The way people with psychosis psychologically adapt and manage the diagnosis of such a mental disorder has been considered a key factor that contributes to the emergence and aggravation of emotional problems. These beliefs about illness can be very important due to their possible association with stigma and its implications in terms of loss of roles and social status. Given the importance of these personal beliefs about the specific diagnosis of psychosis, the Personal Beliefs about Illness Questionnaire (PBIQ) and PBIQ-R have been developed.

The present study aims to explore the psychometric characteristics of the Spanish version of the PBIQ-R in a sample of patients with a diagnosis of psychosis-related disorders.

Participants were 155 patients (54.8% male) of the Public Health Service in Andalusia (Spain). Those who consented to participate filled in the PBIQ-R, the Social Comparison Scale, and the PHQ-9 and GAD-7 to measure emotional symptoms.

All dimensions showed adequate internal consistency values: Cronbach’s alpha extends between .81 and .88; and McDonald’s omega ranges between .87 and .92. The temporal reliability for an interval of 3–4 weeks was high. The correlations between the PBIQ-R dimensions and the other variables included in the study were significant and in the expected direction. The factor analysis of the principal components of the PBIQ-R dimensions revealed a single factor in each of the dimensions that explained 64–74%.

The results support the reliability and validity of the Spanish version of the PBIQ-R.

Online treatments for child anxiety offer a potentially cost-effective and non-stigmatizing means to widen access to evidence-based treatments and meet the increasing demand on services; however, uptake in routine clinical practice remains a challenge. This study conducted an initial evaluation of the clinical effectiveness, feasibility and acceptability of OSI (Online Support and Intervention for child anxiety) within clinical practice. OSI is a co-designed online therapist-supported, parent-led CBT treatment for pre-adolescent children with anxiety problems.

This case series was part of routine service evaluation in a clinic in England where families were offered OSI to treat a primary anxiety difficulty among 7- to 12-year-old children; 24 families were offered OSI, and 23 took it up. Measures of anxiety symptomatology, functional impairment and progress towards therapeutic goals were taken at pre-treatment, post-treatment and 4-week follow-up. Treatment satisfaction and engagement were also measured throughout the intervention.

Mean anxiety symptoms significantly improved to below the clinical cut-off post-treatment, with further reduction at follow-up. Functional impairment also significantly improved and significant progress was made towards treatment goals. The majority of children showed reliable change in anxiety symptoms and reliable recovery by follow-up, and were discharged without needing further treatment for anxiety. Uptake, adherence and engagement in OSI were excellent, and parents reported high levels of satisfaction with the treatment.

We have provided initial evidence that OSI is feasible, acceptable to families, and appears to be associated with good outcomes within routine clinical practice.

Parents of children with eczema or psoriasis experience high levels of parenting stress, which can negatively impact their child’s mental and physical health.

We aimed to investigate the effectiveness, feasibility and acceptability of a mindful parenting intervention for parents of children with eczema or psoriasis.

Seven parents of children (4–12 years old) with eczema or psoriasis took part in an 8-week mindful parenting group intervention. A single-case experimental design was adopted, whereby parents completed daily idiographic measures of parenting stress related to their child’s skin condition. Parents also completed standardised questionnaires measuring their parenting stress, depression, anxiety and quality of life, and children completed a quality of life measure, at four time points: baseline, pre-intervention, post-intervention and 6-week follow-up. Parents provided qualitative feedback after the intervention.

All parents completed the intervention and showed improvements in idiographic measures of parenting stress from baseline to follow-up. Improvements in parenting stress were larger at follow-up than post-intervention, suggesting the benefits of intervention continue beyond the intervention. Six of seven parent–child dyads showed improvement in at least one of the wellbeing measures, from pre-intervention to post-intervention or follow-up. Feasibility was demonstrated through good participant retention, adherence to home practice, and treatment fidelity. Acceptability was demonstrated through positive parent evaluations of the intervention.

Mindful parenting can be an effective, feasible and acceptable intervention for parents of children with eczema or psoriasis. Future studies should attempt to replicate the findings through randomised controlled trials.

Mental health problems are common in youth in low- and middle-income countries (LMICs), including South Africa. Preventative interventions, based on cognitive behaviour therapy (CBT), delivered in schools, have been found to alleviate symptoms of depression and anxiety in high income countries (HICs). However, less is known about whether youth in LMICs are able to engage with the core concepts of CBT.

