IAPT & CBT – Clinical Psychology 1/8
WHAT IS IAPT / NHS TALKING THERAPIES?
IAPT = Improving Access to Psychological Therapies (now called NHS Annual Report 2024/25 — NHS Talking Therapies:
Talking Therapies) 1.81 million referrals (down 0.9% from 1.83M in 23–24)
Services which provide evidence-based psychological therapies to those 91.6% accessed NHSTT within 6 weeks (up 1.1% from 90.5%)
with anxiety disorders and depression. For 18+ years experiencing mild to 8.4 sessions of treatment on average (up from 8.2)
moderate psychological difficulties.
These statistics are useful as evidence that NHS Talking Therapies is a high-
NICE provides national guidance and advice to improve health and social volume service, with access targets broadly being met — but access does
care — guidance, advice, quality standards and information. IAPT services not automatically mean all needs are met or all presenting complexity can be
are NICE-aligned. addressed within brief treatment.
IAPT/NHS Talking Therapies — New Approach Features: Potential limitation: The stepped-care approach can mean people begin
Solutions are evidence-based with low-intensity support first, so access to higher-intensity CBT may be
Utilise community settings delayed if initial interventions are insufficient or if step-up processes are not
Provide choice of therapy venue consistently applied.
Quick access; can self-refer
Martin et al.: IAPT increased access to psychological therapies and
Psychoeducation; guided self-help
produced reliable improvement for anxiety and depression. However, it may
Use of technology (instead of in-person)
not be sufficient for the complexity of primary care mental health needs —
This matters because IAPT tries to reduce barriers to treatment: self- complex, comorbid and trauma-related problems may require more.
referral, community settings, and flexible formats mean people can access
support without GP gatekeeping or long waits.
THE STEPPED CARE MODEL — 4 STEPS
STEP 1 Known or suspected depression/anxiety with minimal symptoms. Focus on assessment, support, psychoeducation, active
GP/Primary Care monitoring, referral onwards if needed. May include watchful waiting or brief self-help advice.
STEP 2 Psychological Wellbeing Practitioners. Low-intensity group workshops (topics: anxiety, depression, stress). Guided self-help, booklets,
PWPs homework tasks, self-help techniques. Suitable for milder presentations.
STEP 3 High Intensity Therapists. CBT for moderate to moderately severe depression and anxiety disorders. More in-depth workshops,
CBT Therapists / HITs self-help activities. Skills to change unhelpful thinking; new or more productive coping strategies.
STEP 4 Small minority with severe/complex difficulties, risk of self-neglect or harm, functional impairment, or previous treatment
Specialist Services insufficient. May involve experienced CBT therapists, EMDR, more intense/longer treatment, combined treatments, crisis support,
multi-professional care.
Gyani et al.: Higher step-up rates were linked to better recovery, suggesting stepped care can work well, but only when clients move up the steps
appropriately. The system becomes limited if people remain in low-intensity support when they need more.
, IAPT & CBT – Clinical Psychology 2/8
THERAPIES IN IAPT & COMMON MYTHS ABOUT CBT
Therapies offered depend on the disorder: Common Myths About CBT:
Depression = guided self-help based on CBT principles "The therapeutic relationship is not important"
Anxiety = same as above (not advised for social anxiety disorder or "CBT is about positive thinking"
PTSD) "CBT doesn't deal with the past"
PTSD = Trauma-focused CBT "CBT isn't interested in the subconscious"
Social anxiety disorder = CBT "CBT is quick to learn and easy to practice"
Key point: IAPT is not one single therapy — the type and intensity of Wright & Davis (1994): the therapeutic relationship in CBT is a crucial
intervention depends on the disorder and severity. This means IAPT is component. These myths are useful for evaluation — CBT is structured and
condition-specific when applied correctly. skills-based, but it still depends on collaboration, formulation and a strong
working alliance.
CBT BACKGROUND & GENERIC FRAMEWORK — KENNERLEY, KIRK & WESTBROOK (2017)
CBT focuses on the interactions between: 7 Principles of CBT (Kennerley, 2017):
Cognitions (thoughts) 1. Cognitive principle — it is the belief about situations and events, not just
Affect/emotions the events themselves, that leads to emotional responses
Behaviours (what we do) 2. Behavioural principle — what we do has a strong influence on what we
Physiological changes (bodily states) think and how we feel
Generic CBT Framework: Experiences → Beliefs & Assumptions → Critical 3. Continuum principle — our experiences are all on a continuum; mental
incident/precipitating event → Cognition → Behaviour → Affect → health difficulties are the extreme end of normal experience
Physiology 4. Here-and-now principle — CBT focuses more on current problems and
Based on the assumption there is a circular relationship between a experiences instead of past ones
person's thoughts, feelings, behaviours and physiology. Change in one part 5. Interacting systems principle — all interacts; thoughts, feelings, bodily
of the system can influence the others — e.g. avoidance may reduce anxiety sensations and behaviours influence each other
in the short term but maintains fear in the long term. 6. Empirical principle — CBT benefits from ongoing evaluation; CBT treats
beliefs and predictions as hypotheses to be tested
7. Interpersonal principle — CBT is a working alliance between patient
and therapist; CBT is collaborative
WHAT IS IAPT / NHS TALKING THERAPIES?
