Abstract 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. Key learning aims (1) To become familiar with the concept of misophonia; i.e. hatred of sounds. (2) To evaluate the potential effectiveness of existing interventions for the treatment of misophonia. (3) To gain insight into adapting established therapy methods to novel settings.

Abstract Social anxiety disorder (SAD) is one of the most prevalent co-occurring conditions amongst cognitively unimpaired autistic people. The evidence-based treatment for social anxiety known as cognitive therapy for SAD (CT-SAD) may to an extent be beneficial to autistic people, but adaptations for autistic people are recommended to increase its effectiveness. The present study aimed to co-produce and pilot an adapted SAD treatment protocol for autistic people based on the Clark and Wells (1995) model, including assessing its feasibility and acceptability. A bespoke 12-week CBT online group intervention was created to meet the needs of autistic people with a diagnosis of SAD. The treatment protocol was created collaboratively with autistic people. It was piloted with seven adult participants (three males, four females) with autism or self-identified autism who completed the group intervention targeting SAD symptoms. With regard to feasibility, we met our initial aims of recruiting our intended sample size of a minimum of six participants for the intervention with an attendance rate of at least 80% of sessions. The excellent completion and attendance rates, respectively 100% and 95%, indicate that the intervention was acceptable to our participants. These findings extend previous research and support the continued adaptation of CBT interventions for autistic people. Furthermore, the evidence of feasibility indicates that further study to evaluate the efficacy of this group intervention is warranted. Key learning aims (1) To reflect on social anxiety, autism and identify ways to improve the delivery of cognitive therapy for autistic people. (2) To identify useful adaptations to cognitive therapy for autistic people. (3) To learn how to deliver group cognitive therapy remotely for autistic people who present with social anxiety.

Abstract For young people with eating disorders (EDs), family-based therapy (FBT) is generally recommended as first-line treatment. Although there is an abundance of evidence demonstrating the efficacy of FBT, less than half of young people achieve full remission with this treatment. Enhanced cognitive behaviour therapy (CBT-E) is an established alternative to FBT, demonstrating effectiveness in individuals who have not achieved full remission with FBT. It is also recommended when family therapy is unacceptable, contraindicated, or ineffective. Despite some overlap – particularly in addressing maintaining factors and prioritising weight normalisation – the two treatments diverge significantly in conceptualisation of the eating disorder, proposed mechanisms of action, role of both young people and parents, and strategies and processes of therapy. These differences may contribute to one treatment being effective where the other has not, but can present challenges and difficulties for the young person, family and clinician when transitioning from FBT to CBT-E. In this paper, we provide guidance for clinicians delivering CBT-E with young people who have a history of FBT treatment. We highlight common issues encountered among this cohort, discuss how they can present a barrier to successful implementation of CBT-E, and describe solutions. Key learning aims (1) To learn the commonly encountered barriers to treatment when implementing CBT-E for young people who have previously engaged in FBT. (2) To learn strategies to overcome these barriers focusing on the young person, parents and multi-disciplinary team.

Abstract Drawing on extensive experience in training and supervising clinicians in enhanced cognitive behaviour therapy (CBT-E), we have identified ten prevalent misconceptions and communication gaps. These misunderstandings can impact the implementation of CBT-E and may potentially reduce its effectiveness. They include misconceptions regarding CBT-E’s flexibility, suitability for certain patient groups, real-world applicability, and alignment with anti-weight stigma principles. Such misunderstandings may make clinicians hesitant to recommend or deliver CBT-E appropriately. In the present paper, we address these misconceptions and gaps in communication and provide evidence-based guidance on CBT-E practice. We aim to enhance clinicians’ confidence in using CBT-E flexibly and appropriately, with the hope that this will improve its effectiveness. Key learning aims (1) Recognise common misconceptions and communication gaps about enhanced cognitive behaviour therapy (CBT-E) for eating disorders. (2) Develop an understanding of how CBT-E can be implemented across diverse clinical settings and patient populations. (3) Strengthen therapists’ confidence in delivering CBT-E flexibly while maintaining fidelity to its evidence-based framework.

