Tag Archives: Evidence Base

Image of a person looking at shelves of books in a library - linked to blog theme of inviting research papers on cognitive analytic therapy

A Call for CAT Research Papers

In this guest blog, Peter Taylor offers an invitation to contribute CAT-related papers to a forthcoming special issue of Psychology and Psychotherapy: Theory, Research, and Practice. He also outlines his thoughts on how the evidence base in CAT might be strengthened.

Sam Hartley and I are editing a special edition of Psychology and Psychotherapy: Theory, Research, and Practice, focussed on cognitive analytic therapy (CAT) (see the submission details here). We are hoping this special issue will help capture where CAT research is currently, and serve as an impetus to those involved in or thinking about research relating to CAT. We are also hoping this special issue will also help showcase to those outside of the CAT community what this approach may have to offer, and so generate wider interest.

We welcome submissions focused on CAT, adopting a wide variety of research methodologies. These can include reviews, small-scale clinical evaluations or studies of theoretical principles and mechanisms. Please do have a look at the call details and consider if anything you are involved in could be submitted. Let’s see if this special issue could trigger some new interest and exciting research into CAT. The deadline for submissions is 1st November 2019.

In light of this special issue I would like to share some thoughts about where CAT currently sits with regards to research. I work as a senior lecturer at the University of Manchester and have an active research interest in CAT. Whilst I am a qualified clinical psychologist I am not a qualified CAT therapist. My experience of CAT came though my clinical training, but my interest since then has been primarily about researching the CAT approach to psychological difficulties and what it may offer clients.

The CAT community is currently a thriving network, supported by the Association of Cognitive Analytic Therapy (ACAT). A myriad of local special interest groups help maintain connections and shared ventures, as do partner organisations like Catalyse. However, from a slightly outsider perspective, I feel concerned that this growing clinical interest has often not transitioned into research interest and activity.

I have been increasingly involved in research concerning CAT over the last few years. I would argue that providing robust research evidence concerning its value is essential, both to support current practice, and to make the case for additional support of CAT within services. There has been a consistent ongoing stream of CAT-focused research, much of which was helpfully summarised in the 2014 review by Calvert and Kellett. However, I believe that a concerted and collective investment in both the scale and scope of CAT research would really help us to better understand how, when, and in what way, CAT may be of value to those in health services.

I recently ran a search on PsycINFO with the keyword “cognitive analytic therapy”. (PsycINFO is probably the main online database for psychology, including clinical psychology.) Two-hundred and ninety-four articles were identified, with fifty-three having been published in the last three years. A quick screening of these identified seventeen that could be considered empirical research. There are a few where the line between an evaluative research study and something more illustrative is blurry. Given the enthusiasm for training in CAT, and adopting the approach in many clinical settings, this number of empirical studies illustrates for me that the CAT research base is more limited than it might be.

There are various possible reasons why there has not been more research on CAT. My own feeling is that CAT has been adopted and championed by individuals with predominantly clinical roles. They may have less time for doing research, or may not feel confident in their research skills. Connections with academic departments and research groups have not quite flourished, in comparison with other approaches like CBT.

A brief review of the seventeen studies I found leads to two observations worth highlighting.

First, the majority are small-scale evaluations of CAT or some aspect of this approach (n = 11). This observation highlights one characteristic of the CAT literature that I alluded to earlier. It has been very much led by clinicians and emerged from clinical contexts, where small-n designs have been embraced. What is notable though is the lack of larger-scale systematic research studies. I identified three larger studies, but still with small samples of around n = 30-50. This suggests a difficulty in the transition from smaller to larger scale studies.

Second, a large number of these studies involve the same individuals leading the research. For example, Stephen Kellett is a leading author (first or second authorship) on nine of the studies. This suggests research into CAT has not branched out beyond particular research-active individuals and groups as much as it could have. However t it also demonstrates that individuals knowledgeable in undertaking research exist in the CAT community. There is therefore potential for modelling and scaffolding of research capacity.

So how might we move ahead to encourage and support more research in CAT?

1) Focusing on the first observation, small-n studies (e.g. case series) are important. They are part of a recognised step within the MRC guidance on developing the evidence base for complex interventions. Crucially, they help answer important questions about feasibility and acceptability. The lack of CAT research outside of this area suggests to me both a challenge but also an opportunity to develop and expand the CAT research base further.

2) Larger-scale trials typically require funding, which is notoriously difficult to obtain. However there may be other ways of extending CAT research. Linking up researchers from multiple services or groups may help to establish collaborations for undertaking larger-scale research.

3) There is also potential in using routinely collected outcome data that many services hold, using common measures. I wonder if there is scope to collate this data to further evaluate the potential benefits of CAT. I recall there was some discussion of this latter possibility at the 2018 CAT research conference in Manchester.

