In this episode of Let's Talk about CBT- Research Matters, Steph speaks with clinical psychologist Katherine Wakelin about her recently published clinical guidance paper, Cognitive therapy for moral injury in post-traumatic stress disorder: integrating religious beliefs and practices, in The Cognitive Behaviour Therapist.

Together, they explore how therapists can compassionately and effectively incorporate clients' religious beliefs into cognitive therapy when working with moral injury. Katherine shares the motivation behind writing this paper, guidance on involving spiritual leaders in treatment, and practical tips for therapists who may feel apprehensive about discussing religion in therapy.

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Transcript:

Steph: Hello and welcome to Let's Talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT.

In this episode, I am joined by Katherine Wakelin. Katherine is lead author of the paper Cognitive therapy for moral injury in post-traumatic stress disorder: integrating religious beliefs and practices which was published in the cognitive behaviour therapist

Hi, Katherine Welcome to the podcast.

Katherine: Hello. Thank you for having me Steph.

Steph: Thank you for coming. So just before we start, would you please tell the listeners a little bit about yourself and the areas that you work?

Katherine: Sure. My is Katherine, Katherine Wakelin, I'm a clinical psychologist. I did my training at the University of Surrey and since then have always part of training and after training worked in a range of different specialist trauma services, so I guess certainly work in PTSD has been a specialist interest of mine for quite a few years now. I currently work in a community mental health team in Hampshire, and I guess my role within the team is in a specialist trauma place there as well. And by the time this airs I'll also be working at the University of Southampton as part of their doctorate programme as well. So that's a bit of my background and yeah what I'm currently doing.

Steph: Great. And congratulations on your new role then. That's exciting. So I probably collared you about this paper this time last year, maybe we were at the conference, because it was in progress. And I really wanted to chat to you about it, because I thought it was a really interesting paper. And I was like, if it gets published, do you want to come on the pod? You very, very kindly agreed. So often on the podcast, we often talk to people about research papers, what they did, why they did it. This is slightly different because this is a clinical guidance paper where you're giving actually practical guidance for CBT therapists on how to work with this client group. So was there any particular motivation behind writing this paper, how did this come about?

Katherine: Definitely. Well, I guess it probably brewed over a few years. I think the first case I worked with, which was a PTSD case using cognitive therapy for PTSD, where moral injury was a big component in it, was when I was working at the Traumatic Stress Service in South West London with my colleague Sharif, who co-authored the paper with me. And I guess that certainly was a really exciting piece of clinical work where I drew, with lot of Sharif's encouragement and support, but drew on the client's religious beliefs that were largely underpinning and driving the moral injury that initially we'd overlooked that aspect. And then I guess as time has gone on, worked with similar cases across different religions and different religious backgrounds, but really clearly seeing this theme, particularly when working with moral injury, actually the real value if religion is a key part of somebody's identity, then the real relevance to their PTSD and their distress and that ongoing maintenance, unless that's considered. So that's something that over time kept coming up and with Sharif's encouragement, he'd been saying all along, we should publish a paper on this. And I was like, yeah, yeah, sure. But then I guess when, over time when that kept coming up, we thought, okay, this is an idea actually that I think is a key part of the missing puzzle that perhaps didn't seem to be written about or widely talked about within the PTSD world or CBT world either.

Steph: So I'm sure that many people will be familiar with the term moral injury, but just in case for anyone who isn't, would you mind just saying a little bit about what we mean by moral injury and how this might present when working with clients with PTSD?

Katherine: Definitely. So I guess the paper or the definition our paper drew on throughout was Litz's definition of moral injury, which is sort of the leading in the field generally and how it's defined is the profound psychological distress that arises from very extreme events which violate somebody's very deeply held morals. This could involve somebody maybe perpetrating acts or failing to prevent acts or even bearing witness to acts that really violate their own moral code. So that could be for example somebody, it's really common in the veterans I've worked with, perhaps who've been part of events whether it be civilians are injured or killed or unintended consequences of actions, accidental car crashes or accidents where others are hurt or harmed or even where you've been a bystander of events and you've been unable to intervene and you've watched something very horrific play out. Or I guess even being subjugated to other people maybe betraying you or treating you in ways that severely violate your own moral code. So I guess that's the definition that's talked about in the paper, consistently refers to you throughout. But certainly Hannah Murray, has written a very fantastic paper on moral injury in cognitive therapy PTSD so I would certainly read that and our paper definitely leans on that a lot as a foundation and introduction to work in moral injury which was I think Hannah's paper was one of the first I think really clearly and explicitly laid out conditions of how you might be able to routinely be working with this for PTSD and then I guess mine and Sharif's paper expand on that and think particularly in the realm of working with clients with religious beliefs and that's a part of the identity. And actually the paper highlights the intro but Litz's actually original definition of moral injury, I guess defines it as profound as a whole list but profound psychological, biological but also like spiritual distress is named in that which I think the clues in the name, isn't it? If we're not considering someone's spiritual religious beliefs as part of working with this deeply, deeply held distress that is very relevant to somebody's moral code, then we're missing an obvious piece of the puzzle.