To explore how young people in the Western Cape, South Africa, understand key CBT concepts, such as feelings, thoughts and behaviours.

We interviewed 22 young people (10–15 years of age; mean age 11.6 years; SD = 1.0) recruited from two public primary schools in the Western Cape, South Africa. Interviews were audio-recorded, transcribed verbatim, translated from Afrikaans into English where necessary and analysed thematically using a deductive approach.

Young people described feelings as internal, private, and should only be shared with trusted others. They also described how feelings varied, depending on the situation. They found the concept of thoughts more challenging to describe. Youth were able to say what they do when they experience unpleasant feelings, and they linked their behaviours to their feelings and thoughts.

In this cultural context, our qualitative investigation found evidence that young people were able to engage with abstract concepts including feelings and to some degree, thoughts. To ensure that CBT-based interventions are developmentally appropriate and accessible, psychoeducation may help youth distinguish between thoughts, feelings and behaviours, and a focus on identifying and naming feelings may be beneficial.

Effective dissemination of cognitive behavioural therapy (CBT) has been assisted by clearly defined competencies, skills and activities, and validated scales used to measure therapist competence and adherence. However, there is no validated measure of the resource and infrastructure support therapists require to enable them to deliver CBT in line with best practice.

This study aimed to validate an index of resource infrastructure and support for the delivery of CBT.

This study took an existing questionnaire developed by Groom and Delgadillo (2012) and aimed to establish its psychometric properties through expert review and a pilot study.

This resulted in a shorter questionnaire with good content validity, internal consistency (α = 0.80) and temporal stability (r = 0.74, p < .00). The index consists of six components, and construct validity was demonstrated through positive association with measures of work engagement (r = 0.31, p < .00) and practitioner wellbeing (r = 0.47, p < .00).

The questionnaire provides a valid and reliable index of service support for delivering CBT, and is positively related to engagement and wellbeing among CBT practitioners.

To gain a better understanding about which aspects of the treatment work for obsessive-compulsive disorders (OCD), the investigation of possible change factors is essential. Psychological flexibility (PsyF) has been of interest in research on successful OCD therapy for some time. Exposure interventions and cognitive strategies in cognitive behavioural therapy (CBT) for OCD may enhance PsyF. To date, however, no process studies have been published that clarify the role of PsyF as a possible change factor for the reduction of OCD symptoms.

This study investigates whether PsyF works as a mediator in successful CBT treatment of OCD.

The study recruited 112 adults diagnosed with OCD in a multi-modal in-patient treatment with specific CBT including exposure and response prevention (ERP). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to measure OCD symptoms and three self-constructed items to assess PsyF. PsyF was conceptualised as the capability of patients to accept stressful feelings and thoughts. Data were collected weekly. For statistical analysis at the process level, longitudinal multi-level models (MLMs) with random intercepts and linear growth curves were estimated to test for mediation of PsyF on Y-BOCS.

OCD symptoms decreased significantly and PsyF increased in patients throughout the course of therapy. MLM revealed that higher average values in PsyF were associated with lower Y-BOCS sum values, but only values between subjects significantly predicted the degree of obsessions and compulsions.

Although research shows that PsyF is enhanced by CBT and also shows a connection with Y-BOCS values, its role as a mediator could not be confirmed.

Behavioural couples therapy (BCT) and alcohol behavioural couples therapy (ABCT) are couples-based interventions for substance use disorders (SUDs) that have been deemed a ‘gold standard’ treatment. Despite the substantial amount of promising research, there is a lack of research on the active components of treatment and treatment mechanisms and moderators. Since the most recent meta-analysis, a number of studies have been conducted that advance our understanding of the efficacy of BCT and ABCT.

The purpose of the present review was to provide an update on the current knowledge of these treatments and to investigate mediators and moderators of treatment.

A systematic search strategy of relevant databases from 2008 to 2021 identified 20 relevant articles that were coded for relevant information including study design, treatment, outcomes, as well as mechanisms and moderators.

The results indicated that BCT and ABCT are successful in reducing alcohol and substance use for both male and female clients, dual problem couples, and for reducing post-traumatic stress symptoms and intimate partner violence. The reviewed studies discussed a number of treatment mechanisms, with the most studied mechanism being relationship functioning. Moderators included relationship functioning and patient gender.

