The Future of Mental Health Therapy: How One Revolutionary Program Tackles Multiple Disorders at Once
Spanish researchers combine online modules with video group sessions to treat anxiety and depression together, showing remarkable results
Maria, a 35-year-old teacher from Valencia, had been struggling with both anxiety and depression for years. Her mornings began with worry about the day ahead, her evenings ended with rumination about what went wrong, and throughout it all, a persistent sadness colored her daily experiences. Like many people with emotional disorders, Maria faced a frustrating reality: traditional therapy often required separate treatments for each condition, making recovery a long and expensive process.
What Maria didn't know was that she was about to participate in groundbreaking research that would challenge everything we thought we knew about treating mental health conditions. Instead of addressing her anxiety and depression separately, she would experience a revolutionary approach that tackled both conditions simultaneously through an innovative combination of online learning and live group video sessions.
The Problem with Traditional Mental Health Treatment
Anxiety and depression are among the most common and disabling mental health conditions worldwide, affecting millions of people and imposing enormous costs on healthcare systems. What makes these conditions particularly challenging is that they rarely occur alone. Research shows that up to 82% of people with one emotional disorder also have at least one other, creating complex presentations that traditional disorder-specific treatments struggle to address effectively.
The current system often requires people to navigate separate treatments for each condition, working with different therapists using different approaches. This fragmented care is not only inefficient and expensive, but it also ignores the reality that anxiety and depression share many underlying mechanisms and often fuel each other in destructive cycles.
Adding to these challenges, many people face significant barriers to accessing mental health care: long waiting lists, high costs, scheduling difficulties, and the stigma associated with seeking help. Even when treatment is available, dropout rates for online interventions can reach 40%, leaving many people without the support they need.
A Revolutionary Approach: Treating the Root, Not Just the Symptoms
Recognizing these limitations, researchers at Universitat Jaume I in Spain developed an innovative approach called "transdiagnostic" therapy. Rather than treating anxiety and depression as separate conditions, this method addresses the common underlying factors that contribute to all emotional disorders, such as negative thinking patterns, emotional avoidance behaviors, and difficulties regulating emotions.
Their program combines this transdiagnostic approach with two innovative delivery methods: a "blended" format that mixes online self-study with live group sessions, and videoconferencing technology that makes group therapy accessible from anywhere.
"The transdiagnostic approach posits that emotional disorders are manifestations of a common psychopathological vulnerability underlying these disorders," the researchers explained. By addressing these shared roots rather than individual symptoms, the treatment can be more efficient and potentially more effective than traditional approaches.
How the Program Works
The treatment consists of 16 online modules delivered over 24 weeks, combined with 8 group therapy sessions conducted via videoconference. This "blended" approach harnesses the strengths of both formats: the flexibility and accessibility of online learning combined with the support and motivation that comes from connecting with others facing similar challenges.
The online modules cover four core components:
Present-Focused Emotional Awareness and Acceptance: Learning to recognize and accept difficult emotions rather than fighting them, which often makes them worse.
Cognitive Flexibility: Developing the ability to think about situations in more balanced and helpful ways, breaking free from rigid negative thought patterns.
Addressing Emotional Avoidance: Identifying and changing behaviors used to avoid difficult emotions, which typically backfire and maintain mental health problems.
Graduated Exposure: Gradually facing feared situations and sensations in a structured way to reduce their power over daily life.
The program also includes a unique component focused on increasing positive emotions and overall wellbeing, recognizing that recovery involves more than just reducing symptoms.
Participants work through the online modules at their own pace between group sessions, which are held every three weeks. During the video sessions, therapists help clarify concepts, address difficulties, and prepare participants for upcoming modules. The combination ensures that people receive both professional guidance and peer support while maintaining the flexibility to engage with the material when it works best for them.
Testing the Approach: Real People, Real Results
To evaluate their innovative program, the researchers recruited 34 adults from their community clinic, all diagnosed with at least one emotional disorder according to standard psychiatric criteria. The group was representative of people seeking mental health treatment: 79% were women, most were in relationships, and the vast majority had high levels of education. Importantly, 82% had multiple disorders, reflecting the complex presentations that make traditional treatment challenging.
