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.

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.

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.

1. (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. (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.

Implementation of video call-based cognitive behavioural therapy (CBT) has increased significantly since the COVID-19 pandemic, enabling more flexible delivery, but less is known about user experience and effectiveness. This systematic review and meta-analysis investigated feasibility, acceptability, and effectiveness of individual video call-based CBT for adults with mild to moderate mental health conditions (Prospero CRD42021291055). Medline, Embase, PsycINFO and Web of Science were searched until 4 September 2023. The Effective Public Health Practice Project Quality Assessment Tool (EPHPP) assessed methodological quality of studies. Meta-analysis was conducted in R. Thirty studies (n=3275), published 2000 to 2022, mainly in the USA (n=22/30, 73%), were included. There were 15 randomised control trials, one controlled clinical trial, and 14 uncontrolled studies. Findings indicated feasibility, acceptability and effectiveness (effect size range 0.02–8.30), especially in post-traumatic stress disorder (PTSD) for military populations. Other studies investigated depression, obsessive-compulsive disorder, panic with agoraphobia, insomnia, and anxiety. Studies indicated that initial challenges with video call-based CBT subsided as therapy progressed and technical difficulties were managed with limited impact on care. EPHPP ratings were strong (n=12/30, 40%), moderate (n=12/30, 40%), and weak (n=6/30, 20%). Meta-analysis on 12 studies indicated that the difference in effectiveness of video call-based CBT and in-person CBT in reducing symptoms was not significant (SMD=0.044; CI=–0.086; 0.174). Video calls could increase access to CBT without diminishing effectiveness. Limitations include high prevalence of PTSD studies, lack of standardised definitions, and limited studies, especially those since the COVID-19 pandemic escalated use of video calls.

1. This review assesses feasibility, acceptability, and effectiveness of individual video call-based CBT for adults with mild to moderate common mental health conditions, as defined by the ICD-11.

2. Secondary aims were to assess if the therapeutic relationship is affected and identify any potential training needs in delivering video call-based CBT.

3. The adjunct meta-analysis quantitatively explored whether video call-based CBT is as effective as in-person interventions in symptom reduction on primary outcome measures by pooling estimates for studies that compare these treatment conditions.

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.

The aim of this systematic review is to evaluate psychosocial interventions for HD.

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.

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.

Despite the limited research on psychosocial interventions for HD, this systematic review suggests it is a promising area for further research in this area.

1. (1) To identify what psychosocial interventions are available for people experiencing hoarding difficulties.

2. (2) To identify how available psychosocial interventions for hoarding difficulties are delivered and by whom.

3. (3) To examine the effectiveness of psychosocial interventions for people experiencing hoarding difficulties.

National guidance recommends that relatives of people with dementia receive support to develop coping strategies. STrAtegies for RelaTives (START) is an evidence-based manualised intervention for delivery on a one-to-one basis by trained graduate psychologists to family carers of people with dementia. However, implementation of START in standard National Health Service (NHS) provision has proved difficult. We describe collaboration between a Talking Therapies service and a Memory Service to co-facilitate and run START as a group. We consider implementation outcomes according to RE-AIM domains showing: the collaboration reached higher number of carers than other implementation initiatives (reach); there was significant reduction in caregiver anxiety and a trend towards significant reduction in depression (effectiveness); feedback from service users and clinicians on the service model has been positive (adoption); delivery has been supported by the written and audio materials (implementation); and the initiative has sustained over five years, despite the COVID-19 pandemic and staff turnover (maintenance). Finally, we discuss implications and potential future development.

1. (1) To develop knowledge about the content of the STrAtegies for RelaTives (START) coping intervention for family carers of people with dementia.

2. (2) To understand the similarities between low-intensity cognitive behavioural therapy for anxiety and depression, as provided by Psychological Wellbeing Practitioners (PWPs), and START psychoeducational content and skills exercises.

3. (3) To reflect on the rationale for group delivery of START.

4. (4) To consider the benefits of collaboration between Talking Therapies and Memory Services for implementing START.

Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it.

Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis.

Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy.

Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND.

1. (1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition.

2. (2) To understand the facilitators of and barriers to ACT for plwMND.

3. (3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.

