1. (1) To understand how Ehlers and Clark’s (2000) cognitive model and related treatment of PTSD can be applied when racism is part of the traumatic event.

2. (2) To provide guidance, tips and examples on how to identify key personal meanings around the trauma index event involving racism.

3. (3) The article will encourage therapists to reflect on their own identity and experiences (or lack of) around racism, considering how this might hinder or facilitate the appropriate inclusion of racist experience within CT-PTSD.

4. (4) To provide suggestions on how to ensure that supervision of CT-PTSD supports the consideration and addressing of relevant experiences of racism and supports therapists where patient experiences may overlap with their own experience of racism.

1. (1) Following reading this paper, readers will better understand the diagnostic and practice-based complexities involved in assessing traumatic events as a Psychological Wellbeing Practitioner (PWP) in an NHS Talking Therapies service.

2. (2) Readers will also be aware of the emotional challenges PWPs in this service have reported experiencing as a result of assessing service users that report having experienced traumatic events.

3. (3) The reader will also learn about PWPs’ perspectives on what could improve this NHS Talking Therapies service’s processes involved in assessing traumatic events and reflect on whether this might be generalisable across other, similar services.

1. (1) To explore the experiences of TTad staff in interpreter-mediated therapy, examining the practical barriers and interpersonal challenges they face in delivering effective care.

2. (2) To identify and understand the distinct yet inter-related barriers to interpreter-mediated therapy, highlighting how these contribute to the overall challenges in delivering therapy.

3. (3) To recognise the gap between existing guidelines for interpreter-mediated therapy and their implementation in clinical practice, emphasising the need for consistent application and better adherence.

4. (4) To advocate for a strategic and comprehensive approach to addressing barriers that involve shared responsibility across all staff and levels of TTad.

5. (5) To underscore the necessity of continued research and regular monitoring to improve interpreter-mediated therapy, ensuring that clients with limited English proficiency receive equitable access to mental health services in the long term.

Research on the acquisition of psychotherapeutic competencies attributes an important role to procedural knowledge. We developed and evaluated a brief video-based measure of procedural knowledge in clinical psychology (the Pro CliPs Task).

The Pro CliPs Task consists of seven distinct case vignettes, each presented in four brief videos, and eight open-ended questions pertaining to each case vignette. The instrument was developed and validated in a multi-stage process, which included conceptual development, a feasibility study and an evaluation study. In the feasibility study (n=66 psychology students), the item characteristics and reliability of the coding method for the open-ended answers, authenticity of the case vignettes and general applicability of the measure were assessed. The following evaluation study (n=68 psychology students, n=65 postgraduate psychotherapy trainees) was conducted to investigate the validity of the instrument.

The item characteristics of the Pro CliPs Task were largely found to be within the expected range and inter-rater reliability was excellent. The case vignettes used were perceived as highly authentic, and the Pro CliPs Task was generally evaluated positively by participants. In the evaluation study, the Pro CliPs Task was strongly associated with declarative knowledge and therapeutic self-efficacy. Postgraduate psychotherapy trainees outperformed psychology students in the Pro CliPs Task.

The Pro CliPs Task holds promise as a valid and brief measure of procedural knowledge in clinical psychology with potential for use in research, training and teaching contexts.

1. (1) To gain insight into the role of procedural knowledge in clinical psychology and the limitations regarding its assessment.

2. (2) To learn about the theoretical basis and conceptual development of the Pro CliPs Task, a recently developed measure to assess procedural knowledge in clinical psychology.

3. (3) To evaluate the Pro CliPs Task regarding its item characteristics, inter-rater reliability, applicability, authenticity and validity.

Why, What, Who, When are a set of questions, sometimes referred to as the ‘WH calibration questions’ that help interrogate a concept in terms of its application and utility. In this article these questions are used to evaluate decisions made by footballers around their mental health (MH) and wellbeing. They allow us to examine the help-seeking behaviours of footballers, such as: Why seek help? What help is available? Who to go to? When’s the right time? The article examines the psychotherapies, mainly CBT, suitable for football players and offers practical examples of how clubs have supported their players. The roles of multi-disciplinary team members involved in promoting the wellbeing of players are discussed. The content of this paper is based on a review of the literature and personal knowledge of the authors’ experiences as MH clinicians in professional football clubs.

1. (1) To show the extent to which professional footballers experience mental health difficulties, and the nature of these problems.

2. (2) To highlight the thought processes of footballers during their management of their mental health.