4) Whilst much of the research concerning CAT has been understandably about the therapy, I also wonder about designing research directed at testing some of the conceptual and theoretical principles that underlie CAT. For example, we recently found that the Personality Structure Questionnaire (PSQ), a tool designed to assess mechanisms of action linked to CAT, is associated with difficulties around self-harm. Specifically, scores on this measure, which captures instability in self-concept or personality, distinguished those with recent (past year) and historic self-harm, with greater instability being apparent for those with recent self-harm.

Returning to a point in my second observation, I noted earlier my perception that CAT lacks strong links with academic departments and research institutions. It feels like currently in the UK there are a small number of academics who also have an active research interest in CAT. I would count myself in this group. My experience has been that many CAT clinicians have a real interest in research but either lack the capacity or confidence to develop research projects themselves.

Stronger links with academic departments and research-active academics is a possible solution here. Networking and collaboration with and between academic departments may help increase the spread of this interest and research activity.

We should perhaps also consider how the next generation of researchers could be involved in research about CAT. Funded PhD studentships with a CAT focus might be one option. For clinicians wishing to develop their research capacity further, clinical research fellowships such as those available through NIHR may also provide opportunities and ongoing support.

It will be interesting to see how the Catalyse practitioner training will be influenced by someone as research-active as Stephen Kellett joining the core trainer team as of this year.

I wasn’t able to make it along to the second CAT research conference organised jointly between Catalyse and ACAT in April 2019. However, following the Catalyse 25 Years conference in May, a small group of researchers and research-interested clinicians in the North arranged to meet informally this coming September. It would be great to hear of other local connections and collaborations which might be able to move forward with some of the ideas I’m proposing in this blog.

Moving beyond the submission deadline for the PAPTRAP special issue 1st November 2019 – I look forward to seeing research confidence growing, the evidence base for CAT becoming more solid, and generated by a broader group of clinicians and researchers.

You can follow Peter on Twitter via @PJTaylorClinPsy

Black and white image of geese journeying together across a cloudy sky in a rough formation

Journeying Together: A Second CAT Research Conference

Plans for a second research conference hosted jointly between ourselves and ACAT have now come to fruition.  ACAT is leading on the organisation of this second event – The Research Journey From Start To Finish: Motivating-to-Motivated – which takes place in London on 1 March 2019.  Again this conference aims to bring together people interested in hearing about and developing the evidence base for cognitive analytic therapy.

You’ll be welcome to attend whether you want to gain an update on current and future research in CAT, make connections and develop your research networks, or get support in developing your own research ideas.  Those with roles supporting the research activity of others are also most welcome to attend.  This could be a useful day to attend if you are a research tutor or supervisor on a core professional training.  Similarly if you have responsibility for supporting psychotherapy research activity within a  mental health or learning disabilities trust, you may make helpful connections.

The theme of a research journey was present throughout last year’s conference.  People shared stories of projects at different points along the way and reflected on what had helped or hindered them complete different stages. Alison Jenaway’s guest blog about the 2018 conference tells you more about that day.

When thinking about an image to help promote the 2019 event, we liked the metaphor of migrating geese.  Apparently they fly together to help reduce air-drag and conserve energy.  Different flock members move in and out of the front position depending on who has energy and resources to lead.   Of course following is as important as leading in this context.  We share a direction and learn from each other.  As peers we can reciprocally motivate with helpful “honking” in order to keep up a pace.

Of course none of this precludes solo flyers who want to take their own direction.  After all, would CAT ever have developed without a bit of independent thinking?

We’re not content, of course, with merely developing a metaphor or an understanding of relational processes in research.  As with the CAT model, some action is expected and encouraged.  To support concrete action getting “off the ground”, this year ACAT is offering three free places for people planning a project on CAT.

To be considered for one of these places, you’re invited to share a maximum 2000 word outline of a realistic project you can take forward, complete and publish. This should include:

  • Your main research question
  • Why it is important
  • The method you are planning to use to answer it
  • Any previous work or publications that you would be building on
  • The next steps you intend to take to get the project off the ground

The deadline for submissions is 10 January 2019.  If you’re successful we may be able to match you with a mentor from within the CAT community or related networks.  We will of course welcome you back to present at a future CAT research conference.

Whether or not you wish to apply for a free place, you can get some inspiration from the list of presentations lined up for the day, offered by Stephen Taylor, Barney Dunn, Steve Kellett, Steve Jefferis, Liza Messing and Samantha Hartley.   Topics include integrative models for nurse supervision, learning from research into other therapies, making use of data on CAT in IAPT, qualitative research into mapping, group interventions, and coproduction with young people around brief therapy for self harm.

You can also follow the hashtag #CATres19, and add to it with any queries and comments. Please also feel free to share any links or resources you think may be useful in the run up to the conference.