Steph: So in the paper, you offer several practical ways of incorporating religious beliefs into therapy in the context of moral injury. Would you be able to just talk through a few of those?

Katherine: Yeah, definitely. I guess the paper tries to of walk readers through how they might consider religion at various different aspects of somebody's treatment. In the beginning, certainly holding that in mind when you're formulating distress with clients. And I guess the formulation is always a work in progress. So certainly I've been, I've certainly missed that to start off with somebody in our initial formulation. And as our work's progressed actually we've come back to formulation, added that in actually that perhaps maybe a fear of a higher order judgment or condemnation based on acts they've perpetrated perhaps is actually really fuelling that current threat in their PTSD that might have been missing initially. And I guess it's been really I guess some of the guidance by Griffiths talks about listening out for the sacred but I guess the idea of clinicians more routinely listening out for sort of language that might imply religion or spiritual beliefs, people talking about maybe being deserving or mentioning prayer or religious communities at all. I guess really listening out for that in your sessions as natural points to then pick up on and just explore I guess, if religion is part of their identity. So listening out for religion, I think it's really important. But then certainly when you're getting into the work and when moral injury is a big theme of that, because that's not always necessarily obvious when you first begin. And I guess these are things that people may never have ever admitted or talked about before because the traumas and the shame and the guilt could be so profound. It might not be obvious you're going to be working with moral injury until you get into the work. I guess as you get into that that often feels an actual place also to just gently prompt and open up conversations around religion. I guess you can give really good psycho education around moral injury and Hannah certainly lays that out in her paper really nicely. But then sort of opening up and sort of thinking, I guess, very understandably when these types of events happen, people can be informed by their morals or things that govern their behaviours and actions and can hold a lot of shame. I guess I'm curious for you, whether or not religious or any beliefs around spirituality can impact on moral code. Is that relevant for you? Opening questions early on or when moral injury comes into light is helpful. So we can hold that in mind on our formulation. But I guess the big part of the paper then moves into thinking about how we can actually practically use religious beliefs and teachings or spiritual beliefs and teachings within the updating work of cognitive therapy for PTSD. So I guess a big part of it is I think often having these conversations with clients. I know I've certainly worked with clients where it's really obvious on the surface that they may be feel very responsible for maybe some horrific events that happened. But actually when you can't I guess keep downward arrowing perhaps beneath that, fears of what that means about themselves or being condemned, being maybe judged as evil, being punished by a higher order God. And I guess that then really driving the distress. So I think when you reach that bit and you're able to acknowledge those appraisals, I think a key part of then starting those updating conversations often is- certainly I name that I'm not a religious expert or not trying to be a religious expert. And I know that they'll know a lot more about their religion than I do. So I guess I'll often start quite general questions of asking, I wonder, is there any religious teachings or scriptures that they're aware of that could be quite important to us when we're kind of trying to update some of these appraisals? And clients can really surprise you sometimes and draw on things that you certainly would never have thought of. And then I guess when clients get stuck, that's a really natural point in which the paper then guides you through of how you might set up inviting a religious leader or surveying religious experts to bring in their perspective. If that's going to be, if these are really key cognitions that we're needing to think about, but in terms of the updating work. And then as we always do, then linking those updates really nicely back into the membrane.

Steph: Yeah. And one thing that I really liked about this paper as well is that you had some really illustrative case examples of that as well, didn't you, and how incorporating those techniques, I guess, into the work has really helped them move forward.

Katherine: Definitely. And yeah, so try to really bring it to life in the paper. We had Zara and Ali were some of the case examples we discussed throughout. And I tried to put within the paper real life quotes and answers that we gathered from imams and like religious Christian chaplains and ministers that we surveyed as well included as well so that's hopefully can be quite a useful resource for other therapists when they're working with similar clients or similar beliefs to get ideas from and have some confidence I guess to sort of implement similar ideas within their CBT work.

