Adapting CBT for Autistic Clients with Prof Ailsa Russell

In this episode of Practice Matters, Rachel Handley is joined by Professor Ailsa Russell to explore how CBT can be adapted to meet the needs of autistic clients. They unpack common myths, including the idea that CBT is unsuitable for autistic people or that encouraging behaviour change simply means asking clients to mask, and discuss where a neuro-affirmative stance fits into formulation and treatment.  Ailsa talks through practical adaptations therapists can make from using plain, concrete language instead of metaphor, to allowing more time for foundational work and generalising skills beyond the session. She also shares what the evidence base tells us about CBT's effectiveness with autistic people, why service structures often fall short, and what she has learned from her own autistic clients over the years.  Further resources:  Find out more about Ailsa's work here OCD and Autism: A Clinician's Guide to Adapting CBT can be bought from Jessica Kingsley Publishers here  Russell, A., Gaunt, D. M., Cooper, K., Barton, S., Horwood, J., Kessler, D., Metcalfe, C., Ensum, I., Ingham, B., Parr, J. R., Rai, D., & Wiles, N. (2020). The feasibility of low-intensity psychological therapy for depression co-occurring with autism in adults: The Autism Depression Trial (ADEPT) – a pilot randomised controlled trial. Autism, 24(6), 1360-1372. https://doi.org/10.1177/1362361319889272    Stay Connected:  Follow us on BlueSky and Instagram: @BABCPpodcasts  Send us your questions and suggestions: [email protected]  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 

In this episode of Practice Matters, Rachel Handley is joined by Dr Antonia Dittner, consultant clinical psychologist and lead author of "A Therapist's Guide to CBT to Support Adults with ADHD," to explore what CBT has to offer this often misunderstood client group. Together they unpack the diagnostic picture, the overlap with anxiety and depression, and why a formulation driven, transdiagnostic approach can help therapists feel more confident with this client group. Antonia walks through the four core elements of therapy: behavioural work on routines and habits, thinking patterns, managing emotions and impulses (including how procrastination often develops as a way of avoiding difficult feelings), and longer standing beliefs and coping. She also shares practical tips for structuring sessions, addressing shame and self-criticism with compassion, and what services can do to support access for neurodivergent clients. Further resources: A Therapist's Guide to CBT to Support Adults with ADHD by Antonia Dittner and colleagues Find out more about training and support from NAAAPS (National Adult ADHD and Autism Psychology Service) Stay Connected: Follow us on BlueSky and Instagram: @BABCPpodcasts Send us your questions and suggestions: [email protected] 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

In this episode of Practice Matters, Rachel Handley is joined by Dr Scott Waltman, president-elect of the US Academy of Cognitive and Behavioural Therapies, to explore what Socratic questioning really is and why it matters. Scott describes it as thinking with our clients rather than for them, comparing it to Socrates' own idea of being a midwife for thought. They discuss the evidence behind Socratic questioning, the difference between guided and provided discovery, and how Scott's research reshaped Padesky's well known four step model. Scott also shares practical advice on focusing questions, and on working with a client's own definitions to shift stuck beliefs. Further resources: Find out more about Scott's work here Socratic Questioning for Therapists and Counselors can be bought from Routledge here Stay Connected: Follow us on BlueSky and Instagram: @BABCPpodcasts Send us your questions and suggestions: [email protected] 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  

In this episode of Practice Matters, Rachel is joined once again by Professor David Veale, this time to explore emetophobia, the specific phobia of vomiting. David explains why this is the most common specific phobia presenting for treatment, despite being largely overlooked by researchers for years, and the devastating impact it can have, from avoided pregnancies to missed medical care. Together they unpack what drives the fear, how it differs from OCD and eating disorders, and why tolerating uncertainty rather than seeking reassurance is at the heart of effective treatment. David also shares his "vicious flower" formulation, practical tips for therapists who might be squeamish themselves, and exciting developments in virtual reality treatment. Further resources: David's self-help book, Free Yourself from Emetophobia, co-authored with Alexandra Keyes, is available here Find out more about David's work and publications here Stay Connected: Follow us on BlueSky and Instagram: @BABCPpodcasts Send us your questions and suggestions: [email protected] 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 Autumn 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