The most common primary diagnoses were generalized anxiety disorder (35%), major depression (27%), and agoraphobia (15%), with many participants having additional conditions. This multi-disorder presentation made the group perfect for testing whether a single transdiagnostic treatment could address multiple conditions simultaneously.
Remarkable Results Across Multiple Measures
The results were striking and exceeded the researchers' expectations:
High Completion Rates: Despite the 24-week duration, 68% of participants completed the entire program, with another 15% completing at least half the modules and attending half the sessions. This completion rate is significantly better than many online interventions and suggests that the blended format successfully addresses common barriers to engagement.
Excellent User Experience: Participants rated their expectations highly before starting (47 out of 60) and were even more satisfied afterward (49 out of 60). The online platform received "excellent" usability ratings both initially and at treatment completion, indicating that the technology enhanced rather than hindered the therapeutic experience.
Dramatic Symptom Improvements: Both anxiety and depression symptoms showed significant reductions from pre-treatment to post-treatment, with improvements maintained at the 3-month follow-up. The effect sizes were large, meaning the average participant improved more than most people would without treatment.
Broad-Based Benefits: Beyond the primary symptoms, participants showed improvements in emotional regulation abilities, reduced negative thinking patterns, better quality of life, and decreased interference with work and social activities. They also reported increases in positive emotions and extroversion.
High Engagement: Participants completed an average of nearly 13 out of 16 online modules and attended an average of 5.4 out of 8 group sessions. They logged into the platform an average of 36 times and rated all modules as useful, with scores ranging from 7 to 8.3 out of 10.
Why This Approach Works So Well
The success of this blended, transdiagnostic approach appears to stem from several key factors:
Addressing Root Causes: Rather than treating symptoms in isolation, the program targets the fundamental processes that underlie multiple emotional disorders, creating more comprehensive and lasting change.
Flexibility Without Isolation: The online components allow people to work at their own pace and revisit materials as needed, while the group sessions provide connection, support, and professional guidance.
Peer Support: Group sessions enable participants to learn from others facing similar challenges, reducing feelings of isolation and providing motivation through shared experiences.
Comprehensive Skill Building: The program doesn't just focus on reducing negative symptoms but actively builds positive emotional regulation skills and wellbeing.
Accessible Delivery: Videoconferencing eliminates travel barriers and scheduling conflicts while maintaining the benefits of group interaction.
The Flexibility Factor
One particularly interesting finding was the significant variability in how long participants spent on each module. While the recommended pace was about one module per week, actual completion times varied considerably, with some modules taking much longer than others.
Module 5 (Practicing Acceptance) took the longest on average, reflecting the challenge many people face in learning to accept rather than fight difficult emotions. Module 8 (Emotional Avoidance) also required more time, likely because identifying and changing avoidance behaviors requires significant self-reflection and practice.
This variability highlights the importance of flexibility in mental health treatment. Rather than forcing everyone through the same rigid schedule, the program allowed people to spend more time on areas where they needed additional support while moving more quickly through concepts they grasped easily.
Real-World Implementation Advantages
The program's design offers several advantages for real-world implementation:
Cost Effectiveness: Group delivery is more economical than individual therapy, while the online components reduce therapist time requirements compared to traditional face-to-face treatment.
Scalability: The blended format can reach more people than traditional therapy while maintaining quality through structured, evidence-based content.
Reduced Stigma: Online participation may feel less intimidating for people hesitant to seek mental health treatment, while group sessions normalize the experience of emotional difficulties.
Accessibility: Videoconferencing eliminates geographical barriers and reduces scheduling conflicts that often prevent people from accessing care.
Limitations and Future Directions
While the results are promising, the researchers acknowledge several limitations that future studies should address. The participant group was predominantly female and highly educated, limiting the generalizability to more diverse populations. The study also lacked a control group, making it impossible to definitively attribute improvements to the intervention rather than other factors.
The 24-week duration, while allowing for thorough skill development, may be challenging for some healthcare systems to implement. The researchers suggest that future versions might experiment with more frequent group sessions to reduce overall treatment length or make some modules optional to customize the program for different needs.
Additionally, while improvements in most areas were maintained at the 3-month follow-up, positive emotion and extroversion gains were not sustained, suggesting that these areas might need additional attention or booster sessions.