Steph: So I guess the process of seeking advice from other religious experts for me was quite new, but obviously something really innovative that you've done in your therapy. Is there anything that people should be mindful of or consider if they're going to incorporate that into the work that they're doing?

Katherine: Yeah, definitely. And I get these questions quite a bit because I think it does feel daunting, doesn't it? Inviting a religious leader into a therapy session, perhaps. But I guess I'll just reflect back. I think every time we do behavioural experiments, every time we take clients outside of the therapy room, every time we interview someone or survey someone, we're taking a relational risk, aren't we? We don't quite know what's going to happen. We can't predict the whole thing. So I guess there is an element of I guess being able to know that we won't know exactly what's going to happen but I guess what we can really do is really think about it carefully beforehand and put in as much support and preparation to try and make this as a most helpful experience as possible for the client and make it as therapeutic as possible. So I lay it out on the paper how I guess my experience of doing this, which so far has had a great success rate but obviously you can't sort of foresee everything. I guess the big things being starting this conversation collaborative with a client and really thinking through together. If you get into this point of actually acknowledging that you as a therapist aren't an expert in this particular religious area, certainly, but you can see how important it to the client and really validating that, how essential it obviously is to their belief system and their identity and actually the real, I guess, significance of that and importance of us weighing that into therapy. I guess usually I've had expensive clients being like, yes, yes, of course, and buying into that. I guess thinking, okay, if you don't know these answers to these big questions, because often clients in my experience have been grappling with questions around, could they be forgiven? Perhaps if they've maybe unintentionally or accidentally maybe ended somebody's life or resulted in very serious accident and thinking about who could we ask? And I guess how I usually set it up is sort of saying that, you know, in CBT, when we get to really important issues, there may well be things where we want to survey or ask xperts in the area so that we, both me and you can learn. And I think it's a really nice modelling as well of lowering the power dynamics as well, because you're really naming that you're the therapist, don't hold the answers, and you're going to be really guided by the client. So really making those conversations as collaborative as possible. And generally I've found clients to be really over actually that a sort of seemingly secular NHS clinician would be entrusted in their faith in this way. So then I guess lead you on to if they've brought into this, if you know if they're really nervous, I guess it's thinking about ways we can do it and to reduce maybe some of the some of the fears they may have and thinking what that pretensions may be. So for some people I've certainly found it to be helpful often, giving them a choice, but generally clients I've experienced prefer maybe for me to source a religious leader as opposed to themselves. So, it's someone who's not known, they're not in their community. I guess these communities often are quite small and quite tight knit and I guess fears around confidentiality can be quite real for our service users or whether it's a survey rather than actually face to face interview, again, that can reduce obviously, anonymity of the client even more so. I mean personally my preference is generally to try and interview somebody with the client there as well if possible because I think it really could bring it to life for the client. It can really I guess allow them to have natural follow-up discussions and questions you didn't even know that they had and arise from it and I guess if you get a really compassionate I'm thinking about some of the leaders I work with, like a really compassionate minister or imam who's able to kind their tone of voice and the way they speak can really, it's not just the words on the paper that they're saying, but also the way they're saying it and teaching the client can have a really emotional felt sense to those words as well that a survey might not. But you know, you'd be led by what the client is wanting. And then I guess in terms of then actually setting it up, I'd usually always give a session to really think through what questions we'd want to ask, linking them really to some of the key appraisals that we're wanting to update, all the key things that they're really stuck on. And I give examples of the types of questions some of my clients have asked in the paper. So whether it's around certain scenarios, whether it's feasible for God to forgive them or what they can do in terms of moving forward or making an amends can be really, I guess, key things to ask or particularly asking about what teachings we can draw on.

