Getting the most out of therapy – Therapists report what you should know before starting

Of 1.7 million referrals for therapy in 2022-23, more than 1 million people dropped out before starting or during their therapy. This represents a dropout rate of over 60%. Many patients report worries about therapy, uncertainty about the process, and ill-preparedness for the journey ahead as to why they didn’t engage. 

Using the scientific Delphi Consensus approach with 41 therapists, researchers from Warwick Medical School, University of Warwick, have published a report in BMJ Open listing recommendations for things people should know, and steps they can try, while awaiting therapy to help get the most out of it when it starts.  

Dr. Nathan Hodson, one of the study’s leads and Honorary Clinical Research Fellow at Warwick Medical School, said: “Talking therapy is robustly shown to make a real difference to those with anxiety and depression, but too many people currently miss out. Many people grow demoralised and frustrated whilst on the waiting list, and understandably so, but this consensus provides positive steps people can take while waiting to start therapy which will boost their experience later.” 

In this study, the authors worked with 41 therapists across seven NHS trusts to produce a consensus curriculum focused on the most commonly offered form of therapy in the NHS, Cognitive Behavioral Therapy (CBT). This process resulted in a set of 27 statements about therapy which at least 80% of therapists agreed would improve sessions if patients knew them in advance. 

The Consensus distilled therapists' recommendations of what people should know before starting therapy, such as: 

• NHS Talking Therapy is a partnership where the therapist is on your side. The fastest recovery happens when you work together as a team with your therapist. 

• Most of the change happens outside the sessions: it's not just about thinking differently in therapy; it’s about trying different approaches in between sessions and discussing them with the therapist. 

• CBT will not solve all worries or problems, but it will help you manage and cope better with them.  

And there are practical recommendations of things that therapists recommend people do before starting therapy, which include: 

• Reflect on and document the changes that you want in your life before you start with therapy, so that you and your therapist can set goals together. 

• Talk to loved ones about the fact you're going to start therapy, because you might need to discuss therapy with them later. 

• If you are worried your therapist might not understand your faith, values or culture, write these worries down and show your therapist so they can adapt to support you. 

Dr Simon Williamson, Visiting Researcher at Warwick Medical School and Clinical PhD Fellow (Imperial College London) said: “I’m very excited about the potential of this new consensus curriculum. Therapists and patients who have been through therapy have many valuable insights into the process. Bringing these perspectives together into a structured resource for people waiting to start therapy should be incredibly valuable.” 

To translate this consensus to improve retention rates, the researchers identified the need for a cheap, scalable and engaging means by which to communicate this guidance prior to therapy, particularly because patients typically disengage from information leaflets. 

The research team has built an app, which provides videos and podcasts to help people feel more confident about engaging with talking therapy. The EveryStep app offers one activity each day to aid preparation for therapy and is currently being trialed.   

Robert Aston Clinical Supervisor and Therapist, NHS Coventry, Warwickshire & Solihull Talking Therapies said: “The EveryStep App is a great resource for clients who are due to receive therapy from our Talking Therapies service. It prepares clients in a number of ways – helping them gain insights into what therapy will look like and how they can get the most from sessions (regular attendance, use of home therapy). As a service we feel that this will help clients understand the therapy process in greater detail, engage more fully in therapy, and in turn facilitate better outcomes.” 

Given the significant rise in demand for mental health support in the UK, stopping patients from disengaging from NHS Talking Therapies is an urgent policy priority. This consensus curriculum and EveryStep app can provide support to patients to prepare and benefit from talking therapy that has been shown to lead to large improvements in depression and anxiety. 

ENDS 

Notes to Editors 

The paper, ‘Preparing for Cognitive Behavioural Therapy: A Delphi Exercise to Develop A Consensus Curriculum’ is published in BMJ Open. DOI: 10.1136/bmjopen-2024-097681 

For more information please contact:  

Matt Higgs, PhD | Media & Communications Officer (Press Office) 

Email: Matt.Higgs@warwick.ac.uk | Phone: +44(0)7880 175403 

About the University of Warwick 

Founded in 1965, the University of Warwick is a world-leading institution known for its commitment to era-defining innovation across research and education. A connected ecosystem of staff, students and alumni, the University fosters transformative learning, interdisciplinary collaboration and bold industry partnerships across state-of-the-art facilities in the UK and global satellite hubs. Here, spirited thinkers push boundaries, experiment, and challenge conventions to create a better world.