Implications for the Future of Mental Health Care
This research represents a significant step forward in making evidence-based mental health treatment more accessible and efficient. By demonstrating that multiple emotional disorders can be effectively treated simultaneously through innovative delivery methods, it challenges traditional approaches and opens new possibilities for healthcare systems worldwide.
For individuals struggling with emotional disorders, the findings offer hope that effective treatment can be more accessible, affordable, and comprehensive than previously thought. Rather than navigating separate treatments for different conditions, people may soon access integrated programs that address their full range of psychological needs.
For healthcare systems, the approach offers a potential solution to growing demand for mental health services. By treating multiple conditions simultaneously through efficient group and online delivery, more people can receive evidence-based care without overwhelming clinical resources.
The Human Element in Digital Care
Perhaps most importantly, this research demonstrates that technology doesn't have to replace human connection in mental health treatment. The success of the blended approach suggests that the future of therapy lies not in choosing between digital and in-person care, but in thoughtfully combining both to maximize their respective strengths.
The high satisfaction rates and excellent usability scores indicate that when technology is designed around therapeutic principles rather than convenience alone, it can enhance rather than diminish the quality of mental health care.
The researchers are already planning larger, controlled studies to further validate their approach and explore optimal implementation strategies. Future research will likely examine different combinations of online and group components, test the approach with more diverse populations, and investigate long-term outcomes.
For Maria and the millions of people worldwide struggling with multiple emotional disorders, this research offers genuine hope for more effective, accessible, and comprehensive mental health care. The future may well involve integrated treatments that address the whole person rather than isolated symptoms, delivered through innovative formats that combine the best of technology and human connection.
As the researchers concluded, this blended, transdiagnostic approach "seems to be feasible and preliminarily effective in addressing emotional disorders." For a field long constrained by traditional boundaries between disorders and delivery methods, that represents a promising step toward a more integrated and accessible future for mental health care.
The message is clear: effective mental health treatment doesn't have to be lengthy, expensive, or fragmented. With thoughtful innovation and evidence-based approaches, comprehensive care can be delivered efficiently while maintaining the human elements that make therapy truly transformative.
Jiménez-Orenga, N., Díaz-García, A., Lorente-Catala, R., González-Robles, A., Paredes-Mealla, M., García-Palacios, A., & Bretón-López, J. (2025). Feasibility, acceptability, and preliminary efficacy of a blended transdiagnostic group CBT for the treatment of emotional disorders. Internet Interventions, 40, 100823.
Better Sleep, Better Work: How a Digital Therapy Program is Transforming Workplace Mental Health
New study shows that combining sleep therapy with emotion regulation skills dramatically improves insomnia, depression, and anxiety in working adults
Emma, a marketing manager at a Birmingham tech company, had been struggling with sleep for months. She'd lie awake at 2 AM, her mind racing with work deadlines and project worries, then drag herself through the next day exhausted and anxious. Like millions of working adults in the UK, she was caught in a vicious cycle where poor sleep fueled stress and anxiety, which in turn made sleep even more elusive.
What Emma didn't know was that she was about to become part of groundbreaking research that would demonstrate how a novel digital therapy program could break this cycle and transform both her sleep and her mental health.
The Hidden Cost of Sleepless Nights
Insomnia affects about 10% of the general population, but its impact extends far beyond individual suffering. In the workplace, sleep problems contribute to increased accidents, more sick days, reduced productivity, and employees simply going through the motions while physically present but mentally exhausted.
The numbers are staggering: insomnia costs the UK economy approximately £50 billion annually, equivalent to nearly 2% of the country's total GDP. That's the result of 200,000 lost working days each year due to sleep-related issues. Without intervention, experts predict this cost will rise to £60 billion by 2030.
For individual workers like Emma, the personal cost is equally significant. Chronic sleep problems don't just leave people tired; they dramatically increase the risk of developing depression and anxiety, creating a complex web of interconnected mental health challenges that traditional approaches often struggle to address effectively.
A New Approach: Targeting Sleep and Emotions Together
Recognizing that insomnia rarely occurs in isolation, researchers at the University of Warwick developed an innovative program that tackles both sleep problems and emotional regulation simultaneously. Their approach, called digital Cognitive Behavioral Therapy for Insomnia plus Emotion Regulation (dCBT-I + ER), represents a significant departure from conventional treatments that address these issues separately.
