In this episode, Helen is joined by Mia and Alice Farrington to talk about OCD in children and young people. Mia shares her lived experience of developing OCD as a child and what it was like to go through CBT with Alice as her therapist. Alice, a clinical psychologist at the Oxford Specialist Psychological Intervention Centre, explains how OCD presents differently in young people than in adults, why CBT works so well, and what treatment can look like, including externalising OCD and using behavioural experiments.

The conversation also covers guilt and shame, the impact on families, how OCD can change its "mask" over time, and where to find support.

Resources & Support:

Find out more about the resources and support mentioned in this podcast at OCD UK: https://www.ocduk.org

Find out more about Oxford Health Specialist Psychological Intervention Centre: https://oxfordhealth.nhs.uk/ohspic/

If you or someone you know needs urgent help, reach out to Samaritans at 116 123 (UK) or visit samaritans.org

We have more information on how you can find help and support on our Mental health support services page here: https://babcp.com/what-is-cbt/mental-health-support-services-information/

Find more information about CBT- www.babcp.com

Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts

Have feedback? Email us at [email protected] Follow us on Instagram & Bluesky: @BABCPpodcasts

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 episode was produced by Steph Curnow

In this episode, Helen is joined by Becky and Romanah to talk about specific phobias and how CBT can help.

Becky shares her personal experience of living with a phobia of medical situations, also known as blood-injury phobia, what it took for her to seek help, and what the journey through therapy was really like, including the tough moments alongside the breakthroughs. Romanah was Becky's CBT therapist in an NHS Talking Therapies service and explains how CBT approaches specific phobias, the importance of working collaboratively, and how exposure work helps people gradually build confidence in situations they have long been avoiding.

Becky reflects honestly on how hard the process was, how the anxiety got worse before it got better, and what it meant to build trust with a therapist who was both supportive and willing to give her a gentle push. Both guests share advice for anyone who recognises themselves in the discussion and is thinking about reaching out for help.

Resources & Support:

If you or someone you know needs urgent help, reach out to Samaritans at 116 123 (UK) or visit samaritans.org.

Find out more about NHS Talking Therapies services and where to find help here

We have more information on how you can find help and support on our Mental health support services page here

Find more information about CBT on the BABCP website

Find our sister podcasts and all our other episodes in our podcast hub here

Have feedback? Email us at [email protected]

Follow us on Instagram & Bluesky: @BABCPpodcasts

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 episode was produced by Steph Curnow

In this episode, Helen is joined by Colin Blowers, James Jackson, and Hashir Aazh for a thoughtful conversation about tinnitus and how cognitive behavioural therapy can help.

The panel draws on professional expertise and lived experience to explore what tinnitus is, why it can become distressing, and the importance of getting it checked. The conversation focuses on how CBT can support people to change their relationship with tinnitus, reduce distress, break unhelpful cycles of attention and anxiety, and live a full and meaningful life even when tinnitus is present. Key themes include acceptance, habituation, flare-ups, and why learning to manage reactions to tinnitus, rather than trying to eliminate it, can make a real difference.

This episode will be helpful for anyone experiencing tinnitus, supporting someone who is, or interested in how CBT can help people live well with long-term conditions.

Resources & Support:

Helpful website:

NHS information about tinnitus: https://www.nhs.uk/conditions/tinnitus/

More information about tinnitus can be found at Tinnitus UK

World Tinnitus Congress- https://wtc2027.co.uk/

Books:

Living Well with Tinnitus: A self-help guide using cognitive behavioural therapy- Hashir Aazh and Brian C.J. Moore

Find more information about CBT- www.babcp.com

Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts

Have feedback? Email us at [email protected]

Follow us on Instagram & Bluesky: @BABCPpodcasts

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 episode was produced by Steph Curnow

In this episode, Helen is joined by Jackie and Professor Roz Shafran to explore loneliness through both lived experience and clinical psychology perspectives. Jackie shares her personal journey with anxiety, bereavement, and loneliness, describing how these experiences affected her mental health and led her to seek CBT support. She reflects on what helped, what was challenging, and how strategies such as goal setting and connection building continue to support her today.

Roz Shafran, Emeritus Professor of Translational Psychology at UCL, offers a clear and compassionate overview of how loneliness is understood in research and clinical practice. The conversation explores the difference between loneliness and social isolation, how loneliness can affect people at different stages of life, and what effective interventions can look like.

The discussion covers stigma around loneliness, access to support and why loneliness deserves to be taken seriously. Jackie and Roz also share practical advice for anyone who recognises themselves in the discussion and is considering reaching out for help.

Resources & Support:

If you or someone you know needs urgent help, reach out to Samaritans at 116 123 (UK) or visit samaritans.org

We have more information on how you can find help and support on our Mental health support services page here: https://babcp.com/what-is-cbt/mental-health-support-services-information/https://babcp.com/what-is-cbt/mental-health-support-services-information/

The loneliness umbrella study mentioned by Roz is:

Solmi, M., Veronese, N., Galvano, D., Favaro, A., Ostinelli, E.G., Noventa, V., Favaretto, E., Tudor, F., Finessi, M., Shin, J.I., Smith, L., Koyanagi, A., Cester, A., Bolzetta, F., Cotroneo, A., Maggi, S., Demurtas, J., De Leo, D. and Trabucchi, M. (2020). Factors Associated With Loneliness: An Umbrella Review Of Observational Studies. Journal of Affective Disorders, [online] 271, pp.131–138. doi:https://doi.org/10.1016/j.jad.2020.03.075.

Find more information about CBT- www.babcp.com

Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts

Have feedback? Email us at [email protected]

Follow us on Instagram & Bluesky: @BABCPpodcasts

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 episode was produced by Steph Curnow

In this episode, Helen Macdonald talks with CBT therapist Sally Tribe about the impact of menopause and how Cognitive Behavioural Therapy can help.

Sally shares her own experience of perimenopause, describes the wide range of symptoms people can experience, and explains how CBT can support those affected. The discussion covers the biological, psychological, and social aspects of menopause, the importance of awareness in workplaces and healthcare, and what reasonable adjustments and compassionate understanding can look like.

They also talk about the latest guidance from NICE, how to access CBT through the NHS or private routes, and why no two menopause experiences are the same.

Useful Information

The British Association for Behavioural and Cognitive Psychotherapies (BABCP) is the lead organization for CBT in the UK.

Find a NHS Talking Therapies service here

Read the article by Sally on the menopause here

Get in Touch

If you have any questions or suggestions for future episodes, please email the Let's Talk About CBT team at [email protected].

You can also follow us on Instagram and BlueSky at @BABCPPodcasts.

Remember to rate, review, and subscribe to the podcast wherever you get your podcasts. You can also listen to our sister podcasts: Let's Talk About CBT - Practice Matters and Let's Talk About CBT - Research Matters.

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

It's World Mental Health Day 2025, and this year's theme is 'access to services - mental health in catastrophes and emergencies'. The theme highlights the importance of people being able to protect their mental health in times of global instability.

In this special episode of Lets' Talk about CBT, Helen Macdonald speaks with Kerry Young, a consultant clinical psychologist specialising in PTSD, particularly among asylum seekers and refugees. They discuss the impact of trauma on mental health, the challenges faced by asylum seekers in accessing mental health services, and the importance of community support. The conversation also touches on the role of interpreters in therapy, barriers to accessing services, and positive developments in mental health support for asylum seekers.

Useful Information

• The British Association for Behavioural and Cognitive Psychotherapies (BABCP) is the lead organization for CBT in the UK.
• For those interested in supporting or learning more, Kerry suggests looking up: Freedom from Torture, the Helen Bamber Foundation, Breaking Barriers, Host Nation and The Refugee Council
• More information from the European Association for Behavioural and Cognitive Therapies can be found here
• Find translated health information from Doctors of the World here and translated mental health information from the Royal College of Psychiatrists here

Links to services by region:

Find a NHS Talking Therapies service here

Wales:

https://sanctuary.gov.wales/refugeesandasylumseekers/healthandwellbeing#

https://www.mentalhealth.org.uk/our-work/programmes/refugee-programmes/refugee-and-asylum-seekers-wales

Scotland:

https://scottishrefugeecouncil.org.uk/health/#Mentalhealthsupport

Northern Ireland:

https://www.mentalhealth.org.uk/our-work/research/journey-wellbeing-refugees-transport-and-mental-health-northern-ireland

Ireland:

https://www.hse.ie/eng/about/who/primarycare/socialinclusion/intercultural-health/mental-health-supports/

Get in Touch

If you have any questions or suggestions for future episodes, please email the Let's Talk About CBT team at [email protected].

You can also follow us on Instagram and BlueSky at @BABCPPodcasts.

Remember to rate, review, and subscribe to the podcast wherever you get your podcasts. You can also listen to our sister podcasts: Let's Talk About CBT - Practice Matters and Let's Talk About CBT - Research Matters.

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

Ever heard of low Intensity CBT and wondered what it was all about? Or what it would be like to receive it? In this episode of Let's Talk about CBT, Helen talks to Laura Stevenson-Young, a cognitive behavioural therapist and Director of Low Intensity CBT Clinical Training at Newcastle University and Emily who shares her lived experience of low intensity cognitive behavioural therapy. Together, they explore what low intensity CBT is, what it's like to receive it, and how it can empower people to take control of their mental health.

Emily talks candidly about the challenges that led her to seek help, including grief, anxiety, fertility concerns and low self-esteem. She describes the impact of low intensity CBT on her life, and the practical tools she still uses today. Laura explains how this type of therapy works, who it's for, and why it can be so effective.

Resources & Support

Find an NHS Talking Therapies service: https://www.nhs.uk/nhs-services/mental-health-services/find-nhs-talking-therapies-for-anxiety-and-depression/

More about CBT and BABCP: https://www.babcp.com

Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts

Have feedback? Email us at [email protected]

Follow us on Instagram & Bluesky: @BABCPpodcasts

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 episode was produced by Steph Curnow

Transcript:

Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't. I'm Helen Macdonald, your host. I'm the Senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies.

Hello and welcome. Today, I've got Emily and Laura with me and we're going to be talking about low intensity CBT, what that is and what it's like to be on the receiving end. But first, I'm going to ask you both to introduce yourselves. Emily?

Emily: Hi, yeah, thank you for having me. I'm Emily, I live in Yorkshire with my fiancé. And in November 2022, I reached out to my local mental health service for a number of reasons, which I'm sure we'll cover in this podcast. I began with a four-week introduction to CBT program, which was in a group setting online. That was in December. And then by January, I began my CBT therapy and yeah, it was one of the best things I've done.

Helen: Thanks, Emily. And Laura.

Laura: Hi, Helen. Thanks for having us and Emily. So, I'm Laura Stevenson-Young. I'm a cognitive behavioral therapist and Director of Low Intensity CBT Clinical Training at Newcastle University. So this means that I train practitioners to deliver low intensity CBT interventions for many different types of mental health problems, namely depression and low mood, generalized anxiety disorder, panic, OCD and some other problems that can really affect the quality of people's lives such as stress or sleep difficulties and long-term health conditions. So I trained as a low intensity CBT therapist, mostly known as a Psychological Wellbeing Practitioner or PWP for short, well over a decade ago. And I then went on to further CBT training and became a clinical trainer in low intensity CBT. So this is probably really going to come out today, but I'm a real advocate for low intensity CBT, the practitioners who deliver it. I'm so passionate about the work that they do and how they empower people to manage their own mental health within NHS Talking Therapies.

Helen: Thanks Laura. So Emily, you said there were a number of things that led to you reaching out to the local mental health services. And I wonder if you're willing to tell us a bit more about what was going on?

Emily: Yeah, of course. Yeah. I mean, kind of looking back, I should have done it a lot earlier than I did. It was kind of a lot of things building up over probably a couple of years. My mood definitely was low after losing my granddad and then with different job roles, kind of things to do with that, it was an ongoing thing. And then in 2022, that's when I'd gained a lot of weight, I was losing a lot of confidence, and I was letting a lot of stress at work get on top of me, which then had an impact on my relationship. And then obviously we were just coming out of lockdown as well. So I think that had a massive impact on my mental health. It was definitely, there was a lot of low mood and also anxiety around all I wanted to do was see friends and family, but the thought of doing that was actually making me incredibly anxious and busy places were making me anxious, new surroundings were causing kind of panic attacks. We'd gone on a trip and we were getting on a plane kind of in 2022 and I had a full panic attack getting on the plane. And there was nothing within my brain that was pinpointing what exactly it was. But I think...overriding the kind of that sadness and that anxiety there was a lot, it was around, I looked in my notes when I knew that we were doing this podcast and on the 12th of January I'd written in my notes as I was about to start my CBT I'm scared because I might not have control over what the future will bring and that might in my head was asserting so health wise I'd had some news regarding I was diagnosed with PCOS and an underactive thyroid, which both have a big impact on fertility and kind of me and my partner were trying to conceive and every single month it was like you were failing at being a woman really because it wasn't happening for us. That's still an ongoing thing now, that's not kind of changed but my mindset has changed off the back of...having CBT and I kind of went into counselling after that as well. And my mindset then has started now. I'm learning to deal with different things in a more logical way instead of going with them thoughts and thinking that that's it kind of thing, if that makes sense.

Helen: Thanks, Emily. And it sounds like there was a combination of all sorts of really difficult things going on. I mean, you've talked about your physical health, you've talked about what was going through your mind, you were talking about the way that you were feeling. There's an awful lot that was going on for you there. And thank you for sharing that with us. And I'm just sort of really curious to hear about what it was actually like having that low intensity CBT? I'm going to come back to Laura and ask her to explain a bit more about what that really means. But from your experience of being on the receiving end, what was it like?

Emily: Yeah, I think it's so, you're thinking ahead and a lot of my thoughts was always, I kept thinking, I shouldn't be doing this, I'm taking that away from someone else who needs this more than me. I could go and talk to my friends and family about this, of how I was really feeling or my partner, even. And there's only so much I think that you're comfortable to open up and tell your friends and family and speak about and but actually talking through everything and kind of making them thoughts in my head a lot more logical and combating them unhelpful thinking styles that I was doing, what just helped me so much and kind of rationalizing everything in my brain. And I think with my CBT therapist, she spoke a lot about negative automatic thoughts with me. It's every time there was something that was happening my immediate thought was the complete, the most negative response to it. So combatting that was a big thing for me and speaking about that.

Helen: Thanks, Emily. And I mean, if I can just come to Laura now, Emily's just spoken really clearly about lots of stuff to do with thinking, negative automatic thoughts, thinking logically and so on. Can you say a bit more about that from the perspective of somebody who delivered those kind of interventions? Why is that helpful? What's that about?

Laura: Hmm, it's a good question I guess. So in Emily's case the therapist was working with her on how she was thinking about herself and her difficulties and there lots of ways to work with thinking and negative thoughts in CBT. So you can work on the content of thinking, what our thoughts actually are and what they're saying or the process of thinking which is how we engage with the process of those thoughts. And I guess the most common way a low intensity therapist will engage with negative thoughts, particularly in low mood presentations and people with confidence issues is content, usually through means of reality testing or a CBT therapist might call it cognitive restructuring. Because for many of us, and we'll all resonate with this, is that we can make assumptions of what others think about us, we can have untrue and negative appraisals about ourselves and our situation. So, for example, others think badly of me or I'm terrible at my job or like Emily said, I'm failing as woman and things will never get better. And our mind can really convince us of these things that aren't true. And even sometimes if there is some truth to our negative thoughts and maybe things aren't going so well, still having all or nothing thinking or having a hundred percent conviction in these negative thoughts is really unhelpful. So it's more helpful to balance our negative thoughts with evidence sort of against their truth, if you like. And this is really important because in any CBT format, whether low or high CBT, we're trying to help the person feel emotionally better through cognitive and behavioral change. If we could tell ourselves to stop feeling sad or anxious, well, I guess we would simply do it and I probably wouldn't have a job. But because that's not possible, we have to relieve our distress and emotions through how we're thinking and what we're doing that are worsening those problems. So cognitive therapy and working with thoughts can really help people pay attention to alternative facts and information that challenges their negative automatic thinking. And this is so important because when we feel bad, these emotions are like magnets. They start to attract information that fits them. So other things that aren't going so seemingly well tend to feel worse. But when we feel better, these things tend to have less power or less weight. So imagine if I asked you to go for a walk and come back and tell me how many blue cars you saw, you'd probably come back and give me a definitive number, so around about 10. But if I were to then ask you how many red cars you saw, you probably wouldn't be able to answer. And it's not because red cars weren't there, as there would have very likely been at least one. It's just that you weren't looking for them. And this is what sadness and anxiety can do to us. It gets us to pay attention to and dwell on information that fits them. And what Emily's therapist helped to do was pay attention to information and facts that didn't actually readily fit those feelings and might have said something else about Emily or her life that can very well start to lift distressing feelings by providing alternative ways of thinking.

Helen: Thank you so much, Laura. For me as a CBT therapist, that's a beautiful explanation, particularly of the cognitive bit of what we do in CBT. And I'm really curious to hear from your point of view, what's the difference between low intensity and other forms of CBT? What is it that makes it low intensity as compared to other ways of delivering or contexts for CBT.

Laura: Yeah, well, I guess the first thing I'd say is that low intensity CBT is a type of cognitive behavioural therapy. And I think actually the name in itself undersells it. It can often mislead a patient accessing this care to feel as though they're receiving something less. And actually, that's not the case at all. All low intensity means is that the practitioner is working with someone for a briefer period of time but still does all the things that other psychotherapies aim to do. For example, the formation of a meaningful relationship between the therapist and client, helping the client understand what their problem is and how it's been maintained and pave the way to alleviate and change that distress. It's how it's done in low intensity CBT that's slightly different to other therapies. So the real sort of emphasis in low intensity CBT is that, it is, as I said, brief. So usually around six to eight weeks of 30 minute sessions with a trained practitioner. And it's been found to be clinically effective for the problems that I mentioned there. So there's an evidence base that this type of therapy can support a person suffering from depression, anxiety disorders and various other difficulties and we can be reasonably confident that those people will respond to or benefit at least somehow from this type of intervention. It's different in that it's more suitable for those who have less severe symptomatic presentations and those that are maybe less chronic. So what I mean by that is the problem has perhaps a recent onset or hasn't been there for such a long time or for those where the impact on the person's function is not severe. And this is really because low intensity CBT involves educating clients on how to use CBT interventions and encouraging them to maximize the use of these interventions between the sessions. So, it requires the person really to have a reasonable sort of capability and opportunity and motivation to do those things. But it's really important that I say that this does not mean that those with more severe and chronic presentations won't benefit from low intensity CBT is we actually know that as the demand for mental health care increases, more and more people who do have a severe set of symptoms are undergoing low intensity CBT and they are responding well, even if they do need to go on to a more intensive therapy at the end of that brief term of low intensity interventions. And I think why Emily's case is quite notable is that she did go on to have further intervention. She had lots of different things going on and severe presentation of those. But what's memorable for her are the things from low intensity CBT actually. So the way in which she engages with her thinking for example is those takeaways for her. So the key difference really is it's its briefer and the emphasis is more helping people understand what their problems are and educate them how to use CBT interventions. So it's less sort of intense. And I think one of the key things about it is that it's incredibly empowering for individuals who have it. Because if they respond well, it conveys to the person that they can take control of their own mental health and that they can actually really help themselves, which is an important protective factor for future mental health difficulties because it facilitates this positive self narrative which I think you really get from low intensity CBT that you don't in other places.

Helen: Thanks Laura. And I realized that our listeners can't see you, but I can see Emily nodding. And I just wonder if I can come back to you, Emily, and ask you, when Laura's talking about that, what's coming up for you? What do you think of what she just said?

Emily: Yeah, I mean, kind of think back to a few minutes ago, I said I should have done it a lot earlier, but in my brain space, I was not ready for it. And I think that is a huge thing with anyone. I mean, I'm such an advocate for low intensity CBT now, and I will tell people if they're struggling with things, like I would always say to them,, give it a go. Like, there's no reason not to give it a go, but it is so important that you have to want to do it and you have to want to make that change and you have to put the work in. So my sessions were brilliant, but I had to go away and do a thought record and think about it out of them sessions. And it was that I was thinking about it constantly really, and arguing with myself in a way in my brain. So when I was having those negative thought automatic thoughts, it was being aware of that and changing the narrative in my own brain, which you have to be able to do yourself.

Helen: And I guess, hearing what you're saying there, there's quite a commitment. People who've had CBT out there will have heard of having to do your homework or between session work, things like that. I'm just wondering for you at the time, Emily, what was most challenging? I mean, were there aspects of it that were particularly difficult?

Emily: I think what I found most challenging was actually recognising those thoughts because I was so used to, at the time, having these negative thoughts and to me that was normal. So it was having to just use another part of me to look at it from an outside perspective and challenge my own thoughts and that is what I found the most difficult.

Helen: Right, I've got you. And I'm thinking about what you've said to us today. It sounds like there's quite a lot of what you did learn that you're still putting into practice now. So in terms of what you came away with, I mean, Laura's just described, it's quite a brief approach. And although you've said you went on to do other things, are there techniques, strategies? Things you tell yourself that you use particularly from that that is still relevant now?

