Cognitive Analytic Therapy Research Articles

Cognitive Analytic Therapy (CAT) in borderline personality disorder: a case report on the efficacy of longer treatment duration

ABSTRACT This article presents a case report on the use of Cognitive Analytic Therapy (CAT) in treating a patient with features of Borderline Personality Disorder (BPD) over an extended treatment duration. The case report highlights the effectiveness of CAT in addressing complex and entrenched issues and emphasises the use of the Sequential Diagrammatic Reformulation (SDR) and Multiple Self State model as key therapeutic tools. The findings demonstrate the benefits of longer treatment duration in CAT for individuals with features of BPD and underscore the importance of tailoring treatment to individual needs.

Feasibility and acceptability of integrating repertory grids into reformulation and termination during cognitive analytic therapy.

Feasibility and acceptability of integrating repertory grids into reformulation and termination during cognitive analytic therapy.

The Relational Approach to Treating Self-Harm (RELATE): study protocol for a feasibility randomised controlled trial study of cognitive analytic therapy for adults who self-harm versus treatment at usual

BackgroundSelf-harm is a prevalent behaviour that has a major detrimental impact on a person’s life. Psychological therapies have the potential to help, but evidence of effective interventions remains limited. Access and acceptability of interventions can also be a significant challenge, with individuals either being unable to access help or having to endure long waiting lists. Cognitive analytic therapy (CAT) is a time-limited and relationally-focused psychotherapy that may provide a valuable treatment option for people who self-harm. This protocol outlines the methodology for the first feasibility randomised controlled trial (RCT) of CAT for adults that self-harm. The trial will aim to determine the feasibility, acceptability and safety of undertaking larger-scale evaluations of CAT for self-harm within an RCT context.MethodAn RCT design with 1:1 allocation to CAT plus treatment as usual (TAU) or TAU alone. Participants will be adult outpatients with three or more instances of self-harm in the past year (target sample of n = 60). CAT will be 8 one-to-one weekly 60-min sessions plus a follow-up session up to 8 weeks after the last session. Assessments will occur at baseline, 12 weeks and 18 weeks after randomisation. Qualitative interviews with participants will gain insights into the feasibility and acceptability of CAT. Feasibility outcomes will be judged against progression criteria.DiscussionCAT may be an effective and accessible treatment option for people who self-harm, providing a more relationally orientated alternative to more behavioural therapies. The proposed feasibility RCT is an important first step in evaluating CAT as a treatment for self-harm.Trial registrationThe trial was pre-registered (21/10/22) on ISR CTN (ISRCTN code: ISRCTN75661422).

Beyond the symptoms: Exploring attachment styles and reality-testing among schizophrenia clients from a nursing perspective.

INTRODUCTION: Insecure attachment styles are associated with mental health problems and may influence reality perception. This study investigated the link between attachment styles and reality-testing impairment in individuals with schizophrenia. A cross-sectional survey with 200 participants diagnosed with schizophrenia assessed their attachment styles (Psychosis Attachment Measure) and reality-testing abilities (Bell Reality Testing Inventory). A significant positive correlation emerged between insecure attachment and poorer reality testing (r = .394, p < .001). Avoidant attachment was most prevalent (mean scores: 17.01, SD = 3.71), followed by anxious attachment (16.53, SD = 4.20). Reality-testing impairment manifested across all three domains: uncertainty of perception (7.16, SD = 2.45), reality distortion (3.52, SD = 1.21), and hallucinations/delusions (26.63, SD = 5.83). Interestingly, specific demographics (male, unmarried, 40-50 years old) and those with a duration of illness of less than 5 years had higher mean scores (27.35, SD = 5.61). Insecure attachment styles, notably anxious and avoidant, are dominant among clients with schizophrenia, who also struggle with reality distortion, perceptual uncertainty, and hallucinations/delusions in all three domains. Healthcare providers and nurses should understand the psychological dynamics of clients with insecure attachment styles to establish effective therapeutic relationships. A secure, structured, and consistent environment is vital to modifying insecure attachment styles and promoting reality orientation. Secure Attachment Style Oriented Psycho-Educational Program, Mentalization, Cognitive Interpersonal Therapy, and Cognitive Analytic Therapy can help reduce reality-testing impairment. Fostering Maternal and Child Health (MCH) centers on empathizing secure bonds between mothers (and mothers-to-be) and their children to promote healthy attachment styles as a preventive measure.

Types and mechanisms of idiographic change during guided self-help for anxiety.

