pre- to post-treatment, with a large effect size (d = 0.85). Significant improvements were also observed across all secondary outcomes, with large effect sizes for depression (d = 1.01) and anxiety (d = 0.89), and a medium effect size for functioning (d = 0.58). The complete case analysis yielded larger effect sizes across most outcomes. These findings provide preliminary support for the potential benefits of CBT-I as a primary treatment for symptoms of insomnia, with secondary benefits for anxiety, depression, and functioning in patients presenting with mental health difficulties within an NHS Talking Therapies service. Implications for the service and future service evaluations are discussed.

Key learning aims

1. (1) To develop understanding of the evidence base for CBT-I for sleep and mental health outcomes.

2. (2) To consider the outcomes of CBT-I when delivered by Psychological Wellbeing Practitioners in an NHS Talking Therapies service.

3. (3) To evaluate clinical recovery rates in line with NHS Talking Therapies criteria.

A long-term physical health condition (LTC) is one ‘that cannot currently be cured but can be controlled with medication and/or other therapies’. Around 30% of people with an LTC have mental health co-morbidities. Systematic reviews suggest adapted cognitive behavioural therapy (CBT) produces positive outcomes for LTC clients compared with control conditions. However, limited research includes long-term follow-ups or the client’s voice, preventing conclusions about mechanisms of change or sustainability. This qualitative study explored long-term health experiences of CBT for adults with LTCs in UK primary care, and what elements of CBT participants deemed responsible for change. The sample included 10 individuals with an LTC. Findings were constructed through inductive-deductive reflexive thematic analysis, integrating participant-led narratives with psychological theory. Four themes were identified: a validating and normalising therapeutic relationship, lack of therapist skill and knowledge of LTCs, adjusting to and accepting LTC, and de-catastrophising LTC-specific beliefs. Participants discussed the importance of both common and specific factors. A trusting therapeutic relationship was essential, while collaboratively applying techniques to promote adjustment and acceptance was necessary for long-term gains. The study highlights embedding health psychology theory and third-wave approaches within a process-based, transdiagnostic framework enhanced through LTC-specific training and supervision. By attending to identity disruption, illness representations, values conflict, and low self-efficacy, therapists can deliver interventions that consider the lived realities of LTCs.

Key learning aims

1. (1) To explore how participants understood and described the emotional, cognitive, and identity-related changes that occurred following CBT, with particular attention to long-term adjustment and meaning making.

2. (2) To identify which therapeutic processes participants perceived as most helpful or unhelpful, including both CBT-specific strategies and common relational factors, and how these were thought to influence change.

3. (3) To contextualise participants’ accounts within broader health psychology and process-based frameworks, considering how their narratives reflect mechanisms highlighted in models such as the Self-Regulatory Model, the Transdiagnostic Model of Adjustment to LTCs, and third-wave approaches.

Cognitive behavioural therapy (CBT) is a widely recommended, evidence-based modality. Cost-effective interventions such as CBT are particularly valuable in low- and middle-income countries, which typically have considerable resource constraints and service delivery challenges. Despite its benefits, CBT remains under-utilised by clinical psychology practitioners in South Africa, possibly due to poor perceived self-competence of practitioners. We employed a qualitative exploratory design to explore student clinical psychologists’ perceived self-competence in delivering CBT in their first year of masters studies at one university in South Africa, using once-off individual semi-structured interviews (n=5). Data were analysed using reflexive thematic analysis, following an inductive-deductive approach. We identified two over-arching themes: (1) Training experiences shape perceived self-competence in CBT, and (2) Making sense of competence and readiness for practice. The findings suggest that perceived self-competence in CBT is shaped by training experiences, with supportive supervision, practical application, and positive client outcomes enhancing confidence. Limited prior exposure to CBT, rigid teaching approaches, and inconsistent feedback created challenges in developing self-competence which seemed to influence decisions about using CBT in practice. The findings provide important insights regarding the gaps in CBT training in South Africa, which may influence the use and uptake of CBT by future clinical psychologists. These findings highlight the importance of training environments that promote flexibility, experiential learning, expert supervision and constructive feedback in developing competence in evidence-based interventions. Further research is needed to establish whether these issues are shared amongst trainee students at other universities.