Emily: Yeah, I mean, you know, with that comprehensive restructuring, it's challenging them thoughts and I'm not like, I wouldn't sit here and say that it is a hundred percent kind of all you need to do is these sessions and you're fixed because I think Laurie will agree that's not the case. But a lot of it is them distraction techniques. I got back into reading again, which really helps me mentally at the end of day sitting down with a book and not a lot of things that are used as distraction techniques and I am still bad for it, I'll hold my hands up, is scrolling on my phone. And I think when we're in this generation particularly, it's, your phone is attached to your hand for work, for socialising, for social media and you're getting a lot of information and all that information can be quite overwhelming, especially if you're kind of Googling the things that are in your, in your brain and, and then next thing you're flicking onto Instagram and you're seeing these influencers living these perfect lives. Then with me, another thing, it was like going on social media and I'm at that age where, you know, everyone's getting married, everyone's having babies. And at one point, and I hate saying it, but seeing people with baby announcements on social media, that would really affect me. And I hate saying it because on one hand I was so happy for them because I know how difficult it can be for some people. But then on the other thing, it was something that would really affect me. So I think one kind of distraction technique is to put the phone away, put the technology away and spend time face to face with people or with a book. I think that really does help me.

Helen: Thanks, Emily. And I think you've really drawn out there that you've done all that work on your thinking, but it really involves taking action as well, isn't it? You do things differently, like even something like putting the phone away. And as you just said about it being attached to your hand, that sounds simple, but it isn't always easy. And Laura, hearing Emily talk about the things that were most challenging and the things that she still uses from those low intensity interventions. Is that similar to your experience of other people who've had low intensity CBT?

Laura: Yeah, definitely. I mean, I always say that the hardest thing about any format of cognitive behaviour therapy is that you're sort of fighting your own mind with your own mind, aren't you? Which is quite a paradox, sorry. But I think what's important in particularly cognitive behaviour therapy, as you mentioned there Helen, is that behavioural aspect. Any therapy helps somebody focus on the things that are in their control. And I really appreciate Emily's honesty there and the things that would bother her and how she would then focus on the things that she could control to manage how she was feeling. I mean, when we do engage in the things that are within our remit to change and influence, it can bring good feelings, if you like, online. For example, we might feel a sense of achievement, enjoyment or connection to others when driven to engage in the things that we can actually control. And this encourages future behaviors or activity that influences the way we feel, and we call this positive reinforcement. So when we learn that something good or a good feeling follows a behaviour, we tend to keep doing that. And the more that we feel in control and motivated to engage in what we can control, the things that we don't have control over tend to lose their power and sort of fade into the background a little bit. They seem less important. And this can be so helpful for someone because as Emily says, it's not that these things aren't going to rear their head from time to time. It's not leading to someone into a false sense of hope that all of their problems are going to magically disappear or be fixed but that you do have the ability to experience happy times and good things in your life, and we need to focus on them and move towards them to gain the benefit of those things. And even in cognitive restructuring and in reality testing it's not about completely flipping narratives and thinking you know really positively about adversity or things that we're unhappy with in our lives and might want to change. It's more thinking in a more balanced way about those things that might neutralize how bad and intense feelings of sadness and anxiety can be. And when we do lift those feelings a little bit, people function better. They're motivated to engage more in the things that might be important to them or that might distract them. And this is all really helpful.

Helen: Thanks Laura. And I've noticed that you've really made the point there that this isn't just unrealistic positive thinking for the sake of it. You really brought out that there are potentially more balanced ways of thinking about things. It's not trying to convince ourselves that difficult things aren't difficult, but perhaps the way that we respond to them and how they make us feel doesn't have to be that way.

Laura: Yeah, definitely. And I think that's really important to facilitate in low intensity CBT as well. It's all about living better and improving the quality of your life by engaging in what you can control, thinking in more balanced ways, rather than dwelling on those things that you can't. And sometimes, you know, a negative thought can convince us that, you know, they're true to such an extent, you know, like failure, we actually start to behave as if those thoughts are true and they increase our conviction in them and low intensity CBT really helps somebody become educated on what their problem is and how it's being maintained in those cognitive behavioral terms. So we call this sort of socialization to cognitive behaviour therapy where somebody learns that actually and really sees how their thinking and what they're doing is maintaining how bad they're feeling. And the emphasis on low intensity CBT is really intervening in those vicious cycles by essentially showing someone or teaching someone how to use these interventions on themselves and encouraging them to do those things outside of the session. So they become almost like a skill that somebody might use all the time, which luckily, is how Emily has responded to her low intensity CBT, which I think is fantastic and a great example of how this works at its best.

Helen: And you're reminding me of one of my friends, colleagues and mentors from years ago who used to talk about giving it away in the sense of people that we work with. If you end up being essentially your own therapist, you have your own toolkit, you've got a lot of those skills and techniques for yourself to use. And it's not that people wouldn't ever need more help or to go back for some more of the same or something different, but there's something about the way that this type of therapy works.

Laura: Definitely Helen, it's empowering isn't it? When you feel that you do have the skill set to manage your own difficulties, your problems and adversities, it can create such a positive sense of self, how you move forward in your life with these problems and not get stuck in them. And I really like that analogy of becoming your own therapist, if you like. And I think that is one of the staples of low intensity CBT is its a real sort of teaching of these skills to clients so that they can use them. yeah, resonate with that very much.

Helen: Emily, I was going to ask you, if we are, you know, sort of being listened to by a range of people out there, if there's somebody who's got similar kinds of experiences to what was happening for you when you reached out, is there anything that you would want to say to someone who's maybe thinking they might benefit or might be thinking, I'm just not going to go there?

Emily: I think the most powerful thing that I can say is just always have an open mind to it because you might think that it's not for you, you might think you won't respond to it, you might think that you don't want to talk about your issues and talking is the most amazing thing to do and if you are comfortable to speak to your friends and family about these things, even opening up in that sense is amazing but actually having CBT, I would recommend to anyone even if you're not displaying kind of anxiety and depression to the extent that I was, it has changed my life really.

Helen: It's really great to hear you say that, Emily, and just a really great recommendation that so many people could benefit from taking that step and reaching out, seeking help. And I'm wondering, Laura, what you would say to somebody who may recognise some of the things that Emily's talked about, or some of the things that you've mentioned in terms of the broader range of things that low-intensity CBT can help with. What would you say to somebody who's contemplating it.

Laura: I would first of all say that engaging in these types of strategies can be in the end extremely rewarding and as I mentioned really influence your sense of self, your ability to manage your mental health in a much more positive way. As I said before, I think, you know, the name undersells itself, but the aim of it is to empower you to be able to manage your difficulties. It's feeling in control of your problems and the things that are happening to you can maximise your independence and overall the way that you think about yourself. So as Emily said, I really encourage you to give it a try. Sometimes you might feel as though things are so bad that nothing can change them. You might think that simply thinking or doing differently isn't going to change anything. But I really encourage you to take the risk and try anyway. If you imagine if you went to the GP with a seriously bad headache that you've had for a week and the GP tells you to take paracetamol, you think, well, there's no way something as simple as that's going to work. So you don't try it. And this means that you'll continue to suffer and likely never find out if it would have helped. And if low intensity CBT doesn't get you where you need to be, there are other things that are available in NHS mental health services that can support you past brief CBT if you need it. So, I really encourage you to give it a try. If you live in England and are over 18 and you're struggling with low mood, anxiety disorders such as lots of worry, excessive worry, obsessive compulsive disorder, feelings of panic, struggling to sleep, feeling overwhelmed with stress, then there is help available to you. This type of therapy can help. If you were to just even go on to Google and type in, find my local NHS Talking Therapy service and follow those links, it will take you to service that you can self-refer yourself to for an assessment. And I really don't want to go on but if I might touch on something that Emily said before actually because I think if you are feeling like Emily that your problems maybe aren't as bad as others and that people are worse off, I encourage you to think that that's not actually what's important here. Those people need help but so do you. The most important thing is you. All of our problems are relative to our unique and individual set of circumstances. And if those set of circumstances are causing you to feel distress, depressed or anxious for a prolonged period of time and you cannot manage it yourself, then you need help. Just as anybody else would regardless of how better or worse off they are than you. So if you're concerned about your mental health, please go to your nearest mental health service. Your therapist is never going to be concerned with who is worse off. They're only ever going to be concerned about you and how they can help you fight the things that are keeping you stuck on your problems and the quality of your life. So please remember that you're just as important as anybody else and go forward for help if you need it. If it's okay I may just also make a nod to some self-help things that are available online even if you were to type in NHS self-help for mental health problems actually one of our regional mental health trusts up here in the North comes up CNTW and they have lots of free self-help books online that you can work through and give this a go yourself perhaps if you wanted to before getting the help of a therapist.

Helen: Thanks Laura. And we'll put links to those in our show notes, along with some other links that people can find, perhaps if they're not in England. A lot of our listeners are in England and in the other UK countries and in Ireland. And we've got listeners further afield as well, which is great. But we'll put some links in our show notes that just give some pointers to where people can find both self-help materials and links to local mental health services. I'm aware that low intensity CBT is not necessarily available everywhere and where it is available, it can be called all sorts of things as well. You said you were a psychological wellbeing practitioner, which is a commonly used word in England. It might actually mean something else in other countries as well. But we'll put some links in our show notes so that people can find more information if they'd like it.

Okay, so, I mean, it just sounds like from what Laura's saying and from Emily's experiences, it's been largely really positive, even though we're talking about some really difficult stuff. Emily had got a number of different things that were happening together and Laura, you've expressed it really well about it doesn't have to be comparing yourself with somebody else who might be worse or better than you at having sort of a difficulty. What we're trying to do with offering relatively brief interventions is actually making it more available to more people. And I'm just wondering if there's anything else that either of you would like to say that our listeners might be interested to hear, whether that's about the therapy itself or any other information that you think is useful for people to know.

Laura: I think the last thing I would say on it, and I think Emily touched on this point earlier in the podcast, is that you do have to be in a place to try and move towards your distress and have a commitment to trying to change what's keeping those things going. Have some idea of how you want to be helped and what you want to achieve from therapy can be really useful in creating direction for your therapy when you start it. Even if you know that you're suffering from a mental health problem and you're not quite sure what to do about it, then that is also what a therapist is there for to guide you through it. That's not all the be all and end all, but with particularly low intensity therapy, having something that can create some direction of where you want to be in your life and what you might do to get there I think can be useful but that's not the be all and end all of it.

Emily: I think just off the back of what Laura's just said as well, like when I reached out to my local mental health service, I didn't know what I wanted from it. I didn't know that my thought processes would be reconstructing. I didn't know all these terms that I'm saying now. All I knew was that I'd got to a place where I had to do something about it and my situation in the sense of, you know, health wise, things are better. But I couldn't sit here and say everything got fixed. I got everything I wanted out of life right now. And all them feelings that I had just went away magically. It's not a magic wand. It's just about managing them feelings better and taking positive steps. It was like a brain fog was lifted off me in sense of being able to take them positive steps to help my situation. So I think it's just worth noting, it's not a magic wand and reiterating that fact that you do have to want to help yourself. And yeah, as Laura said, just give it a go.

Laura: And don't be fooled by the name. Low intensity therapy is hard work. You do engage in strategies that you have to use on yourself to alleviate that fog that Emily's describing there. And that is hard work outside of the sessions that you'll consolidate your learning with your therapist when you return. And, you know, I think Emily can, it's testament that when you put that work in, you can live better, you might not get all of your problems solved. I think if any therapy can do that, tell me what it is and I'll go for it. It's just about living better. Please try it if you think that you need it because it can make even a small difference to the quality of your life.

Helen: Thank you. So I'm just going to ask if you have any final thoughts that you'd like to share with our listeners before we finish.

Laura: No, just if you're struggling with anxiety and depression, get help.

Emily: I think what Laura's just said sums it up perfectly.

Helen: Fantastic. So I'd just like to say thank you again, both of you. I really value you spending time with me and I'm very grateful that you've been speaking about all these things with us today. Thank you.

Emily: Thank you, Helen. Thank you for having us.

Laura: Thank Helen. Thanks.

Helen: Thank you. Thanks for listening to another episode and for being part of our Let's Talk About CBT community. There are useful links related to every podcast in the show notes. If you have any questions or suggestions of what you'd like to hear about in future Let's Talk About CBT podcasts, we'd love to hear from you. Please email the Let's Talk About CBT team at [email protected], that's [email protected]. You can also follow us on X and Instagram at BABCP Podcasts. Please rate, review, and subscribe to the podcast by clicking subscribe wherever you get your podcasts, so that each new episode is automatically delivered to your library and do please share the podcast with your friends, colleagues, neighbours, and anyone else who might be interested.

If you've enjoyed listening to this podcast, you might find our sister podcasts Let's talk about CBT- Practice Matters and Let's Talk about CBT- Research Matters well worth a listen.

In this episode, Helen Macdonald speaks with Chris Frederick- advocate, suicide survivor, founder of Project Soul Stride, and self-described "Mental Health Jedi." Chris shares his deeply personal journey, from childhood trauma and racial adversity to becoming a mental health advocate and what helped his recovery- and the things that didn't.

Resources & Support:

If you or someone you know needs urgent help, reach out to Samaritans at 116 123 (UK) or visit samaritans.org

Brent Recovery College- https://www.cnwl.nhs.uk/services/recovery-and-wellbeing-college

The Listening Place- https://listeningplace.org.uk/

James' Place- https://www.jamesplace.org.uk/

Find more information about CBT- www.babcp.com

Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts

Have feedback? Email us at [email protected]

Follow us on Instagram & Bluesky: @BABCPpodcasts

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 episode was produced by Steph Curnow

Transcript:

Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't. I'm Helen Macdonald, your host. I'm the Senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies.

Today I'm speaking with Chris Frederick. I'm absolutely delighted to have him here with me in the studio. He's going to share about his personal history and some difficult experiences that he had in his earlier life. How he ended up looking for help with his mental health and some of the things that helped as well as some of the things that were less helpful and how he's then started using his lived experience to help inform professionals, services and members of the general public about what helps and what helps people to access the kind of support that they need. He's also going to tell us how he ended up being known as the mental health Jedi.

Chris, would you just like to introduce yourself and tell us a bit about who you are?

Chris: So my full name is Chris Frederick. Born and bred in London, currently living in northwest London. I guess I like to introduce myself. Firstly, is I'm a suicide attempt survivor. I think it's important to get that out there. I'm an advocate and founder of Project Soul Stride, which we'll touch on a little bit later. And, also I'm a mad Star Wars fan.

Helen: Oh, fantastic. And you've just mentioned a couple of things, really important things about your background and who you are. Is there anything else that you'd be happy to tell people listening today about your background and challenges or barriers that you've experienced?

Chris: I mean I guess if I backtrack to the story that, that brought me to that point, very quickly in the barriers, because they might be things that listeners would identify with. I'm a twin, I'm 55. Growing up for us in the early seventies was a tough time. We lived as a small family of four in a flat in a council estate in Wembley and due to the pressures that my father and my mother who were very young, they were only 19 and 18, and they'd not long been in the UK from the Caribbean. So they themselves were carrying their own baggage, their own trauma, their own legacy and that transferred, I guess, onto us as young children.

My father was a very strict, sort of military type figure. A beautiful looking man- if you put a picture of Muhammad Ali at his prime and my father at his prime, they could almost be twins, brothers, because that's how you know, he was tall, statuesque, beautiful green eyes, but on the downside, he had a heavy hand. And you know what I mean by that Helen, he had a heavy hand. He was quite, he was an intimidating character. And that manifested itself in negative behaviour in the house, physical abuse of various descriptions. And we grew up watching and witnessing and being victim of that as we grew up, and this is all within a black community. And then we moved at the age of 11, we upped sticks and moved to Chislehurst, which was a suburb of Kent. So imagine now we've moved from an all sort of majority ethnic community to now an ethnic minority community where we were the only black family on the street. Elms Street Avenue number 60, remember it well. Went to Kenmore Manor, and I remember for the first three years we were two of only five non-white pupils in the entire school. So without going into too much detail, you could also now begin to identify with the certain trends, the recurring themes, the racism of course, the pressures from my family. My parents eventually split up and divorced. My relationship with my twin eventually split. And so we ended up the complete, the family was completely fractured and still is today. And you bundle all that up. I started to experience mental ill health probably at the age of 19. And I'll tell you what it was, it was alopecia. Because I used to have, I used to have, if you could see me now, I've bald hair. and I started to feel there were bald patches appearing in the back of the scalp. So I went to the doctors and you said, oh, you've got alopecia. we could inject you with steroids, give you some cream. I said, well, what's the underlying reasons? And he goes, oh, it's stress. you. What can we do? What can I do to overcome that? And again, that was in the late eighties so talking about counselling and therapy again wasn't really part of the dialogue back then. Right. And then at the alopecia came back 10 years later. So I was beginning to realise I had some problems. And then I took off to Asia, lived there for 20 years, had an amazing time, an amazing experience. Again, suffered racism, but of a completely different type in China, Beijing, Singapore, Hong Kong as a black man, very few in number, but I didn't let that deter me. I had a very good career. I had a lot of experience and beautiful people, travelling a lot. But it all came to a head. It all came to head, and it's something that I called the ripple effect because it almost as if there was an author I spoke to last year, he when he heard my story, he said, I'm sorry to say this, Chris, but it almost sounds as if it was inevitable that you would reach breaking point and attempt to take your life, based on everything that you told me and that ripple that had gone through, the desperation for wanting to find love, family, belonging, identity, all the things that have become so precious to me now manifested itself when I lost my last job in Singapore in 2018, and I tried to commit suicide later that year. And then that was the time for me to leave Asia. After nearly 20 years, I realised that I needed to close the book on that era of my life. And I moved to Los Angeles and then a few months later moved to London, and then I attempted suicide again a couple of years later during Covid. So, you know, I've looked into the precipice, I've looked into the darkness, and twice I wanted to disappear from the world.

Helen: And Chris, I'm really grateful to you for sharing so openly about what's happened to you and just such, such a combination of difficult life events and the circumstances that you were living in. And I mean, I will say that the show notes will have links to help and more information for people who may experience similar things or be concerned about risks and safety. But I'm really grateful for you to sharing so openly and you've said that all of these things really have brought you to where you are now. Tell me a bit about how you went from what sounds like a real, you said looking into the abyss, to accessing something that made a difference to you, or how you got the right kind of support, the right kind of help.

Chris: So I mean, if I tell you, Helen, that when I got admitted into Ealing Hospital after my second attempt, at that moment in time, it was like, oh, finally I'm about to get some help. Finally, I'm about to be recognised as an individual who needs support from the NHS. And then through that whole process of being in the hospital, the psychiatric team at the hospital were very good, they were very helpful. The clinical psychologist came to see me. She spoke to my mum separately and said, okay, we need to help your son. And when I got discharged, I got put into the hands of the community mental health team, the Brent Community mental health team, and they were smashing. They'd come around two, three times a week. They'd make sure I was taking my medication. And then I started to ask them, okay, where do we go from here because I've got you guys for about a month. I'm really concerned what happens then. I just don't want to keep falling back into these bad habits. So they started to say, okay, firstly we're going to start to give you some information, some literature and then we're going to start to talk to you about what was then, Helen, IAPT, now Talking Therapies. I said to them, look, I don't know if I'm ready to go into therapy quite yet. I'd like something just to, just as a teaser, just to start giving me a little bit of confidence, a little bit of awareness of even how to talk or be around people who might have experienced this stuff.

So they said, we've got the solution for you, the Brent Recovery College, the CNWL Brent Recovery College. I said, oh, that sounds interesting what do they do? Oh, they've got a curriculum of courses, and you go online, and they've been facilitated by lived experience, peer support trainers. You are going to be in classrooms of about 12 people, they've all got experience of mental illness. They're all there like you. They want to see other people on the screen. They want to connect with people whilst learning new skills. And I said, I've been a lifelong learner this sounds just a ticket for me to get things going. And when I spoke to the admissions clerk, she said something that really, we talk about that light bulb moment. She said to me, Chris, the mantra at the Recovery College is we turn recovery into discovery. And when, and I used that today because it was like, this journey I'm about to embark on isn't just about me getting well. This is about me learning about myself and about the world around me and how it impacts me. And I said, I'm really going to invest a lot of time in this model and, ironically, ImROC which is the organisation that does all of the training for all of these recovery colleges, I'm now a trustee on the board of directors of ImROC and I tell my story, why did I want to join this charity? It was because of my experience with the Brent Recovery College.

Helen: Right. Okay. So I can really hear that, that was something of a turning point going into the Recovery College. So can you tell us a bit about what you learned at the college? What courses did you do?

Chris: Oh yeah. Listen, I think I did about 12 courses from sleep, sleeping well, diet, writing about mental health, mental Health First Aid. There were all sorts of really interesting courses, each semester they come out with about 20 different courses and they're always being adapted and some of them might be just one or two hours. There might have been others that are spread over four weeks, and you've got to put two hours in a week, and they give you a certificate. I mean, there were many more, and most of them were really good. One or two maybe was not so good. But I think the main thing was it was the people. I was feeling that sense of connection and that sense of belonging. It wasn't just about me anymore. It was about being with other people, and I think that was, for me, that was the main purpose of it.