To compare idiographic change during two formats of guided self-help (GSH); cognitive-behavioural therapy guided self-help (CBT-GSH) and cognitive analytic therapy guided self-help (CAT-GSH). Qualitative inductive thematic analysis. Semi-structured interviews with N=17 participants with a reliable change outcome on the GAD-7 after completing GSH for anxiety. Changes were categorised and themes extracted. No differences between CAT-GSH and CBT-GSH were found regarding types of change reported. The five overarching themes found were personal qualities of success, enlightenment through understanding, specific tools and techniques, changes to relationships and tailoring support. Four themes maximally differentiated between the two different types of GSH; CAT-GSH enabled relational insight and change whilst CBT-GSH enabled better understanding of anxiety, new coping techniques and supportive relationships. Both common and model-specific factors contribute to patient change during GSH. Whilst all forms of GSH are grounded in the psychoeducational approach, separate theoretical foundations and associated methods facilitate different types of ideographic change.

Cognitive analytic therapy for the treatment of post-traumatic stress disorder: a randomized controlled trial

Background Post-traumatic stress disorder represents a multifaceted clinical entity with a profound impact on mental health. This study was conducted to evaluate the effects of cognitive analytic therapy on the manifestations of post-traumatic stress disorder. Materials and methods From May 21, 2023, to July 7, 2023, we conducted a randomized control trial in the outpatient clinic of a psychiatry Hospital. Participants were Iran-Iraq war veterans (N = 40) with a confirmed diagnosis of post-traumatic stress disorder. They were randomly allocated to cognitive analytic therapy and control groups. The primary outcome was re-experiencing, and the secondary outcomes included avoidance, hyperarousal, depression, anxiety, and numbness scores measured by appropriate questionnaires before and after the interventions. The cognitive analytic therapy group received a weekly program totaling 12 sessions of therapy adjunct to pharmacotherapy, each session lasting 90 min, and the control group received only pharmacotherapy. Results Within-group analysis showed that cognitive analytic therapy (N = 19) decreased all symptom scores (all p < 0.001), while the control group (N = 20) showed a decrease in hyper-arousal, depression, and anxiety (p < 0.001) scores. Between-group analysis implied that cognitive analytic therapy was more successful than usual pharmacotherapy in decreasing all outcome scores (all p < 0.001) Conclusion A 12-session program of cognitive analytic therapy was effective in alleviating re-experiencing, avoidance, hyper-arousal, depression, anxiety, and numbness in post-traumatic stress disorder. It was safe and acceptable by participants reflected by a high retention rate. We recommend the incorporation of cognitive analytic therapy to the treatment of post-traumatic stress disorder.

A Brief Cognitive Analytic Therapy-Informed Approach for Young People That Have Self-Injured (CATCH-Y): A Case Series.

Non-suicidal self-injury (NSSI) presents an increasingly prevalent problem for young people; however, there remains a scarce evidence base for effective, scalable treatments for adolescents. This study aimed to assess the feasibility and acceptability of a brief, cognitive analytic therapy (CAT)-informed intervention for young people who engage in NSSI (CATCH-Y). A case series design recruited 13 young people who met the inclusion and exclusion criteria to participate in the five-session intervention. Eligible participants were aged 13-17 years (M = 15.15, SD = 1.28) and had engaged in NSSI at least once in the previous 6 months. Feasibility and acceptability were measured via recruitment, retention, qualitative feedback and missing data. The secondary outcome measures of personal recovery and motivation were administered pre- and post-assessment, with measures of depressive symptoms and urges to self-injure. The intervention was found to be largely feasible and acceptable with high rates of recruitment, retention and pre-/post-assessment data completeness. Measures showed preliminary support for positive change in rates of NSSI, urges to self-harm, low mood and personal recovery, although results were mixed. Completion rates for remote assessments were low. The findings of this study support further evaluation of the CATCH-Y intervention on a larger scale. In-person assessments may be preferable to remote to ensure good completion rates.

Pilot Evaluation of a Remote Psychotherapy Service for Students Who Self-Harm: University-Community Outpatient Psychotherapy Engagement (U-COPE).

Self-harm is becoming increasingly common in student populations. Brief psychological therapies might be helpful for those who have recently self-harmed. The current paper reports on an evaluation of a brief psychotherapy service delivered via remote means, namely University-Community Outpatient Psychotherapy Engagement (U-COPE). The service combines elements of psychodynamic interpersonal and cognitive analytic therapy to help students who present with self-harm related difficulties. The primary aim was to understand students' and practitioners' experiences of a remote psychotherapy service. Semi-structured interviews were conducted with a total of nine participants (seven students and two practitioners). Interview data were analysed using thematic analysis. Analyses of the interviews across the stakeholders revealed three overarching themes: 'Accessibility'; 'Therapeutic experiences'; and 'Spaces and places of therapy'. Students appreciated the rapid access to intervention, especially as student services are typically characterised by long waiting lists. Despite the brief nature of the intervention, many students reported feeling a sense of control over the direction and pace of the therapeutic sessions, which is an important consideration for those who self-harm. The findings suggest that U-COPE may be helpful to students with difficulties related to self-harm. Further investigation of this brief intervention is warranted in order to ascertain whether U-COPE has a long-term impact on difficulties and distress-related behaviours.

