Effective, evidence-based psychological therapies for prolonged grief reactions exist but are not routinely available in United Kingdom National Health Service (NHS) services. This audit evaluated the feasibility and clinical effectiveness of a high-intensity prolonged grief disorder therapy (PGDT) treatment pathway in an NHS Talking Therapies (NHS-TT) context for clients with a prolonged grief reaction alongside depression, anxiety and/or post-traumatic stress disorder. Seventeen experienced high-intensity therapists were trained to deliver PGDT. Ninety-one clients were treated between April 2022 and April 2024, 80 of whom met criteria and were included in this audit; 83% of clients completed at least four treatment sessions (a liberal estimate of minimum adequate dose), the mean number of sessions attended was 10.29 (SD=5.81) and rates of drop-out were low (16%). Data completeness rates were 100% depression, anxiety and functioning measures and 61% for the grief outcome (Brief Grief Questionnaire; BGQ). There was no evidence of treatment-related harms. There were statistically significant, large pre–post treatment effect size improvements across outcomes from intake to last treatment session (p<.001; Cohen’s d>1.05). According to NHS-TT outcome metrics for combined changes in anxiety and depression, 82% of clients exhibited reliable improvement, 72% showed recovery, and 68% of clients achieved reliable recovery. On the BGQ, rates of reliable improvement were 77% and rates of recovery were 63%. Effects held when focusing on the subgroup with more severe grief symptoms (intake BGQ≥8; n=40). These findings suggest it is feasible and probably effective to implement a PGDT pathway in an NHS-TT context.

1. (1) To become familiar with prolonged grief disorder (PGD) as a diagnostic construct.

2. (2) To gain insight into using prolonged grief disorder therapy (PGDT) to treat PGD.

3. (3) To understand ways to train and supervise National Health Service Talking Therapies (NHS-TT) high-intensity therapists to implement PGDT.

4. (4) To evaluate the potential feasibility and effectiveness of implementing PGDT in an NHS-TT context.

Economic variables such as socioeconomic status and debt are linked with an increased risk of a range of mental health problems and appear to increase the risk of developing of post-traumatic stress disorder (PTSD). Previous research has shown that people living in more deprived areas have more severe symptoms of depression and anxiety after treatment in England’s NHS Talking Therapies services. However, no research has examined if there is a relationship between neighbourhood deprivation and outcomes for PTSD specifically. This study was an audit of existing data from a single NHS Talking Therapies service. The postcodes of 138 service users who had received psychological therapy for PTSD were used to link data from the English Indices of Deprivation. This was analysed with the PCL-5 measure of PTSD symptoms pre- and post-treatment. There was no significant association between neighbourhood deprivation measures on risk of drop-out from therapy for PTSD, number of sessions received or PTSD symptom severity at the start of treatment. However, post-treatment PCL-5 scores were significantly more severe for those living in highly deprived neighbourhoods, with lower estimated income and greater health and disability. There was also a non-significant trend for the same pattern based on employment and crime rates. There was no impact of access to housing and services or living environment. Those living in more deprived neighbourhoods experienced less of a reduction in PTSD symptoms after treatment from NHS Talking Therapies services. Given the small sample size in a single city, this finding needs to be replicated with a larger sample.

1. (1) Previous literature has shown that socioeconomic deprivation increases the risk of a range of mental health problems.

2. (2) Existing research suggests that economic variables such as income and employment are associated with greater incidence of PTSD.

3. (3) In the current study, those living in more deprived areas experienced less of a reduction in PTSD symptoms following psychological therapy through NHS Talking Therapies.

4. (4) The relatively poorer treatment outcomes in the current study are not explained by differences in baseline PTSD severity or drop-out rates, which were not significantly different comparing patients from different socioeconomic strata.

The objectives of study 1 were to use expert opinion to identify the limitations of the Health Anxiety Inventory – Short Version (SHAI) for administration in medical populations and to develop an adapted version for medical populations. The objective of the second study was to evaluate the psychometric properties of the adapted measure. A three-round Delphi study method was used in study 1. Eight experts with experience of living with a physical health condition and four experts by profession working within physical health were invited to review the SHAI. Study 2 employed a cross-sectional mixed methods questionnaire design. Individuals with multiple sclerosis (n=115), myalgic encephalomyelitis/chronic fatigue syndrome (n=84) and chronic pain (n=116) were invited to complete a battery of questionnaires via an online survey. The adapted version of the SHAI for Medical Populations (HAI-M) consisted of 12 items scoring from 0 to 3, reaching high consensus (75% agreement) for administration in medical populations. All groups rated the HAI-M as more acceptable than the SHAI and no significant differences were found on HAI-M scores between clinical groups. The HAI-M demonstrated high internal consistency (.875), good test–retest reliability (.812) and convergent validity (.801). Divergent validity was also acceptable (.515). This study provides preliminary evidence for a psychometrically sound health anxiety screening tool for use in medical populations.

1. (1) To gain insights into the presentation of health anxiety in medical conditions.

2. (2) To consider the validity and reliability of using questionnaire measures developed using analogue sample norms, and how this may affect measurement when used in different context and settings.

3. (3) The process of systematically adapting, developing and testing standardised measures for use in special subgroups.