Helen: And I'm really hearing you about how important it was that sense of belonging and that sense of connectedness with other people as well as learning specific, I mean, it sounds like a combination of knowledge and skills that you were learning at the Recovery College.

Chris: Yeah, definitely. Yeah.

Helen: So tell me, out of all of those things, what was the best thing that you learned at the Recovery College?

Chris: Logical thinking about problems, problem solving. Being honest, even if you feel uncomfortable in a type of environment where you are talking about this stuff, which can be tricky with strangers. It's being honest, it's being articulate. And, if I look at my mind map now, some of the models that I learned from the Recovery College in terms of being able to segment information and data so that it makes sense with always thinking about the story arc. Where are you when you start? What's your, where are you at the midpoint and where do you want to end up? And when I went into the Recovery College program, I had, I already started to think about where I wanted to be at the end. And so I was building myself every time. I was building myself another pavement, another step in the journey and the journey now is very clear. It's crystal clear what I'm here to achieve and a lot of that was built from my time, with the CNWL.

Helen: So from that, given that some of our some of our listeners may be involved in services, or as therapists. Is there anything that you would like to see therapists and services doing more of? I mean, on the other hand, less of maybe, but is there anything that you would really want to see?

Chris: Yeah, I mean I, my first experience with CBT came after I started with the Recovery College cause that was, I was signed, actually, I was signposted to IAPT in Brent. My GP failed to do the referral, which I won't get into now cause it was a complete debacle. So I actually ended up doing my own self-referral and then I just had to wait and wait. So my early experiences of CBT were not great because I had response times are really slow, understandably, this was through covid and then waiting lists were very long. And then when I kept asking each time during the assessment what type of therapist can I get access to? Oh, can I speak to a black therapist? And the answer was no, we don't have any, or if you insist Mr. Frederick, you'll have to wait for an even longer period of time. So I was so used to hearing the word no, Helen. And then when I started to do research into therapeutic, sort of models and I challenged them. I said, look, I know what CBT is. I said, but for someone like me, I even wrote it down today. I was like, someone like me, what about something like EMDR, my friend's using in LA and says, Chris, it's perfect for you. What about ACT or solution focused therapy? And every time I kept saying to them, right. What are the chances? Can I get that instead- like a shopping menu. No. Mr. Frederick, no. We don't do that, you'll just, we'll have to funnel you down the CBT pathway and that's all you are going to be allowed. Six sessions with a therapist that we give you, and its only CBT.

So now imagine somebody who has been through suicide attempts, is still a risk as terms of assessment, and now I'm now the power shifts from me to this system that is just ignoring my needs. And then you have to just sit there and accept what they give you. You can, it's quite frustrating when you think about it like that, isn't it?

Helen: It really sounds that, and I mean I know that, nowadays you speak openly about being a suicide survivor, and you're saying about in that situation, having to wait a long-time and not being given the kind of choices that are supposed to perhaps be available to people. And I'm just thinking about that experience, that personal experience shapes your advocacy work now. And I'm just wondering about what you would say about reaching people who are under served. And I know that this is an audio podcast. You're speaking to a white woman from a British background here, and you asked, could I see a black therapist? And you were just told no. I'm just thinking how that all shapes what you do now and how you promote providing access to people from a variety of minoritised groups.

Chris: No absolutely, it's a great question. I mean, I'm not saying that because I've been through about 52 hours of therapy so far. Okay. I'm not saying, and that's across five therapists, only one of them was black, which I'll tell you how I found her in a second. So I'm not saying that the therapists, I'm not saying that they were not good, not at all. I'd say two of them were very good and we actually made quite a lot of progress. But I think the fact is that I kept repeating the CBT model every time with these therapists. It was like moving the needle, it was only fractions rather than inches. And I wanted to make some real progress. And the time came where, and in fact, before I tell you about that. it was while I was waiting, I needed to find something that I call buffer services so I'll quickly plug, The Listening Place, which were brilliant because when I called them in Kings Cross and I said, I'm experiencing suicidal thoughts. I've had two attempts. I'm on the IAPT waiting list for about six to eight weeks. Is there anything you can help me with in the short term, cause I'm really anxious. And they said, brilliant, you are just a type of client that we take on, come in to see us. We are going to give you eight, eight individual sessions with a volunteer listener. And you come in and you just talk about this stuff. And they specialised in speaking or hearing from people with suicidal thoughts. And I thought, brilliant. Now. The fact is though, Helen, I had to use Google to find The Listening Place, and it was only because I knew what keywords to search. So now I think about it, what would your average person on the street who doesn't know about this stuff, they're just going to sit and wait six to eight weeks and not realise that there are other services out there that can help them in the short term or in those gap moments. And I think that's one area that I do like to talk about in my work, which is we need to be more creative, we need to be more inventive, and we need to promote all services and let, and each of us, we can create our own menu because it should be bespoke for every single person. That's what I maintain. Yeah. Does that make sense?

Helen: Yeah, it's really helpful to hear you say that, Chris, because I know that a lot of the intention is to make sure that we are offering evidence-based therapies that are appropriately adapted to individuals and that we especially in some areas compared to others we've got a long way to go to really make that happen for everybody who might benefit from those services. And again, we'll put links on our show notes for some of those things that you discovered because you knew how to look for them and it could well be useful for our listeners to have that information out there.

Chris: And I'd also say, not that I've used them directly, I've visited them, but James' Place who are expanding really well, they've got a beautiful site in London and similarly to The Listening Place, they're not just listeners, they actually, again, deal with a lot of men with suicidal thoughts and their service is superb from what I can see online.

But let's talk about the turning point here, because this is where, it's the story arc you'll start to see where the transformation really started to take place. I was on LinkedIn, so you'll get, you're getting a sense now, Helen, that I'm a big user of technology that's helped me. But it does make you think though, because if you are an individual who's not confident on technology, you are already at a massive disadvantage. Right? Which is in itself is something needs to be addressed. But anyway, so I'm on LinkedIn and it was January last year and I happened to see this post from Black Minds Matter UK, which is a charity that I follow. And it had this poster, and it was saying we are now offering 10 free sessions for clients to see a black therapist. And it, and at that time I'd been about five, six months out of therapy and knew I was going to need some in the new year. And when I saw this, Helen, can you imagine the level of optimism and excitement? I jumped out of my bed, jumped onto my computer, quickly did the self-referral, and from the moment I logged into that website and did and filled in that form, right, it took seven days to get the response on email, acknowledging receipt of my form. It took just another seven days to get the assessment call done and then only another seven days before I was in session one of 10 with this black therapist. So it was totally seamless, and it was rapid response.

Helen: Yeah and it really sounds like that was going to meet a need, which just wasn't really being met.

Chris: Exactly, exactly. So the difference is it wasn't six sessions, it was 10. So that was one thing. Secondly, it was with a black therapist, and so we didn't have to go through the initial cultural familiarity aspect, she was happy to share some of her life story. We talked about parents from the Caribbean, we talked about food, we talked about music, and so we were beginning to build a relationship, a rapport, and that for me was fundamental because when I go into these types of therapeutic relationships, we talked about the power differential, the therapist and the client. And it was only until we got through to session eight, I made a note of this because I think it is quite important. I said to her, how is it that you are able to get so much out of me? How is it that we're making so much more progress than I've ever made before? And I was curious, I asked her, I said, what kind of me methodology, what kind of framework you're using? I think I understand roughly what this stuff is but just tell me. She said I'm an integrative counselling psychotherapist. I said, well that sounds interesting. What does all that mean? She goes, well, I use a combination of CBT, person centred, psychodynamic. And I was like, this sounds really cool cause nobody's ever told me about this before. I think I've only ever done the CBT, but the fact that we're using person centred and psychodynamic I think that's why we were really clicking. And I've circled that because I thought that was worth sharing with you today, Helen. I think this is very important.

Helen: Thank you. And again, it's the whole journey that you've been telling me about, the stages of what happened to you that meant that you did actually need to seek help. And then the whole journey of trying to obtain the right help and then really meeting somebody who's truly collaborated with you and really got it, really been able to, I don't know, it empowered you in that situation, which can be disempowering, especially if you're feeling vulnerable. And so really meeting somebody very skilled and the importance of that shared background as well.

So I mean, along this journey, you've also been very much focused on helping other people as well. And I know that you've told me before when we've spoken before that you've met people across the country and abroad as well. And this is Project Soul Stride that you've spoken about. So tell me about that project and things that you've learned or, what would you like to share about that?

Chris: Yeah. Soul Stride was born August 15th. I mean, I woke up one day. Listen, I hadn't washed for a week. I hadn't brushed my teeth for a week. I was smoking like a chimney. I was in a bad place. I was in danger of going back into some real bad depression and I woke up one morning and I said I've got to do something. So I sat down with a blank sheet of paper and I had my Chat GPT AI open, and I said, look, I started scribbling stuff down randomly, started circling stuff, and I was looking for a project for about three months that would force me to get my ass out of bed at least three times a week for about three hours a day. Number two. Connect me with people on the screen so that I could actually feel like I wasn't the only person in the world. Number three would force me to write and draw and highlight because I'm a very visual person and that's how I get my heart rate going. And so I put all of this stuff into Chat GPT, and it already knew about my mental health background. And I said, what do you think I should do? And it said, okay, why don't you do this lived experience project where you speak to 30 people and you tell them your story arc, and then you get their feedback, and then you ask them point blank questions like, what do you think about the state of the industry? Where do you think the opportunities are? Where are the gaps? What are doing to improve things for black people, blah, blah, blah. And because I came from recruitment into sales and business development, using my network to connect with people was a piece of cake for me. And so 30 people grew, it doubled and it tripled. And by the time I finished my Excel spreadsheet, I'd gotten to speak to about 185 people in 15 months from public health directors, academic professors, CEOs of major mental health charities, think tanks, talking therapy leadership up in NHS England. I mean, I mapped the entire sector, including grassroot, black owned organisations in London. And I think I'd written notes, maybe a hundred, 150 pages of notes.

Helen: Oh wow.

Chris: like, so half of that stuff I still haven't read back. I still don't even, so I'm sitting on a wealth of information and knowledge, but what it's told me, number one is that there is a gap. Number two, there is a distinct lack of strong black voices in this field, particularly men. Number three, if done well, this advocacy work can open so many doors into influential spaces, not just into terms of PPIE research projects, but also advisory board positions where you really are where the decision makers are taking are making critical decisions.

Helen: And I really hear you about that's an incredible number of people that you managed to contact and the influence that, that you have available to make a real difference to people's experience. And I know that you've been part of a recent evaluation, review of the organisation that I'm here as part of the BABCP, the organisation for CBT in the UK and Ireland. And one of the things that, that we've been doing as an organisation is reflecting on how we hear the voices of people who have personal experience, lived experience, expertise, however, whichever words we choose to use. Can you tell us a little bit about your reflections and what you would advocate in terms of involving people so that we really meaningfully include that?

Chris: Yes. I mean, when I've had such a joy in partnering with the BABCP from the 2024 annual conference in Manchester, which was just, that was probably the first time Helen, where I had taken myself out of the comfort of my bedroom because I do a lot of stuff online. But actually doing it in live in a, in an auditorium, God, it was shaking. There were maybe 40 people in that auditorium. But I knew that was such an important milestone in my advocacy work that I had to tell my story. I had to be totally and utterly vulnerable and let's, the chips were fall where they may, and you'd be amazed, the response was quite staggering. People were writing stuff down, they were looking at each other quizzically as if to say, we didn't know that, we need to be hearing more about this stuff and then when we had finished, we literally got mobbed from the audience because they, they started running down from the audience to take photographs of us., I wrote this article, from Panic to Paparazzi and I started to write it on the train coming back from Manchester because I wanted to capture the emotion.

And this leads back to your question, which I wrote a couple of things down here when I read that report about the BABCP, and it's not unique to organisation, but number one, more space for lived experience, particularly I feel in curriculum design and delivery, proves the point that Leila invited me to a three-four hour workshop that she delivered on cultural humility training, several weeks ago. And she had a spot in her training schedule for me to share my lived experience, and when she turned the microphone over to me, the response again was quite staggering, and so it made me again, reinforce the message. Having folks like me involved in delivery, design of training curriculums is important, and of course, leadership. Organisations such as yourselves to have voices like ours involved in decision making, leadership influence. It's not just about- and this might sound weird, but it's not just about ethnic involvement, actually. It's about lived experience involvement. If you can get the two together, brilliant. But I think lived experience for me is the most important and of course diversity, whether it's gender, race, neurodivergence, whatever that is.

Helen: Yeah and Chris, I mean, reflecting on what you've just said, and thank you for sharing that. I'm really hearing your courage and I like the panic to paparazzi, and your courage in being in a situation where we are wearing a hat where we are supposed to be being the helpful ones and helping people who need support, need mental health treatment and so on. And yet here we are learning so much from you and you actually teaching us a lot of things that we need to learn. And I just wondered if an organisation like ours had what a Mental Health Jedi might call a Yoda moment. What wisdom or lesson would you hope for us to take forward in terms of listening to lived experience?

Chris: The cultural humility and awareness aspect is essential, should not be taken lightly. I feel in some situations it can be given a tokenistic response. I think there must be genuine equity in the conversation, and co-production of we talk about co-production of solutions. Actually, I would like to talk about co-production of ideas right? Before we even get to solutions because quite frankly, folks like me never get to rubber stamp a service design model before it hits the market. Right? I understand that as somebody coming from private sector. But if we go back to the consulting and advisory part, I'd actually think we be involved in the earlier stages of discussion and investigation about some of these opportunities. Yeah.

Helen: And building on, what you've just said, you and I were talking about let's say certain film franchises before we started making the recording, but I would really like people listening to hear about how you became known as the Mental Health Jedi and what drives your mission. I know that one of the things that you've become very keen to do is to promote mental health access and particularly equity. Tell me how that happened.

Chris: You know, Star Wars for me and it's so strange that we're having an honest conversation cause when I started talking about this two years ago, I started to think, Chris, you're coming across as a real geek here, like a real nerd. Like, people were just not going to take you seriously. And I was like, no, no, no I'm going to stick with this. So when I started talking to this author, she said to me, Chris. I've seen some of your posts on LinkedIn and you are referencing Star Wars a lot. and she says like, you've almost become the Mental Health Jedi. And I said, say that again. And she said, the Mental Health Jedi. And I was like, I wrote it down on this piece of paper and I was circling it, and I said, I'm going to use that. And even when I started to sign off on my social media posts, Mental Health Jedi And I in one night I created the new Star Wars fans group. But what's really cool is when I look through the list of people and all the countries, I think at last count there was something like 35 countries or 25 countries around the world that people have joined this group. And I take great delight in creating some amazing content because what it does me is it helps me escape my advocacy work, because talking about suicide and mental health every week, Helen, you know what that's like, it can take a real toll. So when I down tools and just put on my Star Wars hat and my Star Wars gear and put on John Williams on my Alexa device, and I start typing stories and quotes and images and reels. It just helps me use all my creative juices. It's amazing.

Helen: And I, I mean it sounds amazing. It sounds really interesting. And also just that message that, in terms of looking after your own wellbeing, even though you are dealing with really difficult stuff as part of your work. You are also, you've got things that are rewarding. You've got things that are completely different that use your creativity and create connections with people. So you really are living what you are advocating in terms of looking after your own mental health.

Chris: Totally. I mean, people now connect with me on LinkedIn and say, Chris, we love the fact that you are an advocate and you are linking it with Star Wars because it's such a door opener. I love the darkness and the light story of Star Wars, that balance and that represents and reflects my life and the life of many. And the quote I had, which was the Jedi don't fight emotions, they learn from them. And actually that philosophy has really helped in my healing and my advocacy style of work. And so I really live it. I live it, Helen.

Helen: And that's a great quote. Thank you. And Chris, I mean, I'm really grateful for everything that you shared with us today, from your own personal journey and all the difficulties that you've faced and the things that you've done about it. What's been helpful, what hasn't, what we can do more. I mean, you've just covered so much. Is there anything else that you would really want to say that perhaps I haven't asked you about or that we haven't really covered properly.

Chris: I think to wrap up and I guess this message goes out to the clients because that's who I really want to look out for. So I have four things because I was going for four and they're very quick, rapid fire. Number one is you are not alone or broken. Okay? Remember that? Most important. Number two, you are only human. We are not infallible. Number three, please consider therapy. Okay? Become comfortable with feeling uncomfortable because that's when your body reacts, in a way, it's telling you are on the right path. No matter if you are feeling sick or you get a migraine, you know you're doing something right. And lastly, and this I think is also very interesting and I got this from therapy. Being in the courtroom feeling judged is only in your own head. So take ownership. Yeah. And be brave. Be curious, and please ask the help cause nobody really knows what's wrong with you until you ask for help. My friends made so many assumptions about the state of my mental health, but when I started to open up, it was only then they were like, why didn't you tell us before we could have helped you so many years ago? I just didn't know how to ask for help, but now I do.

Helen: Chris, thank you so much. I'm really grateful for you spending this time with me today. Really appreciate it. Thank you.

Chris: You're very welcome.

Helen: Thanks for listening to another episode and for being part of our Let's Talk About CBT community. There are useful links related to every podcast in the show notes. If you have any questions or suggestions of what you'd like to hear about in future Let's Talk About CBT podcasts, we'd love to hear from you. Please email the Let's Talk About CBT team at [email protected], that's [email protected]. You can also follow us on X and Instagram at BABCP Podcasts. Please rate, review, and subscribe to the podcast by clicking subscribe wherever you get your podcasts, so that each new episode is automatically delivered to your library and do please share the podcast with your friends, colleagues, neighbours, and anyone else who might be interested.

If you've enjoyed listening to this podcast, you might find our sister podcasts Let's talk about CBT- Practice Matters and Let's Talk about CBT- Research Matters well worth a listen.

In this latest episode of Let's Talk About CBT, host Helen Macdonald is joined by two international guests- Tafi Mazikana and Sherrie Steyn who share their journey from CBT service user and therapist to CBT innovators.

Tafi, originally from Zimbabwe, opens up about his experiences with anxiety while working in a high-pressured job in finance and how a digital CBT intervention through IAPT (now known as NHS Talking Therapies) changed his life. He talks candidly about the cultural stigma around mental health, what it was like to try therapy for the first time, and his realisation that CBT is about learning practical, empowering skills.

We also hear from Sherrie, a clinical and community psychologist from South Africa and co-founder of the Vimbo Health app along with Tafi. She reflects on her friendship with Tafi, the surprising conversations that sparked their collaboration, and the importance of culturally adapted therapy.

Together, they describe how Vimbo Health was developed to meet the unique challenges and needs of people in South Africa, particularly in terms of language, cultural metaphors, accessibility, and affordability. They explore how therapy can be made more relevant and relatable, from replacing metaphors like "three-legged stools" with potjie pots to tackling barriers like mobile data costs and mental health stigma.

Whether you're a therapist or someone curious about accessing help in a different way, this conversation shines a light on how CBT can be tailored, inclusive, and transformative.

Resources & Links:

Learn more about Vimbo Health: https://www.vimbohealth.com/

Information on CBT and how to find a therapist

If you or someone you know needs urgent help, reach out to Samaritans at 116 123 (UK) or visit samaritans.org

Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts

Have feedback? Email us at [email protected]

Follow us on Instagram & Bluesky: @BABCPpodcasts

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 episode was produced by Steph Curnow

Transcript:

Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't. I'm Helen Macdonald, your host. I'm the Senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies.

I'm absolutely delighted today to have some international guests for you. And in a moment, I'm going to ask, Tafi and Sherrie to introduce themselves. We're going to be talking with them about the experience of having CBT and then some really exciting developments that have happened since. But first, let's start with some introductions. Tafi, would you like to tell people who you are?

Tafi: Yes, definitely. Thank you, Helen, really a pleasure to be with you today on this podcast. So I'm Tafi Mazikana and I'm Co-founder and CEO of Vimbo Health, a metal health app that's operating mostly out of South Africa. My background as I've shared, is not as a practitioner. My background is as a patient, of CBT who became very curious, perhaps too curious. So I was living in the UK working in banking and finance, and I was just very lucky to come across the services of IAPT which allowed me to self-refer in this area of mental health. I never knew that one could actually reach out and do something, so that was game changing in itself. But I was offered to have a digital CBT intervention, which was very transformative for me but obviously just left question marks as someone born and raised in Africa to say, well, who's thinking about the African context? Because, as I'll share later, there are things and ways of thinking and speaking that are different and I was just curious about who is going to think about that. And so became more and more involved, in this area of CBT, and in particular digital CBT.

Helen: Thank you so much, Tafi. There's lots that we're going to talk about there. Before we start that though, Sherrie, can I ask you to introduce yourself please?

