A frequent complaint by service-users of psychiatric inpatient units is the unavailability of talking therapy at precisely the time when they need to make sense of their situation. However, conventional models of cognitive-behavioural therapy (CBT) delivery, with set numbers of sessions and diagnostic specificity, are not well suited to the conditions of the acute ward, with variable and unpredictable lengths of stay and multiple and indistinct presentations. This pilot study describes a modification of CBT designed to deliver an effective, brief therapy in these conditions. The approach is grounded on the cognitive science-based model, interacting cognitive subsystems, and draws on dialectical behaviour therapy and other recent, mindfulness-based CBT approaches to provide a combination of simple formulation and skills-based treatment. Evaluation in the inpatient setting also presents challenges, and these have been met by choosing measures that tap into self-efficacy and confidence in the management of emotions rather than symptomatic change. The evaluation data on a small number of cases suggest the effectiveness of the approach and the need for wider testing of the model. Copyright