In 1993 Behavioural and Cognitive Psychotherapy published a supplement edited by Ann Hackmann with the title “Behavioural and Cognitive Psychotherapies: Past History, Current Applications and Future Registration Issues”. This was the journal's first ever supplement and it provided an overview of the state of behavioural and cognitive psychotherapies at that time. It was intended to provide a context for discussions concerning the future of the field, and as Paul Salkovskis said in his editorial, “[the supplement]. . .will be an important reference source for years to come.”

CBT is now considered to be a “family” of related therapies. Seven future challenges for CBT are defined and their relationships with one another considered. They are: clarity (shared definitions of CBT and its terminology), coherence (shared therapeutic principles and theory), cohesion (integration of individuals and subgroups using CBT), competence (assessing standards during training and personal development), convenience (accessibility and public awareness), comprehensiveness (applicability to a wide range of problems) and connectivity (links to other disciplines). Key issues concerning the fragmentation of the discipline and difficulties in judging competence are discussed. It is proposed that through improving the clarity, coherence and cohesion of CBT, there would be improvements in the remaining four domains, which would enhance its overarching efficacy and influence on improving public health.

The theory and principles of Metacognitive therapy (MCT) are described and data supporting its effects are summarized. MCT does not advocate challenging of negative automatic thoughts or traditional schemas. It proposes the existence of a universal maladaptive thinking style that causes disorder and focuses on helping patients regulate their cognition more adaptively. It aims to reduce worry and rumination and alter problematic patterns of attention and coping. In doing so it targets underlying metacognition that controls thinking and helps patients develop new ways of consciously experiencing inner events. Data from treatment studies suggest that individual MCT techniques and full treatment are highly effective. Further randomized trials are clearly warranted.

Mindfulness is the latest addition to the armamentarium of cognitive behavioral therapists. Mindfulness methods from the wisdom traditions, as well as from current psychological theories, are beginning to be used as cognitive behavioral strategies for alleviating psychological distress and for personal transformation. The use of mindfulness as a clinical tool is in its infancy, with attendant growing pains in theory, research and practice. We briefly discuss the historical context of the use of mindfulness, recent developments in theory, research and practice, and future developments. We conclude that mindfulness shows a lot of promise as a clinical treatment modality, but there are inherent pitfalls in the developing approaches.

This paper introduces Acceptance and commitment Therapy (ACT) as one of the newer contextualist behaviour therapies. A brief history of the development of ACT is outlined. The concepts of equivalence and laterality and the important relationship between Relational Frame Theory and ACT are then described. The “hexagram” summary of the six core linked processes in ACT is presented and, finally, the research evidence to support the effectiveness of ACT applied to a range of clinical conditions and client groups is summarized.

The delivery of cognitive behaviour therapy (CBT) in the UK has moved through two phases. In the first phase specialist practitioners delivered bespoke CBT to individuals often experiencing complex and longer-lasting problems. This phase has been characterized by waiting lists and a high quality service delivered to a few. In the second phase of service delivery CBT has begun to be delivered in all sorts of different formats, including CBT self-help/guided CBT, behavioural activation, computerized CBT and group based CBT that aim to increase access to CBT delivered in these ways. It remains unclear how these varying models – “high intensity” (phase 1) and “low intensity” (phase 2) should relate – and even who does best with each. There are implicit assumptions by practitioners reflected in language such as “stepping up/down” that assumes high intensity working is superior in some way to low intensity. Few studies have however examined this in depth and what studies there are suggest these beliefs may be incorrect for many. How these new ways of working will be introduced, evaluated and integrated into existing services currently remains a challenge. A helpful way of resolving some of these issues is to view CBT using a learning/teaching paradigm. In this the focus is primarily on how the client wishes to learn to tackle their problems. This provides a helpful way for both introducing different and new ways of working, and also maintaining a focus on the client's needs at the centre of service development. Crucially, phase two CBT working does not replace phase one. How the two approaches complement each other and compare will be two of the interesting questions to be addressed over the next few years.

This paper provides a selected review of recent studies highlighting key aspects of mood disorders research. Cognitive models and clinical trials of cognitive therapy of depression are evolving and adapting to increase applicability to the spectrum of depressive symptoms and syndromes experienced by clients, as well exploring beyond acute phase treatment to relapse prevention. In contrast, cognitive models of bipolar disorders and the effectiveness of the therapy are unclear and there are more questions than answers for researchers in this area.

This paper reviews recent theoretical, conceptual and practice developments in cognitive-behaviour therapy (CBT) for anxiety disorders. The empirical status of CBT for anxiety disorders is reviewed and recent advances in the field are outlined. Challenges for the future development of CBT for the anxiety disorders are examined in relation to the efficacy, effectiveness and cost-effectiveness of the approach. It is concluded that the major challenge currently facing CBT for anxiety disorders in the UK is how to meet the increased demand for provision whilst maintaining high levels of efficacy and effectiveness. It is suggested that the creation of an evidence base for the dissemination of CBT needs to become a priority for empirical investigation in order effectively to expand the provision of CBT for anxiety disorders.

The past decade has seen considerable growth in the evidence base of cognitive behavioural therapy for psychosis. Consistent reports of moderate effect sizes have led to such interventions being recommended as part of routine clinical practice. Most of this evidence is based on a generic form of CBT for psychosis applied to a heterogeneous group. An increase in the effectiveness of cognitive behavioural interventions may require new protocols. Such therapeutic developments should be based on the theoretical understanding of the psychological processes associated with specific forms of psychotic presentation. The current evidence base of CBT for psychosis is reviewed, and barriers that have held back the development of this research are discussed.