Sherrie: Hi Helen. Thank you for having me. My name is Sherrie Steyn and I am from South Africa. I'm actually very fortunate to be from the East coast, so the sunny side, and my background is in clinical and community psychology. I tend towards the behavioural types of psychology. So I've done some ABA or as we call it VBA now and of course a special interest in CBT. So having done that clinical and community psychology, I then went on to do one of the allied CBT training courses through UCL. So I was very fortunate, to have done that. And that's a little bit about my background and, yes, I'm also the co-founder and CSO of Vimbo, I like to say I'm the science, because it sounds cool and yeah, just very happy to be here and share some of our experiences with you today.

Helen: Thank you so much. So if I can come back to you, Tafi, I wonder if you would be willing to just tell our listeners a little bit about what it was that made you actually reach out to access CBT. Do you mind telling us a bit about what was happening for you that meant that you were seeking some help?

Tafi: Yeah, absolutely. I think what I with hindsight realise is that it was difficulties that built up gradually over time and came to a point where they sort of caught me off guard. At the time that I reached out for help, I was working in the banking sector there in London on very stressful, large projects, which brought on a lot of anxiety, but I traced back my difficulties to over 10 years ago in terms of when those little moments of a negative self-talk, which started as innocent, and then grew into something of its own life, sort of started to happen and without the right tools then entering into that professional world, I do think I was at a disadvantage. I had some great tools in terms of being quite active and taking part in sports and exercise. So that's amazing but definitely what I came to realise is that I was actually lacking other tools that could have helped me to not get into a situation where I'm feeling like I'm in a lot of difficulty. So yeah, so I always describe it as, for me, in my case, not one thing in particular, but I feel like a gradual buildup of life just happening or that negative thinking pattern becoming something of its own.

Helen: And I think it's quite important to notice that, that it doesn't have to be some one particular dramatic event or something key that changes. It might be a combination of things or a buildup over time. So can I ask you a bit about when you did access the CBT, what did you actually get? What happened in CBT for you?

Tafi: Yeah, so I think for me, I grew up in Zimbabwe in Africa, and there isn't a tradition of seeking help. So for us, therapy is something that we saw in movies, we know that movie characters in Hollywood have therapists and get help. Or we associated it with people who we knew in the community who are undergoing inpatient care. And those are the forms of help that we knew to be there. Things that are not related to us in terms of early intervention, it is more something that happens when you are at the stage of acute care, which is inpatient. So essentially when I reached out for help, I was a bit sceptical of what was offered because it didn't fit the moulds of what I thought help looked like. And when I chose the route of going for the self-guided digital option that I was given there. I was, again, sceptical because it was not what I thought therapy looked like. I chose it because it was, it felt like a lower barrier because I was still quite afraid to talk about my feelings and to talk about my thoughts and experiences. But yeah, but, needless to say, I was actually shocked and quite impressed at how effective it was. And so that, that introduced me into the idea that help is something you don't have to wait until you are at that acute phase of need. But also, it taught me that CBT is about, in my opinion, I guess I'm not a practitioner, so please take it with a bit of salt, but it taught me that CBT is about building skills, which is quite a positive thing. It's actually quite empowering is what I learned then, and I think that's what resonated the most with me and got me hooked onto this form of help.

Helen: Thank you. And I just wanted to emphasise that there's several things that you've said there. I mean, firstly, you're coming from perhaps a cultural context that's less familiar to some of us. I suspect a lot of our listeners will be in the UK, although there are people from elsewhere. But that experience of really not being used to talking about feelings will be very familiar to a lot of our listeners, that sense that it's got to be really bad before you seek help, I think will also be something that people out there might feel. And yet what you've said, it was an earlier intervention, and it wasn't nearly as bad as it might have been. So I just wondered if I can talk to Sherrie for a moment and ask about what it was like for you, getting to know Tafi and,from the CBT therapist's point of view.

Sherrie: Well, I think what the first thing that strikes me is that Tafi and I socialised fairly regularly. We were a bit younger in those days. So the socialising honestly did tend to focus on large groups, at the pub, at a museum, at a place, and even when we do have dinner time, so if Tafi would come over and just hang out and have a meal, you are still so preoccupied with the day to day that unless someone brings something to you, you might not actually know what's going on. Whilst all this was going on, I had no clue what Tafi was going through. So the first time we actually really got talking about this was when he was visiting me, so after he had completed his treatments and we were hanging out on the balcony that I'm looking at, and we were just talking. He was talking about what am I going to do in America. And I was talking about having left the NHS and working in CBT and that's how the conversation started really was after the fact.

And like a lot of conversations between Tafi and I, we of course got down to the pragmatics first before we got around to hey, this realisation that how is it that we see each other all the time? I'm a therapist, you literally went through the same service I used to work at, the same type of service and I'm only learning this about you now. And I think that's very telling and I don't think that necessarily has anything to do with Tafi and I as individuals. I don't think this is unique. I think this is really common, that it's part of that stigma that sometimes it's even difficult to say it to ourselves. And if it's difficult to say it to yourself, how do you then say it to someone else? So I think that's part of what that, that process is, that Tafi was in a space where he was at able to also recognise that this is something I can talk about because it's not something I need to feel ashamed of.

And Tafi gave me the opportunity to ask the kinds of questions you don't get to ask as a therapist. So what was that process of waiting actually like? What did it look like when you got to the website and you were being directed? What did that look like and what did that feel like and was it difficult to navigate those kind of technical questions that I do think massively impact your journey, so that was also just really fortunate.

Helen: Thank you, Sherrie, and I mean, one of the things that, that it was really telling there as well. I mean, sometimes, if I let people know what I do for a living, they'll ask me, are you reading my mind? And the point that you've just made there is that you've got a friend that you socialise with, you've known for years, and yet you didn't necessarily know what was going on until it came up in, and I think you used the phrase after the fact, and I think that might be a lesson for us as therapists as well, that not to assume that people will tell us because it might be hard or it might not come up.

Sherrie: Or they might be concerned that we're going to try and push them into therapy because it's literally our job. So Tafi really touched on this, where he had an idea about what therapy was. And I think so many of our decisions are based on these ideas and it's not necessarily what therapy is. So in my own life, I remember having a conversation with a friend of mine. I was on my way to therapy because everyone should have therapy. And my friend was like, oh yeah, therapy, easy peasy, you go and lie in a sofa and talk about your problems. And I was like, what? what sofa? And I was not doing psychotherapy, unfortunately, there was no sofa involved. But my point is it's just genuinely not having an understanding and not being in a society where we can be comfortable talking about these things and me going, actually no, there's no sofa, I don't talk about my feelings. It's very different. And then I guess for me, that was an opportunity to explain to my friend what I did as a therapist. Not necessarily what I was doing in therapy, but I was like, hey, just so you know, my clients don't lie on a sofa either. So again, just I think dispelling a lot of the mythology of therapy is a big part of it. And yes, that stigma does cling on us as therapists with our mind reading, and our desire to treat you.

And Tafi was amazing. He was so real with me about it too, about how scary it was. And it's not something you spend a lot of time thinking about as a therapist cause you're spending so much time thinking about making everyone comfortable. But why are you spending so much time making people comfortable? cause it's actually really scary and uncomfortable experience at first, and we learn about it, but it hits differently when it's someone like really genuinely sharing that with you.

Helen: Thank you. So Tafi, no sofas. What did you actually have to do if you weren't? I mean, I completely agree with Sherri, that image of lying on the sofa, telling someone your deepest secrets, that's not actually what therapy is really like. So for you, what was actually helpful? What was it that, that you benefited from when you accessed the therapy if it wasn't lying on a settee?

Tafi: No, that's a great, great question. I think the first, was the normalisation of it for me because as someone who hadn't had any previous contact with the concept of mental health assistance or what help looks like. I actually assumed that everybody is going through the same experience as me, which is that they have these feelings, they have negative thoughts that they deal with internally and externally you are presenting strength and just being happy and getting on with things and getting on with people. And then what you deal with is your own problem that you deal with by yourself. And I just assumed that everybody is going through the same human experience where they have their challenges, their difficulties, but there are theirs to deal with.

So that's what I assumed was happening. So it was actually quite helpful in itself just to understand that, actually my experience is more severe with some of these feelings than I should have to put up with. So not to say that I am not normal, but it's more than I have to put up with, and I could actually get rid of quite a lot of these things, and it's normal for a lot of people to feel that way. So when I was at the height of feeling like, ooh, I could, I can say with hindsight now that I will say I was struggling. I just thought this was normal. But the tension was so high that when I got to that escalator at Bank Underground Station, I would feel a lot of these physical sensations of, I guess now that I know are associated with the anxiety of the challenges that I had to then go tackle. So these are things that I notice now, and I think the normalisation of that and just understanding that these are things that you don't have to feel basically, if you are willing to try and go through these steps. So I was already hooked at module one and I could tell this is for me.

Yeah, so I really think there's, I believe a lot of people out there, like me for whom a lot of their need is a gap in information, just a gap in knowledge about how normal it is and the fact that there are things that can be done. So just those two things, as basic as they are, I think can have a lot of a big impact for people like me who just haven't been exposed to any therapeutic techniques or language or discussion.

Helen: And it's really interesting to hear you talk about that. At the same time, I do wonder whether there were any steps that you were expected to take that were actually really hard. I mean, you did mention that it was hard to get on the escalator at the Bank underground station. Were there things in the therapy itself that were particularly difficult?

Tafi: To be honest with you, when I self-referred through IAPT, the first step was to have a phone call with someone and that was very uncomfortable for me because I had never discussed these inner things with anybody. So that was quite daunting but because I had chosen the self-guided program from there it was up to me. I think as someone who resonates with academic things or from the finance world, you're used to learning that I was in a comfortable space once I was meeting those topics in a place where I'm having privacy. What it has done for me though, is that I am now open to face-to-face therapy because I understand the context, the language, I'm more understanding of that is normal. And also I understand better what therapy is about and what I can get from therapy. So I just needed an introduction, which gave me, I think a sense of being in control and also the privacy that I needed at this time to be able to unpack a lot of these things and understand them so that, years later, I can talk openly with you now. So yeah, so I think for me there was just quite a good fit between the form of help for the stage of my journey, which I was in.

Helen: Well, I guess the next question then really is how did you get from that and finding the guided self-help materials? How did you get from that towards developing the app? So you know, you've gone from being somebody on the receiving end to developing something that helps other people.

Tafi: Yeah, I think when I was on the receiving end, one of the things that I found really shocking and I didn't expect myself was that, for me, I struggled with a lot of automatic negative thoughts. Those I'm useless, or I can't do this, or I'll always be like X, Y, Z. I struggled a lot with those automatic negative thoughts. So developing that skill around identifying how thought, feelings, behaviours are connected and starting to do that repeatedly for myself and then doing repeatedly thought challenging. I found that over time, naturally I was having less of the negative thoughts without intentionally trying to not have them. I just wasn't having them, and I was having more of the balanced thoughts being my automatic thoughts. So I found that really transformative. I found the mindfulness exercises to also be really powerful as I practiced it more and more. I just, again, it wasn't intentional that I was thinking different. I just three months later realised wait a minute, I'm thinking differently, I'm not having the same experience of life, if you like, that I was having before. So that's what gave me a deep sense of that the science that's behind this, really works because I can say what I want about my ability to read and to understand what I'm reading but definitely there's some science that's happening in the background that is doing something to me here. I believed in the method, I believed in the science through my personal experience but then I also, at times, although it was an amazing intervention, it worked for me. I did feel like, I'm a bit of an accidental user. They didn't imagine this Zimbabwean, crazed kid, coming through and, and using this, which is fine because I think the interventions are developed with their whole audience in mind. It doesn't mean they can't be used elsewhere but there is definitely a person in mind, as the audience, which for me triggered the question of saying, well, who will think about the African context? Who's going to have enough of an interest to say if this is made for, with the metaphors, with the ways of thinking, talking, that we have here in Africa, that from living in both places I know are quite different. It became a question of who's going to think about that, but that's not something that I did alone because of course, Sherrie was herself resonating with that question to say, well, who's going to think about it? And obviously yeah, that's how things came about.

Helen: That's fantastic and I'm really curious to hear from you both, have you got any examples of the kind of metaphors or analogies that I might use because I'm based here in the UK that are different from the ones that would resonate with people that are from where you come from originally?

Sherrie: Yeah, so one of the metaphors we frequently use in the UK is talking about a stool when we are talking about balance, the stool needs three legs. Okay in South Africa, we're going to tell you about a potjie pot.

Helen: You are going to have to explain that, Sherrie.

Sherrie: So a potjie pot, it's like a cauldron. It's a type of cooking pot. It's a very popular African cooking pot, it's used outdoors, but it's something that is a bit more familiar to us. It's a small thing. Of course, we have stools, but even the word stool is just very English. So yeah, we talk about potjie pots instead.And then just simple things like if we are talking about animals, I'm not going to talk to you about a fox, you don't have any foxes. I'm probably going to describe a different animal. Simple things like when we are talking about barriers, I'm not going to be speaking to people in London about rolling blackouts. They'll be like, what are you on about? But if I'm working with the clients or even within the app, if I'm guiding you through a particular skill where I need to think about your ability to follow through on that skill. I need to think about whether you have access and when you have access. And even if I don't think about that, I'm going to help you think about that. So when we're planning, we're going to think, okay, what are your barriers? Because they look different. Of course everyone has their own unique barriers, but I'm talking about social barriers. I'm not going to say, oh, pop down to the shops, if I know that you live in a location, and that you got to go to the spaza, I'm going to say go to the spaza. Those kinds of little differences. And then also in terms of broader differences, so acknowledging and bringing into the culture, bringing in those cultural aspects. So we are very big into Ubuntu, that's something I bring into the CBT. We put a lot of focus on, I guess more of a communal aspect and what does community mean to us as Africans? What do our networks look like because they might look a bit different. So for example, if I'm in England, I might suggest you go to a peer support group. If you're in South Africa, I might say, hey, go to your elders. We know what that means, there's someone in your community who's designated an elder, you can go and speak to them. That's kind of part of their role. So just thinking a little bit differently about what is life like for you? Yeah, we all human, but you know, these are the things that make us who we are, but also your environments. It's absolutely linked to everything. That's what the five areas model is. We don't put this all on you. This isn't all on you. You are part of this broader system. So we like to try and bring that in, and I think there's something about that is also quite African.

Helen: I'm loving what you're saying. And even though what you're saying, it is African, to me it's really relevant to everybody everywhere thinking about what actually is meaningful to you, in your context, wherever you are, whether that's the middle of London or the middle of nowhere, whichever continent you are in and something about using sort of images that are familiar to you, your community, your locality, and who are the people that you go to talk to that isn't the therapist, for example, who are the people who'll support you? To me it all sounds really relevant.

Tafi: Absolutely. If I could just add to or build on the cultural differences. They can be in ways that surprise us, I think people might not expect certain things. So for example, like Sherrie's saying, in our culture at a funeral, there are songs that are sung, and they're not necessarily downbeat songs as well. So it's just that idea that cultures can work dramatically differently. Another example is I always use this, my own experience of, we have the saying in the UK that a person changes like the weather. And for me growing up in Zimbabwe, I thought it meant that person is very reliable, isn't it? Because the weather hardly changes. It's 25 degrees, it's sunny. I can rely on that person.

Helen: That's a wonderful example.

Tafi: Yeah, it of course took one trip to Manchester and experiencing the weather changing in one day to know that, okay, that's not what that means. And so I wouldn't blame someone in the UK for assuming that statement has the same global relevance as it has in the UK, but clearly it would be a cultural disconnect for some of here.

Helen: Thank you. And I mean, as a therapist standing here, I'm making notes, about what you're saying and, we do talk about including people from different backgrounds and different cultures that always need to think more carefully and more broadly about what are the implications of the assumptions that I make without realising I'm making them. And I just love that one about being like the weather. I really love that one.

Sherrie: And again, I think the focus is as you said, I mean, it's not that it's not going to be relevant to someone else. I think that the process of therapy is hard graft. I don't still need you to put in the cognitive energy to figure out a metaphor that doesn't hit quite right. So again, it's not saying, oh, we need vastly different, no. All we are saying is, hey, let's just try and make it as accessible as possible and that does mean not spending an extra five minutes trying to figure out what on earth I'm talking about in a metaphor that is just weather.

Helen: So can you tell us a bit about how the app itself actually works? It's been developed for that context, but you said it may well have a broader relevance. Tell us a bit about what somebody expects if they're looking at the app.

Sherrie: So I would say it's important for us to think about our specific aims. So like most people, one of the big aims was to introduce some kind of intervention. So South Africa does tend to focus on, what I would call a late-stage intervention, so hospitalisation, inpatient care. And so we were recognising this massive gap. Obviously, Tafi and I are seeing that within our personal lives and that was one of the first things. So we really wanted to give something to plug the gap, so access. Tafi and I are absolute nerds, total geeks. We wanted it to be very scientific. Yes, we did want it to be something for the African context, but you know, specifically. we wanted it to be top quality for the African context. We didn't want it to be the forgotten, oh, okay, we made it for here, but you can have it anywhere, we wanted to actually do something that was ours. So I think that was the starting points which obviously leads you to thinking about the barriers. So what are the major barriers? Why is it that most people are receiving inpatient care? So you start there, you obviously start doing your research on the ground. Just ask people, don't make assumptions, what is your experience? Okay, do you have health insurance? Do you not have insurance? Those are two very different pathways, very different experiences. So starting to understand what that map looks like, and then thinking, okay, how do we plug this gap?

So our first iteration, we were actually looking at doing a completely text-based intervention. And we realised, look actually that's not going to be quite enough what for what we are trying to do. And so that's how we landed on the app. And then from the app, I basically just took therapy, it's not reinventing the wheel, honestly. There's no miracles happening here. I took what we do in therapy, so best practice and I applied that to an app. So the first point of call when you get to the app is to go through your symptom levels. We don't work with diagnosis, we tend to talk about symptom levels. Okay? I can't diagnose you, I don't know your whole history, but I also don't need to know your whole history at this point. So we get you to start thinking. So this is what Tafi was talking about introducing a vocabulary, so an understanding that's your first points already. We're saying, okay, let's talk about what you're experiencing. The user then gets feedback on those measures. We use the PHQ, we use the GAD, we use the WSAS of course. So that gives us an idea of what you're experiencing and that allows us then to streamline them into a particular treatment module. Okay. So the different modules are, of course, for different presentations. At the moment, the app focuses on anxiety, depression, and we have two comorbid groups depending on whether the user feels that they want to focus on the anxious symptoms more, or they want to start with their depressive symptoms more. So what is the bigger focus for the user at the time? We've also included what we call our wellbeing group, which is for people who have come to the app, they're presenting as subclinical in terms of their symptom levels. But clearly you're here because you feel you need something or you want something, you want to do something. So we focus on resilience there. So yeah, fine, you're not presenting, and again, I use the word presenting because we know that sometimes we can withhold information, but also no scale is perfect. So we sort of then direct those people to what I consider the more resilient focused stuff. So a lot of mindfulness, relaxation practice, so still getting something but not quite the full treatment.

The user then goes through a process in the app. So generally, it's exactly like face-to-face therapy. Basically, the modules mimic a one-to-one session. So we start off with a joke, a little bit of dopamine to get you hooked. Yes, shameless in that. Little bit of dopamine, bring a bit of humour, get you to feel a bit relaxed so you can really engage with the content. The content's very short, it's very modulated, and any session, we start by reviewing what you've done. I introduce a rationale for what you're going to learn, so that skill or technique, we go through that and most crucially, we then focus on the practice. So that's one of the things we're very big on. I think one of the things Tafi hit on is this amazing thing where CBT is crazy in that I don't actually need you to understand why you are doing what you're doing. If you just do the stuff, you will eventually notice the benefits. And that's not just based on the data, that's based on Tafi's experience, it's based on my own experience. So we very much focus on the behaviour because at the end of the day, it's, I do think it's not so much about what we think and what we say, it's about what we go and do. So we try to get the user to really focus on how are you going to integrate this? How do you make this part of your life? So very practice focused. We review the practice and the idea is that you get to a point where you feel you've mastered a skill before you move on. So that's where the self-guided part is. You can just go through it all, but the self-part is really in terms of thinking about, okay, I can give you all the tools, but you still have to make that decision for yourself if you've mastered it. And more importantly, do you find it helpful? Because you don't need to find everything helpful. We take least intervention first. I'm happy if you do one module and this is the thing that you need. Because I think that's the tricky part about any kind of therapy is finding what fits for you. What is your motivation. So for example, Tafi, he was very comfortable with the app because like he said, he likes learning so it was an environment he was familiar with. So that's really the focus on the app, is on those real world skills. And I guess ultimately we are trying to teach you that iterative process of being your own therapist. And that's really what the app is about. With some sign posting, of course, because I would be a terrible community psychologist if I didn't do some sign posting.

Helen: Tell me a little bit about what you mean by signposting, because I think I might have been about to ask you, sort of if somebody needs more or needs something different, how would they know?