3. (3) To provide a description of the therapies available to footballers, and highlighting the forms of CBT in common use.

4. (4) To emphasise the need for a holistic approach to MH provision, and clarify the roles of people within football clubs who provide MH support.

5. (5) To reflect on the need for ‘in-house’ specialist mental health input within professional football clubs.

Video-recordings are considered crucial for effective supervision, but empirical evidence is limited. We thus conducted a naturalistic study to assess supervisees’ evaluations of a structured video-supervision technique (‘Give Me 3’ [GM3]) compared with video-supervision as usual (VSAU) and supervision based on self-report (SAU). Twenty-four participants in postgraduate training in cognitive behavioural therapy conducted each supervision method and provided quantitative ratings of supervision satisfaction. A subsample of nine trainees participated in semi-structured qualitative interviews. Repeated-measure ANOVAs revealed no difference in post-session ratings of supervisees’ satisfaction with supervision. Retrospective comparisons of the three supervision methods resulted in significant differences in perceived effort and comfort but not in usefulness. The qualitative interviews suggested that the supervisees generally appreciated the benefits of video-supported supervision, while evaluations of GM3 and VSAU were mixed. VSAU and GM3 both appeared to have distinct advantages which might enrich supervision if aligned with the therapeutic context and supervisees’ goals.

1. (1) How does trainees’ supervision satisfaction differ between supervision with or without the review of video-recorded therapy sessions?

2. (2) Is structured video-supervision perceived by trainee supervisees as being more satisfactory than unstructured video-supervision?

3. (3) How do supervisees perceive the differences between structured versus unstructured (video)supervision? When is each method deemed most useful?

Young adults with a psychotic disorder often experience difficulties in social functioning. We developed a modular virtual reality treatment to improve social activities and participation by targeting common causes of social functioning difficulties in patients with a psychotic disorder (VR-SOAP). This paper details the development of this intervention, encompassing a piloting phase.

Using an iterative Scrum method with software engineers, clinicians, researchers, and individuals with lived experience of psychosis, we developed a treatment protocol along with a software prototype. Subsequently five patients with a psychotic disorder, aged 18–40, and three therapists, piloted VR-SOAP. Feasibility was assessed by means of interviews and session forms. Acceptability was evaluated along the seven domains of the Theoretical Framework of Acceptability (i.e. affective attitude, burden, ethicality, intervention coherence, opportunity costs, self-efficacy, and perceived effectiveness).

The final protocol consisted of the following modules and targets: 1. Motivation and Pleasure (negative symptoms); 2. Understanding Others (social cognition); 3. Safety and Trust (paranoid ideations and social anxiety); 4. Self-Image (self-esteem and self-stigma); 5. Communication (communication and interaction skills). Modules were piloted by the participating patients and therapists. The modules proved feasible and showed a high degree of acceptability on all seven domains of the acceptability framework.

The modular VR-SOAP treatment protocol and prototype was acceptable and feasible for therapists and patients. The primary recommendation for enhancement underscores the need for flexibility regarding the number of sessions and the content.

1. (1) Understanding the development and structure of a novel modular CBT treatment in VR.

2. (2) Learning to use specific VR modules to target negative symptoms, social cognition, paranoid ideations, social anxiety, self-esteem, and communication skills.

3. (3) Gaining insights into the feasibility and acceptability assessments of a novel modular CBT treatment in VR.

Exposure and response prevention (ERP) is the first-line psychological treatment for obsessive compulsive disorder (OCD). Recent research shows that the Bergen 4-day Treatment (B4DT), which is a concentrated ERP program, can be very effective. However, this intensive format has not been widely implemented, and it is unclear whether positive outcomes are unique to B4DT, or whether a similar intensive ERP program (not based on B4DT) is equally effective. We examined short- and long-term outcomes of the Melbourne Intensive Treatment-OCD (MIT-O) program, an out-patient intensive ERP program for OCD involving an intensive phase of four full-day sessions conducted over two weeks, and a supportive 21-day phase involving self-directed tasks and twice-a-week check-in calls with the therapy team. Participants were 21 individuals with OCD. The severity of OCD, depression, anxiety, stress, obsessive beliefs, and emotion regulation difficulties were assessed at four time points (pre-treatment, post-treatment, 6-month, and 12-month follow-up). Results showed a large and significant decrease in OCD and obsessive beliefs at post-treatment. These improvements were maintained at 12-month follow-up. Using international consensus criteria for treatment response, almost all participants (90.5%) showed at least partial treatment response and one-third were in remission at the final assessment. These results showed that the MIT-O program was effective, but post-treatment and 12-month remission rates were somewhat less favourable than previously published results from the B4DT program. Nevertheless, the MIT-O post-treatment outcomes were comparable to other CBT programs for OCD and should be considered when other longer term treatment formats such as in-patient treatments are not feasible.