The results point to the need for additional research on active treatment components, mechanisms and moderators, in order to provide a more efficient and cost-effective treatment.

Many patients with mental health disorders become increasingly isolated at home due to anxiety about going outside. A cognitive perspective on this difficulty is that threat cognitions lead to the safety-seeking behavioural response of agoraphobic avoidance.

We sought to develop a brief questionnaire, suitable for research and clinical practice, to assess a wide range of cognitions likely to lead to agoraphobic avoidance. We also included two additional subscales assessing two types of safety-seeking defensive responses: anxious avoidance and within-situation safety behaviours.

198 patients with psychosis and agoraphobic avoidance and 1947 non-clinical individuals completed the item pool and measures of agoraphobic avoidance, generalised anxiety, social anxiety, depression and paranoia. Factor analyses were used to derive the Oxford Cognitions and Defences Questionnaire (O-CDQ).

The O-CDQ consists of three subscales: threat cognitions (14 items), anxious avoidance (11 items), and within-situation safety behaviours (8 items). Separate confirmatory factor analyses demonstrated a good model fit for all subscales. The cognitions subscale was significantly associated with agoraphobic avoidance (r = .672, p < .001), social anxiety (r = .617, p < .001), generalized anxiety (r = .746, p < .001), depression (r = .619, p < .001) and paranoia (r = .655, p < .001). Additionally, both the O-CDQ avoidance (r = .867, p < .001) and within-situation safety behaviours (r = .757, p < .001) subscales were highly correlated with agoraphobic avoidance. The O-CDQ demonstrated excellent internal consistency (cognitions Cronbach’s alpha = .93, avoidance Cronbach’s alpha = .94, within-situation Cronbach’s alpha = .93) and test–re-test reliability (cognitions ICC = 0.88, avoidance ICC = 0.92, within-situation ICC = 0.89).

The O-CDQ, consisting of three separate scales, has excellent psychometric properties and may prove a helpful tool for understanding agoraphobic avoidance across mental health disorders.

Paranoia is common across the clinical and non-clinical spectrum. Cognitive behavioural therapy for psychosis currently yields modest results, warranting research into symptom-specific maintenance factors to improve outcomes. There is strong evidence of a relationship between insecure attachment and increased paranoia, but little is known about the mediating mechanisms. Emotion dysregulation is associated with both insecure attachment and paranoia, and a candidate causal mechanism.

This study aimed to determine if emotion dysregulation mediates the association between attachment and paranoia.

Sixty-two individuals with elevated paranoia were recruited from NHS services and community settings across the South of England. Mediation analyses were conducted on trait attachment, emotion regulation and paranoia variables, which were collected at one time point.

As predicted, emotion dysregulation mediated the relationship between attachment avoidance and paranoia, and between attachment anxiety and paranoia. Emotion suppression did not mediate the relationship between attachment avoidance and paranoia, possibly due to power. Attachment avoidance correlated with deactivating emotion regulation strategies (e.g. lack of emotional awareness) and attachment anxiety correlated with hyperactivating emotion regulation strategies (e.g. impulse control difficulties). Both deactivating and hyperactivating strategies correlated with paranoia.

Emotion dysregulation is not routinely targeted in cognitive behavioural therapy for psychosis. This study suggests that incorporating emotion regulation strategies in therapy may improve clinical outcomes. Experimental studies are now required to support a causal argument, and pilot intervention studies should investigate if emotion regulation skills development (aligned with attachment style) is effective in reducing non-clinical and clinical paranoia.

Low self-esteem (LSE) has been associated with several psychiatric disorders, and is presumably influenced by transdiagnostic factors. Our study was based both on investigations of the relationship between depression and LSE (vulnerability, scar, reciprocal models) and on theories of cognitive factors contributing to the development and maintenance of LSE, such as Melanie Fennell’s model, the catalyst model and the Self-Regulatory Executive Function model.

Based on the theories above, in our cross-sectional study we aimed at understanding more specifically the transdiagnostic factors that can maintain LSE in a heterogeneous clinical sample.

Six hundred and eleven out-patients were assessed by SCID-I and self-report questionnaires. The model was tested by structural equation modelling.