Young people are increasingly distressed by the climate and ecological crises (eco-distress). This has been associated with the failure of people in power to act appropriately, which may cause moral distress and moral injury. We examined this hypothesis by interviewing 13 young adults (19–25 years) in the UK about their climate concerns and perceptions of how State actors and authorities are responding to climate change. Using reflexive thematic analysis, four themes were developed: (1) Climate change is a wicked problem, (2) Moral distress is associated with witnessing acts of omission and commission, (3) Moral distress drives eco-distress, and (4) Opportunities for moral repair. Climate concerns extended to broader concerns about ecological degradation (eco-distress), linked to feelings of moral distress arising from repeatedly witnessing powerful people failing to act on climate change. Eco-distress was also exacerbated by (a) witnessing others in society failing to take appropriate responsibility, (b) realising the limitations of individual action, and (c) being embedded within a culture where personal contribution to climate change is inescapable. In contrast, eco-distress was lessened by seeing authorities engage with the issues morally, and further mitigated by collective, ethical, pro-environmental action. This adds empirical evidence to support the hypothesis that eco-distress involves moral distress and injury arising when State authorities and other powerful bodies engage in wrongful acts and omissions on climate change. We argue that this is affecting the wellbeing of young people and supports the argument that such wrongful (in)action infringes human rights. Clinical implications are discussed.

1. (1) To understand how and why moral distress and moral injury relate to the distress that young people feel about climate change (eco-distress).

2. (2) To consider the clinical implications of formulating eco-distress in a way that includes reference to the violation of core moral codes.

3. (3) To explore what opportunities exist that could reduce moral distress and support young people.

4. (4) To understand how research into moral distress and moral injury in relation to climate change can offer important insight into the relevance of eco-distress to human rights infringements and justice-oriented care.

5. (5) To discuss practical solutions that might support moral repair, both in psychotherapy settings and in broader social policy.

Climate change distress is a challenge to people seeking help, and to those providing help. Those providing help are working in a new area of clinical practice where little is known, but they may also be experiencing climate change distress. The aim of this article is to highlight the personal and professional implications of the unfolding climate crisis and how we might better understand and support those with understandable, yet intense, emotional reactions to the climate crisis. This article consists of a first-person narrative by the first author, and a commentary on the narrative based on the psychology of climate change literature by the second author. We have worked independently on the narrative and commentary; each is responsible for their own contribution. The narrative highlights the first author’s personal experience of moving from denial to facing the truth of the climate crisis and the impact on professional practice. The commentary by the second author found that literature is scarce, but more familiar areas of practice may help to understand and respond to climate change distress. Practitioners face a situation where they may experience similar emotions to their clients, analogous to the shared threat of the pandemic. Awareness of the crisis is daunting, but therapy, self-reflection and action can help hold our emotions and support our clients. The evidence is limited but experience of the pandemic suggests that CBT can respond, adapt, innovate, and even revolutionise mental healthcare. These two perspectives suggest, despite the challenges, there may be reasons for hope.

1. (1) To increase familiarity with climate change distress and its multi-faceted presentations.

2. (2) To understand the importance of self-care for climate activists and the different forms this may take.

3. (3) To consider the implications of being a practitioner helping people with climate change distress, while also experiencing climate change distress.

4. (4) To reflect on the tensions between, and the potential integration of, the personal and the professional in the context of climate change.

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.

1. (1) To understand the concept of climate distress and its various emotional responses.

2. (2) To explore the relevance of acceptance and commitment therapy (ACT) in addressing climate distress and promoting psychological well-being.

3. (3) To examine the importance of psychological flexibility in coping with climate change.

4. (4) To analyse the role of ACT in embracing climate distress as a natural human experience.

5. (5) To investigate how ACT can encourage pro-environmental behaviours and climate change mitigation efforts.

As we face a future of rising global temperatures, and associated extreme weather events, distressing emotional responses are understandable. Climate scientists comprise a unique group, in that they must regularly confront the reality, and consequences, of climate change. In this paper, we explore how the principles of compassion-focused therapy (CFT) might be applied to comprehend the responses of climate scientists to climate change; by doing so, we aim to gain a deeper understanding of these responses in order to consider fruitful avenues for providing support and investigating this area further. We consider how flows of compassion, and blocks to compassion, might play a role in climate scientists’ experiences. Additionally, we conceptualise a role for compassion towards the wider world and humanity more broadly. Finally, by applying the CFT Three Systems model to current understanding of climate scientists’ emotional experiences, we seek to proffer a potential conceptualisation of them.

1. (1) To formulate the emotional experiences of climate scientists from a compassion-focused therapy perspective.

2. (2) To explore how blocks to flows of compassions serve to negatively impact and/or maintain difficult emotional experiences of climate scientists.

3. (3) To consider ways in which the field of psychological therapy can support climate scientists through a difficult emotional journey, and how future research might explore this further.