And then I guess what I've also found is a big emphasis on once you've agreed some difficult questions, I guess the importance is you get in their consent, but I guess how much they'll be willing for you to share with a spiritual leader in advance. So, you know, normally you don't need to share their full name or anything like that, but maybe a bit of background about the sort of thing you're looking for help for. So maybe it might be saying that, you know, I'm in NHS therapist, I'm working with somebody, maybe who was a veteran holds a lot of shame and guilt around some of the lives that have been lost in combat and whether or not we're looking for a religious leader who might be able to help answer some of our questions about God's forgiveness and our war or injust actions. That sort of level of detail would be initial things I'd be thinking about. And I usually would always try and if you find somebody suitable, NHS Chaplaincy is a really good place to start if you're an NHS therapist. But as well, or if they don't have somebody who's suitable, whether they can recommend you somebody. I've used networks, I guess, within my workplace or colleagues who I know are particularly aligned with a certain religious. If they can recommend me a leader, I guess that's going to be particularly compassionate and understanding to mental health. I'm really sounding that out. I think then largely set up really nicely. I usually would meet with the religious leader with the clients agreement in advance of the session actually just to have a brief chat with them really check out that they do feel comfortable asking these types of questions or show them the questions. And I guess if I had any concerns at that point that would give me a chance as a therapist to step back or reconsider if we need to, if there's maybe someone who'd be more suitable.

Steph: Yeah, that did answer one of my questions, which was like, I wonder if this has ever gone wrong. When you've been like, actually, maybe this person isn't suitable for this after all.

Katherine: And I mean, yeah, exactly. So I think that's the real importance of trying, if possible, to have a conversation with them in advance. It gives you a bit of a as well as a therapist to give them, the religious leaders, bit of psycho-ed around a bit about what PTSD is, if they don't know already, which can be really helpful. But generally, I've found religious leaders to be so respectful and so compassionate, and I guess often a big part of their role within their communities is also a very pastoral role often and they've brought a whole level of , I guess, spiritual knowledge, but also a real warmth and like a real compassion that's hard to convey, I think. Yeah.

Steph: Yeah, because it just took quite a special type of person to be a religious leader, doesn't it? So you would imagine that they would be bringing that really, compassion and that empathy with them to the work as well.

Katherine: And you know, I think therapists often have lot of apprehensions about that, but I think just do your homework and do your thinking carefully beforehand. And certainly, I think if you're having a recommendation, so if it's through the NHS Chaplaincy Service, they'll have been screened, they'll have been vetted, they'll be trained to work within health settings. If not, if it's maybe a colleague or a friend of yours who has an understanding of mental health who's able to recommend somebody who knows somebody and going through that way I found I guess to be a really effective and helpful way. And I guess also I guess also needing to think in ahead in advance of like who I guess a client would deem an expert as well so I guess there's lots of different sects or denomination between various religions or I guess what if any qualifications a client would require to feel that they would have the knowledge I guess to be able to answer some of these questions are obviously helpful things to think through with a client in advance of then going on your search for somebody but yeah.

Steph: Yeah, and I think your paper talks about that a bit doesn't about how you work really collaboratively with the client on that and asking them who they would feel would be most appropriate and how, how then you could find that person.

Katherine: I guess I've certainly been quite surprised because I'd say almost most people I've worked with have often been a lot less picky or specific than I thought they would be. Maybe if they've particularly aligned within a specific denomination and I've thought, do we need to really match this? And then they've actually been a lot more open than I thought. So sometimes clients can surprise you. And I guess it's really understanding who and what they would deem as knowledgeable on this.

Steph: And you say in the paper as well that CBT therapists often report some discomfort maybe in bringing religion into the therapeutic work. Is there anything that you'd like therapists to know or any practical tips about how they can manage this if they are feeling apprehensive?

Katherine: Yeah, I think that's such a big question. I my big take home would be, be curious and actually, because we're curious about so many things, why are we often just not curious about religion? Actually, there's no difference there. I think, you know, your therapeutic training of empathy, validation, open questions, your Socratic questioning, being, listening. All of that are going to be your key soft skills that you're going to be needing here. And it's not about you as a clinician holding religious answers or expertise on spiritual guidance topics. Often when clients have sort of said, I guess maybe being a bit surprised that I've been interested or even being like, I guess, maybe are you religious too? But I guess how I always frame it is if it's important to you then it's important to me and in our work and when you're getting to this point in cognitive therapy PTSD and think moral injury is so explicitly tied to somebody's moral beliefs and if they're religious then religion is going to be a good part of that. It's quite a natural seamless flow I've found and so actually just being curious, holding those open questions and I guess naming that you don't, you may get it wrong as well. So, think that's a really nice way of balancing the power dynamics. You know, I'm really mindful. You know a lot more about Hinduism than I do. There may be things that I say, I get it wrong. You do call me out on that and name that because I certainly am willing to like learn alongside you and I can hear how important this is to you. So I guess I'm wondering how we can integrate into this work more. And I guess those kinds of conversations have really reducing the power dynamic. I think therapeutically that is also really valuable as well. And clients can teach you things. So I've learned so much through this work, things I never would have known, amazing updates that I never would have, we never would have generated ourselves or I never would have generated with my standard CT PTSD textbook in mind. And that's been so, I've seen such a quick and rapid clinical shift for clients because we got to something that I guess is so culturally meaningful and so in line with their religion and their identity.