Based on the fit indices, the hypothesis model did not fit the data; therefore, a modified transdiagnostic model was emerged. This model made a good fit to the data [χ2 (12, n=611)=76.471, p<.001; RMSEA=.080, CFI=.950, TLI=.913] with a strong explanatory power (adj R2=.636). Severe stressful life events and depressive symptoms lead to LSE indirectly. Self-blame, perfectionism, seeking love and hopelessness have been identified as mediating factors in the relationship between depressive symptoms and LSE. Although there was a significant correlation between state-anxiety and LSE, as well as LSE and rumination, these two factors did not fit into the model.

The new transdiagnostic model of LSE has great potential in the treatment of various mental conditions and may serve as a guide to developing more focused and more effective therapeutic interventions.

Cognitive behavioural therapy (CBT) is an effective treatment for panic disorder with agoraphobia (PDA). However, implementation of some of the procedures involved, particularly in vivo exposure, can be time consuming and taxing for routine health care services. CBT with exposure taking place in virtual reality (VR-CBT) is a more time-efficient option and has shown promising results in the treatment of PDA. However, VR-CBT requires expensive equipment and appropriate virtual environments, which historically has been costly and cumbersome to produce. Thus, access to VR-CBT has been sparse in regular care environments.

The aim of this study was to investigate whether VR-CBT using filmed virtual environments produced with a low-cost 360-degree film camera can be a feasible and acceptable treatment for PDA when implemented in a primary care context.

This was an open feasibility trial with a within-group design, with assessments conducted at pre-test, post-test, and 6-month follow-up. Participants (n = 12) received a 10–12 week treatment programme of VR-CBT and PDA-related symptoms were assessed by the primary outcome measure The Mobility Inventory for Agoraphobia (MIA) and the Panic-Disorder Severity Scale-Self Rated (PDSS-SR).

The results showed that treatment satisfaction was high and participants were significantly improved on PDA-related measures at post-treatment and at 6-month follow-up with large effect sizes (Cohen’s d range = 1.46–2.82). All 12 participants completed the treatment.

These findings suggest that VR-CBT with 360-degree video virtual environments delivered to primary care patients with PDA is feasible, acceptable, and potentially efficacious.

According to Clark and Wells’ cognitive model (Clark and Wells, 1995), social anxiety is maintained by both a negative self-image and self-focused attention (SFA). Although these maintaining factors were investigated extensively in previous studies, the direction of this relationship remains unclear, and so far, few studies have investigated self-image and SFA together within a current social interaction situation.

The aim of this experiment is to investigate the influence of a negative versus positive self-image on social anxiety and on SFA during a social interaction.

High (n = 27) and low (n = 36) socially anxious participants, holding a manipulated negative versus positive self-image in mind, had a real-time video conversation with a confederate. Social anxiety, SFA and state anxiety before and during the conversation were measured with questionnaires.

An interaction between negative self-image and social anxiety showed that high socially anxious individuals with a negative self-image in mind were more anxious than those with a positive self-image in mind during the conversation. They were also more anxious compared with low socially anxious individuals. Furthermore, high socially anxious individuals reported higher SFA; however, SFA was not affected by negative or positive self-image.

The present results confirm once again the strong influence of self-image and SFA on social anxiety, highlighting that a negative self-image has more impact on socially anxious individuals. Moreover, the present results suggest that SFA is not necessarily affected by a negative self-image, indicating that therapies should focus on both.

Personal practice (PP) is an integral component of many psychotherapy training programmes. It aims to promote personal and professional growth and is often conducted in a group format (g-PP). Group cohesion is one of the most researched mechanisms in group psychotherapy, but has rarely been studied in the context of g-PP.

This exploratory study examines the associations between cohesion, satisfaction with g-PP, its impact on personal and professional development, and theoretical orientation in a sample of n = 329 German psychotherapy trainees. Cohesion was assessed with the group questionnaire (GQ-D; Positive Bonding, Positive Working, Negative Relationship).

Overall, participants reported high levels of all outcome variables. Positive Bonding was the strongest predictor of satisfaction with g-PP (β = 0.46, p<.001). While trainees in cognitive behaviour therapy reported significantly better cohesion scores (d≥0.31), trainees in psychodynamic therapy reported significantly higher satisfaction with g-PP and its impact on their developments (d≥0.30).

Group cohesion appears to be an important factor in g-PP that should be actively promoted by group leaders. However, longitudinal study designs are needed to better understand the emergence of cohesion in g-PP as well as potential moderating factors.