Key learning aims

1. Readers of this paper will be able to:

   1. (1) Identify factors influencing self-perception of CBT competence.

   2. (2) Understand how CBT training occurs as part of a Master of Clinical Psychology programme in South Africa.

   3. (3) Understand how the perception that CBT is rigid hinders CBT implementation.

To reduce the burden of depression, it is important to ensure that adolescents have access to effective, early interventions. Limited research has explored psychological practitioners’ views during the development of such interventions, despite the potential for this to improve implementation. A brief, imagery-based intervention (IMAGINE) has been co-developed to address issues in treatment provision for symptoms of depression in adolescents. Here, we investigate psychological practitioners’ and supervisors’ views about factors that may act as barriers and enablers to implementing IMAGINE. We used a qualitative interview study with (1) qualified low-intensity practitioners with experience of working in schools, and (2) clinical supervisors to these practitioners, working in England. Reflexive thematic analysis was initially inductive followed by a deductive mapping to normalisation process theory, a theory of how interventions become implemented and embedded in practice. Twenty-four participants (14 low-intensity practitioners and 10 supervisors) were interviewed. Six themes were identified: (1) ‘We could be doing more for young people with low mood’, (2) ‘IMAGINE stands out while feeling familiar’, (3) ‘Which young people is IMAGINE for?’, (4) ‘Pushing the depth of low-intensity practice’, (5) ‘Getting everyone on board’, and (6) ‘A good fit for services, more or less’. The findings show enthusiasm for new interventions to address adolescent depression, with low-intensity practitioners eager to enhance their clinical skills. This was balanced with concerns about the demand for low mood interventions and whether some components of IMAGINE fit within low-intensity practice. These insights suggest barriers and enablers for developing psychological interventions.

Key learning aims

1. (1) To identify implementation and contextual factors that may act as barriers and enablers to implementing imagery-based depression interventions in schools.

2. (2) To explore how an imagery-based psychological intervention for depression in adolescence is perceived from the perspective of psychological practitioners working in schools and their supervisors.

3. (3) To inform future research in the development of imagery- and school-based interventions for adolescent depression.

NHS Talking Therapies for anxiety and depression (NHS TTad) were established in 2008 to increase and improve treatment for anxiety and depression, with the intention of reducing inequalities through being particularly responsive to individuals from marginalised groups. However, racially minoritised clients are under-represented within NHS TTad services, and are more likely to drop out of treatment. A service evaluation was carried out at a central London NHS TTad service to explore the experiences of clients from the ethnic group that was most likely to disengage. The aim was to find ways in which the service could be improved to enhance the experiences of this group and increase the rate of treatment completion. A service audit revealed that clients with a Black background, regardless of their specific ethnicity, had the highest drop-out rate and were significantly more likely to disengage than the White British group. The service evaluation involved interviewing six clients from this group who had recently dropped out of or declined treatment. Interviews were structured and analysed using narrative inquiry, and pattern coding was used to reduce large amounts of data into four main themes. Overall, participants found accessing support relatively easy but had limited knowledge on the service. A lack of choice and flexibility around appointments were highlighted as key factors in not completing therapy. Based on their experiences, participants recommended incorporating community and cultural learning into therapists’ training, and giving clients the option to request a therapist from a similar background. Recommendations are provided for service delivery.

Key learning aims

1. (1) To identify which clients, based on ethnicity, are most likely to decline or discontinue treatment within an NHS TTad service in Central London.

2. (2) To increase understanding of the treatment experiences of clients from the ethnic group with the highest drop-out rates.

3. (3) To provide recommendations offered by these clients for service providers, aimed at improving engagement and treatment completion.