Working together towards overcoming transgenerational trauma – Using cognitive analytic therapy with child-caregiver dyads

Children, young people, and families who seek support from community CAMHS have experienced a disproportional number of childhood adverse experiences. Many families continue to endure uncertainty and adversity due to global events and political context (e.g. racism, poverty, and gender-based violence). Building trust within this context requires therapists to work in trauma-informed ways that focus on establishing effective therapeutic relationships. Cognitive analytic therapy (CAT) is an approach that mainly focuses on relationship patterns to help people overcome psychological distress and develop positive ways of relating that encourage emotional wellbeing. Whilst offering therapy within a child and adolescent mental health service, I have extended the use of CAT to focus on both the young person’s relationships and the relationship between caregiver-child; also referred to as a child-caregiver ‘dyad’. Theoretically, working dyadically offers advantages over individual therapy including providing opportunities to influence and overcome transgenerational patterns that may not be possible within individual sessions with young people. I have termed this way of working ‘Dyadic CAT’ and propose that there are several adaptations to individual CAT that therapists may consider when offering a dyadic intervention including: (a) identifying what to work on within therapy, (b) exploring ways of factoring in power imbalances, and (c) balancing the needs of three learners to promote discovery within therapy. CAT with dyads may also benefit from an additional phase focused on creating a ‘safe base’ prior to the reformulation phase. Early outcomes and anecdotal evidence indicate that CAT can be a successful intervention for caregiver-child dyads in promoting change and healing from transgenerational trauma. Further practice-based research is needed to develop the structure and practice of Dyadic CAT including the integration of other relational theories.

A randomized controlled trial of cognitive analytic versus compassion-focused therapy for PTSD in Iran-Iraq War Veterans

LAY SUMMARY Posttraumatic stress disorder (PTSD) is a common, debilitating mental illness with a substantial burden on individuals and society. The authors aimed to compare the effects of cognitive analytic therapy and compassion-focused therapy on Veterans with PTSD. This study showed that a 12-session program of cognitive analytic therapy or an 8-session program of compassion-focused therapy was effective for treating PTSD. The interventions controlled re-experiencing, avoidance, and hyperarousal in PTSD. Also, they decreased depression, anxiety, and numbness in patients with PTSD. Compassion-focused therapy was more effective in controlling avoidance and depression than cognitive analytic therapy.

Using Cognitive Analytic Therapy as a Transdiagnostic Intervention for Comorbid Personality Disorder, Posttraumatic Stress Disorder, and Functional Neurological Symptom Disorder: A Case Report of a 68 Woman’s Journey Toward the Integration of Dissociated Self-States

Functional neurological symptom disorder (FND) is associated with complex specialist investigations and poor prognosis. The theoretical understanding of FND posits that functional symptoms are predisposed by both psychological factors, including attachment disturbances and childhood trauma, and biological factors such as neuroplasticity and epigenetics. Current treatment recommendations include psychological therapy, with moderate effects observed with cognitive-behavioural therapy and psychodynamic therapy modalities, however, psychological understanding is key to success. The current case report describes cognitive analytic therapy (CAT) with a 68 year-old woman presenting to services with diagnoses of FND and borderline personality disorder (BPD). The target problem for therapy was integration of fragmented self-states (dissociative and driven) pertinent to both FND and BPD. 16 session CAT was delivered, with four follow up sessions, exploring unhelpful patterns of relating with self and others, based on an unconscious repertoire of internalised patterns and procedures from early life. CAT tools were used to facilitate change; reformulation and ending letters, mapping and the therapeutic relationship. Scores on the personality structure questionnaire (PSQ) and an idiosyncratic measure of state-shifting indicated positive outcomes, sustained at 3 month follow up. This shows modest early acceptability and feasibility of CAT for working with comorbid BPD and FND, providing a validating and blame free formulation of the development and maintenance of symptoms. Additional measures would have improved the ability to comment on the effectiveness of the treatment and future research implications are discussed.

Evaluating cognitive analytic therapy within a primary care psychological therapy service.