Traumatic brain injury (TBI) can alter day-to-day life. While changes in cognition and physical function are most often cited, emotional disturbances, notably depression, are also common. For individuals who experience depression symptoms, mindfulness-based cognitive therapy (MBCT) may afford the opportunity to address these symptoms by teaching skills to mitigate negative thought patterns and foster acceptance. Yet, as with any treatment for depression, MBCT may not be the best fit for everyone. According to the literature, characteristics such as age, gender, and baseline mindfulness or pain levels have the potential to affect treatment response. While these factors have yet to be explored within a TBI sample, we must additionally consider whether possible cognitive impairment due to TBI plays a role in treatment response. Drawing from an earlier multi-site randomized controlled trial to explore the efficacy of MBCT for depression in a TBI sample, the current study examined the associations between a number of baseline factors (demographic, emotional, physical, and cognitive) and decreased depression scores post-intervention. Partial correlations adjusted for gender. Findings indicated that only higher levels of pain at baseline were associated with lesser effectiveness of the intervention. MBCT offers a good treatment option for most individuals experiencing depression following TBI.

1. (1) To explore factors associated with treatment response to MBCT for depression after TBI.

2. (2) To understand how cognitive impairment resulting from TBI need not preclude treatment response.

3. (3) To reflect on the role of pain in treatment response.

Cognitive behavioural therapy (CBT) and eye-movement desensitisation and reprocessing (EMDR) are NICE-recommended evidence-based treatments for post-traumatic stress disorder (PTSD). However, there is less specification of which individuals might find CBT versus EMDR more effective, or whether other factors influence treatment outcomes. This study describes a service evaluation of trauma-focused CBT (CT-PTSD) and EMDR treatment outcomes for PTSD in a London out-patient NHS Talking Therapies (NHS TT) service over 11 years (N=1580). The evaluation was conducted in an adult sample (mean age 37 years), of which 65% were women. The mean number of treatment episodes for PTSD in the service in the sample was 2.39 (SD=1.86), and the mean number of therapy sessions attended was 6.15 (SD=6.43). When using NHS TT recovery criteria, there was no significant difference between PTSD recovery rates in the service for those who received CT-PTSD (40.8%) versus EMDR (43.6%). CT-PTSD was associated with greater reductions in anxious and depressive (but not PTSD-specific) symptoms than EMDR, but this was confounded by the fact that individuals receiving CT-PTSD in the service had higher anxiety and depression scores at start-of-treatment. Older age and non-female gender were associated with higher anxiety and depression scores. PTSD recovery rates were comparable to other NHS TT services. There is no clear indication that either CBT or EMDR is a more effective treatment for PTSD symptoms in the service, although preliminary findings could inform treatment planning regarding differential effects of the treatments on anxious and depressive symptoms. Other clinical implications are discussed.

1. (1) To gain a better understanding of the relative effectiveness of trauma-focused CBT and EMDR for PTSD, as provided in a working NHS TT service.

2. (2) To allow better-informed clinical and treatment pathway planning for individuals with trauma problems in a talking therapies service.

3. (3) To contribute to the wider research literature on effective interventions for trauma within cognitive therapy and NHS frameworks.

Despite high levels of depression and anxiety, there is relatively little attention to psychological treatment approaches to mental health issues for older adults living in nursing homes. Recent studies support the use of cognitive behaviour therapy (CBT) in this population and here we aim to highlight how CBT can be successfully adapted and implemented with beneficial results. The ELders AT Ease (ELATE) program is a unique service delivery model illustrating delivery of CBT with older adults living in nursing homes. The six modules forming the program, based on CBT, are described. A systems wide approach to delivery is emphasised and illustrated through two clinical case descriptions. Innovative mental health programs can have positive benefits for both residents and staff and support the use of CBT in this vulnerable and under-served client group.

1. (1) Knowledge of the content and application of CBT for older adults living in nursing homes.

2. (2) Understanding of CBT session structure as applied to older adults living in nursing homes.

3. (3) Recognising and utilising specific strategies to highlight a systemic approach as central to implementing CBT strategies, such as behavioural activation and reminiscence, with considered involvement by staff and family.

1. (1) To learn about the utility of adapting existing treatments as opposed to developing new treatments.

2. (2) To learn about the potential of propensity score matching in the analysis of routinely collected datasets.

3. (3) To learn about delivery of behavioural activation in groups.

4. (4) To better understand how to enhance and evaluate treatment protocols using theoretically informed and low-cost treatment augmentations.

Family-based treatment (FBT) has proven efficacy among adolescents with eating disorders (ED). However, it is not effective or suitable for all young people and their families, which makes alternative treatments important. This is the first pilot study to compare the relative effectiveness of manualised enhanced cognitive behaviour therapy (CBT-E) among a transdiagnostic eating disorder sample of adolescents for whom CBT-E was their first ED treatment (n=42), and a group who had previously started FBT which had been discontinued without full recovery (n=27). Participants (n=69) aged 13–17 with an eating disorder completed manualised CBT-E. Outcome measures included body mass index (BMI) centile, ED psychopathology and clinical impairment. Across the cohort, results showed improvements across ED psychopathology, clinical impairment and BMI centile. The effect of the intervention on ED psychopathology and clinical impairment did not vary between groups, nor did attrition rates. There was a difference between the groups on BMI centile, with those who had previously been treated with FBT showing no change in BMI centile, whereas those with no previous FBT increased BMI at post-treatment. Implications from this research suggest that CBT-E is a viable promising alternative and could be offered among those for whom FBT has not achieved full recovery.

1. (1) Delivering CBT-E to adolescents with eating disorders who have previously engaged in FBT but have not achieved full recovery is a promising subsequent treatment option.

2. (2) CBT-E was similarly completed and displayed similar overall group reductions in eating disorder symptoms in those who had discontinued FBT without full recovery compared with those who had not previously engaged with FBT.

3. (3) Results suggest that CBT-E could be offered when FBT has not achieved full recovery, although more research is required to understand optimal timings of treatment transition in such instances.