Tag Archives: Research

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

CATCH Trial Recruitment

Can you help the CATCH trial recruit people for a Feasibility Trial on Cognitive Analytic Therapy-informed Containment for self-Harm?

Trainee clinical psychologists from the University of Manchester are conducting this study under the supervision of Dr Peter Taylor and Dr Samantha Hartley.  Participants need to have had no previous experience of cognitive analytic therapy and be:

  • aged 16 and over
  • from the Manchester and Liverpool areas
  • currently engaging in self harm
  • not currently in therapy

For full details of ethical approval, inclusion and exclusion criteria, participant information etc, please contact the research team on the numbers below or via catch@manchester.ac.uk

Flyer outlining the Cognitive Analytic Therapy-informed Containment for self-Harm (CATCH): A Feasibility Trial

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)