Misophonia is a condition characterised by intense emotional reactions to sounds that would not bother most people. Currently, there is no widely accepted and effective treatment for misophonia. Most published studies on treatment have used behavioural therapy, cognitive interventions, or audiological treatments; however, there is no comparison of the effectiveness of these approaches. This 6-week study aimed to compare the effects of brief, self-administered versions of exposure and tinnitus retraining therapy (TRT) in 58 adults with misophonia. The participants, randomly assigned to the two treatment groups and a wait-list group, were assessed at three time points (baseline, week 3, and week 6). The exposure group was given self-exposure homework assignments, where the patient was expected to self-expose to the live or recorded misophonic sound that was agreed upon during the week 0 assessment, for 20–40 minutes, three times a week. The patients in the TRT group were given a set of pre-recorded music pieces and asked to listen to any piece of their choosing for 20–40 minutes a day, three times a week. Self-report measures of misophonia severity (Misophonia Checklist), and interference due to symptoms were rated at each time point by the patients. The assessor also rated improvement at each time point. The study is registered in ClinicalTrials.gov (registration no. NCT05993286). The Intention to Treat (ITT) analyses revealed no difference between the three groups in terms of self-rated misophonia severity at week 6. The assessor-rated percentage of improvement favoured exposure, although the response rate was very low; only six out of 39 participants were rated as moderately or much improved, five of whom were in the exposure therapy group. The results underscore the need for finding ways to increase treatment response in misophonia.

Imagery rescripting (ImRs) is a therapeutic technique that uses mental imagery to update the meanings associated with traumatic memories and reduce re-experiencing and emotional distress (Arntz, 2012). It is commonly used as a therapeutic technique for post-traumatic stress disorder (PTSD). The present study evaluates an ImRs intervention specifically developed to target somatic flashbacks. Somatic flashbacks can be understood as re-experiencing somatosensory sensations, such as touch or physical pain. The study aimed to investigate the feasibility, safety, and acceptability of the intervention. The study also explored if the intervention led to any differences in participants’ experiences of somatic flashbacks and their global symptoms of PTSD. A non-randomised feasibility study design was used. Seven participants who reported experiencing somatic flashbacks at assessment were recruited into the study. The ImRs intervention consisted of a pre-intervention session to complete measures, two ImRs intervention sessions, and a 4-week follow-up session. Participants’ experience of the intervention was measured at the end of the second ImRs session. Participants’ somatic flashbacks and global symptoms of PTSD were measured pre- and post-intervention and at follow-up. ImRs was feasible, safe, and acceptable. Frequency, intensity, and distress of somatic flashbacks reduced, and sense of coping increased following the intervention. A brief ImRs intervention for somatic flashbacks is a promising intervention. Future research should explore the prevalence of somatic flashbacks, underlying mechanisms of ImRs, the optimal timing and content of the intervention, and whether this can be integrated into existing trauma therapies.

Key learning aims

1. (1) To assess if imagery rescripting is a feasible intervention for somatic flashbacks.

2. (2) To assess if imagery rescripting is a safe intervention for somatic flashbacks.

3. (3) To assess if imagery rescripting is an acceptable intervention for somatic flashbacks.

4. (4) To assess if the imagery rescripting intervention led to any differences in participants’ experiences of somatic flashbacks and their global symptoms of PTSD

The Bergen 4-day treatment (B4DT) for obsessive compulsive disorder (OCD) is a concentrated form of exposure and response prevention that has been implemented at the Icelandic Anxiety Centre. The aim of the present study was to assess 12-month results of 86 participants undertaking the treatment. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was administered at pre-, post-, and 3- and 12-month follow-up, accompanied by measures on generalised anxiety (GAD-7), depression (PHQ-9), and functional impairment (WSAS). The mean pre-treatment score on Y-BOCS was 30.5 (SE=0.5), the post-treatment score was 10.7 (SE=0.4), and the 12-month follow-up score was 11.5 (SE=0.9). There was no significant difference in Y-BOCS scores from post-treatment to 3- and 12-month follow-up, which indicates that treatment gains were maintained over time. Functional impairment, along with symptoms of anxiety and depression, decreased significantly from pre- to post-treatment, with further reductions in functional impairment observed at the 12-month follow-up. All participants completed treatment, and at 12-month follow-up, 83.7% had responded and 67.4% recovered. Among the participants that had responded or remitted at post-treatment, 22% had a worse outcome at 12-month follow-up, but 54% of the participants in the response or no change categories at post-treatment had a better outcome at follow-up. These results support the effectiveness and long-term benefits of the B4DT when implemented outside of its country of origin.

