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INTERRUPTED TALK: Exploring the barriers encountered by psychiatry trainees with utilising a CBT-based framework in patient clinical encounters in an NHS Trust – A qualitative study
Published online by Cambridge University Press: 26 August 2025
Abstract
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Introduction
The UK Royal College of Psychiatrists and the General Medical Council both recognise the value of and commend the use of Cognitive Behavioural Therapy (CBT) in understanding and treating Psychiatric disorders. It is now mandatory to incorporate in CBT in psychiatry training. Previous research and the authors’ own experiences as a trainee have shown that despite being trained in CBT, there continues to be limited use of CBT in routine clinical practice by psychiatry trainees. This study was conducted at a UK NHS Trust as an educational service evaluation.
Objectives
Despite trainees receiving extensive CBT training and completing a 12-session CBT case early in their training, many do not use this skill. The objective of the study was to explore any barriers psychiatry trainees encountered in utilising CBT in routine clinical practise.
Methods
A qualitative, ethnographic approach using focus group discussions was used. Three Focus groups were conducted. These were audio-recorded and transcribed verbatim, then analysed using a General Thematic Analysis. A coding framework was used to organise emergent themes into five broad categories and are shown in the results section.
Results
Table 1:
Barriers to CBT use
| Training Factors | Patient Factors | Psychiatrist/Clinician Factors | Systemic Factors | Other Factors |
|---|---|---|---|---|
| Not taught in medical schoolsInsufficient trainingTraining too abstractTime-lag between training and practiceLack of access to information on further trainingTrainers’ emphasisNo familiarity with integrating into assessments | Patient WillingnessSuitabilityPatient preference for medicationPatient mindset about psychiatrist’s roleNot considered tangible by patientsPoor rapport with medics in in-patient settingsSeverity of illness | Few advocatesSubspecialisationLack of confidenceUnavailability of senior cliniciansCulture of cliniciansLack of autonomyLack of practiseNot part of Doctor’s role | TimeType of care setting (Community vs Inpatient)Pressure on services.No senior modellingLack of clarity of conceptFocus on other areas at assessment.Lack of supervisionNo therapist continuity or formalised follow-up | CBT is too structured |
Conclusions
Psychiatry trainees were eager to use their CBT skills more often yet find barriers hindering their aspirations. In a specialty where talking with patients can sometimes be as effective as offering them medications, having a deeper understanding of the hindrances trainees encounter with regularly deploying this skill is crucial.
Disclosure of Interest
None Declared
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- European Psychiatry , Volume 68 , Special Issue S1: Abstracts of the 33rd European Congress of Psychiatry , April 2025 , pp. S443
- Creative Commons
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.- Copyright
- © The Author(s), 2025. Published by Cambridge University Press on behalf of European Psychiatric Association
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