The program combines proven sleep therapy techniques with skills for managing difficult emotions. The reasoning is straightforward: poor emotional regulation, particularly problems with rumination and worry, often maintains and worsens insomnia. By addressing both issues together, the treatment can be more effective than tackling either problem alone.
"Interventions simultaneously addressing insomnia and emotion regulation are needed," the researchers explained. "This integrated approach acknowledges that insomnia rarely occurs in isolation."
Testing the Program in Real Workplaces
To test their approach, the research team conducted a rigorous study involving 159 working adults recruited through Midlands-based organizations and social media. All participants had at least mild insomnia plus symptoms of depression or anxiety, making them representative of the millions of workers struggling with these interconnected issues.
Half the participants received the new digital therapy program immediately, while the other half were placed on a waiting list, allowing researchers to compare outcomes between treated and untreated groups. This gold-standard research design ensures that any improvements can be confidently attributed to the intervention rather than other factors.
The program itself was delivered entirely online over eight weeks, combining self-guided digital content with four video therapy sessions. Participants spent about an hour per week working through interactive modules covering sleep science, behavioral strategies, cognitive techniques, and emotion regulation skills.
Remarkable Results Across Multiple Areas
The results were striking. Participants who received the dCBT-I + ER program showed dramatic improvements compared to those on the waiting list:
Insomnia improvements were substantial: The effect size for sleep improvements was very large (1.7), meaning the average treated participant improved more than 84% of untreated participants. Nearly half (45%) of those who started with clinical-level insomnia no longer met criteria for the disorder after treatment, compared to just 3% in the control group.
Depression lifted significantly: With an effect size of 1.6, improvements in depression were larger than typically seen with digital treatments specifically designed for depression. About 30% of participants with clinical depression at the start no longer met criteria for the condition after treatment.
Anxiety decreased markedly: Anxiety improvements showed a large effect size of 1.2, with 30% of those with clinical anxiety levels seeing their symptoms drop below the clinical threshold.
Overall wellbeing improved: Participants reported significant improvements in psychological wellbeing, suggesting the benefits extended beyond just reducing symptoms to enhancing positive mental health.
Why This Approach Works So Well
The success of the combined approach appears to stem from addressing the fundamental interconnections between sleep and emotional health. Poor sleep disrupts emotional processing, making people more reactive to stress and less able to regulate difficult emotions. Conversely, problems with emotional regulation, particularly rumination and worry, interfere with the ability to fall and stay asleep.
By targeting both issues simultaneously, the program breaks this vicious cycle at multiple points. Participants learn both practical sleep skills (like sleep restriction and stimulus control) and emotional regulation techniques (like mindfulness and cognitive reframing) that work together synergistically.
The digital format proved particularly effective for working adults, offering flexibility to engage with the program around work schedules and removing barriers like travel time to appointments. The addition of live video therapy sessions provided personal support while maintaining convenience.
The Workplace Advantage
Delivering the program through workplaces offered several unique benefits. It reduced stigma by normalizing mental health support as part of employee wellness. It also made treatment more accessible to people who might not otherwise seek help through traditional mental health services.
The timing during the COVID-19 pandemic may have contributed to the program's success, as many participants were working from home with greater flexibility to engage with the digital format. However, the researchers note that the low dropout rate (just 15%, compared to up to 40% in some digital interventions) suggests the program would likely remain effective in normal circumstances.
Importantly, the program was delivered by trained but non-clinical staff, making it more cost-effective and scalable than traditional therapy approaches. This suggests that effective mental health support can be provided beyond the constraints of traditional clinical services.
Measuring Success: Multiple Perspectives
The researchers used both subjective and objective measures to assess improvements, including sleep diaries completed by participants and wearable devices that tracked sleep patterns. Interestingly, while participants reported dramatic improvements in their sleep quality and duration, the objective measures showed more modest changes.
This discrepancy, common in sleep research, doesn't diminish the significance of the findings. As the researchers noted, "subjective experiences often drive treatment-seeking behavior and influence therapeutic outcomes." For people suffering from insomnia, how they perceive and experience their sleep is often more important than objective measurements.
The fact that participants felt dramatically better about their sleep, even if objective measures showed smaller changes, suggests the program successfully addressed the distressing aspects of insomnia that most impact quality of life.