Sherrie: Yeah. So one of the things about the app is we have designed it to be completely self-guided. So it can be a standalone intervention, but a tool should have more than one use. So it is also intended to be used as a therapeutic tool, not just with CBT therapists. So in terms of giving your client that literally in pocket support- you don't remember what I said in session. That's fine. Go to your app. So that's wonderful because it does free up a lot of space in your therapy sessions. We work with quite a lot of OTs. OTs absolutely love the tool. Again, it means that they can focus on something else in their session whilst also ensuring that their clients is getting that additional support because as we know, it's very rarely that you have some kind of long-term difficulty or even short-term health difficulty without that impacting your mental health. I think the main thing is find what motivates you. That's where the signposting comes in. So sometimes it's simple things like, I suggest some yoga stretching as part of your nighttime routine. Okay. I can literally signpost due to a YouTube video. Fabulous. Or I can signpost due to yoga institute that, and there are lots, that have free resources. That's the signposting.

Of course we also do crisis signposting. That's the reality if you're working with any kind of mental health. No intervention is everything and that's where I think signposting can come in handy is going, hey, we aren't actually everything. Here are some other options.

Helen: And I'm really pleased that you said that I was going to ask you about, if there was a reason to worry about someone's safety or if there was some kind of emergency really, your app helps people to go to the right place for help.

Sherrie: Unsurprisingly, it's one of the first things that we thought about. So when it comes to crisis support, most systems have their own particular way of dealing with it, who you refer to, who you deal with, you've got a supervisor, whatever the case is. An app doesn't necessarily perfectly fit into that, especially if you're an app working across multiple use cases So that was one of the first things that we thought about.So the app includes a little logo at the top of each page. So it's always there. It's quite subtle, but it's easily seen so it doesn't feel doom and gloom. It's just a little red phone, but you hit the little red phone and it's going to take you to that support immediately. And the first thing we do is we just give a normalising message. So simply say, okay, you've come to this page, you clearly need some support. You might be going through something that's absolutely fine. It's normal. But the important thing is that you get the help that you need. Here are a list of options. What do you want to do? I think it's also important that we don't just include telephones because again, I know that when we say one-to-one, we tend to think of that as a conversation, but that is, can be very generational. One to one can also be via an online chat. It can be via email. So again, I think just as a heads up to anyone who's thinking about getting into this, if you are going to be signposting, just think about different types of access. There are different ways that people like to communicate. So yeah, that normalising message and that instant support, and most crucially, make sure it's visible at all times.

Helen: You just mentioned there's a generational difference between people, so you are talking to me- I grew up listening to music on cassette players, so if you've got people out there who are maybe not so familiar with the technology, that they wouldn't necessarily automatically go to an app or might absolutely assume that if you need some kind of help, you need to talk to a person, even if you're not lying on the sofa. You might want to talk to a real person. What would you say to somebody who's maybe less comfortable with doing everything on their phone?

Sherrie: So I get the hesitation there. I think it's important to not get hung up on the delivery method. So in our research we actually found that, we had participants aged 18 to 69. And when we looked at the data, obviously we keep doing the research, but as it stands, age actually had no impact on usage or recovery.so I think a lot of the times this ties back into the ideas about therapy, is don't do yourself dirty. You don't know what your experience is going to be until you try. And it's okay if you try and it's just not for you, but you might be very surprised at just how easy and comfortable it is, and even though you're not talking to someone, one of the big things that we get in terms of feedback is that it feels like you're speaking to someone.

And then finally. We do have you in mind. We have everyone in mind. It's okay if you're not technologically advanced. I don't need you to be, that's Bernard's problem. By the way, Bernard is the other co-founder. He's the tech. It's Bernard's job to make it accessible, but we do really think about just making something that's easy. Again, it's always about reducing that cognitive load. So I would encourage anyone to just give it a try, and that goes for all therapy. So give it a try. If it doesn't work, that's also okay, but you might be very surprised.

Helen: Thank you Sherrie. And I think one of the things that you've told me before we started recording this Tafi is that one of the things that you were bearing in mind when you were thinking about accessibility, I think I understood from you that many people do have a mobile phone, but things like access to data can be an issue. So tell us how you address that as part of the project.

Tafi: Yeah, no, absolutely. And I think, I'll even broaden it to say when we think about our role, in a business journey, we are definitely not replacing face-to-face therapies or tele therapies. And actually, I always start a lot of presentations and conversations by saying if someone has the confidence, as well as the financial means to engage in face-to-face therapy, I 100% recommend it as because now at this stage in my journey I understand the benefit and the power that's to be gained from talking therapy, so that's the starting point. And then of course, for some people the confidence is an issue in which case perhaps regardless of their age, as Sherrie pointed out, they might persevere and figure out how the app works, even though we do try to make it simple. Unfortunately, in our African context, the affordability plays a bigger role because in the UK there's of course the very well, to us, very well resourced NHS to British people under resourced, which it is. but from our perspective, there's a well-resourced public health service that can give you a full dosage of help. And then maybe you can guide me in terms of when you have someone who typically has maybe moderate or moderately severe difficulties, how many sessions would they be allocated by the NHS.

Helen: Well, that's a very good question, but I would say a starting point of at least six and maybe 12 and sometimes more if the difficulties are more severe than that. Yeah, there, there is definitely the possibility of seeing someone who understands and can listen to you and even at what we call low intensity level, that would be probably six sessions. And then at high intensity, probably quite a few more.

Tafi: Okay. And, and so in South Africa we find that the people who do have access to that form of health are those who have private medical aid insurance, private health insurance, which I think is something like 20% or less of the population. And those people form pretty much the wealthier parts of society and they get typically three sessions of face-to-face therapy as what they get through benefits, unless of course unless it is, it's under what they call prescribed minimum benefits where they just have to help you. But if you are getting generally help, at an early stage, you're getting three sessions and that's often what you get either through your employer or your insurer. So there's a huge underdosing that's happening, which means people don't have the affordability barrier before we even get to the other costs. The affordability is just out of there for everybody. And then we do, as you mentioned, try to address other aspects of accessibility, and one of them is mobile data costs, because when I lived in London, you can sit next to someone on the train and there'll be streaming Game of Throne in HD, and watching the full hours episode. For someone in Africa that could be their entire year's budget for mobile data costs, the cost of streaming that. So then we have to make it sensitive to that with a lot of accessibility of the treatment when you're offline. So there's a lot of relevancy that we've built in, but I think the biggest issue we have is just sheer affordability and then the huge amount of underdosing that happens as a result of affordability. And then we also have, of course, the technical barriers of data costs, mobile phones that don't have a lot of storage capacity, things like that. So we address those challenges as well.

Helen: I mean, it sounds like an awful lot of thought has gone into the practicalities of it as well as including the science, and I'm just standing here thinking that although you've designed that for the African context, it really does sound like there's a lot of those things that could well be relevant in the continent of Europe, Britain, where I'm based. I know that Sherrie's not in Africa at the moment. How relevant is it to people who aren't in Africa or from African heritage, let's say?

Sherrie: Absolutely. I mean, as relevant as it was for Tafi when he was in the UK. At the end of the day, these are universal experiences. The only thing that's being changed is the way we communicate the ideas to you, but it's all based on the same science. I mean, none of the metaphors are going to be that wild especially in the age of Google. You might be like, what is a potjie pot? And you Google it and it says cauldron. You might say, what is a hyena? And you can be Google it and it's like an ugly dog, but you know the main idea is there. So I would say it's still relevant.

Helen: Thank you, Sherrie. I am really grateful to the two of you for coming to talk to me today and we're going to finish in a moment, but before we go, Tafi, can I ask you if there's people out there listening who are having similar experiences to the ones that brought you into contact with CBT and everything that's happened since, is there one key thing that you want people out there to know or to remember from our conversation today?

Tafi: Yeah, certainly. I think I can speak from the perspective of a man and our preconceptions of what reaching out for quote unquote help is, and it's just to say it is not a weakness, it's not a weak act. It's actually arming yourself with skills, with tools, that will only better you. So that was the key revelation for me. I always say to people, would you rather your plumber turned up with one spanner or a belt full of tools. And I think it's just gives us that belt full of tools to really just get through life better professionally, and personally as well. So I just encourage them to see it as an upliftment as opposed to an act of weakness.

Helen: Thank you so much. And Tafi and Sherrie, thank you again for coming to talk to me today. It's been an absolute pleasure speaking with you and a privilege to hear about your stories. Thank you.

Sherrie: Thank you so much for having us.

Tafi: Thank you Helen.

Helen: Thanks for listening to another episode and for being part of our Let's Talk About CBT community. There are useful links related to every podcast in the show notes. If you have any questions or suggestions of what you'd like to hear about in future Let's Talk About CBT podcasts, we'd love to hear from you. Please email the Let's Talk About CBT team at [email protected], that's [email protected]. You can also follow us on X and Instagram at BABCP Podcasts. Please rate, review, and subscribe to the podcast by clicking subscribe wherever you get your podcasts, so that each new episode is automatically delivered to your library and do please share the podcast with your friends, colleagues, neighbours, and anyone else who might be interested.

If you've enjoyed listening to this podcast, you might find our sister podcasts Let's talk about CBT- Practice Matters and Let's Talk about CBT- Research Matters well worth a listen.

In this episode of Let's Talk About CBT, Helen Macdonald speaks with Phil Cooper, mental health nurse and co-founder of the charity State of Mind Sport, and Ian Knott, former professional rugby league player and State of Mind presenter.

Phil shares how State of Mind was born out of tragedy and developed into an award-winning mental fitness programme, now reaching thousands of athletes across the UK and beyond. Ian talks candidly about his experience of severe injury, depression, and suicidal thoughts after retiring from sport, and how CBT helped him to rebuild his life.

We hear how sports settings are being used to break down stigma, encourage conversations, and promote mental health support—particularly among men—and how brief interactions and powerful personal stories can save lives.

Resources & Links:

State of Mind Sport website

Information on CBT and how to find a therapist

If you or someone you know needs urgent help, reach out to Samaritans at 116 123 (UK) or visit samaritans.org

Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts

Have feedback? Email us at [email protected]

Follow us on Instagram & Bluesky: @BABCPpodcasts

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 episode was produced by Steph Curnow

Transcript:

Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't. I'm Helen MacDonald, your host. I'm the senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies

Today what we've got for you is an episode about mental health, mental fitness and sports, and I've got Phil and Ian here to talk to me today. Phil, will you just introduce yourself?

Phil: My name's Phil Cooper. I'm a mental health nurse by background. I used to work as a nurse consultant in mental health and drug and alcohol misuse. I love sport. And, for some strange reason or quirk of random chaos, I became to be one of the co-founders of State of Mind Sport charity that focuses on mental fitness.

Helen: Thank you, Phil. Ian, please, will you introduce yourself?

Ian: My name's Ian Knott. I'm a former rugby league professional and I currently am a presenter for State of Mind. I talk about my story, my lived experience of having to retire through a serious injury and then developing mental illness. So I talk about that.

Helen: Thanks very much, Ian, and I'm sure our listeners will want to hear more about that later in this episode. Firstly though, can I ask Phil to tell us a bit more? Phil, will you tell us about State of Mind and how it came to be and what it does?

Phil: Sure State of Mind Sport began unfortunately on the back of a tragedy within the sport of rugby league, where a Great Britain Rugby League international called Terry Newton, unfortunately took his own life in September, 2010. Sent great shock waves, I think, through the whole sport for such a high profile player. At the time there was relatively little support or mental health support for players at that time. I suppose as a mental health nurse who loves rugby league and sport, I read a league paper on a Monday morning, somebody wrote an article saying how the NHS and the sport should get together to try and prevent suicide. Also, somebody also wrote a letter, again a mental health professional, called Malcolm Rae and Ernie Benbow had written the article and I saw this and thinking, wow, this is Monday morning, I shall write these two individuals- checked with my chief exec, of course, because obviously you have to be doing all these things- and then invited them to a meeting we were going to have in good old health style a conference, that soon changed when we invited a couple of players such as Ian, and they suggested, why didn't we ask the governing body for a round of fixtures to promote mental health at that time or mental fitness. I then found myself in the strange position being ferried to Hull Kingston Rovers Ground to be presented before all the chief execs of all the top divisions with clubs to say, this is a really good idea. It's free. So the sport love that bit and, we'll deliver a session to your players before the season and then a round of fixtures themed around that. So we had a State of Mind round in 2011 and player bought into it. There was very little support, as I said, and they began to talk about it on social media. They wore t-shirts in the warmup before the round of fixtures, but crucially, they knew what it was about, and they were all bought in. Things have grown massively since that time, which has been great for us. And also promoting mental fitness in rugby league, one of the toughest sports on the planet.

Helen: Thank you Phil. So can you tell us a little bit more about what you really mean by mental fitness?

Phil: Certainly, okay. I think language is crucial, as I'm sure all your members will realise and will think about on a regular basis. So for me, to get into a situation of encouraging men or engaging men into something that will help them, if I say, if I used to say, well, we'll come in and deliver a mental health session for you into a local grassroots sports club. I can imagine the reaction would be flipping heck, I'm not going into that. However, when you can make the case that actually you are going to go to training for physical fitness, what a lot of athletes will tell you that the mental fitness is perhaps the most important aspect of being a professional sports person or being the best sports person you can be. So therefore, if we go in and say, well, we're going to try and improve your mental fitness, men tend to sort of buy into that, especially if you go to them in their grassroots club, they wouldn't come to me in a community mental health team, but they would certainly go training two nights a week in their local club. And you have a captive audience potentially, especially when the weather's bad and they can't train on the pitch. And the coaches will want something different to either entertain or, keep the players focused on what they want to achieve. So State of Mind deliver mental fitness sessions so we look at anxiety and depression using a GAD-7 and a PHQ-9, as I'm sure your members will be very familiar with and again, we deliver that in a style that's not sat down in front of somebody asking them to fill in a questionnaire with a pen or online or whatever. So we'll do that. We will have two presenters usually. So Ian being one of those, I might have been the clinical dude once or twice with Ian, of course, and I'll ask him about how he's been feeling over the last few weeks using a PHQ-9 or a GAD-7. He'll tell me some strange answers, which he never used to tell me what they were going to be, I would then ask the audience how anxious or how low in mood Ian was based on those answers. So you keep all the information away from your audience, but you involve them to use all the different learning styles, so audio visual, kinaesthetic, all of those learning styles to get to as many of those people as possible. So we've been doing that for 10 years. Hundreds of thousands of people have attended sessions, which is ridiculous when I think back, but also numerous people have told us that they changed their mind about taking their own life and that's the sort of thing that keeps you going every week. And going to wherever we're going of a Tuesday or a Thursday evening, or even as I found myself in a dressing room last Saturday, so before a football match, just talking to players. So all of those things, we do mental health first aid. You can look on stateofmindsport.org if you really want to know. I don't want to want too much about that, but that's what we do. And we go to people where they are. We try to engage people where they are.

Helen: And I'm hearing you are reaching a huge number of people, probably people who wouldn't easily go and look for help, like perhaps men in maybe more traditional settings where we don't talk about mental health or mental fitness as you put it. That's really important. But also this work is saving lives and that seems to me as a really important piece of work that's happening here. And I wonder if I can ask Ian to come in now. And Ian, you said, about your lived experience and that's what's brought you into working with State of Mind Sport. Can you talk a bit about your experiences?

Ian: So my kind of story started in 2004 while playing for Leigh Centurions. At the time I probably had about 12 years I think at professional rugby. I played at the highest-level barring international level, and after 12 years of playing at the highest level, I dropped down division to play for Leigh Centurions And at the time, Leigh were making a massive push to get into Super League. I never played in Super League before, and halfway through the season, I can remember we played against Halifax away from home, and I ran with the ball, and I got tackled and there was nothing wrong with this tackle at all, but I felt these god awful pains in my lower back and it felt like my leg was, I don't know, it's like tingling and my foot was in like a bucket of water or something like that. So it felt, which was strange because we are really hot summers day. So obviously I came off reluctantly, because we are a bit stupid, old rugby players, we do play with injuries. But I did come off, and then a couple of days later the pain got worse, so I got sent for a scan. And I got told in no certain terms had a very large disc prolapse at the bottom of my back. So they said you can't play, you need to obviously get treatment and then you'll be okay for the next season. So I went back and had a meeting with the club, and we all came to the sensible conclusion to ignore the surgeon and played with a slipped disc for half a season. Now to say that was painful would be an understatement. During the week, I couldn't train at all, the pain was that bad. Then on a Saturday morning, I'd have a painkiller injection to do a ball work session. Then on a Sunday, I'd have two full syringes in for 24 places in the spine to try and get me through these games. I'd be throwing up on the pitch, the pain was that bad. It was very hard. It was very difficult, but it ended up being quite rewarding because we won the treble and we gained promotion to Super League, which was amazing. I was lucky enough to be captain and so I managed to lift all three trophies. So then two days after the grand final, I remember having an operation to relieve the disc, woke up in recovery and all the pain down my leg had gone and it felt amazing. I still had a bit of back pain but I could cope with that. So from there, I had rehab and then race to pre-season, and then the next season, like Leighs first year Super League. I think we were about 12 games in, and I think we played Halifax away again, coincidentally. And it's a similar story. I took a ball in but this time it was quite a bad tackle. I got clothes lined, so the legs went from underneath me, and I landed on my spine again. Now these pains came flooding back. I couldn't quite describe to you now how bad the pain was. because it was horrendous. But the best way to describe it would be, my wife was sat at the top of the stand, and I was in the middle of the pitch, and she would hear me screaming from where I was. The pain was bad. So I got stretchered off, straight to hospital. Again, another scan. So as I'm waiting in hospital for the operation, my surgeon came to see me, and he put my scan up on a whiteboard next to me. So obviously I asked him, you know what's the problem? So he said, look, he said, you're not going to be able to play rugby ever again. He said, in my opinion, you're going to struggle to find work again you know the damage is that bad and God knows what I'm going to find when I open you up and look in.

Now, at the time I was strong mentally, so I thought, so I'm thinking to yourself, obviously I'm going to start find work again because I need to, I have two young boys at the time, I have a wife I was supporting, so I need to find work. So I thought, I'll prove you wrong. I woke up in recovery, unfortunately for me, I was screaming in pain, the operation just didn't take, and I spent the next, I'd say roughly 12 months in that hospital. I had five operations on my spine in the space of probably two and a half years. To say that my mental health dipped in that period would be a massive understatement. I'd gone from being a full-time professional and I trained three times a day if I was bored when I got home, I go for a run. Basically, I was hyperactive, I couldn't keep still. I went from that to literally being that to being completely bedridden. My wife, she had her dream job, she absolutely loved it. She had to give that up to become my full-time carer. She had to wash me in bed, dress me in bed, she shaved me in bed. if I needed the toilet for a pee she'd help me pee in a bottle. If I needed a toilet for anything else, she'd help me with that. My wife was amazing how she did what she did, I do not know. But I did I appreciate her for it, not one little bit. I'd do nothing but shout and scream at her all the time. She'd be trying to talk to me, encourage me and I'd just shout at her all the time. Like I said, I had two young boys and they'd come off from nursery and I'd hear them coming upstairs to see their dad, excited and then that for me was like somebody putting the nails down the blackboard, they grated on me so much. I hate saying this now, I really do, my kids and my wife and my world, everything I do is for my wife and kids. But during this period, I wanted nothing to do with them because I was obviously very depressed. I did not know what depression was. And I come from an era and from a sport as well really, where you don't show any weakness. So, I took that into my normal life, and I just tried to put a brave face on things and I wouldn't talk about it, even if I did know what depression was because I was supposed to be a big tough man, so I'm not supposed to talk about the problems. So I didn't and it just got worse and worse. It felt like my head was stuck in a vice and every day this vice was just getting tighter and tighter to the point where I just felt like my head was going to explode. I was taking roughly 30 painkillers a day. I was on liquid morphine. I was on morphine patch. So if I wasn't screaming in pain or screaming at my wife and kids, I was doped out on drugs. That was literally my life in these same four walls all the time. I just, I wasn't living, I was just existing, if that's the right way to say it. And I just didn't know what to do. But I got a lifeline because I got a chance to have a device implanted in my stomach, a pain device, which is, it's called a morphine pump. It's got liquid morphine, it's got anaesthetic inside it, and it goes directly into my spinal fluid. Now, obviously, if we all have a headache or anything, you take tablets and it obviously goes down your body and then it goes to your head. With me, I was taking all this medication it had gone all the way around my body before it got to my back and by the time it got to my back, it wasn't doing anything. So I had a trial for this morphine pump and the pain relief was amazing. But it couldn't fit me in for an operation straight away. I had to wait another six months. So I had this kind of high of having this trial, which was amazing. And then the lows again the depression sinking in because you had to wait another six months. So, as I was waiting, obviously the depression got worse and worse. Again, shouting at my wife and kids again. And I'd say about three days before the operation. I can remember my spirits picked up and I was really buzzing thinking, I'm going to get my life back because that's the way they kind of explained it to me. This pump, you're going to be able to walk about more, you're going to be able to socialise more and things like that. So I was really excited. I was buzzing, so I went in for the operation thinking that's it, now my life's going to start again. But unfortunately for me, I woke up in recovery and I was screaming again in agony. The pain just didn't, so it was worse, the pain relief just didn't work whatsoever because during that six-month period, I was taking more and morphine patches, I was taking even more liquid morphine. So the dosage that they used in the trial, literally just didn't touch me. So again, I spent the next 12 months in and out of hospital. I'd say roughly about between 25 and 30 times trying to get this dosage sorted. And again, to say that my mental health dipped in that period would be an understatement because there's no other way of saying it, I became suicidal. For me, every thought on my mind was not only do I not want to be here, but mainly the way I rationalised it was I didn't deserve to be here. My wife deserves someone to love her, to cherish her, to treat her like the brilliant woman that she is. I wasn't doing that. And my kids deserve someone to love them, to play with them, to teach them right from wrong and just to be a good dad. And again, I wasn't doing that at all. So I thought the best thing for my family and for me to be honest with you, would be for me not to be here.