IAPT = Improving Access to Psychological Therapies (now called NHS Annual Report 2024/25 — NHS Talking Therapies:
Talking Therapies) 1.81 million referrals (down 0.9% from 1.83M in 23–24)
Services which provide evidence-based psychological therapies to those 91.6% accessed NHSTT within 6 weeks (up 1.1% from 90.5%)
with anxiety disorders and depression. For 18+ years experiencing mild to 8.4 sessions of treatment on average (up from 8.2)
moderate psychological difficulties.
These statistics are useful as evidence that NHS Talking Therapies is a high-
NICE provides national guidance and advice to improve health and social volume service, with access targets broadly being met — but access does
care — guidance, advice, quality standards and information. IAPT services not automatically mean all needs are met or all presenting complexity can be
are NICE-aligned. addressed within brief treatment.
IAPT/NHS Talking Therapies — New Approach Features: Potential limitation: The stepped-care approach can mean people begin
Solutions are evidence-based with low-intensity support first, so access to higher-intensity CBT may be
Utilise community settings delayed if initial interventions are insufficient or if step-up processes are not
Provide choice of therapy venue consistently applied.
Quick access; can self-refer
Martin et al.: IAPT increased access to psychological therapies and
Psychoeducation; guided self-help
produced reliable improvement for anxiety and depression. However, it may
Use of technology (instead of in-person)
not be sufficient for the complexity of primary care mental health needs —
This matters because IAPT tries to reduce barriers to treatment: self- complex, comorbid and trauma-related problems may require more.
referral, community settings, and flexible formats mean people can access
support without GP gatekeeping or long waits.
THE STEPPED CARE MODEL — 4 STEPS
STEP 1 Known or suspected depression/anxiety with minimal symptoms. Focus on assessment, support, psychoeducation, active
GP/Primary Care monitoring, referral onwards if needed. May include watchful waiting or brief self-help advice.
STEP 2 Psychological Wellbeing Practitioners. Low-intensity group workshops (topics: anxiety, depression, stress). Guided self-help, booklets,
PWPs homework tasks, self-help techniques. Suitable for milder presentations.
STEP 3 High Intensity Therapists. CBT for moderate to moderately severe depression and anxiety disorders. More in-depth workshops,
CBT Therapists / HITs self-help activities. Skills to change unhelpful thinking; new or more productive coping strategies.
STEP 4 Small minority with severe/complex difficulties, risk of self-neglect or harm, functional impairment, or previous treatment
Specialist Services insufficient. May involve experienced CBT therapists, EMDR, more intense/longer treatment, combined treatments, crisis support,
multi-professional care.
Gyani et al.: Higher step-up rates were linked to better recovery, suggesting stepped care can work well, but only when clients move up the steps
appropriately. The system becomes limited if people remain in low-intensity support when they need more.
, IAPT & CBT – Clinical Psychology 2/8
THERAPIES IN IAPT & COMMON MYTHS ABOUT CBT
Therapies offered depend on the disorder: Common Myths About CBT:
Depression = guided self-help based on CBT principles "The therapeutic relationship is not important"
Anxiety = same as above (not advised for social anxiety disorder or "CBT is about positive thinking"
PTSD) "CBT doesn't deal with the past"
PTSD = Trauma-focused CBT "CBT isn't interested in the subconscious"
Social anxiety disorder = CBT "CBT is quick to learn and easy to practice"
Key point: IAPT is not one single therapy — the type and intensity of Wright & Davis (1994): the therapeutic relationship in CBT is a crucial
intervention depends on the disorder and severity. This means IAPT is component. These myths are useful for evaluation — CBT is structured and
condition-specific when applied correctly. skills-based, but it still depends on collaboration, formulation and a strong
working alliance.
CBT BACKGROUND & GENERIC FRAMEWORK — KENNERLEY, KIRK & WESTBROOK (2017)
CBT focuses on the interactions between: 7 Principles of CBT (Kennerley, 2017):
Cognitions (thoughts) 1. Cognitive principle — it is the belief about situations and events, not just
Affect/emotions the events themselves, that leads to emotional responses
Behaviours (what we do) 2. Behavioural principle — what we do has a strong influence on what we
Physiological changes (bodily states) think and how we feel
Generic CBT Framework: Experiences → Beliefs & Assumptions → Critical 3. Continuum principle — our experiences are all on a continuum; mental
incident/precipitating event → Cognition → Behaviour → Affect → health difficulties are the extreme end of normal experience
Physiology 4. Here-and-now principle — CBT focuses more on current problems and
Based on the assumption there is a circular relationship between a experiences instead of past ones
person's thoughts, feelings, behaviours and physiology. Change in one part 5. Interacting systems principle — all interacts; thoughts, feelings, bodily
of the system can influence the others — e.g. avoidance may reduce anxiety sensations and behaviours influence each other
in the short term but maintains fear in the long term. 6. Empirical principle — CBT benefits from ongoing evaluation; CBT treats
beliefs and predictions as hypotheses to be tested
7. Interpersonal principle — CBT is a working alliance between patient
and therapist; CBT is collaborative