Applications and Implications
The study's findings have significant implications for how we address mental health challenges in working populations. Rather than treating sleep problems, depression, and anxiety as separate issues requiring different specialists and treatments, this research demonstrates the power of integrated approaches.
For employers, the results suggest that investing in comprehensive mental health programs could yield substantial returns. Better sleep and emotional regulation among employees could translate into reduced absenteeism, improved productivity, and lower healthcare costs, though the current study noted that workplace productivity measures didn't show significant changes immediately after treatment. The researchers suggest that sleep and emotional improvements may need more time to translate into workplace benefits.
For healthcare systems, the program offers a scalable solution to the growing demand for mental health services. By addressing multiple interconnected issues simultaneously through digital delivery, more people can access effective treatment without overwhelming traditional clinical services.
Looking Forward: The Future of Digital Mental Health
While the results are promising, the researchers acknowledge several limitations that future studies should address. The participant group was predominantly white and female, limiting generalizability to more diverse populations. The study also occurred during the unique circumstances of the pandemic, which may have affected results.
Additionally, the study only measured immediate post-treatment effects. Longer follow-up studies are needed to determine whether benefits persist over time and whether they eventually translate into improved work performance and reduced healthcare utilization.
The researchers also noted the need to better understand user engagement with digital programs. While overall completion rates were good (73%), more detailed information about which components participants found most helpful could inform future program improvements.
A New Model for Mental Health Support
This research represents a significant step forward in addressing the complex, interconnected nature of mental health challenges facing working adults. By demonstrating that sleep problems, depression, and anxiety can be effectively treated together through accessible digital interventions, it opens new possibilities for both workplace wellness programs and healthcare delivery.
For individuals like Emma, the implications are profound. Rather than seeking separate treatments for sleep problems and anxiety, or struggling through without help, effective support can now be delivered conveniently and comprehensively through innovative digital programs.
The study's success also challenges traditional boundaries between different types of mental health treatment. Rather than treating symptoms in isolation, the future may involve more integrated approaches that address the root connections between different aspects of psychological wellbeing.
The research demonstrates that a relatively brief, digitally-delivered program combining sleep therapy with emotion regulation skills can produce dramatic improvements in insomnia, depression, and anxiety among working adults. With effect sizes larger than typically seen in digital mental health interventions, the approach represents a significant advance in making effective treatment accessible to those who need it.
For the millions of workers struggling with sleep problems and related mental health challenges, this research offers genuine hope. Effective help may be more accessible and comprehensive than previously thought possible, delivered in a format that fits into busy working lives.
As the researchers concluded, the program "emerges as an effective solution to address the high prevalence of insomnia and its impact on the workforce, offering scalability and accessibility beyond traditional methods." For employers, employees, and healthcare systems alike, this represents a promising path forward in addressing one of the most significant public health challenges of our time.
The future of workplace mental health may well involve programs like this one, where the artificial boundaries between different types of psychological distress are dissolved in favor of comprehensive, integrated approaches that address the whole person rather than isolated symptoms. For working adults everywhere, that future can't come soon enough.
Moukhtarian, T. R., Fletcher, S., Walasek, L., Patel, K., Toro, C., Hurley-Wallace, A. L., ... & Meyer, C. (2025). Digital CBT for insomnia and emotion regulation in the workplace: a randomised waitlist-controlled trial. Psychological Medicine, 55, e52.
Therapists Love This New 10-Session Eating Disorder Treatment (But Need Help with Two Key Skills)
First study of clinician experiences reveals mostly positive responses to brief CBT approach, with specific training needs identified
When Dr. Sarah, a young psychologist working in an NHS eating disorder clinic, first heard about a new 10-session therapy for bulimia and binge eating disorders, she was skeptical. How could such a brief treatment possibly help people with complex eating problems that typically took months or even years to address?
But after delivering Cognitive Behaviour Therapy Ten (CBT-T) to dozens of patients over the past two years, Sarah has become one of its biggest advocates. "It's a really lovely therapy," she explains. "I'm massively passionate about it."
Sarah's experience isn't unique. The first comprehensive study of therapist experiences with CBT-T reveals that clinicians are overwhelmingly positive about this innovative brief treatment, though they've identified specific areas where they need more support and training.
