Let's Talk about CBT- Practice Matters

Rachel Handley for BABCP
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The podcast for therapists using Cognitive Behavioural Therapy to help shape and inform their practice.

  1. 28 JAN

    Why simplicity does not mean superficiality: exploring Low-intensity Behavioural Activation for Depression with Prof David Ekers

    How do we make effective therapy for depression more widely available without losing quality or compassion? In this episode, Rachel Handley is joined by Professor David Ekers, a leading researcher and clinician specialising in behavioural activation (BA). David shares the story of how his clinical experience with long waiting lists led him to focus on scalable, evidence-based approaches to care. The conversation explores the development of behavioural activation, the evidence underpinning low intensity delivery, and key findings from major trials including the COBRA and BASIL studies. David explains why behavioural activation is a robust, practical intervention that can be delivered effectively by a range of practitioners, without losing therapeutic depth or compassion. David reflects on common myths about low intensity work, the importance of supervision and therapeutic relationships, and the challenges services face when balancing access, outcomes, and relapse prevention. Further resources: David's University of York webpage can be found here which details all his publications and research projects Papers and links to further information about the trials mentioned in this episode are listed below: COBRA: Finning, K., Richards, D. A., Moore, L., Ekers, D., McMillan, D., Farrand, P. A., O'Mahen, H. A., Watkins, E. R., Wright, K. A., Fletcher, E., Rhodes, S., Woodhouse, R., & Wray, F. (2017). Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation. BMJ Open, 7(4), e014161. https://doi.org/10.1136/bmjopen-2016-014161 Richards, D. A., Rhodes, S., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Barrett, B., Finning, K., Ganguli, P., Warren, F., Farrand, P., Gilbody, S., Kuyken, W., O'Mahen, H., Watkins, E., Wright, K., Reed, N., Fletcher, E., Hollon, S. D., & Moore, L. (2017). Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive–behavioural therapy for depression. Health Technology Assessment, 21(46), 1–366. https://doi.org/10.3310/hta21460 Richards, D. A., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Warren, F. C., Barrett, B., Farrand, P. A., Gilbody, S., Kuyken, W., O'Mahen, H., Watkins, E. R., Wright, K. A., Hollon, S. D., Reed, N., Rhodes, S., Fletcher, E., & Finning, K. (2016). Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority Trial. The Lancet, 388(10047), 871–880. https://doi.org/10.1016/s0140-6736(16)31140-0 BASIL: Gilbody, S., Littlewood, E., McMillan, D., Atha, L., Bailey, D., Baird, K., Brady, S., Burke, L., Chew-Graham, C. A., Coventry, P., Crosland, S., Fairhurst, C., Henry, A., Hollingsworth, K., Newbronner, E., Ryde, E., Shearsmith, L., Wang, H.-I., Webster, J., & Woodhouse, R. (2024). Behavioural activation to mitigate the psychological impacts of COVID-19 restrictions on older people in England and Wales (BASIL+): a pragmatic randomised controlled trial. The Lancet Healthy Longevity, 5(2), e97–e107. https://doi.org/10.1016/s2666-7568(23)00238-6 Littlewood, E., McMillan, D., Graham, C. C., Bailey, D., Gascoyne, S., Sloane, C., Burke, L., Coventry, P., Crosland, S., Fairhurst, C., Henry, A., Hewitt, C., Baird, K., Ryde, E., Shearsmith, L., Traviss-Turner, G., Woodhouse, R., Webster, J., Meader, N., & Churchill, R. (2022). Can we mitigate the psychological impacts of social isolation using behavioural activation? Long-term results of the UK BASIL urgent public health COVID-19 pilot randomised controlled trial and living systematic review. Evidence-Based Mental Health. https://doi.org/10.1136/ebmental-2022-300530 More information and publications related to the study can be found www.BASILStudy.org CASPER: Gilbody, S., Lewis, H., Adamson, J., Atherton, K., Bailey, D., Birtwistle, J., Bosanquet, K., Clare, E., Delgadillo, J., Ekers, D., Foster, D., Gabe, R., Gascoyne, S., Haley, L., Hamilton, J., Hargate, R., Hewitt, C., Holmes, J., Keding, A., & Lilley-Kelly, A. (2017). Effect of Collaborative Care vs Usual Care on Depressive Symptoms in Older Adults With Subthreshold Depression. JAMA, 317(7), 728. https://doi.org/10.1001/jama.2017.0130 Lewis, H., Adamson, J., Atherton, K., Bailey, D., Birtwistle, J., Bosanquet, K., Clare, E., Delgadillo, J., Ekers, D., Foster, D., Gabe, R., Gascoyne, S., Haley, L., Hargate, R., Hewitt, C., Holmes, J., Keding, A., Lilley-Kelly, A., Maya, J., & McMillan, D. (2017). CollAborative care and active surveillance for Screen-Positive EldeRs with subthreshold depression (CASPER): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness. Health Technology Assessment, 21(8), 1–196. https://doi.org/10.3310/hta21080 ‌DiaDeM: More information and publications related to the programme can be found here Insika Yomama: Rochat, T. J., Dube, S., Herbst, K., Hoegfeldt, C. A., Redinger, S., Khoza, T., Bland, R. M., Richter, L., Linsell, L., Desmond, C., Yousafzai, A. K., Craske, M., Juszczak, E., Abas, M., Edwards, T., Ekers, D., & Stein, A. (2021). An evaluation of a combined psychological and parenting intervention for HIV-positive women depressed in the perinatal period, to enhance child development and reduce maternal depression: study protocol for the Insika Yomama cluster randomised controlled trial. Trials, 22(1). https://doi.org/10.1186/s13063-021-05672-0 ‌MODS: More information and publications related to the study can be found www.MODSStudy.org Stay Connected: Follow us on BlueSky and Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don't forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let's Talk About CBT and Let's Talk About CBT – Research Matters for more discussions on evidence-based therapy. Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This podcast was edited by Steph Curnow