So it wasn't a case of, I didn't really think that I wanted to die, but in all honesty, I just didn't really think that I wanted to live anymore. That might sound weird to say, but I just, I couldn't cope with the pain that I was feeling and I couldn't cope with the pain that I could see on my wife and kids face all the time. So, I went downstairs one morning, I just had enough. I got a pint of water, a box of tablets and a bottle of Oramorph, liquid morphine. I took the tablets in the water upstairs, I started to swallow all the tablets because I couldn't cope with it anymore. I realised I forgot the morphine, so as I get up to get the morphine, I've got photographs of my wife, me and my family going all the way down my hallway and down the stairs. I started to look at these photographs and I, throughout my depression and throughout the era of suicidal thoughts, I've gone past these photographs, and thought nothing of it, but for some reason, now I'm not religious at all, but I thank God to this day that I really started to look at these photographs and it's like, I just thought to myself, what am I doing here? I think I'm doing my wife and kids a favour by ending my life when the reality is I'm going to ruin my wife's life, my son's life, my family's and God knows how many others. So I went to the bathroom as quick as I could. I put my fingers down my throat to get as much medication out as I could. Obviously rang for an ambulance and everything. And then from that point I was under the care of the crisis team at the mental health clinic for the best part of eight months, I think something like that. And my time there was, it was difficult, but you know what? It ended up being very rewarding. That's where I was introduced to CBT. And what really helped me was managing to change my thoughts because I honestly thought at the time I was a burden to my family. My wife hated me, my kids hated me when the reality is they didn't, they loved me. And it was me managing to change my thought patterns that really helped me get through this. In all honesty, I struggled with it for a little bit, the CBT, because it is difficult, but the more and more I put my mind to it, the better and better I felt to the point where, at the moment I'm in the best place mentally I think I've ever been. And that's down to me opening up and talking more. Because obviously I had counselling as well, but also through the CBT, to the point where I'd say, I think was it three, three years ago now, I was diagnosed with a form of leukaemia and what could have been the hardest 12 months of my life having chemotherapy. I wouldn't say it became a doddle because it wasn't a doddle, but it became a lot easier, and that was through, obviously, the techniques that I've picked up in the past. Because in the past I would've thought to myself, God, why me again? I've had these back problems, why me? And the reality is, loads of people go through chemotherapy, and loads of people survive it. I spun it in a total positive mindset from it. As I sit here now, I probably, I can be honest with you and say I enjoy what I do more now than what I did before when I ever played rugby, and I thought it was my dream to play rugby, where I'd say now I'm living it where I'm helping others and talking about my problems.

Helen: Ian, thank you so much for sharing that with us, and I'm aware that there's some hard-hitting stuff in there. And I really appreciate how open you've been about sharing your story and for me hearing you tell us about that, you reached rock bottom and, sort of, you found something that kept you with us, which I'm really grateful for, and I'm sure the people who care about you are incredibly grateful that something stopped you from doing that, and hearing about how you had the right therapy and you faced more challenges again, that anybody would find incredibly difficult to manage but your approach to it, the way that you've dealt with it, has been more positive because of what you learned about maybe challenging some of the ways that you were thinking, learning different ways of approaching things. And I wonder if I can ask you, I mean, I'm a CBT therapist and I know that it isn't just about positive thinking. I just wonder if you could tell us a bit more about how you and the person you were working with went about, I don't know, learning how to think about things differently. What happened there?

Ian: Well, the best thing that helped me was doing a thought diary and, actually checking what I was thinking about and then changing it. That did really help me because the thoughts that I was coming up with at first, it just, as I wrote them down and when I came to the conclusions, it just wasn't rational. It just, why is everyone looking at me? Why do I think people are judging me? And, they weren't, but it's what was going on in my head. I was actually thinking that, so to be able to talk about this with my specialist and obviously writing things down, which I still have now, and I still look at them now and I still do write some diaries sometimes. So, that would be the mainstay of what helped me definitely.

Helen: And I imagine after everything that you'd gone through up to that point, there must have been things about having the CBT that were also quite difficult. Can you tell us about the stuff that you perhaps didn't want to do or the stuff that sort of wish you hadn't had to do.

Ian: Most definitely that would be the homework. Because I've had counselling beforehand and obviously that's face to face and just talking. But coming home and then doing it at home because like at the time, because obviously you're not in a positive mind space, I was hoping to get like an instant result, if that makes sense, like just to be able to go and see my specialist a couple of times and all of a sudden, I'll be okay. And it's just not that simple, you really do have to put the work in and a lot of it is homework and writing down your thoughts and then looking at them again and then thinking well, is that right? Am I thinking about that right way? Could there be another way of thinking about that? And at first, like I said, I struggled with it. I really did. It's like, God, I don't want to do this. But the more and more I did it, the more and more it really did help me. And that, so that would be the hardest thing I did, but also probably the best thing I did as well, because that really did help me change the way of thinking.

Helen: So how did you get from whatever was happening there to getting involved with Phil here and getting involved with State of Mind Sport?

Ian: Well that was a chance meeting, to be honest with you. I went to a grand final, that's, I say this about 9 or 10 years ago, watching a game of rugby and then I was about to get in the car, I saw a friend of mine, so I started talking to him and Phil was stood next to him. So as I'm talking to my friend, my wife started to talk to Phil and it turned out that Phil is a Warrington fan, I was an ex- Warrington player. So, I started to talk to Phil, and Phil had heard about my issues. So, he invited me to come along to a meeting that to the lads were putting on and then see if I fancied talking. At first, I went to the meeting, I thought the meeting was fantastic, it really opened my eyes but then obviously my first couple of talks I really struggled with because, opening up and talking about the problems, which I've never done before, it, it really did get to me. I'd become very emotional, I'd cry and then I'd come home, and I'd feel like an adrenaline dump and I feel shattered for a couple of days, it was really hard. But the more and more I did it, the better and better it felt to the point where I really look forward to doing them now.

Helen: And that's for me, it's taken a lot of courage to do that. I mean, I'm hearing about you being at the top of your game, literally being a star in rugby, and the journey that you'd gone through to then start talking to people about what that had been really like for you. And I'm just wondering if I can come to Phil about what it was like then for you meeting Ian and getting him involved in all this?

Phil: Oh man. Well, for me, see, I told you I love sport, you see? So I've watched Warrington all through my life. I'd seen Knotty play for points and loads of times. So I knew all about his playing career, that he kicks some fantastic goals. And he talks a little bit about that when he speaks as well around some of the thought processes around that. So for me it was great. To meet Danielle is, he's a good lady who, he rightly praised immensely earlier on was great because I was thinking, ah, I was thinking. I remember going to a match at Bradford once and at half time they had some former players who had injuries such as Ian. Ian was one of those players walking round. It was a Warrington against Bradford game, and I was thinking wouldn't it be great to get Knotty to speak? But obviously I didn't know him. I've never met him sort of thing. So to bump into his wife at the grand final, you can't miss an opportunity like that to ask, say well do you think he'd be interested in having a meeting? Because I don't know anything about him really other than that. And she was going oh man, he'd love to do that, he was saying that he didn't really have a focus, wasn't obviously, because he of injury, he wasn't working and stuff. So I was thinking, because I've taught alongside many people who lived the experience. I was just hoping, well I know he's got a good story because he used to play rugby. He's had a bad injury, so I'm assuming he will have found that difficult for all the things you said from the being at the top and then not being able to play. So yeah, it's great for me. So I'm a bit like a kid really. So when we did those first sessions many years ago for all those players, my excitement was getting a signed in sheet with all the autographs of the players. Now that's sad, but, and I still got them in me loft, so obviously meeting Knotty is great for me. I'm meeting heroes and being privileged and humbled by hearing Knotty's story. I've heard Ian speak many times in front of many audiences. And also finding it difficult when he first started. But now he can hold an audience very well. And as you heard, the power of the story that he tells. So, for me, he was great rugby league player, but he is also a great presenter. Now so for me that's fantastic. So I feel privileged to have met Knotty and been able to work alongside him really.

Helen: Yeah, that's brilliant. So if somebody was coming to a mental fitness session, they might hear somebody tell their story like Ian's just told us. What else might they expect?

Phil: Okay. So I suppose the way we plan it is, so thinking about blokes and how blokes respond to different health interventions or don't, should I say. So involving players was a crucial element. So obviously someone who's a former top player, like Knotty, talking about his vulnerabilities and also how he overcame those vulnerabilities, gives you a great buy-in and engagement from blokes in an audience. Because they're seeing a bloke who plays the sport, they play a really tough sport. But being able to talk about that is an immense, again, privilege and humbling experience for me. But also, we also try to entertain people. There's always a difficult balance, I guess, or a tricky balance. You don't want to make light of any subject, however, blokes like to have a laugh when they're in any situation, so you have to be aware of that and do that in an appropriate sort of way. Really trying to do it in a stigma free, so in a rugby club or a sports club, so a nonclinical environment usually will engage blokes more.

So I think, I mentioned, a story when we first began in State of Mind when we had that round of fixtures, myself and, Jimmy, who Knotty knew at the Grand Final, was with me that day, before Knotty was involved. And we were just beside the ground. We had a free ticket. It was great. We had a marquee on the terrace. We'd only just started, people didn't know what State of Mind was. And this guy came up with this lady and said, I don't know what State of Mind is, but this is my friend and his son died recently and he's been talking about joining him on social media. So I had a chat with him about 15 minutes before the game kicked off, about support that was around in the local area or stuff that we could point into if he wanted to, so he just walks off. So I'm thinking, oh, right crikey, I hope that went okay. And then at the end of the game he came back and, on his own, but not with his friend this time. And he just said, oh, thanks for talking to me. Before, he said, this was going to be my last game of rugby league. I was going to take me on life tonight, but I don't think I will now. And then he buzzed off again. But I suppose that gave me the insight of, in places where blokes are and giving him some, an outlet maybe have a conversation. And that was a very simple conversation. And, but also something that obviously you do all the time as a therapist and when you are working in mental health. The great thing was we went back a couple of years later, same ground, different team playing against his local team. He came back with his, with his other son and his grandchild, or his grandson came up, gave me a massive hug and said, oh, I feeling emotional talking about this and he just said, oh, thank you so much for your time that day. He said. I don't know whether I'd still be here, I wouldn't be a granddad, that type of thing. And again, that just sort of ramps home the importance of Knotty telling his story. Just you've no idea who's going to hear that story and make a change based on that. Seeing someone else who can do something that's helped them, whether it's CBT or accessing support. Brilliant. And that's the point of doing what we do and that's what keeps us motivated to keep doing what we do.

Yeah, so you'll have a laugh. It's in a stigma free location. Again, little sort of brief interventions that you do as well as part of that. So there's one about alcohol where we'll have a picture of Homer Simpson and I'll do a very brief alcohol screen for people, just four questions, yes or no. And then it's just getting people to think about a situation and then move it on. You don't have to do a therapy with them, you just get them to think a little bit. And hopefully that might make them think, maybe I do need some support here. And that's all perhaps you can do in a simple, in a particular session. But we had a couple of people who've, or students and stuff who've done like, research or dissertations around what we do, been to see some of the sessions and interviewed audience members afterwards, and they say the fact that the sessions are relatable. So you can be clinical, I could be clinical and be dull as anything for half an hour. However, when you are, when you mix clinical information and Knottys powerful story, you've got a bit of a winning combination in my experience. And that prompts people to change a little bit. And just as all therapists will know, their personal interaction with somebody on a one-to-one basis can have such an important influence on the outcome. Having those sort of positive role models in front of you in somewhere that you are very comfortable being and you're not on your own, there's loads of other blokes going, And then what great feedback we get from clubs is that, blokes are talking about it next week in training, job done. You've got people to actually talk about and think and then, so we've not been an embarrassing subject to talk about, but something that they can think on, maybe go and talk to other significant others, whether it's family or whichever friends, but raising the conversation to think like, yeah actually I can talk about this. and it's quite okay and normal to do so whatever normal is, and then you can apply this to playing rugby league or whatever sport you play, you get mentally fitter, and you'll play better and get better results. There you go. Simple really.

Helen: Simple, maybe. Absolutely Phil, and maybe not always easy, but I'm really noticing that those sometimes brief conversations and being in situations where you are going to be somewhere anyway, and that message that it's okay to talk about it, and yeah there's some very heavy stuff in there sometimes, but also having a laugh with other people, while learning something about mental fitness is really positive. And again, I've already said this, but saving lives by doing something that brings that message in places where it's not always heard. And I know that, from what we were talking about before we started the recording, that you've expanded out beyond Rugby League. I'm not a rugby league player and honestly, it's a very long time since I went to see a rugby match of any kind. Tell us a bit more about how this message and this style of helping people to learn more about getting mentally fit, how's that spreading? How are you getting involved in wider things?

Phil: Okay a couple of things really. Been over to Ireland and Northern Ireland. And State of Mind has an organization or a parallel organization there. In the National Ruby League, Australia and New Zealand and Papua New Guinea, they utilise State of Mind, as a means to deliver the same messages across communities in Australia. And the Australian Rugby League team who are currently playing in the Pacific Championships, they have State of Mind on their sleeves, which is like ridiculous really in terms of having conversations and reading a paper on a Monday morning. But I just think lots of other sports, it doesn't really matter what sport you play so, for example, currently we're doing a project with two open age football teams in a local economically deprived area where suicide rates are high. The council asked us if we could have some input. Me and Phil Vievers, another one of our presenters, a former rugby league player and head coach went to, speak to players. They dragged them away from training, so I can't believe that they came. So we had a room full of these lads and they told them about what we want to do, want to try and improve their mental fitness and their mental toughness to play football in the third division of the Warrington and District League. So we're not talking like Premier League game by any stretch, right? So last Saturday, Bold Miners FC, give a quick plug there, they won't believe that they're getting a plug in this location. However, played a local Derby against Redgate FC. Now this was potentially going to be a very feisty experience at this level of a local derby where lots of players knew each other, had moved from different, from each other's teams from time to time Anyway, so met with the coach, the manager before, the head coach before, and he said, oh, why don't you come in the dressing room and have a chat with the lads before. So I just told him a little bit more about what we wanted to do, we sent them a survey that they'd responded to, so they said 80% of them wanted to improve the mental fitness. And I found myself doing an impromptu controlled breathing session for five minutes in the dressing room, about 20 minutes before they went out to, to do their physical warmup before they played. So I'm here and they're all just sat there in a dressing room, in through the nose, out through the mouth, that type of thing, thinking, wow, this is surreal that I'm doing this. But they went out, won six nil. So then now they think I'm great, they're quite happy for me to come back and do more stuff with them, which is great, clearly has nothing to do with me. We thought they played really well. However, that's the potential that you can do. So that's about being in a place where you can do something specific. I sent them another survey, said, well, which bits of these elements of mental fitness do you want to focus on? Managing stress and anxiety, emotional control, well some of the players needed that, a bit of anger management as well, but that's another thing. But they were keen to sort of address it and, help them to be better footballers. But obviously I know that's going to also include, being able to better control stress and anxiety or refer people on. So they all have my email address now, so if anyone's struggling mental health wise, they can contact me, have a chat, and I can signpost them to whether it's NHS Talking Therapies or CBT therapy in different locations. Or mental health services like, Ian spoke about. And I think every time we've been in different sport, it doesn't matter where we've been, we've been to gay league football, hurling, rugby union, rugby league, cricket, football, it doesn't really matter where you are. It doesn't matter what gender, you might have a different emphasis for the women's teams that we address, but again, you can get into that location and hopefully make a difference. And that's the key, just as every therapist will do whenever they engage for that first one-to-one assessment and try and build that initial rapport. That's what it's about. It's a simple opportunity to do

Helen: Thank you so much, Phil. I'm going to ask Ian, people out there listening, some of them may have quite a lot of familiarity with mental health or mental fitness, some might really not or be worried about engaging with it. If you had one key thing that you'd want everybody out there in the general public to know or to bear in mind, what would you say is most important from your point of view?

Ian: No matter how small you think your problems are, because everyone goes through life, at some point you have issues, you have problems and so no matter how small your problems are you need to speak your about straight away, get them off your chest as soon as you can. Especially with men, because we tend to dwell on things and we don't want to talk about our problems, but it's the worst thing you can do because it's a vicious cycle and it just gets worse and worse. So for me. Definitely it'd be to talk about your problems as soon as you can. Like I said, it doesn't matter what your issues are. It could be money problems, relationship issues, it could be anything with school bullying or social media, anything like that. You need to get things off your chest as soon as you can. It's hard and it's very brave to talk about your problems, but for me, we need to get past the being brave, and it needs to be the norm that we can all talk about our problems, and we can all just speak to our friends, just open up and talk no matter what the issue is. So that would definitely be my main thing to, to get across is to open up and speak out and offload.

Helen: That's an absolutely fantastic message, Ian. Thank you so much. And what we will do, alongside this episode is we'll put some links on the show page to make sure that people can find out more, link to the work that you are doing and other projects or other sources of help to make sure that, anyone listening who wants to find out more can do that.

Phil, have you got any final thoughts that you would like everyone out there to know?

Phil: Yeah, I suppose so. Thinking from a therapy point of view really, I think. so sometimes we're limited in where we're located, I guess, and thinking about a new 10-year plan from the labour government about health after the last 10 year plan about a few years ago. But ultimately, a prevention's going to be a big part of that, I think, and perhaps sometimes being able to adapt your practice maybe where you're located. For example, embracing different technologies like immersive technologies where you could do lots of different things to compliment the therapy work that you're doing. The other thing for me as well, again, sorry, I'll just plug this a little bit, but, Mind and Sport England nationally have a draft version that's going to be published next year, which is around safe and effective practice for organisations who provide physical activity, movement, or sports. So those people who work in those locations can feel comfortable enough or confident to signpost people, whether it's to NHS Talking Therapy, CBT, or wherever it is. So for us, it's, we are part of trying to endorse that and utilise all those principles within State of Mind and encourages many other physical organisations or charities or small organisation to try and reassure therapists about if you refer to state of mind or anywhere else, or a swimming group or a fishing group or whichever. But the people who are involved in those groups, are, look at this guidance and can, and feel comfortable and confident enough to refer people to. they're fantastic therapists that are around and, access that support. So if people are talking as Knotty mentioned, then, to get them to the right, the best place to try and find that, and therapy has a massively positive effect on so many people. So that'd be my thing. Just trying to adapt and think about how you deal with some of those things.

Helen: And it really brings to mind for me that when you broaden it out to any kind of sport and activity and making sure that we are making things accessible to anybody from any background, I know that we've spoken mostly about, men in sports where perhaps traditionally the idea of being manly isn't to talk about your feelings and actually how much bravery and courage it takes, but how beneficial it is. But that really does apply across the board. I mean, you've mentioned it doesn't matter what gender and any other background that people come from, there will be a way of accessing the right kind of help. And the more that we can do to make things available in the communities where people actually go anyway, much more likely for people to be able to get the right help if they need support, sooner more geared to their particular needs.

And I'm delighted to hear from you two because I mean, I'm a therapist and we talk quite a bit about men who don't talk about their feelings. And you two are a great example coming from, I don't know if I could use the word quite macho kind of sport, talking in such a way that's really showing that talking about it. However hard it is really worth it and can be done by people who might not normally do that.

Ian, can I just ask you if there's anything else that you would like to say before we finish this episode, is there anything that you would like to share with our listeners?

Ian: Yes, there is actually, it's no matter what therapy you kind of diagnosed to go down or what someone advises for you, to stick at it. Because I've had counselling a couple of times, obviously CBT, mindfulness, and for me, you've got to stick at it because I think every single one of them at one point, I thought, Oh my God, I don't want to do this anymore, this isn't working, but the more and more you do stick at it, the better it gets and it will help, 100%. That's my opinion anyway. I honestly think that no matter what the therapy is, if you put enough work into it, you'll get the help that you need.

Helen: Thank you, Ian. Any final thoughts? Phil?

Phil: Yeah, just to add to that really Knotty that, any therapist working with anyone who does any sport. If they've ever done any training, they'll know about repetition and trying to be as good at kicking a ball, passing a ball, whatever it might be. So to continue to that repetition of controlled breathing or mindfulness pays off. So as you say it's a good sort of way to encourage someone to continue when you put it in the terms of physical fitness and training. So it's exactly the same, just different ball games, so to speak.

Helen: Ian and Phil, thank you so much. It's been a great opportunity to speak with you today.