Key learning aims

1. (1) The Bergen 4-day treatment (B4DT) is a highly intensive format of exposure and response prevention (ERP) for OCD.

2. (2) Treatment gains from the B4DT for OCD are sustained for at least 12 months, with 67% of patients remaining recovered and 84% showing improvement.

3. (3) Approximately half of those who do not fully benefit initially experience further improvement by the 12-month follow-up.

4. (4) Drop-out rates are negligible, which is unusual for exposure and response prevention.

5. (5) The B4DT demonstrates effectiveness beyond its country of origin.

Individuals with co-occurring mental health and substance use disorders present considerations often requiring interventions from multiple services. This paper describes the development and implementation of an integrated service pathway, emphasising collaborative processes and inter-professional relationships. The model, implemented in partnership between an NHS Talking Therapies service and a local substance use service, aimed to improve care coordination and service delivery for adults with co-occurring disorders. This paper provides a description of the pathway, outlining the challenges that prompted its development, the processes involved in its establishment, the roles and responsibilities of professionals, and the mechanisms for ensuring continuity of care. A small service evaluation, employing a mixed-methods approach, examined the outcomes of nine patients who engaged with the one-to-one integrated pathway within the first 10 months of its inception. The implementation of the model resulted in enhanced inter-service collaboration, with improved communication protocols and a shared understanding of service user needs. Clinicians reported that the reciprocal consultative approach facilitated knowledge exchange and skill development across teams. Initial outcome data from a small sample suggests positive trends in patient wellbeing and substance use, with seven of nine patients discharged in recovery. This model, characterised by a reciprocal consultation approach and an emphasis on inter-professional collaboration, demonstrates potential to improve the care for co-occurring mental health and substance use disorders. While the patient outcome data are limited by the small sample size, the findings offer insights for service re-design and future research.

Key learning aims

1. (1) To gain a clearer understanding of the development and implementation of an integrated care model for co-occurring mental health and substance use disorders.

2. (2) To recognise the impact of collaborative approaches on the professionals involved, including influences in communication protocols, knowledge exchange, and skill development across teams.

3. (3) To learn about the initial outcomes of the integrated care pathway and to recognise the potential for improving care in patients with co-occurring disorders.

With alcohol use disorder rising in England, evaluating the impact of interventions used in services is important. This evaluation was conducted in a third sector drug and alcohol service within South England. It aimed to explore the association of a structured cognitive behaviour therapy (CBT) group and engagement for service users in early recovery from alcohol use disorder, comparing outcomes with a previously unstructured psychosocial group. A mixed-methods approach compared the groups. Both groups lasted 12 sessions. Self-reported alcohol consumption, psychological health, physical health, and quality of life were measured using the Treatment Outcomes Profile (TOPs; Marsden et al., 2008). Quantitative data were analysed from 47 service users in the unstructured group and 43 in the structured CBT group. Qualitative analysis explored four service users’ feedback from the structured CBT group through interviews, using thematic analysis. Significantly more participants completed the structured CBT group (93.02% vs 74.47%). Structured group participants, on average, attended 50.97% of sessions, compared with 25.53% in the unstructured group. Mixed-model ANOVAs (repeated measures and between subjects) showed an improvement in psychological health, quality of life, and physical health regardless of the intervention type. Both groups also reduced alcohol consumption. Qualitative analysis identified two emerging themes, accessibility and a sense of belonging, alongside several subthemes. While both groups improved treatment outcomes, findings suggest a structured CBT group may be associated with more engagement and facilitate greater retention in treatment.