    1h 1m

  2. 29/12/2025

    Understanding Historical Context in CBT Practice with Dr Alasdair Churchard

    In this episode of Let's Talk About CBT- Practice Matters, Rachel is joined by Dr Alasdair Churchard, clinical psychologist, CBT therapist and NIHR pre doctoral fellow at the University of Oxford. Alasdair's work focuses on ethnic inequalities in psychological therapies, and together they explore why historical context matters in CBT practice. The discussion covers the importance of addressing ethnic inequalities in mental health services and explores practical considerations for therapists, including how to broach difficult historical topics, the balance of asking versus self-education, and the need to focus on histories of strength and self-empowerment alongside trauma. Further resources: Language used: Talking about race and ethnicity at work | The Law Society, Writing about ethnicity - GOV.UK RHO report: Ethnic Inequalities in Improving Access to Psychological Therapies (IAPT) MHA detentions: Detentions under the Mental Health Act - GOV.UK Ethnicity facts and figures Marmot report: Structural Racism, Ethnicity and Health Inequalities in London - IHE Bansal meta-ethnography: Bansal, N., Karlsen, S., Sashidharan, S. P., Cohen, R., Chew-Graham, C. A., & Malpass, A. (2022). Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography. PLoS Medicine, 19(12), e1004139. Some culturally-adapted CBT links: Williams, M. T. (2020). Managing microaggressions: Addressing everyday racism in therapeutic spaces. Oxford University Press. Rathod, S., Kingdon, D., Pinninti, N., Turkington, D., & Phiri, P. (2015). Cultural adaptation of CBT for serious mental illness: a guide for training and practice. John Wiley & Sons. Beck, A. (2016). Transcultural cognitive behaviour therapy for anxiety and depression: A practical guide. Routledge. Iwamasa, G. Y., & Hays, P. A. (2019). Culturally responsive cognitive behavior therapy: Practice and supervision (pp. xi-348). American Psychological Association. Lawton, L., Thwaites, R., & Warnock-Parkes, E. (2025). Using cognitive therapy for PTSD when racism was part of the traumatic event (s): case illustrations and practical considerations for therapists and supervisors. the Cognitive Behaviour Therapist, 18, e31. What is metacompetence?: Whittington, A., & Grey, N. (2014). Mastering metacompetence: The science and art of cognitive behavioural therapy. How to become a more effective CBT therapist: Mastering metacompetence in clinical practice, 1-16. Helen Kennerley on the working relationship: Kennerley, H. (2014). Developing and maintaining a working alliance in CBT. How to become a more effective CBT therapist: Mastering metacompetence in clinical practice, 31-43. Ian Andrew James on kitchen sink formulations: James, I. A. (2010). Cognitive behavioural therapy with older people: Interventions for those with and without dementia. Jessica Kingsley Publishers. Ken Laidlaw on formulation: Laidlaw, K. (2014). CBT for older people: An introduction. Source for Seamus Heaney quotes: Heaney, S. (2014). Crediting Poetry: The Nobel Lecture. Farrar, Straus and Giroux. DPR model: Churchard, A. (2022). How can psychotherapists improve their practice with service users from minoritised ethnicities? An application of the Declarative-Procedural-Reflective (DPR) model of clinical skill development. The Cognitive Behaviour Therapist, 15, e1. Thwaites, R., Churchard, A., Mofrad, L., Wood, D., & Brooks-Ucheaga, M. (2025). Considering the whole self: integrating identity (s), context and power into the declarative procedural reflective (DPR) model of CBT practitioner development. The Cognitive Behaviour Therapist, 18, e35. SP/SR for therapists from minoritised ethnicities: Chowdhury, S. S., Churchard, A., Lawton, L., Malik, Z., Thwaites, R., & Clements, H. (2025). A novel self-practice/self-reflection programme for CBT therapists from minoritised ethnic backgrounds: a multiple baselines single case experimental study. the Cognitive Behaviour Therapist, 18, e15. Stay Connected: Follow us on BlueSky and Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don't forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let's Talk About CBT and Let's Talk About CBT – Research Matters for more discussions on evidence-based therapy. Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This podcast was edited by Steph Curnow