The eating disorders provide one of the strongest indications for cognitive behaviour therapy (CBT). This bold claim arises from two sources: first, the fact that eating disorders are essentially cognitive disorders and second, the demonstrated effectiveness of CBT in the treatment of bulimia nervosa, which has led to the widespread acceptance that CBT is the treatment of choice. In this paper the cognitive behavioural approach to the understanding and treatment of eating disorders will be described. A brief summary of the evidence for this account and of the data supporting the efficacy and effectiveness of this form of treatment will be provided. Challenges for the future development and dissemination of the treatment will be identified.

Historically people with intellectual disabilities have not been offered or received cognitive behavioural interventions that have been shown to be effective for mental health and emotional problems experienced by those without such disabilities. This is despite many people with intellectual disabilities having life experiences that potentially result in them having an increased risk to such problems. This paper discusses whether such therapeutic disdain is justified based on the evidence that is available and emerging concerning the application of cognitive behavioural interventions for this population. Issues concerning access to services, the ability of people with intellectual disabilities to engage in and benefit from the cognitive components of CBT, and the effect of cognitive abilities and IQ level on treatment effectiveness are explored in relation to this question.

There is a lot of nonsense talked about how to adapt therapy for older people. This is because often authors fail to define the types of populations they are tailoring their therapy for. Such definitions are important with such a diverse patient group, some of whom were “in-service” during the first world war, while others were “doing drugs and dropping out” in the 1960s. To guide our thinking regarding specific adaptations, this paper presents a framework for clarifying therapeutic need. The second section of the paper illustrates ways in which working psychotherapeutically with older patients has helped inform mainstream CBT theory and practice, with particular reference to competence and schema work.

Internalizing disorders of childhood and adolescence are common conditions, but until the past decade, had received little scientific scrutiny. This paper overviews the new knowledge that the past decade of research has given us. The early research began by adopting adult models of disorders, and adult-based modes of treatment. This met with moderate success, but the focus now is on testing whether these models are appropriate for younger clients. The good news is that, for adolescents at least, the adult models do seem to be appropriate. The bad news is that, even in well-resourced treatment trials, barely half of all cases remit. In very recent years, there has been a focus on generating developmentally appropriate models of childhood internalizing disorders, and correspondingly, an increasing interest in developing treatment approaches that are appropriate for young people and their families. The paper concludes with our thoughts on the most important questions for research in the next decade.

Case conceptualization is a foundation of cognitive-behavioural therapy (CBT) because it describes and explains clients' presentations in ways that inform interventions. Yet the evidence base challenges the claimed benefits of case conceptualization. This paper reviews the rationale and evidence base for case conceptualization and outlines a new approach that uses the metaphor of a case conceptualization crucible in which a client's particular history, experience and strengths are synthesized with theory and research to produce an original and unique account of clients' presenting issues. The crucible metaphor illustrates three key defining principles of case conceptualization. First, heat drives chemical reactions in a crucible. In our model, collaborative empiricism between therapist and client provides the heat. Second, like the chemical reaction in a crucible, conceptualization develops over time. Typically, it begins at more descriptive levels, later a conceptualization incorporates explanatory elements and, if necessary, it develops further to include a longitudinal explanation of how pre-disposing and protective factors influence client issues. Finally, new substances formed in a crucible are dependent on the chemical characteristics of the materials put into it. Rather than simply look at client problems, our model incorporates client strengths at every stage of the conceptualization process to more effectively alleviate client distress and promote resilience.

Cognitive behavioral therapy has often been criticized for ignoring the role of the therapeutic relationship. In this article, I outline several dimensions for case formulation and intervention that suggest that the cognitive-behavioral approach can be a powerful theoretical model for understanding the causes of and the strategies for overcoming impasses in therapy. I review how the clinician and patient can collaborate in understanding the importance of case conceptualization, validation, emotional philosophies, victim resistance, schematic resistance, schematic mismatch, sunk-cost commitment, and self-handicapping. The relevance of these factors for both patient and therapist are discussed. During the last decade there has been increased interest in the nature of the therapeutic relationship in cognitive behavioral therapy (Gilbert, 1992; Safran, 1998; Safran and Muran, 2000; Greenberg, 2002; Leahy, 2001; Gilbert and Irons, 2005; Leahy, 2005; Bennett-Levy and Thwaites, 2007; Gilbert and Leahy, 2007). Cognitive behavioral therapists have proposed that the therapeutic relationship reflects interpersonal schemas, earlier attachment problems, emotional processing, failures in validation and compassion, and a variety of processes underlying non-compliance or resistance. Resolving “ruptures” in the therapeutic relationship provides an often essential opportunity for using the relationship as a means to modify cognitive and emotional problems (Safran, Muran, Samstag and Stevens, 2002; Katzow and Safran 2007). In light of the emphasis on “empirically supported treatments” (such as CBT) there is the risk that the alliance in therapy may be foreshadowed by the techniques and protocols used in CBT, perhaps giving credibility to Mahoney's (1991) earlier claim that therapy can become “technolatry”.

Cognitive-behavioural therapy (CBT) supervision has traditionally been presented as an extension of the therapy, a reflexive strategy that includes a commendable commitment to a principled approach. However, a critical review suggests that this strategy has not been implemented with fidelity. Furthermore, this strategy overlooks potentially valuable ideas from the wider field of clinical supervision, runs counter to CBT's empirical roots, and under-values supervision as a discrete professional specialization. For these reasons, it is argued that new developments should be grafted onto the current approach. In future, this augmented version of CBT supervision should be subjected to the same kinds of research and development (R&D) activity as CBT. Initially, this could include developing a manual to specify and operationalize this innovative approach, evaluation of manual-based training, and N = 1 research to assess its effectiveness. Examples of preliminary work are provided, and future R&D directions identified.