We look forward to seeing you there.

For more details and to book your place at the conference – The Research Journey From Start To Finish: Motivating-to-Motivated – visit ACAT’s event page at this link



Crop of presentation image of an hourglass with research words

Inspiring and Connecting Through Research into Cognitive Analytic Therapy

ACAT chair Alison Jenaway reports back on April’s joint research conference in this, her first guest blog for Catalyse.

“Only connect” wrote E.M. Forster, in his book Howards End, as isolation is a killer. I am paraphrasing, but this is what I had in mind when I was planning the idea of a regular Cognitive Analytic Therapy (CAT) research day. I wanted to be able to gather a group of experienced researchers and lock them in a room with CAT therapists who are keen and interested in research. My hunch was that by some magical process, this would produce a future Professor of CAT.  Call me naïve if you like, but this was my hope when I persuaded Stephen Kellett and Glenys Parry to organise the first research conference to showcase CAT.

To be honest they did not take much persuading. I don’t think the people who agreed to present their research on the day did either, nor the experienced researchers that gave up their time to support the day. My plan was that I would just be there to introduce the reasons behind the conference, and then watch the connecting happen from the sidelines. What I was not expecting, was how much I personally would be inspired by the day.

It really was fascinating, not so much the content of the research and the results, but the way each presenter described why they did what they chose to do, what went well, what went wrong, what they might do differently if they started again, and what they would like to do next. This felt different to other research presentations I have listened to in the past, where the presenter seems to be determined to convince you that the way they did it was the right way, indeed the only way it could have been done. It was like going behind the scenes at the theatre, and gave me more of an insight into the “researcher’s attitude”. It really made me feel that perhaps one day, just maybe, I could do this too.

The morning was made up of presentations for research projects at various stages of completion. Peter Taylor kicked off with an explanation of what a Delphi study is, and how his team used it to explore whether CAT seemed, to therapists, to be a helpful therapy for patients with psychosis.  Good luck to anyone who thinks they can get a group of CAT therapists to agree about anything, but there did seem to be some common themes emerging. His team have recently published a case series of CAT in psychosis which includes qualitative data from patients.

Craig Hallam was next, describing a huge amount of work, juggling multiple ethics committees and associated paperwork, in his study on CAT outcomes for people with learning disabilities.  Despite much solid effort and goodwill – his own, his supervisors’ and CAT colleagues working in this area – recruitment remained a challenge. Craig was pragmatic in moving on to a more manageable project that could be completed within the timeframe of his clinical psychology training. I hope that he will find a way to keep the study going once qualified, given the amount of work already put in. There were plenty of nods of recognition around the room as he generously shared a CAT map of reflections on this process.

Mark Evans described a fantastic piece of work, his small pilot randomised controlled trial of CAT for bipolar disorder, carried out with a tiny amount of funding, and what sounded like a massive amount of good will. Katie Ackroyd is similarly amazing, in her ability to get research into CAT consultancy going in the real world of a busy clinical job.

We have all come to expect that now from Steve Kellett, of course, which is unfair of us. As Steve said, he was jealous of the tiny amount of funding that Mark Evans had to spend! Steve presented his work exploring whether narrative reformulation is really necessary in eight session CAT for depression within an IAPT service, conveying in the process how much fun research can be if you are doing it as a team.

There was some great networking over lunch, and Barney Dunn, from Exeter University was available to talk to people who might be interested in applying for an NIHR ICA fellowship programme. In his view, this was one of the best chances we have in ACAT of getting funding for CAT research projects, and developing a future academic researcher into CAT, at the same time. He and other NIHR advocates are happy to support people looking for research funding .

After lunch we divided up into small groups and so I only have a small fraction of what went on. Frank Margison and I had a group of three keen people who were just starting to think about what research they might be able to do, and we all got excited about the possibilities. Frank has a great overview of how to frame a research question and how you might go about answering it. He didn’t seem to mind me interrupting every now and then to say “I’ve just had another great research idea”.

I think everyone else at the day was as inspired by it as I was. I am planning to lock people up in a room together again next year, for a similar day in London, but it may be that Barney Dunn’s ideas are a more practical way forward in the long run.

Dr Alison Jenaway is a Consultant Psychiatrist in Psychotherapy in the Liaison Psychiatry Service in Cambridge, working with patients with physical health problems and medically unexplained symptoms. She is a CAT therapist and supervisor and has been using CAT for around 20 years. She is currently Chair of the national Association for Cognitive Analytic Therapy (ACAT)

cropped image of an arrow etched into a wall

Interesting, engaging, curious minded people?

With our joint Catalyse/ACAT conference Encouraging-to-Engaged in CAT Research now less than two weeks away, CAT practictioner Rhona Brown reflects on the backdrop to the day and conversations with some of those involved in making it happen.

