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Low Intensity cognitive restructuring: when thinking disrupts doing

Assistant Prof. Liz Ruth

Wednesday, 15 January 2025


An effective course of Low Intensity psychological treatment for depression or anxiety will usually have a focus on patient empowerment and behaviour change (Lovell et al., 2008), with the goal of equipping the patient to become their own therapist within a short course of treatment. When negotiating a course of treatment a Low Intensity practitioner will review the triggers, presenting symptoms and impact of the problem alongside the patient’s measurable (typically behavioural) goal for treatment, and propose the most effective intervention or interventions to break down the barriers to behaviour change (Michie et al., 2011) and promote symptom reduction.   

Low Intensity Cognitive Restructuring within a CBT-informed approach for depression and panic has been recommended since the inception of the PWP role (Richards and Whyte, 2009), is well-evidenced, and allows the practitioner to offer a meaningful choice of interventions where there are barriers to Problem Solving, Behavioural Activation or Graded Exposure therapy (Marinan, 2019). A Low Intensity psychological practitioner is skilled in accurately identifying the patient’s presenting problem through a rapid assessment process and must be able to deliver an accessible rationale for the proposed course of treatment in a way that enables collaborative decision making with the patient. Therefore, it is helpful to regularly review in what circumstances Cognitive Restructuring may be the most effective Low Intensity intervention to offer, as well as the circumstances in which it should not be offered. 

The stages of Cognitive Restructuring are described in PWP competency manuals (for example, The University of Sheffield, 2023) and practitioners are given a foundation of theoretical understanding of this intervention in their core training. To advance practice, it can be helpful to review the function and purpose of the stages of the intervention, and problem solve barriers to implementation. 

The event will be equivalent to 2.3/4hrs of CPD.


This workshop will provide a critical review of the role and evidence base for Cognitive Restructuring in Low Intensity Psychological interventions for depression and anxiety. We will discuss the functions of the stages of Low Intensity Cognitive Restructuring, including the role of Behavioural Experiments, and clarify the rationale for Cognitive Restructuring within multi-strand Low Intensity interventions. Attendees will be offered the opportunity to reflect on their current understanding and use of Cognitive Restructuring in their Low Intensity practice and action plan any refinements to implementation of the intervention. And the use of supervision for this intervention.

Learning Objectives

Attendees will have:
• A refreshed understanding of the evidence base and rationale for Low Intensity Cognitive Restructuring.
• A reminder of the stages of Cognitive Restructuring in Low Intensity psychological interventions, including the role of Behavioural Experiments and the function of each stage within the intervention.
• Consideration of the role of Cognitive Restructuring within multi-strand Low Intensity interventions
• Support to improve confidence in overcoming barriers to implementing effective Low Intensity Cognitive Restructuring

Training Modalities

Didactic content, Q&A, polls, case illustration.

Key References

Bennett Levy, J. Butler, G. Fennell, M. Hackmann, A. Mueller, M. and Westbrook, D. (eds) (2004). Oxford Guide to Behavioural Experiments in Cognitive Therapy. Oxford University Press.  

Clark DM, Salkovskis PM, Ost LG, Breitholtz E, Koehler KA, Westling BE, Jeavons A, Gelder M. Misinterpretation of body sensations in panic disorder. J Consult Clin Psychol. 1997 Apr;65(2):203-13. doi: 10.1037//0022-006x.65.2.203. PMID: 9086683.

Farrand, P., Woodford, J. and Jackson, K. (2019). Unhelpful Thoughts: Challenging and Testing Them Out. University of Exeter.

Grist, S. 2020. Chapter 12 Cognitive Interventions: A Thought is Just a Thought. In Farrand, P. (ed). 2020. Low Intensity CBT Skills and Interventions: a practitioner’s manual. London: Sage.

Lovell, K., Richards, D., Barkham, M., Sibbald, B., Roberts, C., Davies, L., . . . Hennessy, S. (2008). Developing guided self-help for depression using the Medical Research Council complex interventions framework: a description of the modelling phase and results of an exploratory randomised controlled trial. BMC Psychiatry, 8. doi:

Marinan, T. 2019. Chapter 10 Treatment Strategies in Papworth, P. and Marinan, T. (eds) Low Intensity Cognitive Behaviour Therapy: A Practitioner’s Guide. London: Sage.

Michie, S., van Stralen M.M. & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42.

Papworth, M. 2020. Chapter 13 Graded Exposure Therapy: Climbing Ladders to Health. In Farrand, P. (ed). 2020. Low Intensity CBT Skills and Interventions: a practitioner’s manual. London: Sage.

Richards, D. and Whyte, M. 2009. Reach Out: National Programme Student Materials to Support the Delivery of Training for Psychological Wellbeing Practitioners Delivering Low Intensity Interventions. Rethink.
Roberts L, Kwan S. Putting the C into CBT: Cognitive challenging with adults with mild to moderate intellectual disabilities and anxiety disorders. Clin Psychol Psychother. 2018 Sep;25(5):662-671. doi: 10.1002/cpp.2196. Epub 2018 Apr 23. PMID: 29687561.

The National Curriculum for Psychological Wellbeing Practitioner (PWP) Programme. 4th Edition. 2022. Health Education England.

The University of Sheffield (2023). Low Intensity Cognitive Behavioral Competency Scale Manual Revised (Treatment). University of Sheffield.

About the presenter

Liz Ruth is an Assistant Professor and Psychological Wellbeing Practitioner course leader at the University of Bradford. She trained as a Low Intensity Psychological Practitioner at the University of Sheffield in 2010 and practiced as a Qualified, Senior and Lead PWP in IAPT for more than a decade before transitioning into education. Elizabeth was the author of and is co-author of A Pragmatic Guide to Low Intensity Psychological Interventions: Care in High Volume (2023).

Who should attend

This workshop is designed to be of interest to any practitioner of a low intensity psychological intervention modality and to supervisors of these modalities. This webinar may be of less interest to trainees as it is designed to prompt reflection for advancing practice after qualification, but any interested trainee practitioners are welcome.

Details coming soon

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