Abstract There has been limited consideration of the training and support needs of therapists from minoritised ethnic backgrounds. This study quantitatively evaluates a novel application of self-practice/self-reflection (SP/SR) to CBT therapists from minoritised ethnic backgrounds. The study aimed to explore the impact of the SP/SR programme on (1) therapists’ skills in working with ethnicity in their clinical practice; (2) their ethnic identity development; and (3) their perceived levels of personal and professional wellbeing, during the intervention and at follow-up. A multiple baseline single case experimental design was adopted. Measures were developed and adapted for this evaluation and weekly outcomes relating to therapist skill development, ethnic identity development, and personal and professional wellbeing were collected. The outcomes of six participants were analysed using visual and statistical analysis. The results indicated that the SP/SR programme significantly improved therapist skills in identifying and addressing similarities and differences in ethnicity within therapy during the intervention. Improvements were also seen across other skills, ethnic identity developmental and wellbeing outcomes between the baseline and SP/SR phases, with some participants showing significant improvements. Outcomes from the follow-up phase presented a more mixed picture. Therefore, the findings give some support for the SP/SR programme in developing therapist skills in working with ethnicity, as well as highlighting differential outcomes for participants related to their levels of experience and engagement. The findings may have possible implications for the personal and professional development of ethnically minoritised therapists, as well as future quantitative SP/SR research. Key learning aims (1) To provide an overview of self-practice/self-reflection (SP/SR) and its theoretical underpinnings. (2) To summarise the current issues around the development of cultural competence, particularly for therapists from minoritised ethnic backgrounds. (3) To introduce and describe a novel SP/SR programme for CBT therapists from minoritised ethnic backgrounds. (4) To highlight the importance of considering ethnicity within clinical practice, both in terms of the provision of culturally competent therapy as well as to support the personal and professional development of therapists from minoritised ethnic backgrounds.

Abstract Introduction: Hoarding disorder (HD) is primarily characterised by difficulties with discarding possessions. Evidence-based psychological interventions such as CBT have been found to be of benefit to people with HD. However, people with HD may receive a psychosocial intervention provided by other professions such as social workers or a multi-disciplinary team before receiving psychological therapy, if at all. Objectives: The aim of this systematic review is to evaluate psychosocial interventions for HD. Method: Searches were conducted on three databases (PsycInfo; MEDLINE; Embase) and grey literature, and the search strategy was designed to capture psychosocial interventions for adults with HD. Results: Studies (n=5) were included where the outcome was related to a psychosocial factors, such as fire safety, tenancy preservation and QoL. These psychosocial interventions show improvements in those with HD, with effect sizes ranging from d=0.86 to d=1.41. Conclusions: Despite the limited research on psychosocial interventions for HD, this systematic review suggests it is a promising area for further research in this area. Key learning aims (1) To identify what psychosocial interventions are available for people experiencing hoarding difficulties. (2) To identify how available psychosocial interventions for hoarding difficulties are delivered and by whom. (3) To examine the effectiveness of psychosocial interventions for people experiencing hoarding difficulties.

Abstract Climate distress describes a complex array of emotional responses to climate change, which may include anxiety, despair, anger and grief. This paper presents a conceptual analysis of how acceptance and commitment therapy (ACT) is relevant to supporting those with climate distress. ACT aims to increase psychological flexibility, consisting of an open and aware orientation to one’s experiences, and an engaged approach to living, guided by personal values. We discuss the pertinence of each of these processes for adapting to the challenging reality of climate change. By embracing climate distress as a natural human experience and promoting value-guided action, ACT offers a promising approach that brings co-benefits to individuals and wider society. Key learning aims (1) To understand the concept of climate distress and its various emotional responses. (2) To explore the relevance of acceptance and commitment therapy (ACT) in addressing climate distress and promoting psychological well-being. (3) To examine the importance of psychological flexibility in coping with climate change. (4) To analyse the role of ACT in embracing climate distress as a natural human experience. (5) To investigate how ACT can encourage pro-environmental behaviours and climate change mitigation efforts.