Thanks for listening to another episode and for being part of our Let's Talk About CBT community. There are useful links related to every podcast in the show notes. If you have any questions or suggestions of what you'd like to hear about in future Let's Talk About CBT podcasts, we'd love to hear from you. Please email the Let's Talk About CBT team at [email protected], that's [email protected]. You can also follow us on X and Instagram at BABCP Podcasts. Please rate, review, and subscribe to the podcast by clicking subscribe wherever you get your podcasts, so that each new episode is automatically delivered to your library and do please share the podcast with your friends, colleagues, neighbours, and anyone else who might be interested.

If you've enjoyed listening to this podcast, you might find our sister podcasts Let's talk about CBT- Practice Matters and Let's Talk about CBT- Research Matters well worth a listen.

In this special episode celebrating World CBT Day 2025, we explore this year's theme: CBT: A Solid Return on Investment. Host Helen Macdonald, Senior Clinical Advisor at BABCP, is joined by a range of voices reflecting on the impact, value, and future of CBT.

We hear from:

• Dr. Adrian Whittington, National Clinical Lead for Psychological Professions at NHS England, about the rollout and outcomes of NHS Talking Therapies.
• Dr. Stirling Moorey, BABCP President, on the historical development of CBT and its increasing relevance and recognition over the decades.
• Nic, a former CBT client, who shares how therapy helped him manage anxiety linked to a long-term health condition.
• Dr. Saiqa Naz, past president of BABCP, who discusses her personal journey into CBT and her commitment to inclusion, diversity, and working with underrepresented communities

This episode offers a rich blend of lived experience, clinical insight, and future vision, showing how CBT continues to be a wise investment for individuals, services, and society as a whole.

Further information and links:

Visit BABCP to learn more about CBT

Find support via NHS Talking Therapies

Discover more about World CBT Day

Find our sister podcasts and all our other episodes in our podcast hub here: https://babcp.com/Podcasts

Have feedback? Email us at [email protected]

Follow us on Instagram & Bluesky: @BABCPpodcasts

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 produced by Steph Curnow

Transcript:

Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't. I'm Helen Macdonald, your host. I'm the Senior Clinical Advisor for the British Association for Behavioural and Cognitive Psychotherapies.

Welcome to this special episode of Let's Talk about CBT celebrating World CBT Day. World. CBT Day takes place every year on the 7th of April, and this year's theme is CBT: A Solid Return on Investment. In this episode, we're exploring just what that means- I will be speaking with Adrian Whittington, who's the National Clinical Lead for Psychological Professions at NHS England and with Stirling Moorey, who's our current BABCP President about how CBT has developed over time and the importance of continued investment in it.

We'll also hear a personal story from Nic, who is a former client of Stirling's, who shares how CBT helped him manage anxiety and improve his quality of life. Finally, I sit down with Saiqa Naz who is past president of BABCP to talk about her journey into CBT from starting out in the Improving Access to Psychological Therapies services, to completing a clinical psychology doctorate, and how she embodies the idea of CBT being a real return on investment.

We hope you enjoy this episode and the range of voices reflecting on the impact and value of CBT. Let's get started! Here's my conversation with Adrian and Stirling….

Adrian, would you introduce yourself please?

Adrian: Yes. Hi. I am Adrian Whittington. I'm National Clinical Lead for Psychological Professions at NHS England, which means within England I'm the professional lead for psychologists, psychological therapists, and psychological practitioners.

Helen: Thank you, Stirling, please introduce yourself.

Stirling: Hi, I'm Stirling Moorey. I am currently the president of the BABCP and I'm a retired psychiatrist and really have been around in the CBT world since 1979. So, Adrian is speaking about CBT today and in the UK particularly and I'll just give a bit of a view of what it's been like to be in the CBT world for this length of time.

Helen: Thank you very much. And so Stirling, if we come to you first, that's a long career- you must have seen a lot of developments over the years. Tell us a bit about what you've seen and how things have developed.

Stirling: Indeed, I mean, so right at the very beginning when I was a medical student, cognitive therapy was just being invented. And so we had BT, Behaviour Therapy, but not the CBT that we have today. And so it was quite sort of revolutionary. The behaviour therapists look down their nose a little bit at it, the psychoanalytic therapists very much looked down their nose, and I remember at one point talking to a psychoanalyst who told me that being a CBT therapist was a bit like playing a tin whistle compared to being a concert violinist. I think things have changed since then. So, over the years, what's happened is that really from the work of pioneers like Isaac Marks in behaviour therapy, Aaron Beck in cognitive therapy, for the first time psychotherapists started to actually address what evidence do we have that this works? And using randomised control trials. And this has been really powerful. It was revolutionary at the time because people thought you couldn't manualise therapy but Beck and others managed to do that. I think that's been the legacy of that, is that the services that are recognised to be really effective and are spread out across the UK that Adrian will talk about, have resulted from us gathering evidence that CBT works. The other thing that's happened is that really up until the early 2000s, we were using CBT in a lot of contexts in the UK, evidence accumulating that it was effective for anxiety disorders, depression, but other things like eating disorders, psychosis, long-term conditions, various things but they were all being delivered within a hodgepodge of services really. And I remember when the IAPT services that Adrian will be talking about, were about to be developed, my chief executive in my trust said this is amazing, it's like moving cognitive therapy from being a cottage industry into therapy mills as he called them. So, we have therapy mills across the UK, which are proving very effective in helping people with anxiety and depression. And it was that revolutionary input of David Clarke and Lord Layard who said, actually, we can work this out as a way to deliver therapy effectively and efficiently, not just in these services here and there, but across the whole country. So there's been so much change and now CBT is there for everyone.

I suppose just finally thinking about what its impact in public consciousness has been, although people maybe have heard of it and maybe witnessed people who've received it, there've been some subtle changes, I think in our perspective on the world that have been influenced by CBT. I think people from the behavioural side now are recognising that a lot of our behaviour is learned in our everyday life. We have habits and people notice they have bad habits and go to podcasts to try and get them to rid them of their bad habits. And people are really aware of cognitive bias- it's there in the media all the time, that recognition that our thinking is not always that rational and straight, for good or ill. And then the third thing is there's a new wave of CBT that's come along that's called the third wave of CBT is really looking at how we can look in and just be aware and notice our thought processes. And so the whole field of mindfulness is very popular these days. So CBT, I think even if people aren't aware of what CBT is as a therapy, it has perfused our consciousness.

Helen: Thank you very much, Stirling. That sounds like a whole symphony orchestra, not just a tin whistle from what you've been saying during your career. And thank you because that perspective of many years in the field and how things have developed, it leads us nicely to speaking with Adrian about, you mentioned IAPT, which stood for Improving Access to Psychological Therapies. I'm going to hand over to Adrian to ask him a bit about that project, how it came about and what happened.

Adrian: Absolutely. Thanks Helen. Well, of course I'm a relative newcomer to the field having been trained as a psychologist 30 years ago and done my additional CBT training, I think 19 years ago, including under Stirling's tutelage as one of my training supervisors. So, it's great to join this session today with Stirling. So, NHS Talking Therapies as it is now was called Improving Access to Psychological Therapies is really something we're very proud of and feel as a sort of world leading program in implementing psychological therapies at scale. As Stirling's mentioned, David Clark and Lord Richard Layard were instrumental in founding the service and arguing successfully for its initial funding and have really been sort of fundamental to its success ever since. It's received investment every year, under every government since 2008 in the UK and it is just an England service so it's important to also remember there's other parts of the UK that don't have the same sort of service at the moment. It really makes a public promise, which is that it will deliver NICE guided psychological treatments. So NICE are our evidence-based, practice guidelines in, in the UK and, sort of established by independent panels of experts for each type of condition. So it makes a public promise, it will only deliver NICE recommended treatments, psychological treatments, that the therapists that deliver them will be fully trained and properly supervised and that it will publicly reveal its outcome data, anonymised, of course, but for the whole country so that we can see at a national scale, but also locally, how the service is performing, and the service can learn and the best performers can show what they're doing that's being so successful, to produce the best outcomes and other services can, can seek to learn from that and implement some of the same strategies.

So we now have a sort of situation where for a number of years, the service has met its objective of 50% of those who coming into the service, are recovering completely from anxiety or depression and about two thirds, improving reliably, during the course of treatment. But it didn't start there, of course, in the early days of talking therapies, as it was then, we would be sort of more around the 30% recovery mark, and it really is through the sort of publication of outcomes and the ability of the service to learn and improve as it goes. That we've reached the 50% objective, and I think we can go further. I'll just mention something about the sort of return on investment point, 'cause I know that's the sort of important theme for today. The latest modelling that we have from London School of Economics shows that a course of talking therapies pays for itself within two years. So the benefits that are generated for the economy are such that within two years post-treatment, the course has paid for itself. We've also got some very exciting evidence coming out of other parts of the world, so there's a Norwegian study recently using, looking at service that is very close in, in sort of style and operation to NHS Talking Therapies that suggests that over a six year period, the benefits economically of investing in a course of talking therapies are fivefold. So in other words, the economy gets out five times more than it puts in over a six year period. So I think that the indications are very clear that the return on investment is there, and there's of course a lot further that we could go. There's a lot more that we could do and perhaps we'll have an opportunity to talk about that.

Helen: Well, yes, and thank you Adrian. And what I heard you say there is not only is the CBT itself, and as Stirling was saying, the CBT itself is evidence-based, we know that it works. And what you've just been saying is about the way that we offer that to people, the way that people can have access to that is also important. It's not just that the therapy itself works, but the fact that we're measuring outcomes and working all the time to improve outcomes. So the whole system, not just the individual on the receiving end, is really important here. And I just wondered for people listening who are perhaps not familiar with sort of measuring outcomes and things, 50% doesn't sound like an awful lot- and you did say that we might be able to improve on that. I just wondered if you could say with treatment before we had CBT widely available in England and what kind of outcomes were people looking at or why is 50% good when we'd be kind of hoping for a hundred?

Adrian: Of course, and of course we hope that every individual who uses the service will recover. But it's not always possible to achieve full recovery within a course of treatment. And this is of course true of physical health treatments as well. But what has happened through the innovation of NHS Talking Therapies is that we now know exactly what's being achieved. And we didn't in fact know this at scale before. So we knew through research trials, which are of course a slightly rarefied version of treatment as usual, where there are sort of very high quality aspects being sort of added in; the state-of-the-art supervision, making sure the therapists are fully compliant with the treatment being delivered as expected. And we know that in those trials it was possible to achieve upwards of 50% recovery rate. So, actually for depression. I think the more real world type of trials was around 50%, but we know it's possible to get much higher than that with some of the anxiety disorders, with some of the specific CBT treatments for those. So, I think we can go further. We thought 50% was pretty stretching, I think when the service was launched. And of course it's taken a while to get there, but we have now stabilised at 50 and so I think it is actually time to push on and see if we can push that further.

Helen: And can I ask Stirling, do you have any thoughts about this?

Stirling: Yeah, so sort of sharing again, my long, long in the tooth sort of view on this. So when I went to the Centre for Cognitive Therapy in 1979, they'd just published the first trial of CBT for depression. And, at that time, medication was the gold standard, and they were told there's no way in which you're going to be able to meet the level of recovery that we get with medication. But that level of recovery is only 50-60%, at the best. And of course that trial showed that it did, that the recovery rate was equivalent or if anything slightly better than the gold standard of medication. And so I think, it would be wonderful, wouldn't it, if we could get a hundred percent of people better. But, in the real world there are so many factors that will influence that. And even in the best designed clinical trials where you get the best medication delivery and adherence, or the best psychotherapy for depression, we're only talking as Adrian says, about 50 to 60%. So if we're getting something equivalent to that out there in the real world in the talking therapies, I think we're doing pretty well.

Helen: And I think it's really important to hear that we are doing the best we can with what works and investing in treatments that really do make a difference, the best that we can do. So going on from there, Stirling, can I ask you how you see the future? I mean, how do you see things going forward and what would you like to see?

Stirling: Well, I think, there's been this tremendous investment in talking therapies for common mental health conditions, which were in the past were sort of looked and that has, sort of, as Adrian was saying produced tremendous results. What we need is to be looking at evidence-based therapies in secondary mental health care where we know that, for instance, CBT for psychosis is a very helpful treatment alongside the usual drug treatment and support. And in eating disorders and, in various areas. So looking at how we might be able to bring in some of the lessons learned from the Talking Therapies program, so that these areas can have both greater investment, which I think is really important and a way of actually delivering evidence-based treatment and evaluating it. And I think there are some interesting developments that, again, Adrian may be able to talk about in that area. So I would like that to happen and the other thing is that for some disorders, CBT is very clearly the most effective treatment. For others, we have a range of evidence-based therapies, and I think that is what's quite nice about the Talking Therapies approach is it isn't limited to one. It's saying if something is effective and we can actually find a way of delivering it effectively, then that can be in the mix too.

Helen: Thank you very much. Well, I think Stirling has invited you to talk about future developments there, Adrian, what are your thoughts?

Adrian: Absolutely. Well, of course, the NHS talking therapy service for anxiety and depression mustn't stand still. So, it's currently seeing about 670,000 patients per year. We know though that's only actually a very small proportion of people who experience anxiety and depression. So there's a lot further we can go on reaching people who could benefit, and that's really important that we continue to do that. And the service also, despite its huge success isn't perfect. We know that there's wait times that are longer than we would like for people to start treatment. So although, people are sort of reaching the sort of assessment point pretty rapidly and having that first contact pretty rapidly, there can be waits that are longer than we would like for treatment to start. So, for that reason, we've been successful in securing additional investment in the service over the next five years that will help us reach more people and reach them faster. And it will do that particularly by increasing the number of high intensity therapists in the service, so those are the people delivering psychotherapy rather than the guided self-help, including CBT therapists. So that's a really important investment that we want to see through, to maximise the benefits, seeing more people for treatment and enhancing as well our recovery rates. We think we can get the recovery rates up. But as Stirling said, there's obviously a whole lot of other potential groups who could benefit from talking therapies or psychological therapies that currently don't often receive a service. And we just wouldn't accept this in other areas of medicine, that, in cancer care, you wouldn't accept that radiotherapy isn't available and so people will just have to make do with chemotherapy. In this case, there's a very clear moral argument for us rolling out the success of psychological therapies to those other conditions, so psychosis, bipolar disorder, experiences that are sometimes classified as personality disorder, eating disorders, key examples. And we do have ambitions to further rollout access to those therapies for those conditions. We've done quite a lot over the last few years to train additional therapists in existing services, but we know that the method of delivery there is a bit challenging because there's so much other pressure on those services so it's hard for people to protect time just to deliver therapies. So really in the next phase of this, what we would like to see is, services that whose main focus is delivering the therapy, working very closely with hand in hand with sort of more traditional community mental health services because of course, for these groups, it might be necessary in many cases for there to be a sort of multidisciplinary approach, other team members involved. It will be a bit different to the talking therapies approach for anxiety and depression. So we're very keen to push that forward and we're working to sort of further the cause of that additional investment. We're not quite there yet.

Helen: Thank you, and it must be really heartening for people listening to hear that the intention is to make sure that as many people as possible who can benefit from those treatments that work are going to have access to it. You did just mention there that services are under pressure and it does make me think that we talk sometimes you, you hear things in the media about services being under a lot of pressure. Is there anything that we can say from a CBT perspective about, looking after the staff or, anything else that we can do to make sure that the people delivering the services do as well as they can.

Adrian: Well, I suppose, it may seem obvious, but sometimes we forget that unless you have well staff, you can't have staff who can truly help patients. And so it is really important that we get this right and that we make sure that there's a sort of, psychologically safe environment within which teams are working. And of course that doesn't mean stress-free environment, but it does mean an environment where the sort of inevitable pressure is dealt with in a constructive way. People are able to speak up to improve things, et cetera. And that's the sense in which I mean psychological safety. It's teams where people can work constructively together, even when the going gets tough.

Helen: Thank you. I don't know if you've got anything to add about that. Stirling, I know that staff wellbeing is a subject dear to your heart.

Stirling: Yes, indeed. I mean, it's one of the things that I want if, if a president of the BABCP can make any difference at all. it's, the hope is that perhaps, we can start to look at staff wellbeing, and maybe on, on a number of levels, that sometimes the attention to burnout has been focused very much on the individual and making them more resilient. And that's important. But we know that actually the factors that are perhaps more important in burnout are more systemic, they're more things to do with the pressure of face-to-face and the system, the service in which the person's working. So I'd really be keen to start looking at what services do that job well, where are the ones where that retain their staff, where staff are satisfied, where they feel able, as Adrian says, to speak up and how do we roll that out? How do we make services that perhaps are not doing quite so well aware of that, because it has a knock on effect everywhere. And particularly the key thing is as you say, if you don't have well therapists, then they can't be so helpful to their patients.

Helen: Thank you. and I know that we haven't necessarily mentioned this overtly while we've been speaking, but my understanding is that services that make sure they're really paying attention to things like diversity in their staff team and making sure that they properly promote access for people from all sorts of different backgrounds are likely to do better. And I don't know if you wanted to say anything specifically about that.

Adrian: Yeah, I mean, it's a really important point, that you raise about dealing appropriately with equality, diversity, and inclusion, and it's something that we know from the data and talking therapies, where we've got further to go. I think. ofcourse, we want to achieve and offer the same sorts of outcomes for people of all backgrounds, and all different protected characteristics who make use of the service. That hasn't always been the case and it still isn't always the case. And so that needs to change. We need that to be a sort of relentless focus. And I think actually, having, some staff teams where everyone feels welcome, included and free from harassment and bullying is vitally important to creating those outcomes for patients. But I suppose one thing that I do want to reflect on is that through the sort of gathering and publication of data, we've been able to do exactly what was referring to earlier in this sort of domain, which is learn from the services that are doing really a lot better with diversity and try to spread that learning. And, we still see disparities and we want to iron those out. But the fact that you see disparities and that some services are able to achieve just as good results or better results, for example, working with ethnic minority patients compared to white patients, suggests that is possible and we need to find out what they're doing and make sure that learning spreads. And that's what we've been trying to do. And sort of, if you look at this data at national scale, we have seen really significant improvements in that sort of equality of outcome, but a lot further to go and still some really troubling hotspots where we would like to iron out inequalities.

Stirling: I agree. We've got a long way to go. I suppose from my perspective, having been teaching since the 1980s, what's changed is in the faces that I see in front of me in our CBT courses, is they're no longer exclusively white middle class people. And I think that the talking therapies initiative has really worked very hard to make the workforce more diverse. And I see that in the people that I'm teaching, but we still have a long way to go, particularly in serving diverse communities.

Helen: Well, it's been really interesting to speak with you both about this and some really interesting developments over the years and interesting views of what's going to happen in the future and exciting things that are going to happen in the future. Just wondered whether you have a key message that you would like people to hear or, one specific experience that highlights that theme about CBT being a solid return on investment. I'm going to ask Adrian first and then go to Stirling. So what are your thoughts, Adrian?

Adrian: I mean, in terms of a key experience, the key experience that I've had is working in the services and seeing people recover and lives be transformed. And that's actually the return on investment that's most important. But if I have one message that's more to those who might be decision makers, in governments for example, it would be investing in talking therapy through a range of different conditions, helps to grow your economy and it reduces use of other healthcare services.

Helen: Thank you very much, Adrian. Stirling?

Stirling: I'd echo that. Really, that's exactly what I was going to say. That CBT can be helpful both on the very much the personal level, which is what's the most important thing, but also economically, there's an argument there. I think just backing that up, so we want to speak to people who might be funding these services in the UK or elsewhere, but also, I think I'd like to maybe speak to some of those people who haven't had CBT or have heard certain things about it. There are a lot of myths about this approach, that it's sort of ultra rational, that it doesn't address feelings, all sorts of things. And I hope that, we've started today perhaps a bit of a conversation about how it can be more, it is more, nuanced than that. And it's about, like any talking therapy, helping real people. And I'll be interviewing a client who's received some CBT who will speak from that very personal viewpoint, how it can change lives and maybe a good return on investment.

Helen: Thank you very much. I'm really grateful to you both and we'll put some links to more information, in the show notes that go with this recording but it just leaves it with me to say thank you very much indeed, Adrian, and thank you Stirling. Really appreciate you speaking with me today.

Coming up now, Stirling is speaking with a former client, Nic

Stirling: Hello, I'm Stirling Moorey. I'm president of BABCP and a cognitive behaviour therapist and on world CBT Day where we're thinking about CBT as a good return on investment, the most important aspect of all of this is the clinical impact is what this does to help people who are coming to terms with problems in all sorts of areas of life. And I'm very pleased today to have with me a client who I've worked with, Nic Allen, who's going to tell us a little bit about his experience of CBT. So welcome Nick.

Nic: Hi there. Thank you.

Stirling: Hi. so maybe if we kick off by you telling us a little bit about what brought you to consider having a course of therapy and why CBT.