Key learning aims

1. (1) To understand how engagement and treatment outcomes differ between a structured CBT group and an unstructured psychosocial group in the treatment of alcohol use disorder.

2. (2) To identify potential mechanisms in a structured group which may influence engagement and treatment outcomes in the treatment of alcohol use disorder.

3. (3) To reflect on differing ways to measure effectiveness of a group in community drug and alcohol services.

Videoconferencing cognitive behavioural therapy (VCBT) has gained increased attention in recent years. While in-person CBT is well-studied, there is limited research on therapists’ attitudes towards delivering CBT through videoconferencing. A cross-sectional online survey on preferences and attitudes towards videoconferencing was distributed to CBT clinicians, mainly psychotherapists, psychologists, and counsellors, during the COVID-19 pandemic. A total of 140 complete responses were analysed using descriptive statistics. Most respondents expressed positive or very positive attitudes towards VCBT, considering it a time efficient option, suitable for building a therapeutic alliance. Agenda setting, goal formulation, assigning and reviewing homework, providing booster sessions, and guided self-help support were the CBT components most respondents perceived as best fitted for the videoconferencing format. In contrast, role-play, exposure with response prevention, and interpersonal skills training were rated as the least suitable techniques. VCBT was considered most appropriate for treating insomnia, stress-related conditions, and anxiety disorders, and least appropriate for bipolar disorder, trauma-related conditions, and specific phobias. The findings indicate that Swedish CBT clinicians largely viewed videoconferencing as a viable format during the COVID-19 pandemic, particularly for diagnostic groups commonly treated with face-to-face CBT and with the use of structured and highly verbal CBT techniques. However, the use of VCBT for more complicated conditions, as well as using interpersonal, experiential and skills training techniques, was perceived as less suitable. Further research is needed to examine clinician preferences and training needs, and the development and delivery of specific CBT components through video, including for more complex cases and younger age groups.

Key learning aims

1. (1) CBT clinicians had generally positive attitudes towards working with VCBT during the COVID-19 pandemic.

2. (2) CBT clinicians preferred structured and verbally provided techniques, over interpersonal and more experiential techniques, when using the videoconferencing format.

3. (3) CBT clinicians perceived VCBT to be suitable for diagnoses commonly treated with face-to-face CBT, such as insomnia, anxiety disorders, and stress.

4. (4) Most CBT clinicians also perceived VCBT as time saving and suitable for maintaining a therapeutic alliance.

5. (5) A session length of at least 30 minutes was preferred among CBT clinicians.

NHS Talking Therapies (TT) is England’s main service for treating people with common mental disorders. Prior research has shown that a high proportion of people receiving TT ‘high intensity’ treatment have concurrent personality difficulties and that these are associated with poorer TT treatment outcomes. We developed a training workshop to enhance the skills, knowledge, and confidence of TT therapists in the treatment of this population and conducted a mixed methods evaluation to investigate whether the training was acceptable to staff and whether it had any impact on client outcomes. A quantitative survey (n=46) and qualitative interviews (n=6) were undertaken with staff and in parallel, we analysed the anonymised health outcomes of two client cohorts, treated pre-training (n=2434) and post-training (n=2358). Multi-level, difference-in-differences analyses revealed statistically significant cohort differences between the last and first scores on the domains of depression (–2.53, 95% CI: –3.02, –2.04), anxiety (–2.70, 95% CI: –3.15, –2.20), social functioning (–2.17, 95% CI: –2.88, –1.47), and phobia (–1.19; 95% CI: –0.29, –0.17). Therapists reported finding the training helpful, particularly in managing therapeutic alliances and enhancing the interpersonal effectiveness of their clients. Furthermore, the survey revealed a positive change in therapist attitudes to, skills related to, and knowledge of personality difficulties post-training. However, staff also suggested that broader structural changes and more resources are needed for TT services to better support clients with personality difficulties. Training initiatives such as this appear to be feasible and helpful for therapists, and may help to optimise client outcomes.