Steph: Yeah, well, that's amazing. And it sounds like that's just been such a helpful thing to give your clients as well. Like you say, just really meeting them where they're at in this process and asking them, working really collaboratively with them.

Katherine: I think sometimes there can be like, maybe it's not a nervousness but I guess maybe a general sort of ambivalence perhaps around, I guess if a therapist sees themselves maybe thinks sort of, I'm not religious or I'm in a secular service so religion's not really, it's not relevant I guess to CBT, it's sometimes an attitude I've come across. I guess what I've really found is religion, particularly working in moral injury, can be your sort of supercharge, I think, and can actually be your sort of superpower in terms of updating and working with some really challenging and really complex and very tightly held morally injurious beliefs. And actually, I think being open to considering how you might be able to draw on it is only going to be in your advantage because there's so much in the religious literature that I think around moving forwards, making amends, forgiveness around building new life, how we keep moving forwards after these events that's going to be really helpful for clients when they're grappling with this.

Steph: . So I guess we might have covered this a little bit already just with what we've been talking about. But what impact do you hope that this paper will have on the world of CBT then?

Katherine: Well, I'm hoping it will be widely read. It's been in the top 10 actually downloaded, which has been excited recently. So we're hoping that means people are reading it. I guess for it to become more routine, for it not to have to be seen as a specialist or unusual adaptation. I think what I guess the angle of the paper was that there is lots of trials which have specifically adapted CBT for religious interventions and followed specific like protocols I guess for spiritually adapted CBT for behavioural activation for people who are Muslim or something like that like very specific and I guess as part of that you need specialist training, you need to access the specialist protocols and the average routine clinician couldn't deliver that intervention and I guess what the angle of this paper was that was meant because the hope was empowering any and all CBT therapists to read that and think, you know what, I could do that. But actually I don't need to have done a specialist course. I don't need to have to have a specialist protocol for doing this. Actually this involves like a good dose of curiosity, openness, a willingness to not have the answers and then be able to draw on the experts when needed is the I guess, real hope of the paper. So that hopefully it can become more of a routinely thought of idea.

Steph: And have you had any feedback from the clients that you've worked with when you've incorporated this or any of the clinicians when you've been using this approach?

Katherine: Yeah, definitely. Definitely been really, really striking, qualitatively and quantitatively from the feedback from clients where we've incorporated religion, certainly have found often to be cases that maybe have felt quite stuck. Maybe they've worked on these traumas before in previous therapy and it's never quite hit the nail on the head. And I guess it's that idea that we maybe hit the surface level initially of maybe it feeling around their fault or something and the whole sort of next layer of the onion around maybe feeling judgment had been missed. And I guess what I found clients fed back, I guess clients have often been quite overwhelmed or even quite emotional actually towards the end of therapy, feeling back that I never thought a white British therapist would be interested in this part of my identity. I guess feeding back often that maybe their friends or their families had been quite suspicious or maybe quite negative of them receiving secular help for their mental health. And they sort of ran out of options. So I ended up going to the NHS. But actually, then their friends and family turning around and being like, why are you going to the mosque now? What have you been doing with that therapist now? How is that NHS therapist now, I guess, seeing you, I guess, re-engaging with their community and their spiritual life again. So guess often that has been reported back and one client I guess put it really well I guess they sort of gave feedback at the end of their words were basically that I couldn't argue with you that you were using or we were using the whole logic and the whole framework that I've built my whole life around aka her religion and actually when we were bringing in passages from the scriptures that I guess her whole religious identity believed in, actually she'd already bought into it so actually it was quite easy win in terms of updating because these are things that already they've built their life around. I guess feedback I've often had for people is I maybe knew that God or Allah was forgiving, but I never knew if he'd forgive something as serious as this, perhaps maybe when someone's died as a result of their actions and never obviously felt brave enough or able to ask that question to their community or to religious leaders. So I sort of held this for many, many years and just the relief that they've felt like, yeah, like a boulder being lifted off the chest was one analogy of describing it was just phenomenal.

