Let's Talk About CBT Dr Lucy Maddox

The British Association for Behavioural and Cognitive Psychotherapies, the lead organisation for cognitive behavioural therapy (CBT) in the UK and Ireland, is 50 years old this year. In this episode Dr Lucy Maddox explores how CBT has changed over the last 50 years. Lucy speaks to founding members Isaac Marks, Howard Lomas and Ivy Blackburn, previous President David Clark, outgoing President Andrew Beck and incoming President Saiqa Naz about changes through the years and possible future directions for CBT.
Transcript 
Dr Lucy Maddox:        Hello, my name is Dr Lucy Maddox and this is Let’s Talk about CBT, the podcast brought to you by the British Association for Behavioural and Cognitive Psychotherapies or BABCP. This episode is a bit unusual, it’s the 50th anniversary of the British Association for Behavioural and Cognitive Psychotherapies this year. And I thought this would be a nice opportunity to explore some of the history of cognitive behavioural therapy, especially the last 50 years.
                                    Some of the roots of CBT can actually be traced way back. Epictetus, an ancient Greek Stoic philosopher wrote that man is disturbed not by things, but by the views he takes of them. This is pretty close to one of the main ideas of cognitive behavioural therapy, that it’s the meaning that we give to events, rather than the events themselves which is important. But actually, cognitive behavioural therapy started off without the C. To find out more, I made a few phone calls.
Isaac Marks:               Hello, Isaac Marks here.
Dr Lucy Maddox:        Isaac Marks was one of the founding members of BABCP and a key figure in the development of behavioural therapy in Britain. I asked him if he could remember what CBT was like 50 years ago.
Isaac Marks:               Originally it was just BT and a few years later the cognitive was added. At the time, the main psychotherapy was dynamic psychotherapy, sort of Freudian and Jungian. But just a handful of us in Groote Schuur Hospital psychiatric department, that’s in Cape Town, developed an interest in brief psychotherapy. And I was advised if I was really interested in it and I was thinking of taking it up as a sub profession, that I should come to the Maudsley in London.
Dr Lucy Maddox:        Isaac and his wife moved to London from South Africa and Isaac studied psychiatry at the Maudsley Hospital in Camberwell.
What was it about CBT that had interested you so much?
Isaac Marks:               Because it was a brief psychotherapy, much briefer than the analytic psychodynamic psychotherapy. We were short of therapists and there wasn’t that much money to pay for extended therapy, just a few sessions. Six or eight sessions something like that could achieve all what one needed to. They had quite a lot of article studies.
Dr Lucy Maddox:        And I guess that’s still true today, that those are some of the real standout features of it, aren’t they? That it is a briefer intervention than some other longer-term therapies and that it’s got a really high quality evidence base.
Isaac Marks:               I think that’s probably true, yes.
Howard Lomas:          There was a group that met at the Middlesex Hospital every month. And that was set up by the likes of Vic Meyer, Isaac Marks, Derek Jayhugh.
Dr Lucy Maddox:        That’s Howard Lomas, another founding member of BABCP remembering how the organisation got set up 50 years ago from lots of different interest groups coming together.
Howard Lomas:          These various groups that got together and said, “Why don’t we have a national organisation?” So that was formed back in 1972.
Dr Lucy Maddox:        Howard’s professional background was different to Isaac’s psychiatry training, but he found behaviour therapy just as useful

