Background: Only about half of people with obsessive compulsive disorder (OCD) show clinically significant improvement following the recommended therapy, exposure and response prevention (ERP), partly due to poor therapy acceptability. A mindfulness-based approach to ERP (MB-ERP) has the potential to improve acceptability and outcomes. Methods: This was an internal pilot randomised controlled trial (RCT) of group MB-ERP compared to group ERP. 37 participants meeting DSM-IV OCD criteria were randomly allocated to MB-ERP or ERP. Results: Both groups improved in OCD symptom severity. However, MB-ERP did not lead to clinically important improvements in OCD symptom severity at post-intervention compared to ERP -the minimum clinically important difference was not contained in the 95% confidence intervals. There were negligible between-group differences in engagement and MB-ERP did not appear to have broader benefits compared to ERP on depression, wellbeing or OCD-related beliefs. Conversely, MB-ERP led to medium/medium-large improvements in mindfulness compared to ERP. Conclusions: MB-ERP is unlikely to lead to clinically meaningful improvements in OCD symptom severity compared to ERP alone. We underline the importance of adhering to treatment guidelines recommending ERP for OCD. Insufficient attention may have been given to mindfulness practice/discussion in MB-ERP and further research is recommended to explore this possibility.

Purpose The purpose of this paper is to examine the impact of service user involvement in mental health training but little is known about what staff, trainees and service users themselves want to achieve. Design/methodology/approach Three separate focus groups were held with service users, training staff and trainees associated with a clinical psychology training programme. Thematic analysis was used to identify aims for involvement. Findings All groups wanted to ensure that future professionals “remained human” in the way they relate to people who use services. Service user and carer involvement was seen as a way of achieving this and mitigating the problem of “them and us thinking”. The authors found that groups had some aims in common and others that were unique. Service users highlighted the aim of achieving equality with mental health professionals as an outcome of their involvement in teaching. Research limitations/implications The samples were small and from one programme. Practical implications Common aims can be highlighted to foster collaborative working. However, the findings suggest that service users and carers, staff and trainees may also have different priorities for learning. These need to be recognised and addressed by mental health educators. Originality/value This was the first study to explore in depth the differing aims of different stakeholder groups for service user involvement. Clarification of aims is a vital first step in developing any future measure of the impact of service user involvement on mental health practice.

BackgroundObsessive Compulsive Disorder (OCD) is a distressing and debilitating condition affecting 1-2% of the population. Exposure and response prevention (ERP) is a behaviour therapy for OCD with the strongest evidence for effectiveness of any psychological therapy for the condition. Even so, only about half of people offered ERP show recovery after the therapy. An important reason for ERP failure is that about 25% of people drop out early, and even for those who continue with the therapy, many do not regularly engage in ERP tasks, an essential element of ERP. A mindfulness-based approach has the potential to reduce drop-out from ERP and to improve ERP task engagement with an emphasis on accepting difficult thoughts, feelings and bodily sessions and on becoming more aware of urges, rather than automatically acting on them.Methods/DesignThis is a pilot randomised controlled trial of mindfulness-based ERP (MB-ERP) with the aim of establishing parameters for a definitive trial. Forty participants diagnosed with OCD will be allocated at random to a 10-session ERP group or to a 10-session MB-ERP group. Primary outcomes are OCD symptom severity and therapy engagement. Secondary outcomes are depressive symptom severity, wellbeing and obsessive-compulsive beliefs. A semi-structured interview with participants will guide understanding of change processes.DiscussionFindings from this pilot study will inform future research in this area, and if effect sizes on primary outcomes are in favour of MB-ERP in comparison to ERP, funding for a definitive trial will be sought.Trial registrationCurrent Controlled Trials registration number ISRCTN52684820. Registered on 30 January 2014.

Purpose – The purpose of this paper is to build a theoretical model of how and what clinical psychologists learn from service user and carer involvement in their training. Design/methodology/approach – A qualitative research design was adopted, and verbatim transcripts of semi-structured interviews conducted with 12 clinical psychologists were analysed using grounded theory methodology. Findings – Findings indicated that clinical psychologists learned from service user and carer involvement in a variety of ways and a preliminary model was proposed, encompassing four main categories: “mechanisms of learning”, “relational and contextual factors facilitating learning”, “relational and contextual factors hindering learning” and “impact”. Research limitations/implications – Further research is required to establish to what extent the current findings may be transferrable to learning from service user and carer involvement in the context of educating professionals from other disciplines. Additionally, participants had limited experiences of carer involvement, and more research in this area specifically would be useful. Practical implications – This study advocates for service user and carer involvement in clinical psychology training, and specific recommendations are discussed, including service user perspectives. Originality/value – Service user and carer involvement has become mandatory in Health Care Professional Council-approved training programmes for mental health professionals, yet if and how learning occurs is poorly understood in this context. This study makes an important contribution in evaluating outcomes of service user and carer involvement in clinical psychology training by advancing theoretical understanding of the learning processes involved. The authors are unaware of similar work.