Meta-analyses show an association between perfectionism and depression and anxiety (negative affect), and that therapy for perfectionism impacts positively on negative affect. No systematic reviews have focused on qualitative studies of perfectionism.

Our aim was to perform a systematic, meta-synthesis of qualitative literature to (i) help inform our understanding of how perfectionism is associated with negative affect, so that we can (ii) inform future development of treatment for perfectionism in young people and to make it more effective.

Included in the meta-synthesis were 37 qualitative studies.

Six themes related to perfectionism were found: (1) the association with negative affect, (2) self-worth dependent on achievement, (3) cognitive and behavioural maintaining factors, (4) the expectations of others, (5) effective elements of interventions, and (6) barriers to treatment.

The qualitative literature supports the notion of perfectionism as an important construct to consider in reducing negative affect. While cognitive behavioural therapy for perfectionism holds promise as a treatment to target negative affect, there was a paucity of qualitative research, particularly related to young people. A greater understanding of the views of young people are required to help tailor more effective interventions for perfectionism that can impact negative affect in this group.

A substantial proportion of patients receiving cognitive behavioural therapy (CBT) do not achieve remission, and drop-out is considerable. Motivational interviewing (MI) may influence non-response and drop-out. Previous research shows that MI as a pre-treatment to CBT produces moderate effects compared with CBT alone. Studies integrating MI with CBT (MI-CBT) are scarce.

To test the feasibility of MI-CBT in terms of therapist competence in MI and various participant measures, including recruitment and retention. In addition, separate preliminary evaluations were conducted, exploring the effects of CBT alone for anxiety disorders and depression, and of MI-CBT for anxiety disorders, depression and unhealthy lifestyle behaviours.

Using a randomised controlled parallel trial design, participants were recruited in routine psychiatric care and allocated to CBT alone or MI-CBT. Means in feasibility measures and within-condition Hedges’ g effect sizes in treatment outcome measures were calculated. Authors were not blind to treatment allocation, while independent raters were blind.

Seventy-three patients were assessed for eligibility, and 49 were included. Participant perceptions of treatment credibility, expectancy for improvement, and working alliance were similar for both conditions. Overall, effect sizes were large across outcome measures for both conditions, including anxiety and depressive symptoms and functional impairment. However, therapists did not acquire sufficient competence in MI and the drop-out rate was high.

MI-CBT proved feasible in some respects, but the present study did not support the progression to a randomised controlled trial designed to assess the effectiveness of MI-CBT. Additional pilot studies are needed.

The Work and Social Adjustment Scale (WSAS) is an instrument that can be easily applied for routine evaluation of the impact of mental disorders on patient functioning. In spite of the interest in its use, there is very little information available on its psychometric characteristics and even less in Spanish.

The objective of this study was to analyse its psychometric characteristics.

The sample consisted of 441 patients treated in a community mental health unit. They filled out the WSAS and two psychopathology measures, one for anxiety and the other for depression. Fifty-five of them, chosen at random, were asked to fill out the scale again a second time to explore its temporal reliability.

The scale showed high internal consistency, a single factor that explained 60.4% of the variance, and temporal reliability of .78 for the total score. Significant correlations were found between the WSAS scores and the psychopathological measures, as well as significant differences between those working and those on leave.

The results confirm the validity and reliability of the scale and support its possible use for routine evaluation of the functional impact of mental disorders.

Although insomnia disorder and social anxiety disorder are among the most prevalent psychiatric disorders, no studies have yet evaluated the use of sequential evidence-based treatment protocols in the population with co-morbid social anxiety disorder and insomnia disorder.

This study aimed to investigate the effects of sequential treatments on co-morbid insomnia disorder and social anxiety disorder. As depression is a common co-morbid syndrome for both insomnia and social anxiety, a secondary aim was to examine depressive symptoms.

A single-case repeated crossover AB design was used. Ten participants between 18 and 59 years of age with co-morbid DSM-5 diagnoses of insomnia disorder and social anxiety disorder received sequential treatments with cognitive behavioural therapy (CBT). Seven participants completed the treatment course. The primary outcomes were symptoms of insomnia and social anxiety, and the secondary outcome was symptoms of depression.