In this bonus episode of Let's Talk About CBT, hear Dr Lucy Maddox interview Dr Tom Ward and Angie about SlowMo: digitally supported face-to-face CBT for paranoia combined with a mobile app for use in daily life.
Transcript
Dr Lucy Maddox:        Hello and welcome to Let’s Talk about CBT, the podcast from the British Association for Behavioural and Cognitive Psychotherapies, BABCP. This podcast is all about CBT, what it is, what it’s not, and how it can be useful. In this episode, I’ll be finding out about an exciting new blended therapy, SlowMo, for people who are experiencing paranoia.
This digitally supported therapy has been developed over 10 years with a team of people including designers from the Royal College of Art in London, a team of people who have experienced paranoia. And a team of clinical researchers, including Professor Philippa Garety, Dr Amy Hardy and Dr Tom Ward.
The design of this intervention really prioritised the experience of people using the therapy in what’s called a design led approach. To understand more I video called Tom Ward, research clinical psychologist based in Kings College London, and I had a phone call with Angie, who’s experienced using the therapy. Here’s Angie’s story.
Angie:                          I mean, I’ve had psychosis for many years. About 20 years ago I was really poorly, I was in and out of hospital. Going back about 20 years ago they kept giving me different diagnoses and I expect everybody else had the same thing. Anyway, then I met a psychiatrist and I was with him for over 20 years until he retired. And he really helped me a lot, I was actually diagnosed with schizophrenia.
Part of me was really scared and another part of me was sort of relieved that I knew that I was dealing with. I get voices, sometimes I see or feel things that aren’t really there. But part of my diagnosis is I also get very depressed. And when I get very depressed, that’s when the voices are at their worst because I haven’t got the strength to sort of fight them off, if you like.
If I’m having a good day, then I can use the skills I’ve learnt in the past to not listen to the voices and to have a reasonably good day. If I’m having a bad day and it’s a duvet day, then that’s when I really suffer with the voices. Unless you can actually accept that you have this issue, and you actually accept that you need the help, it doesn’t matter what they do to help you, you’re just not going to take it on board.
Dr Lucy Maddox:        Angie wanted some help, specifically with paranoid thoughts she was experiencing about people looking at her or laughing at her. She found out about the SlowMo trial and applied to be a part of it. And ended up being one of the very first people to try the therapy. Tom led on the delivery of therapy in the trial.
Dr Tom Ward:              I’ve worked and have worked for the last couple of years trying to develop and test digital interventions for people experiencing psychosis. So I’ve been involved in developing interventions that help people who are experiencing distressing voices. And been involved in work in a therapy called avatar therapy and more recently I’ve been working with colleagues to develop an intervention designed to help people who are experiencing fear of harm from others, which we would sometimes refer to as paranoia.
Dr Lucy Maddox:        In case listeners wonder what avatar therapy is could you just briefly say what that is?
Dr Tom Ward:              So in avatar therapy, digital technology is used with the person to create a representation of the distressing voice that they hear. So we work with the person to create an avatar which has an image which matches the image the person has of their distressing voice. And which comes to sound like the voice that they hear. And we use this avatar direct in dialogue.
Very much with the rationale

Children don't come with a manual, and parenting can be hard. What is evidence-based parenting training and how can it help? Dr Lucy Maddox interviews Sue Howson and Jane, about their experiences of delivering and receiving this intervention for parents of primary school aged children. 
 
Show Notes and Transcript
Sue and Jane both recommended this book:
The Incredible Years (R): Trouble Shooting Guide for Parents of Children Aged 3-8 Years
By Carolyn Webster-Stratton (Author)
Sue also recommended this book:
Helping the Noncompliant Child Family-Based Treatment for Oppositional Behaviour  Robert J. McMahon, Rex L.Forehand 2nd Edition Paperback (01 Sep 2005)  ISBN 978-1593852412

Websites
http://www.incredibleyears.com/
https://theministryofparenting.com/
https://www.nurturingmindsconsultancy.co.uk/
For more on CBT the BABCP website is www.babcp.com
Accredited therapists can be found at www.cbtregisteruk.com
 
Courses
The courses where Sue works are available here, and there are similar courses around the country:
https://www.reading.ac.uk/charliewaller/cwi-iapt.aspx
 