    59 min

  3. 27/11/2025

    The what, how and why of Behavioural Activation with Dr Christopher Martell

    In this episode of Practice Matters, host Rachel Handley speaks with Dr Christopher Martell, a leading expert in behavioural activation (BA) for depression. Christopher shares his journey from early training in CBT to becoming a key figure in the development of BA, describing how behavioural strategies can help people move toward a more meaningful life when depression keeps them stuck. Rachel puts common myths to him, including whether BA is too simplistic for complex cases or ignores thoughts and emotions, and he explains how BA works with both private and public behaviour to support change. They explore the importance of values, small steps, and compassionate coaching, as well as new research into biological mechanisms involved in recovery. Christopher also reflects on therapist challenges, resilience in clients, and why activation sometimes means slowing down. Further resources: Behavioural Activation for Depression: Second Edition: A Clinician's Guide A Darkness Visible- William Styron The Noonday Demon- Andrew Solomon Find out more about Christopher and his publications here: https://christophermartellphd.com/ Stay Connected: Follow us on BlueSky and Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don't forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let's Talk About CBT and Let's Talk About CBT – Research Matters for more discussions on evidence-based therapy. Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This podcast was edited by Steph Curnow

    1h 17m

  4. 27/10/2025

    "The engine of mindfulness is exploration" … discovering Mindfulness-Based Cognitive Therapy with Professor Zindel Segal

    In this episode, Rachel talks with Professor Zindel Segal, Distinguished Professor of Psychology in Mood Disorders all about Mindfulness-Based Cognitive Therapy. (MBCT). Zindel discusses the origins of MBCT, detailing how he and his colleagues transitioned from traditional cognitive therapy to integrating mindfulness as a core mechanism for preventing depression relapse. The conversation explores the fundamental concepts of mindfulness, the challenges therapists face when shifting from goal-oriented CBT to mindfulness inquiry, and the empirical evidence supporting MBCT's efficacy, particularly concerning the neurobiological findings about sense foraging and the role of sensation in recovery. Further resources: Mindfulness-Based Cognitive Therapy for Depression – Segal, Williams & Teasdale Better in Every Sense – Segal & Farb MBCT website Stay Connected: Follow us on BlueSky and Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don't forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let's Talk About CBT and Let's Talk About CBT – Research Matters for more discussions on evidence-based therapy. Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This podcast was edited by Steph Curnow

    1h 13m

  5. 30/09/2025

    Rumination and Depression with Professor Ed Watkins

    In this episode, Rachel Handley talks with Professor Ed Watkins, Professor of Psychology at the University of Exeter a world-leading expert in Rumination and its impact on mental health and wellbeing. Professor Watkins talks about Rumination-Focussed Cognitive Therapy, an evidence-based approach he has developed and trialled to target these specific processes in depression.   They discuss: What is rumination What might be the different between adaptive and maladaptive rumination How rumination can become a habit that can maintain low mood, anxiety and depression The development and application of Rumination-Focused CBT (RFCBT) to depression Practical techniques to shift clients from ruminative abstract, self-critical thinking into concrete, experiential, and compassionate approaches When RFCBT may be especially helpful, including with complex or chronic depression Resources & Further Learning: Find more information about Ed and his publications here Find out more about The Calming Minds Project here Stay Connected: Follow us on Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don't forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let's Talk About CBT and Let's Talk About CBT – Research Matters for more discussions on evidence-based therapy. Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This podcast was edited by Steph Curnow

    1h 25m

  6. 19/08/2025

    Prof Judith Beck : Back to basics… or back to the future?