1. (1) To evaluate the effectiveness of an intensive exposure and response prevention program in reducing obsessive compulsive disorder (OCD) symptoms.

2. (2) To examine the long-term maintenance of treatment gains at 6-month and 12-month follow-up assessments.

3. (3) To report the treatment response rate and remission outcomes achieved through the intensive format.

4. (4) To consider the broader implementation of intensive exposure and response prevention programs as an alternative format for OCD treatment.

Cognitive behavioural therapists and practitioners often feel uncertain about how to treat post-traumatic stress disorder (PTSD) following rape and sexual assault. There are many myths and rumours about what you should and should not do. All too frequently, this uncertainty results in therapists avoiding doing trauma-focused work with these clients. Whilst understandable, this means that the survivor continues to re-experience the rape as flashbacks and/or nightmares. This article outlines an evidence-based cognitive behavioural therapy (CBT) approach to treating PTSD following a rape in adulthood. It aims to be a practical, ‘how to’ guide for therapists, drawing on the authors’ decades of experience in this area. We have included film links to demonstrate how to undertake each step of the treatment pathway. Our aim is for CBT practitioners to feel more confident in delivering effective trauma-focused therapy to this client group. We consider how to assess and formulate PTSD following a rape in adulthood, then how to deliver cognitive therapy for PTSD (CT-PTSD; Ehlers and Clark, 2000). We will cover both client and therapist factors when working with memories of rape, as well as legal, social, cultural and interpersonal considerations.

1. To understand the importance of providing effective, trauma-focused therapy for survivors of rape in adulthood who are experiencing symptoms of PTSD.

2. To be able to assess, formulate and treat PTSD following a rape in adulthood.

3. How to manage the dissociation common in this client group.

4. To be able to select and choose appropriate cognitive, behavioural and imagery techniques to help with feelings of shame, responsibility, anger, disgust, contamination and mistrust.

5. For therapists to learn how best to support their own ability to cope with working in a trauma-focused way with survivors of rape and sexual violence.

This study described the development and assessment of the psychometric properties of the Dissociation-Integration of Self-States Scale (D-ISS). This is a new scale to assess dissociation at the ‘between modes’ or self-state (personality) level. The D-ISS is rooted in cognitive behavioural theory and designed to measure between-mode dissociation (dissociation between self-states) in clinical practice and research.

Study 1: D-ISS scale items were generated and then answered by 344 young adults (16–25 years) who reported experiencing stressful times. An exploratory factor analysis (EFA) was conducted and the results were used to refine the scale to 25 items.

Study 2: The final 25-item D-ISS was completed by 383 adults (18–65 years) who reported experiencing mental health difficulties. A confirmatory factor analysis (CFA) was conducted using the second dataset. Internal consistency, test–retest reliability, convergent validity and divergent validity of the final D-ISS was assessed.

Study 1: The EFA showed a clear 5-factor solution, which was used to refine the D-ISS to a total of 25 items with five items in each factor.

Study 2: The 5-factor solution from Study 1 was confirmed as a good fit by the CFA using the data collected in Study 2. The D-ISS demonstrated good internal reliability and test–retest reliability. The D-ISS showed no correlations with divergent scales. For convergent validity, the D-ISS showed moderate correlations with the Dissociative Experiences Scale (DES-II).

The new D-ISS measure of between-mode dissociation is reliable and valid for the population represented by our sample. Further research into its use in clinical populations is required.

1. (1) To understand and be able to use a new measure of dissociation at the personality or self-states level.

2. (2) To understand the cognitive behavioural model of dissociation.

3. (3) To understand the theoretical underpinnings of the scale, in terms of the effects of childhood and adult adversity and other factors on psychological development.

4. (4) To consider the potential clinical and research applications of the scale.

5. (5) To appreciate the limitations of the research so far and the nature of future research required.

