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.

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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 podcasts@babcp.com, that's podcasts@babcp.com. 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.

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