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Cognitive behavioural therapy (CBT) has, in the space of 50 years, evolved into the dominant modality in psychological therapy. Mechanism/s of change remain unclear, however. In this paper, we will describe key features of CBT that account for the pace of past and future developments, with a view to identifying candidates for mechanism of change. We also highlight the distinction between 'common elements' and 'mechanisms of change' in psychological treatment. The history of how behaviour therapy and cognitive therapy developed are considered, culminating in the wide range of strategies which now fall under the heading of cognitive behavioural therapy (CBT). We consider how the empirical grounding of CBT has led to the massive proliferation of effective treatment strategies. We then consider the relationship between 'common factors' and 'mechanisms of change', and propose that a particular type of psychological flexibility is the mechanism of change not only in CBT but also effective psychological therapies in general. Good psychological therapies should ultimately involve supporting people experiencing psychological difficulties to understand where and how they have become 'stuck' in terms of factors involved in maintaining distress and impairment. A shared understanding is then evaluated and tested with the intention of empowering and enabling them to respond more flexibly and thereby reclaim their life.

Women who are trying to conceive may be at risk of experiencing psychological distress. However, only a small proportion receive appropriate care, although interventions such as cognitive behavioural therapy (CBT) can effectively reduce levels of distress. Our aim was to determine the efficacy and feasibility of an internet-based CBT intervention, called Overcome Fertility Stress (OFS). Fifty-five women who were struggling with conception were offered 3-month access to OFS, which is a fully automated yet individualized program via pre-programmed text, video and audio files. The program tailors its intervention around the symptoms the users report to the program. Significant improvements were demonstrated on infertility-related stress, with small-to-large effect sizes ( = 0.49 to 0.75). Furthermore, there was a significant decline in symptoms of depression and stress from pre- to post-treatment ( = 0.41 to 0.42, respectively). Finally, participants expressed overall satisfaction with the intervention. These preliminary results suggest it is feasible and effective for women who experience fertility stress to receive an internet-based CBT intervention. Finally, these results add to the literature on the effectiveness of psychological treatments for those who struggle with fertility issues.

Background: In recent years, cognitive behavioural group therapies (CBGT) have been increasingly deployed as a strategy to increase the efficiency and cost-effectiveness in treatment of common mental health problems. The vast majority of these therapies are disorder specific, but in the last few years there has been growing interest in transdiagnostic CBGT. Aims: The aim of this study was twofold: to evaluate the treatment effects of transdiagnostic CBGT on disorder specific symptoms and what (if any) differences would be observed in the treatment effects with regard to general as opposed to disorder specific symptoms measured pre- and post-treatment. Method: The participants were 233 adult patients diagnosed with depression and/or anxiety disorders. They underwent a 6-week transdiagnostic CBGT. To compare treatment effects on general and disorder specific symptoms, raw scores on all measures were converted to standardized scores. Results: Pre–post differences were significant and there was no evidence that treatment was differentially effective for general and disorder specific symptoms. Effect sizes ranged from medium to large. Conclusion: The 6-week transdiagnostic CBGT is feasible for a wide range of mood and anxiety disorders. The results indicate that low-intensity transdiagnostic group therapies may have similar effects on both general and disorder specific symptoms.