Let's Talk about CBT- Practice Matters

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

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

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

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

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