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PhD Study: Enhancing engagement with between-session work in Low Intensity Cognitive Behavioural Therapy (CBT) based interventions

This research is led by Mia Bennion as part of her PhD Fellowship. For more information about Mia please check out our PhD Fellowships pages


To find out more about this study and how you can get involved, please read the relevant information sheet below:


If you're interested in taking part in the study, you can get in touch by email:, telephone: 07933 611 477 or post (by returning the 'consent to contact' form to the address provided). 



What are we trying to do?

The aim of the project is to enhance patient engagement with between-session work in Low Intensity (LI) CBT-based interventions.


By seeking to further understand what, how and why factors affect patient engagement with between-session work, the findings of this study can inform future patient information resources, workforce training guidelines and service planning.



Why is this important?

Encouraging patients to complete therapeutic work outside of treatment sessions is neither new nor uncommon in psychotherapy and is considered an integral aspect of Cognitive Behavioural Therapies. Sometimes coined as ‘between-session work’, these activities allow patients to transfer adaptive skills learnt in therapy sessions into everyday life where presenting problems naturally occur.


Between-session work is particularly pertinent during LI interventions, given treatment duration and practitioner input are often minimal (usually involving around 6-8 30-minute treatment sessions). This means that a lot of the therapeutic activity encouraged to take place during LI interventions is completed by the patient independently in the form of between-session work.


Previous research has shown that when patients engage well with between-session work during therapy, treatment outcomes are enhanced, and symptoms are greater reduced. Yet between session engagement appears to vary and a lack of patient engagement with between-session work in CBT is commonly reported.


Findings from individual studies seeking to identify factors which affect patient engagement with between-session work have been inconsistent, contradictory, and inconclusive. It is concerning that the factors affecting engagement with between-session work are poorly understood, particularly given the possible influence this may have on the clinical and economic success of mental health services, particularly Improving Access to Psychological Therapies (IAPT) services in the UK.



How are we doing it?

  • Phase 1 - A mixed methods systematic review and “best fit” framework synthesis aiming to identify predictors of engagement with between-session work in CBT-based interventions. The use of the “best fit” framework synthesis enables the research team to map findings from primary studies retrieved in systematic searches onto an existing conceptual model or framework relevant to healthcare engagement. This allows a conceptual model of engagement for between-session work based on empirical data to be developed as a final product of the review.


  • Phase 2 – A qualitative study will follow to test and further expand this model by interviewing both IAPT patients and professionals about their views and experiences of between-session work during a LI CBT-based intervention. Semi-structured interviews will be used to explore and compare patient and professional perspectives regarding definitions, attitudes, expectations, experiences, barriers and facilitators towards between-session work for LI CBT-based interventions delivered in IAPT. Patient and public involvement and engagement (PPIE) has been sought since the beginning of Phase 2 and involves working with a lived experience advisory panel who will help support the study throughout. This will involve advising on interview topics, patient facing materials and helping to strengthen dissemination strategies. 



Who are we working with?



More information




PhD Fellow


Mia Bennion