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Exploring the barriers to the implementation of cognitive behavioural therapy for psychosis (CBTp)

Fiona Switzer (Psychological Therapies Department, NHS Lothian, Haddington, UK) (Queen Margaret University Edinburgh, Musselburgh, UK)
Sean Harper (South of Scotland CBT Course, NHS Lothian, Haddington, UK) (Queen Margaret University Edinburgh, Musselburgh, UK)
David Peck (Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK)

Mental Health Review Journal

ISSN: 1361-9322

Article publication date: 24 January 2019

Issue publication date: 23 April 2019




The purpose of this paper is to identify barriers for people with psychotic spectrum disorders accessing CBTp in NHS Lothian. Despite national guidelines recommending CBT for the treatment of schizophrenia (National Institute for Health and Care Excellence Guidelines 2014) and (Scottish Intercollegiate Guidelines Network Guidelines 2013), levels of access to CBTp remain low. The overall goal of the study is to uncover emergent themes regarding barriers to access to CBT for patients with psychosis. In addition, the influence of psychosocial skills intervention (PSI) training for psychosis (Brooker and Brabban, 2006) will be explored and if completion of this training effects referral behaviours and attitudes to CBTp.


This study is a quantitative service evaluation project which uses a questionnaire design to explore the factors that influence a clinician’s decision to refer a patient for CBTp. Three qualitative questions are included for thematic analysis to allow the respondents to elaborate on their views on potential barriers. All appropriate Community Mental Health Team (CMHT) staff in adult mental health in NHS Lothian were invited to participate in the study.


CMHT staff in NHS Lothian hold favourable views of CBTp and would support an increase in access for patients with psychosis. Key barriers to access for CBTp identified in this study comprise of, little or no access to CBTp, lack of integration of services and unclear referral pathways. Further themes emerging from the study also included, improving multi-disciplinary communication and increasing CMHT staff knowledge and confidence in CBTp. PSI training was shown to have a significant effect on referral rates. Further research would be warranted to explore the influence of PSI training on CMHT staff confidence and knowledge in CBTp.


This is the first paper of its kind to investigate the potential barriers to access to CBTp in Scotland. The paper has highlighted some key barriers and potential strategies to overcome the barriers identified will be discussed.



Switzer, F., Harper, S. and Peck, D. (2019), "Exploring the barriers to the implementation of cognitive behavioural therapy for psychosis (CBTp)", Mental Health Review Journal, Vol. 24 No. 1, pp. 30-43.



Emerald Publishing Limited

Copyright © 2019, Emerald Publishing Limited

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