Preparing for cognitive behavioural therapy: a Delphi exercise to develop a consensus curriculum

To develop a consensus curriculum describing what information service users should be given prior to cognitive behavioural therapy (CBT).

A Delphi study was undertaken. Following development work with professionals and experts by experience, 30 initial statements were prepared and survey rounds were undertaken until 90% of statements achieved 80% consensus on inclusion or exclusion.

NHS Talking Therapies services in England provide CBT following referral by a professional or self-referral. Out of 1.7 million referrals in 2022-2023 more than 1 million disengaged before or during therapy. Ensuring patients are adequately prepared for CBT is one promising approach to improving engagement and outcomes.

Participants were only included if they had either 3 years of clinical experience in NHS Talking Therapies services or a leadership role in NHS Talking Therapies services. They reported current employment at seven NHS Trusts in England as well as private practice.

Of the 41 participants, 36 completed all three rounds. After three rounds, 27 statements were included by consensus in the curriculum, covering six domains: Emergency information (two statements), What is CBT? (six statements), Practical preparation for CBT (five statements), What does a CBT session look like? (five statements), What is CBT not? (two statements) and How can people get the most out of CBT? (seven statements).

This consensus curriculum provides a basis for ensuring patients are well-prepared for CBT within the context of NHS Talking Therapies. Further research on improving engagement and outcomes from NHS Talking Therapies services should aim to address these 27 topics.