Psychology Training Misses the Mark on Policy Advocacy Skills
Psychology Training Misses the Mark on Policy Advocacy Skills
When psychologists graduate from their training programs, they're equipped with skills to help individuals through therapy and assessment. But a new study reveals a significant gap in their preparation: most receive little to no training on how to influence public policy, despite growing calls for mental health professionals to advocate for broader social change.
Researchers interviewed 18 school and counseling psychologists from the United States and United Kingdom who have experience working with policy makers. These professionals work primarily with children and young people, and all had actively engaged in efforts to influence public policy as part of their professional roles.
The Training Gap
The findings paint a clear picture of missed opportunities in graduate education. Nearly all participants reported that their initial training programs failed to address policy advocacy work. Most said they never heard terms like "public policy" or "advocacy" during their graduate studies.
Instead, their programs focused heavily on traditional individual work such as therapy sessions and psychological assessments. While these skills remain important, participants felt their education treated policy work as completely outside their professional scope.
Some programs mentioned policy work as an "aspirational idea" without providing any practical guidance on how to actually engage with policy makers or influence legislation. This left many psychologists feeling unprepared when they later wanted to address systemic issues affecting their clients and communities.
Skills That Transfer
Despite the lack of explicit policy training, participants found that some aspects of their psychological education proved valuable in policy settings. Communication skills, active listening abilities, and training in facilitating difficult conversations all helped when working with legislators and government officials.
Their education in systems thinking particularly stood out as beneficial. Psychologists learn to understand how different environmental factors influence individual problems, and this perspective naturally extends to understanding how policy changes might address broader social issues.
Research skills also proved transferable, as psychologists could effectively communicate evidence-based findings to policy makers who needed data to support their decisions.
Confidence and Professional Identity
One major barrier identified by participants was a lack of confidence in their ability to influence policy. Many psychologists don't see themselves as having valid contributions to make in political settings, despite their extensive knowledge and experience working with affected populations.
The study suggests this confidence issue stems partly from how policy work is positioned during training. When something isn't taught as part of core professional responsibilities, it signals to students that it's optional rather than essential.
Some participants argued strongly that policy advocacy should be viewed as a moral obligation for psychologists, not an extra activity. They believe mental health professionals have a duty to use their knowledge to improve lives on a broader scale, not just within individual therapy rooms.
Missing Practical Knowledge
While psychologists develop transferable soft skills during training, they lack what participants called "hard skills" for policy work. Many admitted they didn't understand basic processes like how bills become laws or who the key decision makers are in government systems.
This practical knowledge gap means that even psychologists motivated to engage with policy issues don't know where to start or whom to contact. They must seek additional training or learn through trial and error, which creates unnecessary barriers to participation.
Geographic Differences
The study revealed some differences between countries. American participants noted that professional organizations like the National Association of School Psychologists had begun offering policy advocacy training opportunities. However, participants from the United Kingdom felt their professional organizations could do much more to support policy engagement.
Implications for the Future
The research suggests two main areas for improvement. First, psychology training programs need to decide whether policy advocacy is truly part of their profession's core mission. If so, they should integrate relevant coursework and practical experiences into their curricula.
Second, professional organizations should provide ongoing support for practitioners interested in policy work. This could include training workshops, resource guides, and opportunities to connect with experienced policy advocates.
A Complex Challenge
The intersection of psychology and politics creates some complexity. Some participants acknowledged tension around maintaining professional neutrality while engaging in inherently political processes. However, others argued that psychologists can advocate for evidence-based policies without aligning with particular political parties.
The study also highlighted practical constraints on training programs. Graduate psychology education already covers extensive material in limited time, making it challenging to add new content areas.
Moving Forward
The researchers suggest several strategies for improving policy advocacy training. Programs could invite guest speakers who have policy experience, create classroom activities that simulate policy engagement, or develop practicum placements in policy-focused settings.
They also recommend that professional regulatory bodies update their competency standards to explicitly include policy advocacy skills, signaling that this work is indeed part of psychologists' professional responsibilities.
The study's findings suggest that psychology as a profession stands at a crossroads. Mental health professionals increasingly recognize that individual therapy alone cannot address the systemic issues affecting their clients' wellbeing. However, their training hasn't evolved to prepare them for broader advocacy roles.
Whether policy work becomes integrated into standard psychological practice will likely depend on decisions made by training programs, professional organizations, and regulatory bodies in the coming years. The voices of practicing psychologists who have successfully engaged with policy suggest there's both need and appetite for change in how the profession prepares its future practitioners.
The research indicates that psychologists possess many skills relevant to policy advocacy but lack the specific knowledge and confidence needed to effectively engage with governmental systems. Addressing these gaps could help the profession fulfill its potential to create positive change on both individual and societal levels.