    In this episode of Practice Matters, Rachel is joined by Professor Judith Beck, President of the Beck Institute for Cognitive Behaviour Therapy and one of the most influential voices in the field. Judith discusses her personal and professional journey into CBT, the legacy of her father Aaron T. Beck, and the evolution of cognitive therapy from its traditional roots to recovery-oriented cognitive therapy (CT-R). Judith also shares insights on the importance of the therapeutic relationship, strategies for validating clients, managing hopelessness, and adapting CBT across cultures and how therapists can look after themselves, continue learning, and stay connected. Resources and links mentioned in this episode: Beck Institute for Cognitive Behavior Therapy Subscribe to the Beck Institute newsletter Cognitive Behavior Therapy: Basics and Beyond (3rd edition, 2021) by Judith S. Beck Beck Institute social media channels: Facebook: https://www.facebook.com/beckinstitute LinkedIn: https://www.linkedin.com/company/beck-institute-for-cognitive-behavior-therapy/ X: https://twitter.com/beckinstitute YouTube: https://www.youtube.com/user/BeckInstitute   Stay Connected: Follow us on Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don't forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let's Talk About CBT and Let's Talk About CBT – Research Matters for more discussions on evidence-based therapy. Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This podcast was edited by Steph Curnow Transcript: Rachel: Welcome to Let's Talk About CBT Practice Matters, the BABCP podcast for therapists using cognitive behavioral therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who will share insights that will help you understand and apply CBT better to help your patients. Today, I'm really delighted to be joined by Professor Judith Beck. Professor Beck is president of the Beck Institute for Cognitive Behavior Therapy and clinical professor of psychology and psychiatry at the University of Pennsylvania Perelman School of Medicine. She has published prolifically on CBT, including key texts that are to be found on the bookshelves of almost every CBT therapist with a desire to hone their craft. And they really do guide us through the basics and beyond. Judy, welcome to the podcast. Judith Beck: Thank you for having me. Rachel: I'm fortunate to have met you previously during a brief period of study at the Beck Institute many moons ago now. However, I imagine that I feel about spending time talking to you about CBT the same way normal people might feel about chatting to celebrities, given that of course your CBT royalty, your father being Aaron T. Beck, also widely regarded as the father of CBT and that you've worked so closely with him to develop the field. It might perhaps seem inevitable given that background that you would end up in this work, but you clearly could have chosen any number of career pathways. Can you tell us a little bit about your personal and professional journey to where you are now? Judith Beck: So I've always loved children. And when I was probably six or seven, I decided that I wanted to be a teacher. And so when I went to the University of Pennsylvania, I studied education to become a teacher, but I took a lot of psychology courses as well. And I taught kids with learning disabilities for a while and then decided that if I wanted to have a career or met my career as a teacher, I really had to go back and get a professional degree, a master's degree. And so I went back to school and got a master's in educational psychology. Then worked as a supervisor for a little while and decided that I should really probably get a PhD. And it was toward the beginning of my PhD program that I became more interested in psychology and in my father's work. And I really think that I must have been at least subliminally influenced by my dad when I was a teacher and when I was a supervisor. At the beginning when I started to consider going into this field, I had kind of a naive idea and it was an automatic thought. I thought, I just don't know if I'm cut out to be a psychologist because I've always been such an intuitive teacher. I didn't really need someone to teach me how to teach, especially when it came to teaching kids with learning disabilities. It was just quite natural for me to know how to take something that was complicated and break it down and speak to my young students in a way that they could understand. So I thought, how could I learn to be a psychologist? I'm not intuitive at all about how to do that. Rachel: So if it requires some learning, then it can't be for me. Judith Beck: That was my thought at the time. And fortunately it turned out to be wrong. And then I started to learn really in detail about my dad's work, and it all made so much good sense to