Photo by Markus Spiske on Unsplash
This episode was edited by Eliza Lomas
Transcript
Lucy:   Hello and welcome to Let’s Talk About CBT, the podcast from the British Association for Behavioural and Cognitive Psychotherapies, BABCP. This podcast is all about CBT, what it is, what it’s not and how it can be useful.
This episode is the last in the current series so we’ll be having a break for a bit, apart from a cheeky bonus episode, which is planned for a few months’ time so look out for that.
Today, I’m finding out about evidence-based parenting training. This is a type of intervention for the parents of primary school aged children. It draws on similar principles to cognitive behavioural therapy about links between thoughts, feelings, behaviours and bodily sensations and ideas from social learning theory. It also draws some ideas from child development such as attachment theory and parenting styles.
To understand more about all of this, I met with Sue Howson, parenting practitioner who works in child mental health services and Jane, a parent who has experienced the training herself.
Jane:  My name is Jane and I’ve got a little boy called Jack who is seven and he’s in Year 3.
Lucy:  And you’ve experienced evidence-based parenting training, is that right?
Jane:  Yeah, I have. It’s something called the Incredible Years. And there was a really nice lady called Sue and my school put us in touch to form a group to kind of help me manage Jack a little bit more at home.
Lucy:  So, your journey into it was that the school let you know about it?
Jane:  Yeah. Basically, I was having a few issues with Jack at home and I think it was kind of impacting on school as well. So, I was working with the special needs coordinator and she, obviously, had me, Jack and my family in mind as someone who might benefit from working a little bit with Sue.
 I was a bit nervous at first, you know, like professionals coming in, getting involved. But she was really nice and it was really beneficial.
Lucy: Is it okay to ask what sort of difficulties you were having at home, sort of what was going on?
Jane:  Yeah, I can tell you now because it’s all changed, it’s much better.
Lucy:  Oh good, that’s great to hear.
Jane:    I mean, Jack’s a lovely boy. He’s my eldest and he’s really nice and just a bit of a joy – he is now. But I think one of the main things that I was struggling with, with him, was kind of difficulties with falling asleep. In the evenings, he would always want me to fall asleep either next to him or in his bed and that was kind of impacting on our evening, mine and my husband’s quite a lot. And it was taking up a lot of time and I think evenings are quite hard because you’re so tired and you just want to go to bed.
So, that was one of the issues. And the no sleep was impacting on

In this episode Dr Lucy Maddox speaks to Sharon and Dr Anne Garland, about CBT for depression. Hear how Sharon describes it, and how both group and individual therapy helped. 
 
 
Show Notes and Transcript
Books
Overcoming Depression by Paul Gilbert
Podcast Episodes
CBT for Perfectionism
Compassion Focussed Therapy
Websites
www.babcp.com
www.cbtregisteruk.com
Image by Kevin Mueller on Unsplash
Transcript
 
Lucy: Hello and welcome to Let’s Talk About CBT, the podcast from the British Association for Behavioural and Cognitive Psychotherapies, BABCP. This podcast is all about CBT, what it is, what it’s not and how it can be useful.  

In this episode we’re thinking about CBT for depression. I spoke with Dr Anne Garland who spent 25 years working with people who experience depression and Sharon, who has experienced it herself.  

Both Anne and Sharon come from a nursing background. Anne now works at the Oxford Cognitive Therapy Centre as a consultant psychotherapist, but she used to work in Nottingham, which is where Sharon had CBT for depression. Here’s Sharon.  

How would you describe what depression is like?  

Sharon: When I was going to school, when I was a little girl, an infant, we would have to go over the fields because I lived in the country, and go down. I could hear the bell of the junior school but couldn’t find it because of the fog. I walked round and round, I was five, walked round and round and round in those fields trying to get to the bell where I knew I would be safe and being terrified on my own. And that’s how it feels actually. Darkness, cold, very frightening.  

Lucy: I asked Anne how depression gets diagnosed and she described a range of symptoms.  

Anne: In its acute phase it’s characterised by what would be considered a range of symptoms. So, tiredness, lethargy, lack of motivation, poor concentration, difficulty remembering. Some of the most debilitating symptoms are often disturbed sleep and absence of any sense of enjoyment or pleasure in life and that can be very distressing to people. People can be really plagued with suicidal thoughts and feelings of hopelessness that life is pointless.  

I think one of the most devastating things about depression as an illness is it robs people of their ability to do everyday things. So for example, getting up, getting dressed, getting washed, deciding what you want to wear can all be really impaired by the symptoms of depression. I try and help people to understand that the symptoms are real, they’re not imagined. Often people will tell me that they imagine these things or that they aren’t real and that it’s all in their mind.  