Does Group Size Matter in Therapy? New Research Reveals Surprising Gaps in What We Know
Does Group Size Matter in Therapy? New Research Reveals Surprising Gaps in What We Know
When mental health professionals set up group therapy sessions, one of the first decisions they face is how many people to include. Should it be an intimate circle of four or five participants, or a larger gathering of ten or twelve? Despite decades of expert opinions on this topic, a new systematic review reveals that science has surprisingly little concrete evidence to guide these crucial decisions.
Researchers analyzed 17 studies involving over 21,000 participants to examine whether group size actually affects how well therapy works. The results paint a picture of incomplete knowledge in an area where definitive answers are badly needed.
Mixed Results Across Studies
The review found that only seven of the 17 studies showed any significant relationship between group size and therapy outcomes. This inconsistency suggests that the impact of group size may be more complex and nuanced than previously assumed.
Among the studies that did find meaningful differences, most pointed toward potential benefits of smaller groups. However, one study of cognitive behavioural therapy for chronic pain favoured larger groups. At the same time, another suggested that groups with five to nine members performed better than either smaller or larger alternatives.
Different Types of Therapy May Respond Differently
One intriguing pattern emerged when researchers looked at different therapeutic approaches. Groups focused on interpersonal dynamics and emotional processing appeared more sensitive to size changes than structured cognitive behavioural therapy sessions.
This makes intuitive sense when considering how these therapies operate. Process oriented approaches rely heavily on group interaction, personal sharing, and relationship building among participants. In contrast, cognitive behavioural therapy often follows structured protocols with specific skills training components.
The Quality Problem
A concerning finding was the overall quality of available research. Most studies examining group size effects were rated as low quality, with significant limitations in their design and methodology. Only four studies met criteria for high quality research standards.
This research gap means that mental health professionals must rely primarily on clinical experience, traditional practices, and expert recommendations when deciding on group composition. While these sources of guidance have value, they lack the rigorous testing that evidence based practice demands.
What the Trends Suggest
Despite the limited evidence, some tentative patterns did emerge from the analysis. Groups with fewer than nine members showed slight tendencies toward better outcomes compared to larger groups. This aligns roughly with the upper limits that many therapy experts have traditionally recommended over the years.
The research also suggested that clinical settings might see more pronounced group size effects than university or community programs. This could reflect differences in participant needs and functioning levels across these environments.
The Path Forward
The researchers emphasize that much more investigation is needed before making firm recommendations about optimal group sizes. They suggest several approaches for future study, including direct comparisons between different sized groups within the same treatment programs and examination of how various factors might influence size effects.
Questions remain about whether certain personality types or attachment styles make individuals more or less sensitive to group size. The role of multiple facilitators in accommodating larger groups also deserves exploration, as does the potential for different optimal sizes across various mental health conditions.
Implications for Practice and Policy
These findings have practical implications beyond individual therapy decisions. Insurance companies and healthcare systems need evidence based guidelines to set appropriate reimbursement rates and service standards. Without solid research, these important policy decisions rest on uncertain foundations.
The review also highlights opportunities for relatively simple research that could provide valuable answers. Treatment centers could systematically vary group sizes and track outcomes, or analyze data from existing programs that naturally include groups of different sizes.
A Call for Better Evidence
While the current research provides some useful insights, it primarily reveals how much we still don't know about this fundamental aspect of group therapy. The authors argue that decisions affecting thousands of therapy participants should be based on rigorous scientific evidence rather than tradition and expert opinion alone.
This doesn't diminish the value of clinical experience and established practices, but it does suggest that the mental health field would benefit significantly from more systematic investigation of group size effects. As therapy continues to evolve and expand, having solid empirical foundations for basic structural decisions becomes increasingly important.
The incomplete picture presented by current research serves as both a limitation and an opportunity. While therapists and program administrators must continue making group size decisions with imperfect information, the identified research gaps provide clear directions for studies that could meaningfully improve therapeutic outcomes for countless individuals seeking help through group interventions.
Twomey, C., & Dowling, C. (2025). Associations of group size with cohesion and clinical outcomes in group psychotherapy: a systematic review. International Journal of Group Psychotherapy, 75(2), 345-364.
The Sleep Solution: What Science Says About CBT for Insomnia
CBT for Sleep
If you've ever spent sleepless nights staring at the ceiling, you're not alone. Chronic insomnia affects millions of people worldwide, and for decades, sleeping pills seemed like the primary solution. However, a comprehensive review of research reveals that a different approach called Cognitive Behavioural Therapy for Insomnia, or CBT-I, has emerged as the gold standard treatment for sleep problems.
What Makes CBT-I So Effective?