me. And what's interesting is that I've really come full circle. For a while, especially at the beginning, I was primarily a CBT therapist. But then I really became a CBT teacher. And most of my activities now, or many of my activities at the Beck Institute have to do obviously with training and teaching other people to use CBT. Rachel: So you started by integrating psychology into your education and you've come full circle in now you're integrating education into your psychology. Judith Beck: That's right. You sometimes people draw interesting conclusions. More than a couple of people have said, well, you probably didn't go into psychology initially because that's what your father was doing. And I said, no, no, no, it wasn't a reaction to my father. It was just that I was always drawn to working with young children. And that's what I did as a teacher. Rachel: When talking about families, I've often spoken on this podcast previously about how as both a psychologist and a mother, I hope that my professional skills give me skills and insights as a parent that I might not otherwise have. But mostly it feels like I'm just more aware of the many, many ways in which I'm failing as a parent and setting my kids up with all kinds of dysfunctional assumptions about how the world works. I wonder how it was growing up in the Beck household. Was there lots of practice and reflection on CBT principles? Judith Beck: Well, I grew up in the late 1950s and 1960s and I didn't go to university until 1971. And it was really through the later 60s and into the 70s that my father was developing cognitive therapy. But my parents had a very traditional marriage. My father worked all of the time and my mother who actually went to, did something extraordinarily unusual. She went to law school when she had four kids under the age of 10. There were three women in her very large class. Women just didn't do that in those days. It was starting in probably 1961 or 62. Despite the fact that she was in school and then developing her own career, she really had probably 90 % of the care of the kids and the household and organization and so forth. We did have dinner every night, though, as a family. My father stopped work long enough to do that. But we didn't really talk about his work very much. There was one memory that I have that I've told a number of people about, that's when I was someplace around 10, 11, 12 years old. And my father said, Judy, I have a new idea I'd like to run by you. And then he described the cognitive model. That's not a situation that directly influences your reaction, but rather your interpretation of that situation, the thoughts that go through your mind. And so he told me that, and he gave me an example. And he said, what do you think? And what I said out loud to him was, well, yes, that makes sense. But in my own mind, my automatic thought was but that's so obvious. So I think I probably began thinking like a cognitive therapist fairly early on, although we really rarely discussed his work. I knew my both parents were unusual, my mother being in school and becoming a lawyer. And I knew my dad was unusual because he wrote books. And I didn't have any friends who's fathers or mothers wrote books. Rachel: To be fair, I think I've got teenage boys and most of what I say either seems extremely obvious to them or totally ridiculous. I mean, at the other extreme, but it's lovely to hear about your mother as well. Cause obviously we all know so much about your father's work, but obviously two very inspirational, hardworking parents who, you know, work with a love of learning and an interest in doing things in the world. So fantastic. Well, glad he got past you, Judy, because if you'd said it sounds like rubbish, maybe we never would have had CBT. So I'm glad you were one of the first audiences. Now, regular listeners to the podcast will by now be familiar with our podcast challenge. We love a good formulation here at Practice Matters in good CBT style, but because we're an audio podcast, it has to be done unlike almost everything we do in CBT without boxes or arrows or other visual aids. So here's your challenge. Can you give us a brief explanation of how the cognitive model explains psychological distress develops and is maintained without any of those aids. Judith Beck: Sure, so the first thing I want to say is that automatic thoughts do not cause depression. Depression is caused by so many different factors and it's important to take a biopsychosocial view of the development of depression. Automatic thoughts are probably an important precipitating factor among others that ultimately lead to the development of depression. I'm just gonna use depression as an example. But the automatic thoughts don't themselves cause depression. Okay, so the easiest way to talk about a formula