Their symptoms are real, they exist in the body and do exert a really detrimental effect on just your ability to do what most of us take for granted on a day-to-day basis.  

Lucy: And so it’s a lot more than sadness isn’t it? 

Anne: Absolutely. It can be very profound feelings of sadness but often that’s amplified by feelings of extreme guilt, of shame, anger and anxiety is another common feature of depression.  

Also, when people are very profoundly depressed they can actually just feel numb and feel nothing and that in itself can be very distressing because things that might normally move you to feel a real sense of connection. Say for example your children or your grandchildren, you may have no feelings whatsoever, and that in itself can be very alarming to people. 

Lucy: The way that depression and its treatment are thought about can vary depending on who you speak to. Just like with other sorts of mental health problems. More biological viewpoints prioritise thinking about brain changes that can occur with depression while more social perspectives prioritise thinking about the context that people are part of.  

Anne: As CBT tends to take a more pragmatic view of thinking about a connection between events in o

Anxiety is one of the most common mental health problems, but there's a good evidence-base for CBT as a helpful intervention. In this podcast, Dr Lucy Maddox speaks with Dr Blake Stobie and Claire Read, about what CBT for anxiety is like, and how anxious thoughts can be like the circle line. 
 
Show Notes and Transcript
Websites
BABCP
https://www.babcp.com
Accredited register of CBT therapists
https://www.cbtregisteruk.com
Anxiety UK
https://www.anxietyuk.org.uk
NICE guidelines on anxiety
https://www.nice.org.uk/guidance/qs53
Apps
Claire recommended the Thought Diary Pro app as being helpful to use in conjunction with therapy to complete thought records. 
https://www.good-thinking.uk/resources/thought-diary-pro/
Books
Claire recommended this workbook on Overcoming Low Self Esteem by Melanie Fennell https://www.amazon.co.uk/Overcoming-Low-Self-Esteem-Self-help-Course/dp/1845292375/ref=sr_1_2?dchild=1&keywords=self+esteem+workbook+melanie+fennell&qid=1605884391&s=books&sr=1-2
And this book by Helen Kennerley on Overcoming Anxiety is part of the same series
https://www.amazon.co.uk/Overcoming-Anxiety-Books-Prescription-Title/dp/1849018782/ref=sr_1_1?dchild=1&keywords=overcoming+anxiety&qid=1605884437&s=books&sr=1-1
Credits
Image used is by Robert Tudor from Unsplash
Podcast episode produced and edited by Lucy Maddox for BABCP
Transcript
 
Lucy: Hello and welcome to Let’s Talk About CBT, the podcast from the British Association for Behavioural and Cognitive Psychotherapies, BABCP. This podcast is all about CBT, what it is, what it’s not and how it can be useful.  

In this episode we’re thinking about CBT for depression. I spoke with Dr Anne Garland who spent 25 years working with people who experience depression and Sharon, who has experienced it herself.  

Both Anne and Sharon come from a nursing background. Anne now works at the Oxford Cognitive Therapy Centre as a consultant psychotherapist, but she used to work in Nottingham, which is where Sharon had CBT for depression. Here’s Sharon.  

How would you describe what depression is like?  

Sharon: When I was going to school, when I was a little girl, an infant, we would have to go over the fields because I lived in the country, and go down. I could hear the bell of the junior school but couldn’t find it because of the fog. I walked round and round, I was five, walked round and round and round in those fields trying to get to the bell where I knew I would be safe and being terrified on my own. And that’s how it feels actually. Darkness, cold, very frightening.  

Lucy: I asked Anne how depression gets diagnosed and she described a range of symptoms.  

Anne: In its acute phase it’s characterised by what would be considered a range of symptoms. So, tiredness, lethargy, lack of motivation, poor concentration, difficulty remembering. Some of the most debilitating symptoms are often disturbed sleep and absence of any sense of enjoyment or pleasure in life and that can be very distressing to people. People can be really plagued with suicidal thoughts and feelings of hopelessness that life is pointless.  