The notion of cognitive detachment (i.e. the capacity to treat thoughts as just thoughts, with no greater significance or importance) is introduced in this paper. Its link to similar established terminologies (e.g. distancing, decentering, defusion/deliteralisation, detached mindfulness), importance within cognitive behaviour therapies and place within an adapted cognitive-behavioural framework is highlighted. The use of metaphor to facilitate cognitive detachment is then the primary focus of the paper. An overview of how metaphor has typically been used within psychotherapy is presented and reflects mostly the use of therapist-generated metaphor for psychoeducational purposes. While the use of metaphor in serving a therapeutic cognitive detachment function is not new, developing idiosyncratic client-generated metaphors in this regard has been largely neglected, despite the widely held view that client-generated metaphors are more potent. Practical guidance on how clinicians can collaboratively assist clients to intentionally generate their own personalised cognitive detachment metaphor is provided, and specific ways to elaborate metaphors during therapy to enhance metaphor application and hence effectiveness in enabling cognitive detachment is considered. Finally, clinical examples are provided to illustrate the varied, creative and rich metaphors that can emerge from this process.

1. (1) To introduce the term cognitive detachment and understand this important therapy target within an adapted cognitive-behavioural framework.

2. (2) To appreciate the broader use of metaphors in therapy and frame metaphor as one method for facilitating cognitive detachment.

3. (3) To motivate therapists to pursue idiosyncratic client-generated metaphor.

4. (4) To provide an instructional script to support therapists to help clients develop a personalised cognitive detachment metaphor.

5. (5) To provide specific guidance to therapists regarding methods for metaphor elaboration.

Drug and alcohol users have been suggested to face disproportionate exclusion from mental health services, but data on any such exclusion are not readily available. This study examined the clinical records of those excluded from an NHS Talking Therapies service due to drug or alcohol use, focusing on (1) quantitative levels of alcohol consumption, and (2) the rationales documented by clinicians for excluding these individuals. Our results suggest that over half (57%) of those excluded due to alcohol use were consuming below the 15-unit daily threshold recommended for signposting to specialist alcohol assessment. Clinicians cited various rationales for exclusion, including the potential for poor treatment outcomes and health risks associated with concurrent use. Due to being based on a single service, these findings may be limited in their generalisability, but they offer an initial signal that there is potential over-exclusion of some alcohol users from NHS Talking Therapies, and that rationales for exclusion may not consistently align with best practice principles. We discuss implications for NHS Talking Therapies clinicians, and for the development of future clinical guidance.

1. (1) To understand how different levels of drug or alcohol use may affect the outcomes of psychological therapy.

2. (2) To learn why individuals with drug or alcohol use experience exclusion from mental health services.

3. (3) To examine how clinical practice within an NHS Talking Therapies service aligns with best practice principles.

4. (4) To explore skills and clinical principles that can lead to optimal treatment planning for these individuals.

5. (5) To explore how integrated working between NHS Talking Therapies and local drug and alcohol services can enhance service-user experiences.

Smartphone apps combined with psychological interventions may be beneficial for increasing adherence to treatment tasks and augmenting outcomes. Yet, there is limited research on the acceptability and feasibility of adjunctive smartphone apps with psychological therapies for adolescents engaging in self-harm and suicidal behaviours. This study aimed to evaluate the acceptability and feasibility of integrating the Dialectical Behaviour Therapy (DBT) Coach app as an adjunct to a comprehensive DBT programme. The study also aimed to explore statistical trends of the potential relationship between the DBT Coach app and symptom reduction, including self-harm, borderline personality disorder symptoms, emotion dysregulation, and DBT skill use, to inform future study design. A mixed-method design was used to evaluate the acceptability and feasibility of the app and clinician’s portal from the perspective of adolescent and clinician participants. Thematic analysis was used to analyse qualitative data. Results indicated varied experiences of acceptability and feasibility of the DBT Coach app and portal as an adjunct to DBT. Thematic analysis generated four over-arching themes and ten subthemes. The regression analysis provided statistical trends regarding potential relationships between app use and clinical outcomes, which would be helpful to explore in future research. Findings suggest that the app and portal were acceptable and feasible for the most part, with some barriers and challenges identified. Implications of this study are discussed.

1. (1) To learn about the acceptability and feasibility of using a smartphone application as an adjunct to a DBT skills group within a comprehensive DBT programme for adolescents.

2. (2) To explore whether there is a relationship between app use and clinical outcome at the end of the group intervention.

3. (3) To learn about the experiences of adolescents and clinicians using the smartphone app as an adjunct to the DBT skills group.