As humanity faces a future of rising global temperatures, and associated extreme weather events, distressing emotional responses are understandable, but often silenced. Climate Cafés are unique, dedicated spaces where such responses can be shared and validated with others. Semi-structured interviews were conducted with attendees of Climate Cafés facilitated by the Climate Psychology Alliance (CPA). An initial interview of 45 minutes was followed by a shorter follow-up interview 3 months later. Interpretative phenomenological analysis (IPA) methodology was used with seven female participants. Four superordinate themes were identified: (1) Having a keen awareness of threats to planetary health, (2) Action taken in the face of climate change, (3) Journeying from isolation to connection, and (4) Legacy of Climate Cafés. Participants described positive experiences both during and after the Climate Cafés, particularly having their concerns heard and validated, being with others who share their worldview, and feeling more connected. Attending Climate Cafés appears to offer important support to people experiencing distress related to the climate and ecological emergencies. Findings are discussed in light of the compassion-focused therapy (CFT) ‘Three Systems’ model, which offers a unifying theoretical conceptualisation that could support future development and research in this area.

1. (1) To understand the idiosyncratic experiences of seven UK women at Climate Cafés.

2. (2) To begin to conceptualise and apply psychological models to current Climate Café practices, especially compassion-focused modalities.

3. (3) To use the experiences reported here to add to the growing understanding of eco-emotions.

Both extreme weather and climate change have been linked to distress and at times mental health problems. Pro-environmental actions have often been related to higher distress. The uncertainty distress model (Freeston et al., 2020) proposes that in real-world situations, perceptions of threat and uncertainty contribute to distress. The aim of this study is to integrate variables from these two literatures and examine their relationships.

A community sample (n=327) was recruited and completed an online survey. Network analysis was used to analyse the relationships between the variables. Exposure to extreme weather, perceptions of climate change, climate change distress and pro-environmental action were measured along with symptoms of adjustment disorder and post-traumatic stress disorder, and uncertainty intolerance and behaviours.

There was variable exposure to extreme weather, but greater exposure was associated with more severe post-traumatic symptoms. Pro-environmental action was associated with greater severity of adjustment disorder symptoms. The perception that climate change was happening now was linked positively to pro-environmental action and negatively to perceptions of uncertainty about whether climate change was happening.

The results replicate several findings from the emerging climate change distress literature and are consistent with some predictions of the uncertainty distress model, but not others. Uncertainty as to whether climate change is happening now may be a less distressing position. Research that simultaneously considers extreme weather and climate change may help understanding the range of complex responses that may arise as the frequency of extreme weather increases and evidence for anthropogenic climate change strengthens.

1. (1) To consider why the uncertainty distress model may be an appropriate framework to understand responses to extreme weather and climate change.

2. (2) To consider how the perceived proximity of climate change may play a role in peoples’ emotional and behavioural responses to climate change.

3. (3) To consider some of the variables that are linked to pro-environmental action.

4. (4) To consider whether an uncertainty-based understanding of extreme weather and climate change has helpful implications for practice.

Psychological Wellbeing Practitioners (PWPs) are central to NHS Talking Therapies services for depression and anxiety (TTad; formerly ‘IAPT’). This workforce has been trained to deliver low-intensity treatments for mild to moderate depression and anxiety. In practice, PWPs routinely work with more complex clients, likely due to a combination of reasons. Over half of referrals experience concurrent personality difficulties, which are linked to poorer treatment outcomes, and PWPs describe feeling unskilled to work with these clients. This study aimed to develop and pilot a Continuing Professional Development workshop for PWPs about enhancing practice in the context of concurrent personality difficulties; and evaluate acceptability, feasibility and potential impacts on clinical skills and attitudes. This is an audit of routine feedback from a pilot of the workshop offered in a single TTad PWP workforce (n=139). The workshop was successfully developed and a series of five workshops were delivered to 74% of the PWP workforce. Feedback was overwhelmingly positive, and a majority of PWPs reported improved confidence in key skills covered during the workshop, and a positive attitude towards working with clients with personality difficulties after the workshop. PWPs described enhanced capability, opportunity and motivation to undertake work with this client group following the workshop. The workshop showed potential to improve PWP confidence and skill to support TTad clients in the context of personality difficulties, although it is not yet known if this translates to better treatment outcomes for clients. Implications for practice and future research are discussed.

1. (1) Understand the feasibility of gathering feedback and outcome data of a Continuing Professional Development (CPD) workshop delivered in routine practice for PWPs.

2. (2) Understand PWP perspectives on attending a CPD workshop to support tailoring PWP treatments for depression and anxiety in the context of personality difficulties.

3. (3) Reflect on potential opportunity to enhance PWP treatments in the context of personality difficulties via brief training workshops.

4. (4) Consider how COM-B can be used to explore barriers and enablers to PWPs implementing new learning to their practice.