Cognitive analytic therapy (CAT) is used within UK mental health settings as a treatment for transdiagnostic complex psychological presentations. However, it is not routinely offered by the NHS Talking Therapies, for anxiety and depression (NHS Talking Therapies) programme which provides psychological treatments for common mental health difficulties. We aimed to evaluate the outcomes of providing CAT treatment to patients presenting with depression and/or anxiety, within the context of relational difficulties, adverse childhood experience or difficulty managing emotions, returning for further psychological treatment within NHS Talking Therapies. This was a pragmatic, real-world evaluation, involving routinely collected self-report measures of depression and anxiety, to examine the treatment outcomes of NHS Talking Therapies patients offered CAT over an 18-month period. Quantitative validated measures of depression and anxiety were administered at the beginning and end of CAT treatment, and at follow up. Within-group change in depression and anxiety scores were examined statistically, and rates of reliable improvement and recovery calculated. Statistically significant decreases in depression and anxiety scores were observed during the CAT active treatment phase. The recovery rate was 46.4%, and 71.4% of patients showed a reliable improvement post-treatment. Positive outcomes continued to be observed at follow-up, with a recovery rate of 50% and a reliable improvement rate of 79.4%. CAT shows promise as a treatment option for NHS Talking Therapies patients re-presenting with depression and/or anxiety. More research is required to determine if CAT should be offered more widely within NHS Talking Therapies services.

Reformulation letters in cognitive analytic therapy: The practitioner's experience

AbstractObjectivesThe aim of this study was to explore (1) cognitive analytic therapy (CAT) practitioners' experiences of receiving their own reformulation letter as part of their training and (2) CAT practitioners' perceptions about how receiving their own reformulation letter altered their clinical practice.DesignSemistructured interviews were used to elicit participants' (N = 9) experiences of having received their personal CAT, with a particular focus on the reformulation letter, and their perceptions of its impact on them as clinicians and their clinical practice.MethodsInductive “bottom up” thematic analysis was used to analyse the interview transcripts and extract overarching themes and subthemes across all participants.ResultsFour overarching themes emerged from the data: the power of the reformulation letter; inhabiting the client's role; absorbing thinking as a CAT practitioner; and evolving the therapist's technique.ConclusionsCognitive analytic therapy practitioners report experiences of the reformulation letter that indicate a positive impact on their self‐awareness, learning about CAT and consciousness about how their own clients experience therapy. This was also the case when the reformulation letter did not resonate with them to the desired extent as learning from their therapist's limitations was experienced as having an impact on their learning and subsequent practice.

My recovery journey

This poem was written by a service user as an ending letter, reflecting on the 16 sessions of Cognitive Analytic Therapy they completed with a clinical psychologist. The service user consented to sharing their poetry anonymously, to be able to provide hope for others with similar struggles and experiences. It is a pleasure to share these words with the FPOP readership.

Effectiveness of cognitive analytic therapy for mixed anxiety and depression in the context of borderline traits: A quasi-experimental single case design evaluation.

Effectiveness of cognitive analytic therapy for mixed anxiety and depression in the context of borderline traits: A quasi-experimental single case design evaluation.

Addressing the Overprotected Past of Dependent Personality Disorder

Studies and research relevant to Dependent Personality Disorder (DPD) recently have shown controversy regarding whether genetic or external factors contributed more to the development of DPD. This review aims to investigate the relationship between parental overprotection and DPD from the perspectives of the specific effect of overprotective parenting styles on DPD, factors regarding overprotection in DPD, and relevant interventions for DPD. It was found that there was an association between overprotective parenting styles and the development of DPD symptoms. Factors related to overprotection, such as distress intolerance and sensitivity to falsehoods detected from facial expressions, have a relationship with DPD traits. Different psychotherapies have demonstrated their effectiveness. Cognitive behavioral therapy (CBT), clarification-oriented psychotherapy (COP), existential group therapy, and cognitive analytic therapy (CAT) are effective to treat clients' DPD, targeting different symptoms. It is concluded that CBT can aid decision-making, self-confidence, and proper self-cognition. Furthermore, COP and existential group therapy can facilitate emotional and social adjustment. Lastly, CAT can improve identity recognition and reassurance-seeking. Regardless of these effectual treatments, the small sample sizes of previous studies may lower the generalizability. More efforts should be devoted to this field of personality disorder and expand the number of empirical research. The present paper may offer some guidelines for the later development of family intervention studies and programs.

Bringing CAT to structured decision-making

This paper discusses the integration of the psychological model Cognitive Analytic Therapy (CAT) into a decision-making framework to help meet the challenges facing a residential recovery service in Liverpool. The article will describe the service, the need for the framework, its development, and its reception in the service.