Since qualifying as a CAT practitioner I’ve had several opportunities to hear colleagues presenting on research at ACAT conferences and through other local CAT networks. I’m always impressed by both the rigour and commitment of researchers and the favourable results emerging from recent work. I tend to leave with a more optimistic and energised state of mind in relation to the idea of research. Sadly in the wake of other demands, must-do’s, and familiar patterns of clinical working, this dissipates fairly quickly. I return to another annual conference back at my familiar starting point, ready to be impressed and energised again. But what changes?

I suspect I’m not alone in this somewhat tame and occasional aspirational state. Within CAT there’s great enthusiasm for the model and a subjective and anecdotal sense that it’s an approach which can help both therapists and those seeking therapy to become unstuck and move on. Experience suggests that this is particularly the case where there’s a level of complexity in presenting difficulties, often where other more manualised and less relational approaches have yielded fewer benefits.

While the lived experience of both parties in the therapeutic endeavour can be favourable in CAT, we know that in terms of an evidence base, its “emerging” status  can lead to it being excluded as a recommended therapy within the majority of formal guidelines. Most recently, the updated NICE guidelines for eating disorders dropped CAT, despite a jointly produced submission by ACAT on the various RCTs which have demonstrated its value with this presenting difficulty.

So how can this change? The research meeting at the joint ACAT and ICATA 2017 conference in Nottingham brought together a small critical mass of research champions within ACAT’s membership. They updated each other on current work, generated ideas for future funding possibilities, and considered how we could collectively generate a list of manageable projects which could be picked up by those on D Clin Psych training. This meeting dovetailed with Alison Jenaway’s election as ACAT Chair.  Alison admits to being a “bright ideas” type of leader, generating new plans and possibilities, and “pushing where it moves” in a system to enable change.

At a time of much internal and external change, it’s a bonus that ACAT can benefit from this energy in relation to refreshing its research strategy. Outgoing chair Jason Hepple continues to hold a steady space for ACAT’s research committee.  Alison’s ideas for refreshing a research strategy stimulated northern-based research allies and Catalyse associates Glenys Parry and Stephen Kellett to put their networking and persuasive powers together. They have engaged a range of researchers with differing experience and stories to tell about how they have planned, conducted and reported on CAT research.  Glenys, Stephen and Alison will be joined by another six research-active colleagues on 13th April in Manchester to help deliver the first in what’s hoped to be a series of research-focussed events for the CAT community and other stakeholders who want to be involved.

So far the event’s attracted applications from a substantial group of enthusiastic CATs plus one or two others more new to CAT but keen to think alongside CAT community members about researching application of the model in their own fields. There’s a reduced bursary fee for people keen to attend but for whatever reason unable to cover the whole cost of the day.

Stephen Kellett, active in generating or supporting much of CAT’s recent evidence base, is characteristically optimistic about what might be covered. He considers that the evidence for CAT as an intervention with people with complex difficulties attracting a diagnosis of “personality disorder” is “looking good” to the extent that CAT can be considered an evidence based treatment according to the NICE bar for entry. Catch him on a day when he’s not too busy researching to share more ideas and he’ll tell you that the building evidence around CAT’s versatility enables us to “cut [our] cloth accordingly in terms of session contracting…..it’s useful to use 8 session CAT for common mental health problems or focal problems and extend to 16 and 24 for more complex presentations”. His recent work on the impact of reformulation letters demonstrates that “narrative reformulation is helpful for complexity, while less so for common mental health problems”. He goes on to highlight how the Personality Structure Questionnaire (PSQ) “is now a CAT specific outcome measure with really good psychometrics”. Get him onto evidence for CAT consultancy and he’ll enthuse that it “doesn’t really have a peer”.

When I asked Stephen what helped him get started (and keep going) in practice-based research, he shared that this has been possible through “thinking up clinically relevant questions whilst working with clients, matching an appropriate method to [them] and working with interesting, engaging and curious minded people”.

I expect that the research conference will be an opportunity for those assembled to distill and refine such questions based on their own clinical setting, and weigh up best methodologies alongside these key research guides. They’ve walked these paths before, know a whole lot more about the terrain than I do, and I hope that their insights and tips, combined with shared reflections from the larger group, can help make my research journey one which might actually get underway. Another hope is that the day will provide a stronger sense of those relational supports and networks which can keep momentum going between April and the next opportunity to hear the research component at an annual conference.

If you might be one of Stephen’s “interesting, engaging and curious minded people”, open to hitching a ride on Alison Jenaway’s energy for building CAT’s evidence base by starting or completing a research journey yourself, then please consider joining us in Manchester.

To book a last minute place at the conference, visit this page.  You can follow tweets about the day on the hashtag #CATres18