I think one of the most devastating things about depression as an illness is it robs people of their ability to do everyday things. So for example, getting up, getting dressed, getting washed, deciding what you want to wear can all be really impaired by the symptoms of depression. I try and help people to understand that the symptoms are real, they’re not imagined. Often people will tell me that they imagine these things or that they aren’t real and that it’s all in their mind.  

Their symptoms are real, they exist in the body and do exert a really detrimental effect on just your ability to do what most of us take for granted on a day-to-day basis.  

Lucy: And so it’s a lot more than sadness isn’t it? 

Anne: Absolutely. It can be very profound feelings of sadness but ofte

We tend to think about therapy as something that is helpful for individuals, but what about when you want to address problems which affect you and a partner or spouse? In this episode, Dr Lucy Maddox speaks to Dan Kolubinski about cognitive behavioural couples therapy, and hears from Liz and Richard about what the experience was like for them. 
Show Notes and Transcript
Dan recommended the book Fighting For Your Marriage by Markman, Stanley & Blumberg
https://www.amazon.co.uk/Fighting-Your-Marriage-Best-seller-Preventing-dp-0470485914/dp/0470485914/ref=dp_ob_title_bk
Some journal articles on couples therapy are available free online here:
https://www.cambridge.org/core/journals/the-cognitive-behaviour-therapist/information/let-s-talk-about-cbt-podcast
The podcast survey is here and takes 5 minutes: https://www.surveymonkey.co.uk/r/podcastLTACBT
The BABCP website is at www.babcp.com
And the CBT Register of accredited CBT therapists is at https://www.cbtregisteruk.com
Photo by Nick Fewings on Unsplash
 
Transcript
Lucy: Hello, and welcome to Let’s Talk About CBT. It’s great to have you listening.  

When we think about therapy, we often think of one-to-one conversations between one person and their therapist. But what about when the problems that we’re going for help with are related to how we’re getting on with a partner or a spouse? Cognitive behavioural couples therapy helps with these sorts of difficulties. To understand more about it I spoke to a married couple, Richard and Liz, and Dan Kolubinski, their therapist.  

Richard and Liz did this therapy privately, but couples therapy is also available on the NHS to help with some specific difficulties. We hear more about that from Dan later on. For now though let’s hear what Richard and Liz thought of their couples therapy in this interview which I recorded with them remotely.  

Richard: My name’s Richard. I’m 37 years old and I’ve been married to Liz for just over seven years now. I’m a postie at the moment, and kind of lived in Essex most of my life.  

Liz: It’s like a dating programme.  

Richard: It is, isn’t it? Yeah, a little bit. (laughs) 

Liz: So I’m Liz and I make cakes for a living, and write about mental health. So that’s us.  

Lucy: That’s great. So thanks so much for agreeing to speak with me about your experience of couples therapy, and specifically cognitive behavioural couples therapy. Would you mind telling me how you came across it and what made you think you might want to try it? 

Liz: Yeah. So I think it’s something that we’ve spoken about in the past. And we’ve both had therapy separately, and I think we’ve both had various different types of therapy. So Richard has had CBT before, I think we’ve both done psycho-dynamic counselling.  

So when we decided we were going to do it, we realised that for us it was more beneficial to almost do a crash course, as it were, together. So to do a whole weekend, rather than a little bit once a week. And that was how we discovered Dan, and were able to book in with him.  

Richard: Yeah, I think we both understand the value or had both experienced and understood the value of therapy individually. So it was kind of an easy step for us then to decide there could be a lot of value in doing this together.  

Lucy: That makes total sense. So you already had a bit of an understanding of what it might be like, or what it’s like on an individual level? 

Liz: Yeah, definitely. And actually very early on in our marriage we had some couples counselling, which I don’t think was actually as successful, and it was after that that we had separate counselling. And I think it was after we were both able to get ourselves into better positions, as it were, that that’s when we were able to come back together and experience some therapy together.  

Lucy: That’s really interesting. Do you think that helped