CBT-I is a structured program that helps people change the thoughts and behaviours that interfere with sleep. Unlike sleeping pills, which provide temporary relief, CBT-I addresses the root causes of insomnia and teaches people skills they can use for life.
The research shows impressive results. People who complete CBT-I typically experience a reduction in their time to fall asleep, from approximately 60 minutes to 30 minutes. They also spend significantly less time awake during the night. Most importantly, these improvements are maintained months and even years after treatment ends.
When compared head-to-head with sleeping medications, CBT-I performs just as well during the initial treatment period but proves superior in the long term. While the effects of sleep medications wear off when people stop taking them, the benefits of CBT-I continue to grow over time.
Beyond Primary Insomnia
One of the most significant findings is that CBT-I works effectively even when insomnia occurs alongside other health conditions. Researchers have successfully tested CBT-I in people with depression, anxiety, chronic pain, cancer, heart problems, and many other medical conditions. Not only does it improve sleep, but it also often provides additional benefits for the underlying health condition.
Studies show that when people with depression receive CBT-I along with their regular treatment, they are twice as likely to respond to antidepressant medications. The therapy also appears to help prevent depression in people who have insomnia but aren't currently depressed.
Different Ways to Receive Treatment
The traditional approach involves meeting with a trained therapist for six to eight individual sessions. However, researchers have explored various alternatives to make treatment more accessible:
Group therapy has proven nearly as effective as individual treatment, although it may be slightly less helpful for individuals who initially struggle with falling asleep.
Online programs offer convenience and can reach people who lack access to trained therapists. While not as effective as in-person treatment, internet-based CBT-I still produces meaningful improvements and may be a good option when other formats are unavailable.
Brief treatments lasting just two to four sessions can be effective for some people, particularly those who need less intensive intervention.
Telehealth sessions conducted via video conferencing appear to be just as effective as in-person meetings, opening up treatment possibilities for people in rural areas or those with mobility limitations.
The Challenge of Access
Despite its proven effectiveness, CBT-I faces a significant obstacle: there aren't enough trained providers to meet demand. This shortage has resulted in lengthy waiting lists and limited availability in many areas.
The research suggests several potential solutions, including training more healthcare providers from diverse backgrounds, implementing stepped care approaches that begin with less intensive interventions, and expanding the use of online programs, which could all help address this gap.
The evidence overwhelmingly supports CBT-I as the first choice treatment for insomnia. Major medical organizations, including the American College of Physicians, now recommend it as the initial treatment rather than sleeping pills.
However, important questions remain. Researchers are working to understand which components of CBT-I are most essential, how to optimize treatment for different populations, and how to make it more widely available. They're also exploring ways to enhance the therapy, such as incorporating mindfulness techniques.
What This Means for You
If you're struggling with chronic insomnia, this research suggests that CBT-I should be your first consideration rather than sleeping pills. While it requires more effort initially than taking a medication, the long-term benefits are substantial and lasting.
The therapy teaches practical skills like sleep restriction, stimulus control, and cognitive techniques to manage worries about sleep. These approaches help retrain your body's natural sleep system and break the cycle of sleepless nights.
As access to CBT-I continues to expand through online programs and training of more providers, this effective treatment should become available to more people who need it. The research makes clear that we now have a proven, medication-free solution for one of the most common and frustrating health problems people face.
The scientific evidence is conclusive: CBT-I works, it works well, and its benefits last. For the millions of people whose sleep problems have seemed intractable, this represents genuine hope for better nights and better days ahead.
Muench, A., Vargas, I., Grandner, M. A., Ellis, J. G., Posner, D., Bastien, C. H., ... & Perlis, M. L. (2022). We know CBT-I works, now what?. Faculty reviews, 11, 4.
How CBT Therapy Changes the Brain: New Evidence from Depression Research
How Talk Therapy Changes the Brain: New Evidence from Depression Research
For decades, researchers have wondered whether psychotherapy actually changes the brain in measurable ways. A comprehensive review of 14 studies has now provided compelling evidence that cognitive behavioural therapy (CBT) doesn't just help people feel better, it literally rewires neural pathways in the brain.
The Science Behind CBT's Brain Effects
The research examined brain scans from over 300 people with depression before and after receiving CBT treatment. Using functional magnetic resonance imaging (fMRI), scientists tracked how different brain regions responded to emotional, reward, and thinking tasks both before and after therapy.
What they discovered challenges some long-held assumptions about how talk therapy works. Rather than simply teaching people to think differently, CBT appears to fundamentally alter how the brain processes information, emotions, and rewards.
Four Key Brain Changes
The study identified four major patterns of brain changes following CBT treatment:
Calmer Emotional Centers The limbic system, which includes the amygdala and hippocampus, showed reduced activity after CBT. These brain regions are known for processing emotions and forming memories. In depression, they tend to be hyperactive, especially when processing negative information. After therapy, this overactivity decreased, suggesting that patients' brains were no longer stuck in a pattern of emotional hypersensitivity.