The effects of CBT on people with co-morbid social anxiety disorder and insomnia disorder were mixed. The majority of participants improved their sleep quality and lessened symptoms of social anxiety and depression. However, participants differed in their degree of improvement concerning all three disorders.

Sequential CBT treatments are potentially effective at decreasing symptoms of social anxiety and insomnia for people with co-morbid social anxiety disorder and insomnia disorder. The variation in outcome across participants makes firm conclusions about the treatment efficacy difficult to draw.

Negative beliefs about the self, including low self-compassion, have been identified as a putative causal factor in the occurrence of paranoia. Therefore, improving self-compassion may be one route to reduce paranoia.

To assess the feasibility, acceptability, and potential clinical effects of a brief compassionate imagery intervention for patients with persecutory delusions.

Twelve patients with persecutory delusions received an individual four-session compassionate imagery intervention. Assessments of self-concept and paranoia were completed before treatment, immediately after treatment, and at 1-month follow-up. A qualitative study exploring participants’ experiences of the treatment was also completed.

Twelve out of 14 eligible patients referred to the study agreed to take part. All participants completed all therapy sessions and assessments. Post-treatment, there were improvements in self-compassion (change score –0.64, 95% CI –1.04, –0.24, d = –1.78), negative beliefs about the self (change score 2.42, 95% CI –0.37, 5.20, d = 0.51), and paranoia (change score 10.08, 95% CI 3.47, 16.69, d = 0.61). There were no serious adverse events. Three themes emerged from the qualitative analysis: ‘effortful learning’, ‘seeing change’ and ‘taking it forward’. Participants described a process of active and effortful engagement in therapy which was rewarded with positive changes, including feeling calmer, gaining clarity, and developing acceptance.

This uncontrolled feasibility study indicates that a brief compassionate imagery intervention for patients with persecutory delusions is feasible, acceptable, and may lead to clinical benefits.

Recovery from trauma can be naturally occurring or facilitated through psychotherapy. Few brief measures exist to provide clinicians with dispositional, empirical assessments of patient’s sentiments during psychotherapy.

This manuscript presents the Dispositional Recovery and Dysfunction Inventory (DRDI), a measure created to assist clinicians in evaluating patient’s treatment progress during psychotherapy, as well as evaluate its factor structure, reliability estimates, measurement invariance, and correlates.

The DRDI was created based on feedback from experts with experience treating posttraumatic stress disorder (PTSD) and was structurally validated in two distinct populations. Exploratory factor analysis was conducted in sample 1 consisting of (n=401) university students. Confirmatory factor analysis, measure validity and structure validation were then conducted in sample 2 (n=249) composed of 49% individuals with clinically significant PTSD symptoms.

Exploratory and confirmatory factor analysis revealed that the DRDI was best represented by a two-factor correlated traits model representing sentiments related to dispositional recovery and dysfunctional cognitions. The recovery subscale exhibited relationships with convergent measures including authenticity and psychological hardiness (r values of .30 to .60). The dysfunctional beliefs subscale exhibited relationships with convergent measures: PTSD, depression, suicidality and stress (r values of .55 to 80). Measurement invariance across gender and PTSD status was observed.

Initial findings indicate that the DRDI has the potential to be a useful tool to assess individuals’ beliefs about their propensity to recover from and thrive through adversity.

Due to the COVID-19 pandemic, mental health services have had to offer psychological therapy via video with little time to prepare or mitigate potential problems. Identifying the barriers, benefits and training needs highlighted by clinicians may support the effective delivery of care.

Changes in the mode therapy sessions were delivered in during 2020 were assessed in two high-volume psychological therapies services. Sixty-six therapists completed a survey about their experiences of delivering therapy via video.

The lockdown in March 2020 precipitated a dramatic shift from face-to-face to telephone and video-delivered sessions. Most clinicians (89%) found video-based sessions acceptable. Barriers to effective delivery included technological issues, problems with online platforms, and feeling more tired after sessions. Benefits included generalised learning from behavioural work, improvements in efficiency and in the therapeutic relationship, particularly in comparison with telephone-based sessions. Tutorials and support guides were recommended to maximise use of sessions via video.

Video-delivered therapy was liked by clinicians and preferred to telephone-based sessions. Issues with platforms, internet connections and access for patients need addressing, local troubleshooting guides, video-based tutorials and greater support for low-intensity therapists to maximise uptake of video sessions where appropriate, may be beneficial.