The effectiveness of cognitive analytical therapy on improving generalized anxiety disorder and reducing anxiety symptoms in women of Isfahan city

generalized anxiety disorder is a common and debilitating. The present study was conducted with the aim of determining the effectiveness of cognitive analytical therapy on improving generalized anxiety disorder and reducing anxiety symptoms in women in Isfahan. The current research is a single subject study with ABA design. The statistical sample included 5 women with generalized anxiety disorder in Isfahan, who were selected by targeted sampling method. The instruments used are the generalized anxiety disorder scale and the Hamilton anxiety symptom severity questionnaire (1960). In the present study, after the subjects reached the baseline, the intervention based on Ryle and Kerr's cognitive analytical therapy (2012), was conducted during 16 sessions of 90 minutes, and a week after the end, follow-up tests were conducted. Then, in order to analyze the data, visual analysis indicators and graphs such as trend change, stability, data overlap percentage and means percentage improvement have been used. The findings of the research show that cognitive analytical therapy is significantly effective in improving generalized anxiety disorder and reducing severity of anxiety symptoms. Cognitive analytical therapy can be cautiously considered as an effective treatment in psychological interventions for patients with generalized anxiety disorder.

Effectiveness of Cognitive Analytic Therapy in Managing Adolescents with Somatic Symptom Disorder in Delta State

This study investigated the effectiveness of Cognitive Analytic Therapy (CAT) in managing adolescents in secondary schools with somatic symptom disorder in Ika North East Local Government Area of Delta State. Three research questions were raised to guide the study and three corresponding hypotheses were formulated, which were all tested at 0.05 level of significance. The pre-test, post-test, control group, and experimental design were adopted for the study. The population of the study is three thousand, five hundred and sixty-one (3,561) students, which comprised all Senior Secondary Class Two (SS2) students from the twenty public secondary schools in Ika North East Local Government Area. A sample size of forty-six (46) students, made up of twenty (20) males and twenty-six (26) females reporting somatic symptom disorder were selected from two schools using the multi-stage random sampling technique. The research instrument titled “Adolescents Somatic Symptom Scale” (ASSS) was adapted and modified for use by the researcher. Three test experts of measurement and evaluation revalidated this instrument. The reliability of the instrument was determined using Cronbach Alpha reliability method to test the consistency of the test items and a reliability coefficient of 0.70 was obtained. The instrument was administered to the students as a pre-test and forty-six (46) students who evidenced somatic disorder in the two schools were randomly assigned for treatment to experimental group A (Cognitive Analytic Therapy), and B (Control Group). The data collected were analyzed, using descriptive statistics of mean and standard deviation and inferential statistics of paired and independent sample t-test. The findings of the study revealed that, there is a significant difference in the pre-test and post-test of somatic symptoms disorder mean scores of in-school adolescents exposed to CAT and also, there is no significant interaction effect on treatment by sex. Based on the findings, the study recommends among others, that counselling psychologists should embrace Cognitive Analytic Therapy as an effective counselling therapy for adolescents irrespective of gender.

A national study of the psychological theories and therapies covered within clinical psychology training programs in Australia

ABSTRACT Objective Recent advancements in the field of psychotherapy have included a diversification in Cognitive Behaviour Therapies (CBTs), often referred to as the “third wave”, yet relatively little is known about their coverage in Australian postgraduate clinical psychology training. Data were gathered to study the relationships between training program theoretical orientation, therapies covered, and factors determining the coverage of therapies. Method Responses to a semi-structured interview of 28 Directors of Clinical Training (DCT) or equivalent of Australian Psychology Accreditation Council (APAC) approved clinical psychology training programs (representing 72% of all accredited programs) were examined. Results Behaviour and cognitive theories were identified as dominant in programs. Coverage of Beck’s CBT was not correlated with other CBTs, and the number of therapies covered did not distinguish integrative (64.3%) from non-integrative programs. In an examination of the factors guiding the adoption of insight orientated therapies (i.e., Cognitive Analytic Therapy, Interpersonal Psychotherapy, Humanistic Therapy, Psychoanalytic Therapy, Process Experiential/Emotion-Focused Therapy, Gestalt Therapy, and Existential Therapy), the focus of clinical research, and student interest emerged as significant predictors (β = −.16, SE =.06, p < .05, 95% Boot CI [−.27, −.03]). Conclusions Beck’s CBT, and its undergirding theories emerged as dominant and was not associated with coverage of more recent CBTs, suggesting that there is opportunity to diversify therapies covered considering their evidence base.