Key learning aims

1. (1) To understand the potential utility of online training for therapists, in their management of clients with concurrent personality difficulties.

2. (2) To understand high intensity therapist perspectives on attending a workshop to support tailoring treatments for depression and anxiety in the context of personality difficulties.

3. (3) To reflect on enhancing treatment for clients with personality difficulties via training workshops.

Microaggressions have been a topic of significant debate in the psychological and social sciences. Despite an extensive body of empirical evidence, numerous misconceptions persist. This paper deconstructs common misconceptions surrounding microaggressions and addresses their origins, underlying biases, and empirical refutations. We explain the mechanisms that cause and maintain microaggressions through a CBT lens. We examine widely propagated misconceptions, including claims that microaggressions lack scientific validity, are too subjective to measure, and are not indicative of racism or other forms of prejudice. Drawing on the substantial literature base, including validated psychometric scales, experimental studies, and cross-cultural analyses, we demonstrate that microaggressions are not only real but also have significant psychological and social consequences. Empirical evidence links microaggressions to outcomes such as depression, anxiety, and lower self-esteem, reinforcing their relevance in clinical, educational, and workplace settings. CBT models provide a useful lens for understanding how individuals navigate the psychological complexities associated with microaggressive behaviours, helping explain why some people resist acknowledging microaggressions and their consequences. Lastly, we highlight the importance of education for reducing the prevalence of microaggressions and mitigating their harmful effects. Our goal is to provide clinicians with correct information so that they may skilfully and empathetically help clients experiencing microaggressions, and to no longer accept microaggressions as a harmless, misunderstood, or dismissed phenomenon. By debunking these misconceptions, this work contributes to a more scientifically grounded understanding of microaggressions, emphasizing the necessity of continued research and intervention efforts to address the impact of discrimination in society.

Key learning aims

1. (1) Build awareness around the various misconceptions associated with microaggressions.

2. (2) Knowledge of why these misconceptions exist, where they came from, and why they are important to consider and refute.

3. (3) Refuting misconceptions with scientific explanations and evidence.

4. (4) Understand how CBT clinicians can better prevent and respond to microaggressions.

People with complex emotional needs (CEN) often receive poor care and struggle to access the evidence-based therapy they require. As part of community transformation, the Help to Overcome Personal and Emotional problems (H.O.P.E) team in Northumberland, and the Relational and Emotional Difficulties Service (REDS) in Cambridge, were set up to ensure that people with CEN could receive timely therapy without accessing secondary or tertiary services. Both services focus on providing adapted versions of dialectical behaviour therapy (DBT). The present study aims to understand the process followed to establish the two teams, identify whether they have been able to deliver accessible and acceptable treatment, and reflect on shared learning points for other services to consider. The study provides descriptions of the two service designs, further to quantitative and qualitative feedback from participants that completed treatment with the services. The results confirm that people in Northumberland and Cambridgeshire who accessed the services found the therapy to be acceptable and reported significant improvement in their ability to regulate their emotions, a decrease in symptoms associated with CEN, and a greater sense of progress towards achieving meaningful goals in their lives. However, in line with the broader literature, a high number of people dropped out and did not complete the interventions. The results suggest that the H.O.P.E team and REDS are providing acceptable and accessible evidence-based treatment for people with CEN. Reflections for future services to consider regarding reducing drop-out rates, the length of treatment, inclusion criteria, engaging people from minority groups and the use of online vs face-to-face therapy are provided.

Key learning aims

1. (1) Understand the process followed to establish two different CEN services in primary care settings.

2. (2) Identify whether two CEN services have delivered accessible and acceptable treatment.

3. (3) Compare how two CEN services are structured, and highlight shared learning points for other services.