Of all the dangers we face, from climate chaos to nuclear warfare, none is so great as the deadening of our response' (Macy, 2007; p. 92) We are alive at a time of great opportunity, in a world that is burning for transformation.In February 2024, BABCP declared a climate emergency, recognising that planetary health is inextricably linked to human health and wellbeing.As part of a professional collective body, members of BABCP can decide how to be part of a better future.However, before we can determine an appropriate response, we must turn towards the reality of the crises we face today.This special issue orients the reader to the implications planetary crises have for mental health and how we can respond.It explores how developing transdiagnostic approaches can empower people to turn towards the truth and distress of climate change, to find meaning and connection, and support a just transition to a safer world.Many readers will be familiar with current global ecological challenges, but as others may be less well acquainted with the underpinning science of planetary health, a summary is given first.We then discuss how the CBT community can respond.Being a therapist in a time of climate and ecological breakdown poses unique challenges, and we must adapt our tools accordingly.Some other therapeutic modalities, such as psychoanalytic approaches (Weintrobe, 2020) are already engaging with this (Anderson et al., 2024; Haase and Hudson, 2024), and it is time for our CBT communities to do more.We hope this special issue will inspire more engagement, action and advances in theoretical and empirical work.Turning towards the climate and ecological crises is not always easy, so go gently, and remember the community of other practitioners who are reading this alongside you.

Abstract Over the last two decades, self-practice/self-reflection (SP/SR) has been advocated as a useful experiential teaching method on CBT training programmes. As part of this, theoretical positions point to the importance of there being an explicit process of ‘bridging’ between what is learnt about the self (personal development) and the implications of this for clinical practice (professional development). However, exactly how participants experience this synthesis as part of their engagement in SP/SR has not yet been clarified. As such, the present study set out to explicate trainee CBT therapists’ experiences of this process, in order to further our understanding of how they synthesise their personal and professional development during training. Nineteen trainees took part in the study, each consenting to a 1000-word written summary of their learning from SP/SR being entered into the dataset and analysed using thematic analysis. The analysis identified five interconnected themes, illustrating how trainees had (i) identified self-schemas, (ii) increased their awareness of personal context, and (iii) conceptualised the role of the self in the therapeutic process; they had then achieved (iv) personal–professional development via experiential change methods, resulting in (v) perceived benefits for their clinical practice. SP/SR may therefore be a useful vehicle to enhance personal and professional development during training by helping trainees to understand and address the role of the self in cognitive behavioural psychotherapy. Tentative implications for CBT training and practice have been offered. Key learning aims (1) To summarise key theoretical positions and research outcomes underpinning the use of SP/SR as a CBT training method to enhance personal and professional development. (2) To understand trainee experiences of synthesising personal and professional development from SP/SR during training. (3) To consider implications for CBT training and ongoing professional practice.

Abstract Cognitive behavioural therapy (CBT) is one of the best-evidenced psychosocial interventions for psychosis and is recommended by the National Institute for Health and Care Excellence and the American Psychiatric Association. CBT was developed and derived from Western cultural values, which may not be appropriate for non-Western cultures. Trials of CBT in Western countries have indicated that participants from ethnic minority groups demonstrate low rates of engagement, retention, and recruitment. This indicates that the principles underlying CBT may conflict with individual beliefs and cultural values in non-Western countries. Therefore, we interviewed 15 people diagnosed with schizophrenia and 15 with their family members to explore the beliefs and attitudes of people diagnosed with schizophrenia and their family members concerning the proposed CBT intervention for psychosis in the Saudi context. The findings revealed that most participants accepted the proposed intervention. Important factors that influenced participants’ engagement and motivation in the CBT intervention were related to the therapist’s qualities (sex, empathy, and competence), family involvement, religion, and the number and format of CBT sessions for psychosis. Key learning aims (1) To explore the beliefs and attitudes of people diagnosed with schizophrenia concerning the proposed CBT intervention for psychosis and how to improve it to make it more appropriate for their needs and cultures. (2) To explore the beliefs and attitudes of family members of people diagnosed with schizophrenia concerning the proposed CBT intervention for psychosis and how to improve it to make it more appropriate to their needs and culture.