What Makes CBT-T Different
Traditional eating disorder therapy often involves 20 or more sessions, creating long waiting lists and leaving many people without timely access to care. CBT-T was specifically designed to address this problem by condensing effective treatment into just 10 sessions spread across five phases.
The treatment focuses on people with non-underweight eating disorders like bulimia nervosa, binge eating disorder, and other specified eating disorders. Unlike anorexia nervosa, these conditions don't require immediate medical stabilization, making them suitable for this briefer approach.
What makes CBT-T particularly innovative is that it can be delivered by supervised practitioners who don't yet have full professional qualifications, making treatment more accessible and cost-effective. This allows eating disorder services to see more patients more quickly, addressing the chronic problem of treatment delays.
What Therapists Actually Think
Researchers from the University of East Anglia interviewed 13 NHS eating disorder clinicians who had been delivering CBT-T for at least six months. The results, published in a recent study, paint a remarkably positive picture of therapist experiences.
"It's a really nice therapy to deliver and work with patients on," explained one participant. Another noted they had "liked delivering CBT-T the most out of all therapies."
Three main themes emerged from the interviews: predominantly positive experiences, changes over time as therapists gained experience, and specific challenges that need addressing.
The Surprisingly Strong Therapeutic Relationship
One of the most interesting findings was how well therapists were able to build strong relationships with their patients, despite the brief timeframe. This was particularly surprising given that CBT-T specifically instructs therapists not to spend time building rapport at the expense of making progress on eating disorder symptoms.
Traditional therapy wisdom suggests that building a strong therapeutic alliance requires time and specific relationship-building activities. But CBT-T operates on a different principle: that people develop trust in their therapist when they see early improvements in their symptoms.
"I feel like the therapeutic alliance has been really good. I think it tends to be strong," reported one therapist. Another noted, "If they can do the changes then the therapeutic alliance is going to be stronger."
This finding challenges conventional thinking about therapy relationships. Rather than needing extensive time to build trust, it appears that helping people see quick improvements actually strengthens the therapeutic bond more effectively.
The Value of Structure
Unlike many therapists who typically resist highly structured treatments, the CBT-T clinicians appreciated having a detailed manual to follow. This was particularly valuable for less experienced practitioners who might otherwise feel overwhelmed by the complexity of eating disorder treatment.
"It is containing...having that guidance and knowing what to do," explained one participant. Another noted, "You know you're delivering the right thing that you're meant to deliver each week."
This positive response to structure likely reflects the participant characteristics. Most were relatively young practitioners without extensive therapy experience, and research shows that less experienced clinicians tend to view treatment manuals more favorably than seasoned therapists who prefer flexibility.
Growing Confidence Over Time
As therapists gained experience with CBT-T, their confidence grew and their anxiety about delivering the treatment decreased. This is normal for any new therapy approach, but what was particularly notable was how therapists' belief in the treatment model strengthened as they witnessed its effectiveness.
"I became more and more confident with delivering it," shared one participant. Another explained, "I've seen the positive outcome that it has."
This experiential learning proved more powerful than initial training. Seeing patients improve quickly validated the approach and motivated therapists to continue developing their skills with the model.
The Challenges: Where Therapists Struggle
Despite the overall positive response, therapists identified several specific challenges that interfere with optimal treatment delivery.
Imagery Rescripting: The Technical Challenge
Nearly all participants mentioned struggling with imagery rescripting, a technique used in Phase 3 of treatment where patients revisit and rewrite traumatic memories related to their eating disorder. Therapists felt the manual didn't provide enough detail for them to deliver this intervention confidently.
"Imagery rescripting isn't detailed enough to feel comfortable delivering it as a clinician," explained one participant. Another requested, "I would like more training on imagery rescripting."
This technique requires specialized skills that many general CBT practitioners haven't fully developed, yet it's a crucial component of CBT-T for addressing underlying emotional triggers.
Emotion Work: The Vague Guidelines
The second major challenge was what therapists called "emotion work" – helping patients identify, understand, and manage difficult emotions that trigger eating disorder behaviors. While the manual mentions using skills from Dialectical Behavior Therapy (DBT), therapists felt this guidance was too vague.
"The manual is a bit vague... I stray and bring other stuff in," admitted one therapist. Another explained, "The manual says that you can use some DBT skills, but for somebody who has never really used CBT before it doesn't really explain what that might look like."