Enhanced Reward Processing The striatum, a brain region involved in motivation and reward, became more responsive to positive experiences after CBT. This is particularly significant because depression often involves anhedonia (the inability to feel pleasure from normally enjoyable activities). The increased striatal activity suggests that therapy helps restore the brain's natural reward system.
Rebalanced Control Networks The prefrontal cortex, responsible for executive functions like decision making and emotional regulation, showed varied changes depending on the specific task. Rather than simply increasing activity across the board, different prefrontal regions showed increases or decreases in ways that appeared to optimize emotional processing and reduce rumination.
Modified Attention Networks The cingulate cortex, which plays a role in attention and self-awareness, demonstrated some of the most consistent changes. The subgenual anterior cingulate cortex, in particular, showed activity changes that correlated directly with symptom improvement. Patients whose brain activity changed more in this region also showed greater reductions in depression symptoms.
Beyond Traditional Models
These findings challenge the traditional view that CBT works primarily by strengthening cognitive control. Instead, the research suggests that effective therapy involves a more complex rebalancing of brain networks. Rather than just teaching the prefrontal cortex to "override" emotional responses, CBT appears to reduce the intensity of emotional reactions at their source while simultaneously improving the brain's ability to process positive experiences.
The changes weren't limited to emotional processing. Brain regions involved in future thinking, self-reflection, and memory also showed modifications after treatment. This suggests that CBT's effects extend beyond mood regulation to fundamental aspects of how we think about ourselves and our experiences.
Clinical Implications
Perhaps most importantly, the brain changes weren't just statistical curiosities—they correlated with real improvements in symptoms. Patients who showed greater changes in key brain regions, particularly the subgenual anterior cingulate cortex, also experienced more significant reductions in depression severity.
This connection between brain changes and symptom improvement provides objective evidence for what therapists and patients have long known: CBT creates lasting changes that go beyond temporary mood improvements. The therapy appears to create new neural pathways that support healthier patterns of thinking and feeling.
The Bigger Picture
The research included various forms of CBT, from traditional individual therapy to group sessions and computer-based programs. Regardless of the specific format, the core pattern of brain changes remained consistent. This suggests that the therapeutic principles underlying CBT, such as challenging negative thought patterns and behavioral activation, create reliable neurobiological effects.
The studies also revealed that these changes occur relatively quickly. Most participants showed measurable brain changes after just 5 to 16 weeks of treatment, with some improvements visible in as little as 5 weeks. This timeframe aligns with when patients typically begin reporting symptom improvements.
Future Initiatives
While these findings are encouraging, researchers acknowledge several limitations. The studies involved relatively small groups of participants, and the specific brain changes varied somewhat depending on the tasks used during scanning. Additionally, most studies didn't include control groups receiving other treatments, making it difficult to determine whether the brain changes are specific to CBT or occur with other forms of therapy as well.
Future research will likely focus on standardizing methods across studies and investigating whether different types of depression symptoms are associated with different patterns of brain change. Understanding these nuances could help clinicians predict which patients are most likely to benefit from CBT and potentially customize treatment approaches.
What This Means for Treatment
For individuals considering therapy, these findings offer reassurance that CBT can produce measurable, biological changes in the brain. The treatment isn't just about learning coping strategies it's about fundamentally rewiring neural circuits that contribute to depression.
For healthcare providers, the research offers objective markers of treatment progress. While therapists have always relied on patient reports and behavioral observations, brain imaging could potentially provide additional information about how well treatment is working at a biological level.
The study also reinforces the importance of completing a full course of CBT. The brain changes observed in the research occurred over weeks and months, not days, suggesting that consistent engagement with therapy is necessary for optimal neurobiological benefits.
A New Understanding
This research represents a significant step forward in understanding how psychotherapy works at a biological level. By showing that CBT creates specific, measurable changes in brain function, the studies bridge the gap between psychological and neurobiological approaches to mental health treatment.
The findings suggest that effective psychotherapy is not just about changing thoughts and behaviors, it's about changing the brain itself. This neuroplasticity, or the brain's ability to reorganize and form new neural connections, appears to be a key mechanism through which CBT helps people recover from depression.
As our understanding of these processes continues to evolve, it may become possible to develop more targeted and effective treatments that work with the brain's natural capacity for change.
König, P., Zwiky, E., Küttner, A., Uhlig, M., & Redlich, R. (2025). Brain functional effects of cognitive behavioral therapy for depression: A systematic review of task-based fMRI studies. Journal of Affective Disorders, 368, 872-887.
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