    1h 26m

  7. 15/07/2025

    Prof Heather O'Mahen and Dr Sarah Healy on CBT for anxiety and depression in the perinatal period

    In this episode of Let's Talk About CBT- Practice Matters, host Rachel Handley is joined by two leading experts in perinatal mental health- Professor Heather O'Mahen and Dr Sarah Healy. Together, they explore the unique challenges, adaptations, and opportunities that come with providing effective CBT for individuals during the perinatal period. Heather and Sarah draw on their clinical experience, policy work, and research to discuss why perinatal-specific approaches are needed, the prevalence and impact of perinatal mental health difficulties, and how therapists can adapt CBT to meet the needs of diverse parents and families. The conversation also covers access to care, the role of identity and stigma, supporting culturally diverse and neurodiverse parents, and therapist wellbeing when working in this emotionally heightened period. Whether you're working in NHS Talking Therapies, secondary or specialist care, private practice, or simply want to deepen your understanding of this vital area, this episode offers compassionate insights and practical strategies for helping parents during this transformative time. Resources & Further Learning: ·        Find out more about the Pearl Institute here ·        Access the Perinatal Positive Practice Guide here ·        Take part in the Jame Lind Alliance perinatal mental health survey here ·        Listen to the our previous episode on OCD in the perinatal period with Dr Fiona Challacombe Stay Connected: Follow us on Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don't forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let's Talk About CBT and Let's Talk About CBT – Research Matters for more discussions on evidence-based therapy. Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This podcast was edited by Steph Curnow Transcript: Rachel:  Welcome to Let's Talk About CBT-Practice Matters, the BABCP podcast for therapists using cognitive behavioural therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who will share insights that will help you understand and apply CBT better to help your patients. Today, we have the pleasure of being joined by not one but two experts in perinatal mental health, Professor Heather O'Mahen and Sarah Healy. Professor O'Mahen is Professor of Perinatal and Clinical Psychology at the University of Exeter and world leading expert in treatments for depression and anxiety in the perinatal period. Her work focuses not only on improving treatments, but also on improving treatment access, for example, through digital delivery. Heather is also currently National Clinical Advisor to NHS England's Perinatal Mental Health Policy Team. And Dr. Healy is a leading perinatal clinical psychologist with over 20 years' experience in the field. She co-led with Heather the development of the Talking Therapies perinatal competency framework and contributes regularly to the development of perinatal mental health policy. They've also founded together the Pearl Institute, which provides evidence-based training for clinicians working in the perinatal period. You're both so welcome. Thank you so much for making time in your busy schedules to come on the podcast. I think the fact that from the first planning to recording this podcast has taken us about 10 months is probably a good indicator of just how busy you are doing this brilliant work. Heather: Thanks for having us, Rachel. Rachel: Now, I know you're both hugely committed to working in perinatal mental health, and I'm wondering how you came to work in the field and what's kept you fascinated by it personally and professionally? Heather? Heather: Well, I came to it accidentally. I applied to do a post-doc at the University of Michigan when I was living in the States and it was in primary care. But they had rejigged things and then said, we have this other one in perinatal mental health, would you be interested? I had a long-standing interest in women's mental health so that sounded really great to me and I said, yeah, I'm definitely interested. Then I started doing therapy with women, parents from the perinatal period, and also doing research in the area, and I just couldn't stop. It's such an incredible, transformative period in people's lives. It's such a meaningful time to get to work with folks. There's so much that's going on, but there's so many opportunities to walk alongside people during this period of change. And then of course I had my own children and that fed it further. And so here I am. Yeah, yeah, yeah. Then you learn like, wow, it really, really, really, really is important. Rachel: You learn what it's really about. Fantastic. And how about you, Sarah? Sarah:  Yeah, I guess I came a bit of a roundabout way into perinatal. My early kind of career was more on the research side of things, but I started with a master's in the psychology of early development. I was really interested in that early mother-infant relationship. So I did my PhD in that area and I kind of been moving towards clinical psychology. Thought I would end up in CAMHS because I really liked working with children and that kind of parenting piece and then have the great fortune of having an assistant psychologist post in a mother and baby unit. And I just really found the work fascinating and as Heather kind of said, such a transformative time to be working with. So that kind of started me on my perinatal path. And since then, I've really just found the work so rewarding. And similarly having my own, my son, obviously now eight, he just turned eight. The perinatal period is a little bit a while ago, but I think I learned a lot from the work that really helped me as a parent and then being a parent really, I guess, added to my knowledge and passion for the area. Such an exciting, interesting area to work in and you get such variability in the type of difficulties people are having and the outcomes are so rewarding. I get emails from clients I saw years ago, of pictures of their children that are now eight, nine, ten, and you feel you've been really part of that process. Rachel: Wow. So it sounds like you both really have a deep commitment to women's mental health, to parents, to babies, to seeing kids develop and thrive. And that you've really enjoyed working in this joyous, but also incredibly vulnerable and challenging period with people where you can really make a difference. Now, certainly my experience, I've got three kids and experienced postnatal depression after two of them and I remember look back at it being such a precious, incredible time, really special time in my life despite that, but also all these challenges that are piling in. And yeah, at eight, the challenges continue don't they Sarah, but there's a little bit more sleep maybe. Sarah: The sleep is nice. Rachel: But it sounds like you also both had an excitement about bringing together research and practice around multiple areas like physical and mental health and adult and child developmental psychology in ways that can make a big difference and you both obviously live and breathe this work at home as well. But people who haven't worked extensively in the area might ask if we need a special approach to perinatal mental health, you know, can't we just apply what we already know about the evidence-based practice and approaches to depression and anxiety, for example, for the adult population and adapt those where we need them in line with our individual formulations. Heather: I think that's a really good point. And the evidence would suggest that we can adapt many of the interventions that we do have, but that it's really important to understand what's going on for perinatal parents during this period of their life and to be able to, in those formulations and in those adaptations, make sure that you're addressing the key issues that are important for them. I think this has been for some and maybe historically challenging to get their heads around maybe a little bit. Back in the day, back before there was this lovely investment in England in perinatal mental health care, it was certainly the case that I would talk to some clinicians or service leads and they go, ah, but we don't really see that many perinatal parents in our service. I don't think there's actually really much of a need- and nothing could be further from the truth. The need is just as great, if not greater and we know that we see an increased incidence around issues like say OCD during this time and also that there are real problems around birth trauma and issues around loss as well. So it is that parents do experience problems during this time. They do want support, but they want the support that's really family focused, that really understands that the baby is so integral in their lives at that point, and that can address it. And we can do that, but we need to get it right. And if we don't, we don't see the parents, just like the service leads said, we won't see them if we don't get them what they need and want. And I think we can compare this to other significant problems that people might be having and very intensive or transformative parts of their lives, like veterans, for example, or people with long-term medical conditions. And we definitely see the priority there that we need to adapt for those problems as well. So likewise let's do right by perinatal parents. Sarah: I think just to add to that Heather, I completely agree with all those points there, but also thinking about looking at services that are doing it well. And when you have services that really are adapting their interventions to be specific to clients in the perinatal period that are doing lo