Steph: Yeah, sounds like it just really set them free, just being able to do this work and like you say, having not having a boulder on your chest anymore, that must feel such a relief.

Katherine: Definitely, one imam that I worked with, with one client, their language round, I guess it was around whether or Allah could forgive the unintended consequences of the events that have unfolded. And I guess the imam kept referring to Allah giving you a blank page. And that then came sort of a bit of the catchphrase in therapy of this time, now having a blank page and what they were going to do with their blank page now in terms of moving forward and building their lives again. I guess language, I guess it's just different ways of framing things, but I think it fits really naturally with CT-PTST and actually everything we're trying to do in terms of updating key appraisals and cognitons. But then also like fits really well with the reclaiming and rebuilding your life. Religious leaders have often clients I've worked with I guess around specific actions they can do in terms of moving forwards after life. Sometimes there's really specific examples that I would never be able to have generated myself, hold so much meaning for a client and to then be able to start moving on after the events.

Steph: And just from a journal perspective, really, because I'm always curious to ask our guests this, but how did you find the peer review process? Can you remember now? Because it was quite a while ago. Because it's a clinical guidance paper. Did you find the reviewers quite helpful with you in that?

Katherine: Yeah, we did. I had a really good experience. Obviously, I liaised with you quite a little bit when I was sort of working out if it was appropriate for the journal and had specific questions. And yeah, you were really, really fantastic and really responsive. So I felt quite confident submitting that it was felt relevant and appropriate for the journal and then had really fantastic feedback from the reviewers. Both actually were probably the most overwhelmingly positive reviewing experience I've had because reviewing can sometimes feel quite critical. I guess the big point that came out probably from the reviewing process which we tried to tweak the paper to still convey, I guess the key point is that, and hopefully this comes off, is we can all do this. And I guess also about it not being something that necessarily takes extra time, that actually I guess this is something that can routinely slip into our practice. And guess often when we are in time limited practices or companies or cultures or whatever, it can be tempting to cut out, I guess, cut out a lot of CBT, I guess, some of these behavioural experiments, things you do live together and things like surveying or interviewing people. But I guess certainly, I guess the message of the paper, hopefully, if it comes across is that actually by investing just a little bit of time in doing that, you will save yourself many, many, many sessions after that where you're still going round and round on the same cognition you haven't been able to update it. But actually, this builds the effectiveness and certainly what we found in our clinical work. And actually, if we can get to this as soon as possible, then actually you'll have a much, much greater likelihood of completing successful treatment outcomes in your time-limited number of sessions that you've got.

Steph: And I'm really glad that you've got that good feedback then. And I think that definitely comes across in the paper now. And that's a really important message to have, I think, in there too. So finally, before I let you get back to your afternoon, what's next for you? Is there anything that you're working on now that you'd like to share with us that you'd like us to know about?

Katherine: Yeah, I'm working with a couple of other colleagues, going through and Hibbah Hassan, and we're writing another paper at the moment, I guess, trying to , this paper will be specifically about cognitive therapy for PTSD in moral injury. I guess our next paper we're working on is more generally encouraging clinicians to think about how we can discuss religion in CBT when therapists have their concerns, so think about CBT more broadly. I guess thinking about apprehensions or concerns or questions they often have around how do I raise this as topic, what terms if I get it wrong, ones that highlights the differences between me and my client or actually I just don't have enough time to do this justice. All of those key concerns that we've found highlighted in literature and our own clinical practice is writing a practical paper I guess trying to sort of address each of the concerns and give clinicians, I guess, practical ways to try and think about overcoming them more generally in CBT.

Steph: Brilliant, I can't wait to read that when it comes out. So Katherine, thank you so much, this has been such a nice talk. Thank you so much for coming on.

Katherine: It's a real pleasure. Thank you for having me, Steph.

Steph: Thanks so much for listening. You'll find a link to the paper we discussed along with any other useful resources in the show notes, so please do go and check those out. If you enjoyed this episode please take a moment to rate, review and subscribe. It really helps others to find us. And if you have any feedback then I would love to hear from you. You can reach me at [email protected] or follow us on Instagram and BlueSky @babcppodcasts. Our journals are there too, sharing all the latest research as soon as it is published. And don't forget to check out our sister podcasts, Let's Talk About CBT and Let's Talk About CBT Practice Matters. Whether you're new to CBT or just looking to enhance your practice, they're full of insightful discussions and some really helpful tips.

Thanks for tuning again, and I'll see you next time on research matters. Bye