Nic: Yeah. So, I think my experience with anxiety related conditions had been going on for a couple of years. And initially I don't think I was entirely aware that I was suffering from an anxiety related condition. So to provide a little bit of background on myself, I. I have a, inherited heart condition, hypertrophic cardiomyopathy, which has led to like a few lifestyle changes with my life, but generally I've been fit and healthy. And in my early thirties I started to experience some kind of changes in symptoms in my general life, which I think in hindsight probably were related to anxiety more so than anything else. They culminated in panic attacks, so kind of sporadic panic attacks, but several, like a year, maybe once every few months, as well as some kind of baseline anxiety that I was living with day to day. And ultimately what it was that led me to seeking help for CBT was, I tried a couple of different things, I'd gone down the route of speaking to cardiologists and assuming that maybe some of my symptoms were cardiac related. I tried a few kind of like mindfulness type things but ultimately it got to the point where the anxiety was getting in the way of my everyday life. So it was getting in the way of being able to do certain kind of like medical procedures to look after myself and just generally getting in the way of things like holidays and work and things like that. And then via recommendation from a family friend, got in touch with yourself and then, yeah, took it from there.

Stirling: Yeah. Thank you. And so the anxiety was beginning to have quite an impact on your everyday life. Was it?

Nic: Yeah, absolutely. And I think it wasn't entirely clear at the time, and I think in hindsight it's become more clear how much that was having an impact. So it was, the interplay between the anxiety and living with a heart condition meant that, I think I was hypersensitive to any kind of symptoms of physical discomfort, which meant that I was living quite like a limited life. So anytime I felt vulnerable or fragile, whether it's cardiac related or not, I was changing my lifestyle. I was not going out, I was not leaving the house, I was not traveling on certain forms of transport or going to busy places, it was really going in the way of everyday life. And then, yeah, the worst-case scenarios were panic attacks, which meant things like having to leave restaurants in the middle of a meal, all sorts of things like that.

Stirling: So in addition to the panics, your life was sort of understandably becoming more restrictive because if you're fearful that there might be something seriously wrong with your heart, it makes sense not to take risks really.

Nic: Yeah, absolutely. And there was also the kind of, the interplay with physical symptoms of anxiety. So, specifically for myself, I think I felt, kind of impacts on digestion and specifically indigestion and heartburn. And obviously the interplay between the feeling of heartburn and a discomfort in my chest and having a heart condition meant that I was quickly getting into these kind of, these like vicious cycles where it was self-perpetuating. And that was both unpleasant in the immediate term, the physical sensations, but also help to like perpetuate the anxiety.

Stirling: So you've begun to talk a little bit about how perhaps a cognitive behavioural model helped you to understand what was going on. So maybe if we move on to what happened in, in treatment and, maybe starting with what in CBT we call the formulation, which is finding a way of making sense of people's symptoms. So tell us a little bit more about what you learned there.

Nic: Yeah, this was really interesting. This was one of the first things we did together and was one of the kind of first tangible resources I had to help process these thoughts. The formulation, I guess for anyone who's not familiar, and my experience of it was a diagram which sketched out my thoughts. So thoughts that would go through my my brain when I was feeling anxious, the physical sensations that I would then experience as a result of this. So that would be things like heart racing and sweaty palms. Linking that back to a trigger which would trigger all of these things. And then the safety behaviours that I would take when I experience these thoughts and it's kind of hard to visualise, but all of these are connected with different areas indicating how they interact with each other. And I think having this formulation, something that I could look at, visualise, memorise, started to help me make sense of what was going on when I was experiencing these things because, prior to that, it was very hard to get my head around it. I didn't understand the theory, but what I could understand was something was definitely wrong because I was feeling physical symptoms and I was feeling discomfort and pain and fear to the point where in these worst moments, it felt life threatening. It felt like I was about to collapse and die. So to not be able to understand where that's coming from and how all of these things interact with each other meant that I found it very hard to process, and the formulation was the first step towards being able to process this.

Stirling: Yeah. Yeah. Great. And help to guide us a little bit in the work we did together. Yeah. So what were the things that you found most helpful about the therapy?

Nic: Where to begin and so many things. Honestly, I don't know where to begin because take taking a step back, it's been absolutely life changing. It's helped me process these kind of experiences and these, these feelings and basically the mental health issues. I was struggling in a way that I didn't think was possible, I thought it was something that I was probably stuck with or it was just a side effect of life. So at a high level, it's been huge. I think if we want to talk specifics, maybe going from like early on that even the formulation. Initially that started to explain how I could be getting physical symptoms like a racing heart, and then those symptoms potentially not being cardiac related, they're not being related to having hypertrophic cardiomyopathy, potentially they're related to anxiety. And trying to understand like how that all works together, where the anxiety might come from, it started to give me almost a path to understand that, ah, maybe this isn't just, I've got this inherited heart condition which means I'm destined to be ill for the rest of my life. And then, yeah, it's almost like by beginning to understand what might be going wrong, that then I felt empowered to be able to tackle it and tackle it together with yourself.

Stirling: Great. And you've mentioned this idea of safety behaviours, which is things that we do when we're anxious to try and keep ourselves safe in various ways. So it'd be interesting to unpack those a little bit. We mentioned earlier how your life was getting more restricted and you were avoiding certain things. we did some experiments to overcome some of that avoidance, didn't we? How did, how did that play out?

Nic: Yeah, this was a really interesting part of CBT for me to learn, I guess, both for the process and then actually try it out myself, the concept of experiments and it was really powerful for me. So some of the safety behaviours, just to list a couple of ones, were things like holding my partner's hand, seeking reassurance from even my partner or phoning my sister, potentially doing like little things like drinking a sugary drink or something like that. All of these things, which I thought in the moment were things that were keeping me safe and helping me. And I think by working through CBT with yourself, Stirling we were able to, I guess, like rationally analyse whether they actually were keeping me safe, was holding my partner's hand going to prevent me from having a cardiac arrest and rationally, obviously it is not going to. So by understanding that it gave me a chance to process what I was doing, and then that allowed us to formulate these experiments which we could run. So when I was feeling anxious, when I was potentially getting into a situation where these safety behaviours would appeal to me, I could proactively test not doing the safety behaviour, which was a little scary to begin with but I was able to do it, especially in a kind of gradual way. And then we could see the results and see whether anything got better or worse and see whether the safety behaviours were actually helping. And, unsurprisingly, they weren't helping. But it was one thing to know, it is another thing to prove it to myself via experiments.

Stirling: Yeah, absolutely. And, you've mentioned also how it's tricky when you have a physical condition to disentangle some of the sensations that you're getting from what might be anxiety related or might be normal sensations. Would you tell us a little bit more about how you managed to do that over the course of the therapy?

Nic: Yeah, this was really interesting, and this is something that early on in the therapy I was worried I wouldn't be able to get kind of conclusive evidence on like, how would I ever know something isn't my heart condition? How would I know it definitely is anxiety? And I think a couple of things. I think we established that one- I may never get a hundred percent certainty on this stuff that I will have to live with some element of uncertainty, but that's also true for almost everybody, if not everyone, so that became easier to accept. The other was just observations of these experiments, both kind of proactive experiments and kind of accidental natural experiments. So if ever I was in a situation where either I deliberately avoided the safety behaviour and then saw that the physical sensations of say heart racing, hands getting sweaty, didn't happen. That's more evidence for the fact that there probably was an anxiety spiral that was what was causing a or panic spiral that was what was causing the symptoms. And I think by building up this bank of evidence, I guess a natural experiment would be an example of where potentially I was in an anxiety inducing situation, but didn't realise it. I was distracted by something, something unusual had happened and I was distracted by something in the background, a TV being on in a situation when typically I would get anxious and then realising afterwards, oh, that was unusual. Like typically I would've got anxious there, but because I was watching TV I didn't get anxious, which again is more great evidence for the fact that it's probably not a heart condition, because a heart condition wouldn't respond to that. It probably is an anxiety condition that is causing this stuff.

And yeah, by building this bank of evidence week on week, it just got to the point where it just made sense that it was anxiety and I was not able even to convince myself. I just truly believed that it was that, and then almost because I believed that, it became easier to keep testing it and keep pushing the envelope further and further with more difficult experiments to the point where it felt almost like I was training myself. It was almost like going to the gym, but for my mind, kind of building up this resilience to these situations. And the stronger I got the more I reinforced that those conditions pro the root of it probably was anxiety.

Stirling: One of the things that you mentioned, a little bit earlier was. getting reassurance from your partner and and so on. And, it might be helpful to people who are perhaps partners and friends of people with anxiety problems who are going through CBT to hear a bit about how she helped.

Nic: Yeah, absolutely. So, my partner Isabel has been incredibly helpful throughout all of this, both in terms of encouraging me to get help and also supporting me when we're doing this. In terms of what maybe potentially advice to people who are in similar situations. One I would suggest, if you are taking course of CBT, inviting your partner along to come to a session. So we did a session together myself, Isabel, and Stirling, that was incredibly useful. In terms of kind of small, practical tips that help for me, I think, an important step forward was when Isabel and I discussed the, I guess, what to do in a situation where anxiety is setting in. So that would be I think prior to this, whilst I would give into safety behaviours, people around me would also give into safety behaviours and it almost like facilitate these safety behaviours. So Isabelle would be holding my hand and would be reassuring me. Whereas once we've established this formulation and I've shared that with her, she was able to tell me, kind of coach me through it. So say like, okay, if an anxiety situation is arising, then to lean into the anxiety, remember what we've discussed in therapy, try and like ride out the wave of it, remember that it will pass. But also be reassuring in a kind of, in a useful way, which would be something along the lines of acknowledging the situation is real, acknowledging that it is this, it is uncomfortable, but that you can handle it and work your way through it rather than, so instead of it being a safety behaviour, kind of being a bit more of a coach.

Stirling: Great. Thank you so much for sharing those experiences and talking about them so clearly. Anything else that you'd like to say and particularly anything that you would say to people who might be considering whether CBT would be helpful for them?

Nic: Yeah, I think. I think for me, I was probably sceptical before starting this whole process, and then I'd say midway through, I'd say it was possibly after four sessions, there was, it felt like there was a big breakthrough and suddenly things started to get so much better. And towards the end of the sessions I was, I completely changed my opinion, almost to the point that I started to feel like we should be teaching this in schools, some of these skills. I felt like it was something that I just wish I'd known years ago. In terms of like my decision to do it, that decisions I made when I filled out the initial form to get in touch. I think honestly it was one of the best decisions I made in my life, particularly when it comes to like return on investment for it. So in terms of things I've done for myself, that was probably the most impactful thing that I've ever spent money on. I was fortunate to get some support from my workplace, I know it can be expensive, or it can seem expensive. The way I was trying to think about it, it was comparing it to save the price of something like a holiday and maybe having to kind of forgo a particular holiday and instead do this. And in terms of like return on what I've got from that, this has changed my life more so than a holiday would. I do still enjoy going on holiday, of course.

Stirling: Yeah. Thank you. And just to say to people that the other part of this podcast, we were talking about CBT available on the NHS and the Talking Therapy Services are also there to provide help with anxiety disorders and depression. So thanks very much indeed, Nick. Thanks so much for coming on and sharing your experiences today.

Nic: No. Thank you so much for having me.

Helen: And coming up now I'm speaking with Saiqa Naz, who is past president of BABCP

Helen: Saiqa, would you like to introduce yourself?

Saiqa: Hello, I am Saiqa Naz. I am past president of BABCP, so I was president until November 2024. I'm a clinical psychologist and also a CBT therapist and I work in a learning disabilities service.

Helen: Thank you, and one of the reasons why I said you were a solid return on investment is that you were part of a big government project in England, which involved investing very heavily in CBT in what was called the Improving Access to Psychological Therapies Project, which is now called NHS Talking therapies for anxiety and depression. Can you tell us a bit about your personal journey as part of that?

Saiqa: Yeah, so I actually studied in Sheffield, completed my undergraduate, and then I went back to Rochdale, which is my hometown. Beautiful Rochdale, a small town north of Manchester for those people who have not heard. But I struggled. I struggled to find any paid work related to psychology. I struggled to find voluntary work related to psychology, and the transport links were not that great which meant I couldn't leave, come and go, quite easily. So I was in this small town struggling to find any form of experience, and eventually found a little job as a support worker and then I had another job to, to earn a bit more income. So yeah, I was doing like two jobs concurrently. And then the IAPT initiative came along and I was offered a job as a low intensity practitioner or a psychological wellbeing practitioner and then I moved back to Sheffield. So that's how I came into the NHS.

Helen: Okay, so perhaps if you say a little bit more about what training as a psychological well wellbeing practitioner did for you, and then a bit more about your career after that, cause you're not still working in that role.

Saiqa: No, I'm not working in that role, but I'm still using those interventions. I think everybody should learn those interventions, if I'm honest with you. And I think that role gave me a nice introduction to the NHS supervision, you know, learning difference between clinical supervision and line management supervision. I was quite heavily involved in developing groups, the stress, delivering stress management course or managing lower mood. So I really developed my skillset in a range of ways, you know, one-to-one therapy, group therapy, did supervision, developing projects, started to do more outreach work around ethnic minority communities, started to do a bit of thinking around those groups. And that work still stays with me, I don't think I've ever really left it behind.

Helen: So even at that early stage in your career in the NHS, you were thinking about the value of developing yourself as a diverse individual, if you'll forgive me saying so. And we know that was one of the things that the IAPT Project bought, brought in was a more diverse workforce, which perhaps intending to be more representative the communities that people come from.

Saiqa: Absolutely. And so many years later it still is representative of the communities. And I think that is the beauty of the initiative is that I wasn't an afterthought- thanks David and Lord Layard. But I think when they were thinking about it, they obviously thought about us in their thinking in those early stages. And actually when I applied for the job, I can't remember exactly what it said, but it did allude to having knowledge of a different community or knowing a different language. And actually part of my interview was in Urdu at that time 'cause I was tested and I don't think we see that. I think some of that has been lost somewhere actually 'cause those early days where the money was there, the thinking was there, the will was there we've managed to produce a quite a diverse workforce.

Helen: Okay. and that's one of the things that I'm hearing from what you're saying is that you, your particular skills and your own background were particularly valuable and the investment of resources in training people from different backgrounds and who are really embedded in the communities that they served was genuine in enhancing and enriching what we could offer. And being taught CBT skills, which are evidence-based and most likely to help people with the common mental health problems that you were working with in that role. What about when you then went on to do further training? Because you haven't really stopped. Tell us more.

Saiqa: No. Then I went on to do my CBT training. I did that in Manchester and actually moved back to my hometown. And, I felt like I was giving back to my communities and that not just people who looked like me, I think just the town as a whole. There's some quite deprived areas, so there's four boroughs, and I had a day in each of those boroughs, so I felt like I was learning about the town, but I was also able to give back to the town. So I'm quite passionate about it. Yeah, it was tricky getting those videos in to pass. I had one attempt left and my friend said, you know, jump through the hoops. I took a generalized anxiety disorder and PTSD as my training cases and my supervisor John Storey is looking at me. He said, you're spinning a lot of plates Saiqa. And I said, oh, that's because I'm comfortable with depression and so I thought I'll bring something different in. And then when it came to doing the videos, it was, I took some really tough cases in, and they weren't quite meeting the criteria of passing the videos. And I had one attempt left, or I may never been sat here talking to you, Helen, but managed to get through.

Helen: And I think you'll be really speaking to the experience of some of the CBT therapists that are sitting here listening to what you're saying. The challenge of doing the CBT training can be one of the most difficult things that people attempt. So given that you did succeed, and here you are sitting talking with me, is there anything that you would say really helped you to get through those challenges that really did I don't know, improve your access as a clinician to being able to provide this service.

Saiqa: Yeah, I think while I was training, there was a group of us and maybe called the Specials because we'd meet for breakfast in the coffee shop, get there a bit early, and then we'd always be the ones that submitting our work just on the deadline or do the night before? Yeah, the all-nighters. So we were the little group

Helen: The last-minute deadline group.

Saiqa: The last minute deadline group, absolutely. So we did the training, but we ended up forming this lifelong sisterhood of friendship, which I really value, and they're really important and really big part of my support network. I think even continuing my journey. So you get a lot from the training that I think is really valuable and the camaraderie because everyone's going, oh, I'm going to fail if I get thrown off, if I don't pass this video, or I'm not meeting the CTSR…

Helen: So what I'm hearing is that actually you invest a lot of yourself in the training but it's worth it. And those connections with the other people who are in the same boat really helps to get you through.

Saiqa: Absolutely. And you know, you're more confident as a clinician when you come through because people have been watching your videos. You have to quickly get over then, oh, that angle on my face doesn't look right, and why did I do that? Oh, why was that looking, you know, why did I pull that face?

You just need to get over those anxieties if you want to get through it. That's what I'll say to anybody who's in on the course now or thinking about it. And, but as a consequence, because lots of people have had to look at your work and input it into it, and you can refine your skills. I think when you do have those stats later on, you can say, it's not just coming from me, people have looked at my work and actually, it's okay. It's not that bad.

Helen: Yeah, and actually everybody else other than you as the trainee on the camera, my experience is that actually focusing on the client is what gets you through that and trying not to focus too much on whether you've got the right angle or whether your hair looks funny in that outfit.

Saiqa: And am I good enough to be here? Do you know if you're from an underrepresented group, the imposter does come with you. I think you don't lose it. It's there and you don't want to reveal yourself, but. I don't, maybe it's, as I'm getting older, I'm like, yeah, this is just who I'm am.

Helen: I do think it's really important though to acknowledge that the training is hugely demanding, and then if you do come from a minoritised group, you've got additional challenges, and often intersectional challenges. However, you're sitting here talking to me and your career advanced even further after being qualified as a CBT therapist. Tell me what made you decide to train in another profession, even though you were already fully qualified and experienced as a CBT therapist.

Saiqa: Yeah, it's a good question. I think when I first started, when I was doing my undergraduate, I wasn't so aware of CBT and I think we probably could get better at bringing CBT into colleges and undergraduate courses because when I was thinking what am I going to do with my degree, CBT I don't think came up in my research. But then I was on the CBT path because that was the opportunity given to me and I went on the CBT path but I think part of it was, I was aware that it has its limitations. So I'm working people with complex trauma, with interpersonal difficulties and I think I was thinking, oh, then other ways of working with people apart from CBT and maybe I just need to have the humility to go okay, park the CBT for a while, do the training. But I also wanted the training to give me opportunities and open the other doors that, again, traditional CBT therapists are not provided with around leadership or managing services. So I think I was thinking longer term career, it'll give me opportunities, but I wanted to do research as well. So there's multiple reasons why I did it, but I have to say, every single service I went to in placement, there was some form of CBT there. And I've come out of that training even bigger fan of CBT if I'm honest with you, I'm like, yeah, evidence based. Okay, what are we doing? Not what am I doing, what's the evidence saying that we should be doing for this person? So that level of humility, I think that approach brings is really important.

Helen: Yeah. Thank you. So I know that you work clinically now with people who have learning disabilities. Can you tell us, it's one of the areas that we hear about perhaps a bit less in CBT sometimes. Can you tell us a bit about investing in working with people who do have learning disabilities?

Saiqa: Oh, you know, I'm quite big on inclusion and equality and interrogating systems that exclude people. I think I can't keep my mouth shut. But I think as clinicians, it's all of our responsibilities and roles and when we notice who's not in the room, that we then speak. I went to learning disabilities and I've been shocked at the level of underinvestment. And to me, it almost feels like they're the forgotten group. If I'm honest, like I think nationally they've been overlooked and forgotten. And also in our services, you know, some people who have let's call it milder learning disabilities, can access mainstream services. We've got to make room for those people, you know? So I think, I'm trying to think about adapting CBT in that context. And that's what I'm focusing on at the moment is, but again, you know, not digressing too much because don't want to do too much of a drift. And it's not CBT. But what I really want us to do as a workforce is really think collectively about people with learning difficulties and also learning disabilities because they're not in the room. They don't have the social care in place or the care needs in place to enable them to access conferences or sit at tables. So I think we need to be advocates for them and then create space and room for them to come and sit with us.

Helen: Thank you. So I'm hearing that you are absolutely a living example of CBT being a solid return in investment in terms of just your own journey through your career and how you've invested of yourself and you've been able to take advantage of the investment in training in CBT but also your own focus on inclusion, making sure that we are more representative, that we do more to make sure that underrepresented groups do genuinely have that access and the opportunity to have better evidence-based interventions to help improve quality of life and so on. Is it too much to ask you where you see yourself in five years' time?

Saiqa: Oh gosh, sat on the beach, like retired. No, I think, do you know when we talk about being a solid return on investment, a lot of this inclusion work, Helen, it's been done outside in our own time, you know, evenings, weekends, annual leave, holidays my family going what you doing Saiqa, we are at the airport! You know. Right. And I think what really want to see is some of this work embedded into systems, infrastructure because ultimately it's still a nine to five job, isn't it? And I hold their inclusion values. Yeah. I'm trying to convince myself it's a nine to five job but yeah, I think I'll still be involved somehow. I think maybe a little bit more around research because again, people like myself are actually, I don't know, somebody from my background in leading projects and research, to be fair know millions of pounds are invested, Actually, maybe that's where I might be in research and hold onto my clinical work. Yeah.

Helen: Saiqa, thank you so much for talking with me today. It's an absolute pleasure to be speaking with you.

Saiqa: Thanks for having me, Helen.