    1h 28m

  8. 29/05/2025

    Befriending the naughty black dog…. Prof Barney Dunn on learning to live well alongside depression

    In this episode, Rachel talks with Professor Barney Dunn, clinical psychologist and researcher at the University of Exeter, about his work on Augmented Depression Therapy (ADepT) a novel approach to treating depression that targets anhedonia (difficulty experiencing pleasure) and aims to boost wellbeing. Barney shares personal and professional insights into why and how traditional CBT might be augmented to actively help people rediscover joy and meaning in life. He explains how ADepT, based on systematic research, integrates cognitive behavioural principles with techniques from ACT, mindfulness, strengths-based CBT and more, all aimed at helping clients live well alongside depression rather than simply reduce symptoms. Whether you're a therapist working with depression or simply curious about new directions in CBT, this episode offers a thought-provoking and inspiring conversation about what it really means to get better- and stay better. Resources & Further Learning: Find more information about Barney and his publications here Find out more about ADepT here Stay Connected: Follow us on Instagram: @BABCPpodcasts Send us your questions and suggestions: podcasts@babcp.com Subscribe and leave a review – and don't forget to share this episode with your colleagues! If you enjoyed this episode, check out our sister podcasts, Let's Talk About CBT and Let's Talk About CBT – Research Matters for more discussions on evidence-based therapy. Credits: Music is Autmn Coffee by Bosnow from Uppbeat Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee License code: 3F32NRBYH67P5MIF This podcast was edited by Steph Curnow Transcript: Rachel: Welcome to Let's Talk About CBT Practice Matters, the BABCP podcast for therapists using cognitive behavioural therapy with me, Rachel Handley. Each episode, we talk to an expert in CBT who will share insights that will help you understand and apply CBT better to help your patients. Today, we're joined by Barney Dunn, a highly renowned research and clinical psychologist specialising in therapies to improve wellbeing and functioning in depression and related mental health conditions. Professor Dunn is based at the University of Exeter, and he has a finger in many interesting pies, but today he's here to talk particularly about his work developing and implementing treatment for depression with a particular focus on symptoms of anhedonia. Thanks so much for joining us, Barney. Barney: Thank you very much for having me, delighted to be here. Rachel: And just as a starter, we want to think about how you got into this area of research. And as I said, you're interested in lots of different things, but you've devoted a lot of your time and effort to thinking about anhedonia. There's so much to fascinate in clinical psychology. I wonder what got you interested in the field of depression and specifically this anhedonia area personally and professionally? Barney: Professionally, when I was doing clinical training and learning to cut my teeth with a lot of depression cases, hitting a point where I felt like I'd done quite a lot of work reducing the negative and reducing symptoms, but the job was only half done. And clients were saying things like, at the end of therapy, well, I'm not depressed anymore, but I'm still not quite sure what life's for and I'm not enjoying stuff. And I felt...Well, maybe I'm not doing CBT correctly, or maybe there's a bit of a trick missing about how we can do that stuff better. So that was the kind of professional route into it. The personal route into it was a bit more growing up with my dad. So I lost my mum when I was little and was very well supported by my family but seeing my dad in my eyes never quite get back to life, never rediscovering joy and connection and meaning and grinding through and turning the wheels, but not getting pleasure back and thinking there's a missed opportunity there. Even after the difficult, there's possibility for the good. And so that's the kind of personal motivation is thinking of clients like my dad, how could I help them get back to life when they've been through some difficulty and rediscover wellbeing and joy? Rachel So that really meaningful connection for you from your own lived experience with being alongside someone who never got that meaning back. Those are big questions. And I hear what you say, you working in depression, you get good results with your clients in terms of their symptoms improving, but you talked about a job half well done or half done. Currently, how well are these symptoms targeted in mainstream treatments? I mean, it's a brave man who takes on, you know, Beckian cognitive therapy and thinks, right, we need to do better. Barney: Well, I mean, we should follow the data. So if you do Beckian cognitive therapy and indeed any other evidence-based treatment for depression under ideal circumstances, really good therapists who are really well