CAT - guided self-help for anxiety - Cognitive Analytic Guided Self-Help (CAT-SH) development and evaluation

Oct 3, 2026

Background. There is a lack of treatment plurality at step 2 of Improving Access to Psychological Therapies (IAPT) services. This project developed and piloted a cognitive analytic informed guided self-help treatment for mild-to-moderate anxiety delivered by Psychological Wellbeing Practitioners. Method. MRC treatment development guidelines were used, with a 6-session manual developed via practice guidelines and small-scale modelling (n=3), then tested in a mixed-methods case series (n=11). Results. CAT-SH met quality parameters, with 10/11 completing full treatment and 6/10 meeting reliable recovery at follow-up.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages39

Reading Time1 h 38 min

AccessFree to download

Abstract

Background

Method

Results

Conclusion

Context and stepped-care model

IAPT and step two delivery

Guided self-help structure and support

Low intensity interventions and evidence base

[eprints@whiterose.ac.uk](eprints@whiterose.ac.uk)[ ](eprints@whiterose.ac.uk)[https://eprints.whiterose.ac.uk](https://eprints.whiterose.ac.uk) Universities of Leeds, Sheffield and York Deposited via The University of Sheffield. White Rose Research Online URL for this paper: [https://eprints.whiterose.ac.uk/id/eprint/114646/](https://eprints.whiterose.ac.uk/id/eprint/114646/) [Version: Accepted Version](Version: Accepted Version) Article: Meadows, J. and Kellett, S. (2017) Development and Evaluation of Cognitive Analytic Guided Self-Help (CAT-SH) for Use in IAPT Services. Behavioural and Cognitive Psychotherapy, 45 (3) . pp. 266-284. ISSN: 1352-4658 [https://doi.org/10.1017/S1352465816000485](https://doi.org/10.1017/S1352465816000485) This article has been published in a revised form in Behavioural and Cognitive Psychotherapy [ [http://dx.doi.org/10.1017/S1352465816000485](http://dx.doi.org/10.1017/S1352465816000485)]. This version is free to view and download for private research and study only. Not for re-distribution, re-sale or use in derivative works. © British Association for Behavioural and Cognitive Psychotherapies. Reuse This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) licence. This licence only allows you to download this work and share it with others as long as you credit the authors, but you can’t change the article in any way or use it commercially. More information and the full terms of the licence here: [https://creativecommons.org/licenses/](https://creativecommons.org/licenses/) Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing [eprints@whiterose.ac.uk](eprints@whiterose.ac.uk) including the URL of the record and the reason for the withdrawal request. CAT guided self-help for anxiety Abstract Background. There is a lack of treatment plurality at step 2 of Improving Access to Psychological Therapies (IAPT) services. This project therefore sought to develop and pilot a cognitive analytic informed guided self-help treatment for mild-to-moderate anxiety for delivery by Psychological Wellbeing Practitioners. Method. Medical Research Council treatment development guidelines were used. Phase I included development of the 6-session treatment manual using practice guidelines, small-scale modelling (n=3) and indicated manual iterations. Phase II consisted of a mixed methods case series design (n=11) to index feasibility, uptake and clinical outcomes. Results. CAT-SH met established quality parameters for guided self-help. A high treatment completion rate was observed, with 10/11 of patients who attended the first treatment session subsequently completing full treatment. 6/10 of the patients completing full treatment met reliable recovery criteria at follow-up. Effect sizes and recovery rates equate with extant PWP outcome benchmarks. Practitioner feedback indicated that delivery of CAT-SH was feasible. Conclusion. CAT-SH shows promise as a low-intensity treatment for anxiety and further larger and more controlled studies are indicated. Mental health services in the UK are under constant and growing pressure to increase access whilst sustaining quality, despite an ongoing demand-resource schism (Royal College of Psychiatrists, 2009). The Improving Access to Psychological Therapies (IAPT) programme was introduced to address the discrepancy between demand and availability in the NHS in England. IAPT delivers treatments for common mental health problems (depression and anxiety disorders) via the ‘stepped care’ model to increase service efficiency (CSIP; Choice & Access Team, 2008). Effective (and by definition non-restrictive) treatments are delivered first; only 'stepping up' to more intensive traditional therapies due to non-response or risk (Bower & Gilbody, 2005) . Stepped-care models have been evaluated and evidence suggests that stepped care

FAQs

What gap in IAPT services does CAT-SH address?

It addresses the lack of treatment plurality at step 2 of IAPT services for mild-to-moderate anxiety.

How was CAT-SH developed and piloted in the study?

A 6-session treatment manual was developed using MRC treatment development guidelines, then evaluated using a mixed-methods case series design (n=11).

What were the main outcomes from CAT-SH delivery?

CAT-SH met quality parameters, showed a high completion rate (10/11), and 6/10 of completers met reliable recovery criteria at follow-up.

Oct 3, 2026

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