Purpose The purpose of this paper is to examine service-users’ experiences of mentoring trainee clinical psychologists as part of an involvement initiative on a doctoral training course. Design/methodology/approach Seven service-users were paired with trainee clinical psychologists. Pairs met for one hour monthly over six months. Meetings were unstructured, lacked a formal agenda and were not evaluated academically. All seven mentors were interviewed. They were asked about positive and negative experiences, as well as about the support provided. Transcripts were subject to thematic analysis and themes were reviewed by mentors in a follow-up meeting. Findings Overall, the results demonstrate that service-users can be involved in training in a way that they find meaningful and contribute to their recovery. Seven themes were identified: giving hope and optimism; making a difference; personal and professional development; the process; practicalities/logistics; support (positives); and support (areas for improvement). Practical implications The importance of designing involvement initiatives in a way which implicitly supports service-user values was highlighted. Recommendations for designing effective support structures are given. The authors were also involved in the scheme which could have introduced bias. Originality/value The research exploring service-users’ experiences of involvement in training health professionals is limited. This was the first study to explore in depth service-users’ perspectives of involvement in a scheme such as the mentoring scheme. If initiatives are to seriously embrace the values of the service-user movement then seeking service-users’ perspectives is vital.

Background: Depression has serious personal, family and economic consequences. It is estimated that it will cost £12.15 billion to the economy each year in England by 2026. Improving access to psychological therapies (IAPT) is the National Health Service talking therapies service in England for adults experiencing anxiety or depression. Over 1 million people are referred to IAPT every year, over half experiencing depression. Where symptoms of depression are mild to moderate, people are typically offered cognitive behavioural therapy (CBT) self-help (CBT-SH) supported by a psychological well-being practitioner. The problem is that over half of people who complete treatment for depression in IAPT remain depressed despite receiving National Institute of Health and Care Excellent recommended treatment. Furthermore, less than half of IAPT service users complete treatment. This study seeks to investigate the effectiveness of an alternative to CBT-SH. Mindfulness-based cognitive therapy (MBCT) differs from CBT in focus, approach and practice, and may be more effective with a higher number of treatment completions.

This is not a research paper but a personal and collective reflection of patient and public involvement (PPI) for the LIGHTMind 2 randomized control trial (www. isrctn. com/ISRCTN13495752). This trial compares two guided self-help psychological interventions for depression, and is delivered in the UK NHS Improving Access to Psychological Therapy services. The paper is the result of my reviewing our PPI 18 months into the trial. The PPI includes myself as a research team member and co-applicant, with lived experience of depression, mindfulness and cognitive behaviour therapy. There is a Lived Experience Advisory Panel of six people with lived experience of depression or mindfulness, who advise the researchers. Two people with lived experience of mental health difficulties and knowledge of PPI attend the Trial Steering Committee. This paper includes comments from some of the other people with lived experience and from researchers involved in the trial, included as co-authors. I offer the Johari window (Luft, 1970) and the 4Pi National Involvement Standards (NSUN, 2018) as a way of positioning the value of PPI. Developing relationships within PPI is identified as a way of moderating the fear that some people experience as they work with researchers. I describe the importance of principles that incorporate explicit statements about the value of PPI.

ImportanceDepression is prevalent. Treatment guidelines recommend practitioner-supported cognitive behavioral therapy self-help (CBT-SH) for mild to moderate depression in adults; however, dropout rates are high. Alternative approaches are required.ObjectiveTo determine if practitioner-supported mindfulness-based cognitive therapy self-help (MBCT-SH) is superior to practitioner-supported CBT-SH at reducing depressive symptom severity at 16 weeks postrandomization among patients with mild to moderate depression and secondarily to examine if practitioner-supported MBCT-SH is cost-effective compared with practitioner-supported CBT-SH.Design, Setting, and ParticipantsThis was an assessor- and participant-blinded superiority randomized clinical trial with 1:1 automated online allocation stratified by center and depression severity comparing practitioner-supported MBCT-SH with practitioner-supported CBT-SH for adults experiencing mild to moderate depression. Recruitment took place between November 24, 2017, and January 31, 2020. The study took place in 10 publicly funded psychological therapy services in England (Improving Access to Psychological Therapies [IAPT]). A total of 600 clients attending IAPT services were assessed for eligibility, and 410 were enrolled. Participants met diagnostic criteria for mild to moderate depression. Data were analyzed from January to October 2021.InterventionsParticipants received a copy of either an MBCT-SH or CBT-SH workbook and were offered 6 support sessions with a trained practitioner.Main Outcomes and MeasuresThe preregistered primary outcome was Patient Health Questionnaire (PHQ-9) score at 16 weeks postrandomization. The primary analysis was intention-to-treat with treatment arms masked.ResultsOf 410 randomized participants, 255 (62.2%) were female, and the median (IQR) age was 32 (25-45) years. At 16 weeks postrandomization, practitioner-supported MBCT-SH (n = 204; mean [SD] PHQ-9 score, 7.2 [4.8]) led to significantly greater reductions in depression symptom severity compared with practitioner-supported CBT-SH (n = 206; mean [SD] PHQ-9 score, 8.6 [5.5]), with a between-group difference of −1.5 PHQ-9 points (95% CI, −2.6 to −0.4; P = .009; d = −0.36). The probability of MBCT-SH being cost-effective compared with CBT-SH exceeded 95%. However, although between-group effects on secondary outcomes were in the hypothesized direction, they were mostly nonsignificant. Three serious adverse events were reported, all deemed not study related.Conclusions and RelevanceIn this randomized clinical trial, practitioner-supported MBCT-SH was superior to standard recommended treatment (ie, practitioner-supported CBT-SH) for mild to moderate depression in terms of both clinical effectiveness and cost-effectiveness. Findings suggest that MBCT-SH for mild to moderate depression should be routinely offered to adults in primary care services.Trial Registrationisrctn.org Identifier: ISRCTN13495752