supervised, you basically get about 60 % of clients who will meet diagnostic remission at the end, half of whom will relapse within the next two years. So that's ultimately a 30 % proper response rate. And that means we leave a lot of people with a lot of distress afterwards, you know, 70 % of the people that are coming through our doors. If you look at NHS Talking Therapies reliable recovery rates for depression lag a bit behind anxiety recovery rates, and they're a bit below 40%. So more than 60 % of the folks coming through NHS Talking Therapies with depression will be depressed again within a couple of years. So there's definitely still a problem to solve and it feels like a really interesting and clinically important question to work on but one to be humble about because lots of really great minds and really hardworking people have thrown themselves at it, and what we've done is proliferated a lot of equally partially effective treatments but we haven't made any stepwise gains since Beck who did make that massive stepwise improvement in the late 70s. Rachel: Yeah. So it's great that there's evidence-based treatments are out there, but there's still a lot of people that find that there's something lacking at the end of therapy or even don't improve. So if we treat the sort of negative feelings, so there's negative symptoms of depression. Doesn't that automatically also address some of this anhedonia or positive valence system? And if not, why not? Barney:  So I think that's the assumption we all came from to start with, which is there's a continuum of affects, which you go from being really negative, you get to this middle point where you've been meh, and then you move to this position where you're feeling really positive. So if you bring down the negative, the positive will inevitably increase. But then there's been some interesting other ways of thinking about that and recognising that they're at least partially dissociable systems, which means positive affect can move when negative affect doesn't move and vice versa. And again, just to come back to my dad as a case example, when my dad was dying of cancer, there was a lot of distress and difficulty and pain. And there wasn't a way to make that go away. He was dying of cancer, but that didn't mean there weren't things we could do to find wellbeing within the midst of that. One of my favourite memories with my dad in the last few months was he wanted to drive his car again, but he was on too much morphine to drive safely. So we put him on the sit on mower and drove around the garden, kind of destroying my mum's prized flower beds and my stepmother's prized flower beds. And that's one of my favourite memories, like chuckling with my dad on morphine, driving badly around the garden, amongst a whole lot of negative affect. So I think it's quite useful to realise even in the midst of depression, you can find joy and pleasure. There's also an increasing basic science argument here, which is the systems of the mind and brain that regulate negative emotions and avoidance of threat are partially dissociable from the systems of mind and brain that regulate positive emotions and approach towards things. So you can move one without moving the other. And my view is you need to do both in therapy. Bring down the negative, push up the positive. Rachel: Does everyone experience, I mean, you've just spoken about an example of your dad experiencing lots of negative emotion, but still having that positive emotion. Does anhedonia develop for some people and not others in the context of depression? Barney: I think it's like most ways of thinking about depression, things fall on a continuum. Estimates of how many clients have clinically significant anhedonia ranges from 30 % of them having really severe and profound anhedonia to 70 % having significant anhedonia. It's one of the, along with elevated negative affect, it's one of the two cardinal symptoms you need to get a diagnosis of depression. So it's pretty prevalent, but it isn't there for everyone. And it isn't there for the people that have it all of the time. Its just sometimes people need to develop the skillset when anhedonia is with me, how can I step away from it and get back to wellbeing and joy? Rachel: And is there a differential pathway? I mean, will it be some people who are more likely to develop anhedonia than others or circumstances that are likely to lead to that? Or as you say, is it just likely to be there or not at different times than that pathway? Barney: Well, so my view again is like most symptoms, there are many ways into it and many ways out of it. So it's dangerous to put hard and fast generalisations onto it. But I would say there definitely is a kind of genetic, biological basis for your reward system to be more or less reactive for better or for worse. So some people are just born with a capacity that reward washes over them and they really enjoy it. Others have to work a bit harder. I'm incr

    1h 16m
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