In this episode of Practice Matters, Rachel Handley is joined by Professor David Veale, consultant psychiatrist and cognitive behavioural therapist, to explore body dysmorphic disorder (BDD). Together they unpack what BDD really is, how it differs from vanity, social anxiety, and OCD, and why so many people suffering with it end up seeking cosmetic solutions rather than psychological support. David shares the CBT formulation for BDD and explains the key maintenance processes that keep people locked in distress: self-focused attention, comparing, ruminating, checking, and safety behaviours. He also discusses imagery rescripting, the challenges of engagement, and why targeting processes rather than the content of beliefs is so important in this work. The episode also covers what effective therapy looks like in practice, who is most likely to benefit and why persistence matters, the current evidence base, and where David hopes future research will take the field. Further resources: Find out more about David's work and publications here More information on BDD can be found via the BDD Foundation Stay Connected: Follow us on BlueSky and Instagram: @BABCPpodcasts Send us your questions and suggestions: [email protected] 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 Autumn 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

In this episode of Practice Matters, Rachel Handley is joined by Professor Alicia Meuret to explore anhedonia, the reduced ability to feel pleasure, and the development of Positive Affect Therapy (PAT). Together, they unpack why so many clients struggle not just with feeling bad, but with a profound absence of positive emotion, and why traditional CBT approaches may not fully address this gap. Alicia explains the science behind the brain's reward system, breaking it down into three key processes: wanting, liking, and learning. She also introduces PAT, the evidence-based treatment she developed with Professor Michelle Craske, and shares what the randomised controlled trial evidence tells us about its effectiveness compared to more traditional CBT approaches to treating depression. The episode also offers a practical overview of what PAT looks like in the therapy room, including behavioural activation with a positive focus, savouring, gratitude practices, and building a richer emotional vocabulary. Alicia addresses some of the trickier clinical questions too, including how to present a positive-focused rationale without invalidating clients' very real distress, and how these ideas might just change how you look after yourself as a therapist. Further resources: Find out more about Alicia's work here- including links to all the trials mentioned in the podcast Alicia's most recent trial published in JAMA Network Open can be found here Positive Affect Treatment for Depression and Anxiety: Therapist Guide can be bought from Oxford University Press here Stay Connected: Follow us on BlueSky and Instagram: @BABCPpodcasts Send us your questions and suggestions: [email protected] 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  

In this episode of Let's Talk About CBT- Practice Matters, Rachel Handley is joined by Professor Paul Farrand to unpack the theory and practice of low intensity CBT. They explore what low intensity really means, challenging common misconceptions and clarifying its evidence base, including its focus on single-strand interventions and stepped care delivery. Paul discusses how low intensity approaches improve access, efficiency, and patient empowerment, while maintaining clinical rigour through strong practitioner competencies in engagement and risk assessment. The conversation also highlights adaptation for diverse populations, evolving delivery formats, and future directions, including digital innovation and applications in physical health settings. A great listen for anyone wanting to learn more about low intensity CBT or thinking about applying it in different contexts. Further resources: Find out more about Paul and his work here Paul's publications, including the systematic review he mentions can be found here Find out more about the Cognitive Behaviour Therapist Low Intensity special issue here The Sage book in which Paul's chapter on low intensity CBT is included is: Farrand, P. (2024) Low-intensity CBT Skills and Interventions: A Practitioner's Manual. London: SAGE.  More information about NHS Talking Therapies can be found here Stay Connected: Follow us on BlueSky and Instagram: @BABCPpodcasts Send us your questions and suggestions: [email protected] 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  

In this episode of Let's Talk About CBT: Practice Matters, Rachel Handley speaks with Professor Shirley Reynolds about behavioural activation for depression in children and young people. Shirley reflects on what we know about depression in adolescence, the challenges of access to effective treatment, and why brief, values-based approaches may be particularly well suited to this developmental stage. Drawing on findings from large clinical trials, she explains how young people often attend fewer sessions than are offered, prompting important questions about engagement and the design of therapy. The conversation explores how behavioural activation helps young people identify what matters to them and gradually increase meaningful activity. Shirley outlines what a course of BA looks like in practice, from early psychoeducation and activity monitoring through to parent contracting and relapse prevention, and discusses the importance of supervision, system support and therapist wellbeing. Further resources: Find out more about Shirley and her work: https://www.drshirleyreynolds.com/about More information about the online training with Shirley and Laura Pass can be found here: https://www.cbtreach.org/pass-reynolds The IMPACT trial: Goodyer, I. M., Reynolds, S., Barrett, B., Byford, S., Dubicka, B., Hill, J., Holland, F., Kelvin, R., Midgley, N., Roberts, C., Senior, R., Target, M., Widmer, B., Wilkinson, P., & Fonagy, P. (2017). Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial. The Lancet Psychiatry, 4(2), 109–119. https://doi.org/10.1016/s2215-0366(16)30378-9   Stay Connected: Follow us on BlueSky and Instagram: @BABCPpodcasts Send us your questions and suggestions: [email protected] 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

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: [email protected] 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    

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: [email protected] 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