This vagueness led many therapists to improvise or draw from other approaches, potentially reducing treatment fidelity and effectiveness.
The Termination Dilemma
Perhaps the most emotionally challenging aspect for therapists was having to end treatment after 10 sessions, even when patients wanted to continue. CBT-T protocol requires stopping treatment if patients haven't made sufficient progress by session 4, a decision that many therapists found difficult to implement.
"It feels really hard to be sat in front of another human, not as a patient and as a therapist, but as a human being saying, 'you've not done enough to receive any more of our help,'" shared one participant.
This highlights the tension between evidence-based protocols and human compassion that many therapists experience, particularly when working with vulnerable populations.
When Therapists Break the Rules
Despite being trained in a structured protocol, many therapists admitted to making unauthorized modifications to CBT-T. These ranged from adding extra sessions to addressing issues outside the eating disorder scope.
"Definitely had to make adaptations," acknowledged one therapist. Another explained, "If you're going by the protocol you're not supposed to slow it down or make adaptations, but with a real person we often find that we have to."
This "therapist drift" is common across all psychological treatments, but it's particularly concerning with manualized therapies like CBT-T because it moves treatment away from the evidence base that proves its effectiveness.
Who Benefits Most
Therapists noted that CBT-T seemed to work better for some patients than others. They reported particularly good results with patients who had bulimia nervosa or binge eating disorder, and less success with more complex presentations.
"When I see people who have binge eating disorder or bulimia, for me they've done really well," shared one participant. However, another noted, "Sometimes with people who would be described as complex, I find I really struggle to address everything in 10 sessions."
This suggests that while CBT-T is highly effective for its target population, it may need modifications or alternatives for patients with significant comorbidities or complex trauma histories.
Implications for Training and Support
The research findings point to several specific ways that CBT-T training and ongoing support could be improved:
Enhanced Training on Imagery Rescripting: The manual and training programs need more detailed guidance on this technique, including role-play opportunities for therapists to practice in a safe environment.
Clearer Emotion Work Guidelines: Rather than vague references to DBT skills, the manual should provide specific, step-by-step instructions for helping patients manage difficult emotions.
Support for Treatment Termination: Therapists need guidance on how to handle the emotional challenges of ending treatment and clear criteria for when exceptions might be appropriate.
Fidelity Monitoring: Regular supervision and check-ins could help prevent therapist drift and ensure consistent delivery of the evidence-based protocol.
The overwhelmingly positive response from therapists bodes well for the continued implementation and development of CBT-T. When clinicians believe in a treatment and enjoy delivering it, they're more likely to implement it faithfully and advocate for its use.
However, the identified challenges need addressing to maximize treatment effectiveness. The researchers recommend that future versions of the CBT-T manual include more detailed guidance on imagery rescripting and emotion work, and that training programs incorporate more hands-on practice with these difficult techniques.
The study also suggests investigating why therapists make unauthorized modifications to the protocol. Understanding these reasons could lead to either better training to prevent drift or evidence-based modifications that improve treatment while maintaining effectiveness.
This research represents an important step in understanding how innovative brief treatments can be successfully implemented in real-world clinical settings. While much attention is typically paid to patient outcomes, clinician experiences are equally important for successful treatment adoption.
The largely positive response to CBT-T suggests that brief, structured treatments can be both effective and satisfying to deliver, challenging assumptions that longer treatments are always better. For healthcare systems struggling with long waiting lists and limited resources, this offers hope for more efficient service delivery.
For the thousands of people waiting for eating disorder treatment, these findings suggest that effective help may be available sooner than traditionally thought possible. The key is ensuring that therapists receive the training and support they need to deliver all components of the treatment with confidence.
As one study participant summed up the experience: "People always seem to say they feel more confident leaving the sessions, and I think that says a lot about how powerful CBT-T is." With the right support for therapists, that power can be maximized to help even more people recover from eating disorders.
The challenge now is translating these research findings into improved training programs and clinical support systems that address the specific needs therapists have identified. Only then can CBT-T reach its full potential as a game-changing treatment for eating disorders.
Hewitt, C., Coker, S., Burgess, A., & Waller, G. (2025). Clinicians' Experiences of Delivering Cognitive Behaviour Therapy Ten (CBT‐T): A Qualitative Investigation. European Eating Disorders Review.
