WORKING WITH COMPLEXITY AND CO-MORBIDITY - 2025/6

Module Overview

This module introduced trainees to some of the challenges and dilemmas in working with complex, chronic, or co-morbid presentations of Anxiety and Depression. Trainees will apply their critical knowledge of CBT theory to develop clinical skills in working with groups, older adults and presentations such as perfectionism, chronic depression, low self-esteem, long-term health conditions, insomnia, and post-natal depression. This will enable them to better serve the diversity of clients accessing Talking Therapies services. The module will develop further skills in the use of imagery, and support trainees to consider the broader applications of CBT interventions. Other co-morbid difficulties that trainees may encounter in talking therapies services are introduced (including eating disorders, addictions, psychosis, and personality disorders) so they are better equipped in assessing these and understanding what evidence-based treatments they can refer clients on to. The module will provide the opportunity for trainees to review their learning from previous modules in light of the clinical practice experience they have gained throughout the year. This supports the trainee’s ability in applying CBT with more complex presentations, deriving CBT-driven formulations in cases of co-morbidity.

 

We acknowledge that this module has drawn on research that historically privileges White, male and Westernised epistemologies, assumptions, theories, and outcome research that may not fully reflect the diversity of students and the populations we serve, and in some cases discriminate against more diverse perspectives. We are actively working together to develop a less biased and more balanced knowledge base through more varied reading lists, culturally sensitive application, diverse case studies, and assessment rubrics. We welcome the collaboration with our students in the endeavor to provide a more robust, just, and inclusive representation of the discipline. Please email tim.gibson@surrey.ac.uk if you have any queries or feedback. 

Module provider

Psychology

Module Leader

JERAJ Sarfraz (Psychology)

Number of Credits: 30

ECTS Credits: 15

Framework: FHEQ Level 7

Module cap (Maximum number of students): N/A

Module Availability

Semester 2

Prerequisites / Co-requisites

None

Module content

Indicative content includes skills practice workshops on:

• Introduction to cross diagnostic processes and a multi-diagnostic CBT approach for working with anxiety disorders and depression


• CBT for perfectionism and procrastination across anxiety and depression


• Comorbidity and chronic depression


• Advanced imagery


• CBT for working with older adults


• Introduction to CBT for eating disorders


• Introductions to CBT for addictions


• Introductions to CBT for psychosis


• Introductions to CBT for personality disorders


• CBT and insomnia


• CBT and Neurodivergence


• Group CBT for anxiety disorders and depression


• Considerations for the broader application of the CBT model

Assessment pattern

Alternative Assessment

N/A

Assessment Strategy

The assessment strategy is designed to:

Provide students with the opportunity to demonstrate their knowledge of comorbid and complex presentations when working with anxiety disorders and depression. To critically evaluate the research literature in this area and apply the knowledge and interventions in clinical practice.

Thus, the summative assessment for this module consists of:

Written Case report:

• 
  A written extended case report of a client presenting with an anxiety disorder including complexity or co-morbidity, clearly illustrating how the trainee has conceptualised and subsequently treated this case, with particular emphasis on the theoretical links to practice. (Addresses learning outcomes 1, 2, 3, 4)
  

CTS-R

• 
  A Video recording, self-rated CTS-R and 1000-word reflection of an anxiety disorder therapy session. (Addresses learning outcomes 1, 2, 3, 4)
  

 

Formative assessment:

Debate:

• A class debate on a topic relating to CBT and complexity/comorbidity. Trainees are split into two teams and asked to prepare arguments for and against a proposed statement, with reference to relevant literature The debate itself is a form of formative feedback – through the process of discussion and receiving rebuttals from the other team.

Journal club:

• The trainees will be given the opportunity to take part in a journal club where they will present an up to date and relevant article/research paper as part of a small group to the wider group. The trainees will be expected to demonstrate the relevant theory practice links. There will be opportunity for both teaching staff and trainees to ask questions, discuss and feedback on this presentation.

CTS-R:

• Formative video recorded treatment session and self-rated assessment CTS-R with a client supervised and marked by the Course Supervisor using the CTS-R and formative feedback given to the trainee in a meeting with the Course Supervisor.

Feedback:

• Trainees will receive multiple opportunities for feedback from tutors and peers during skills workshops, the Classroom Debate and Journal Club.


• Trainees will receive verbal and written feedback from supervisors in relation to their clinical practice through weekly supervision and a formative CTS-R.


• Trainees will meet with their personal tutor during this module and will have the opportunity to give and receive feedback on progress and understanding to date.

Module aims

• Allow trainees to further their knowledge of the complexities and comorbidities associated with Anxiety and Depression in clients that may seek support in Talking Therapies services, including taking into account other diagnosis, and the implications this has for clinical practice.
• Trainees will be introduced to some of the interventions which may aid the therapeutic process and more complex anxiety and depression presentations. This will include developing further skills in imagery and the broader applications of CBT.
• Trainees will continue to build their skills in critical evaluation of therapeutic process and intervention in light of these additional challenges and conditions.

Learning outcomes

Methods of Teaching / Learning

The learning and teaching strategy is designed to: Draw on the three-part model of therapist skill development presented by Bennet-Levy (2006). This model proposes that three systems of learning must operate for effective skill development: the declarative system (knowledge gained through lectures and reading), the procedural system (knowledge gained through application of declarative knowledge in practice) and the reflective system (knowledge gained through reflection on practice). The trainees will therefore be encouraged to;

 

• Acquire theoretical, empirical, and practice-based CBT knowledge.


• Think critically to evaluate this knowledge to support their clinical decision making and practice.


• Develop clinical skills to achieve the best outcomes for patients.


• Develop reflective practice skills to help evaluate their development as effective CBT practitioners and therapy professionals.

 

The above learning and teaching strategy relates to this module in terms of supporting trainees in the acquisition of relevant theoretical, empirical, and practice-based knowledge of cases of anxiety and depression that may be complex, chronic or co-morbid. Trainees will learn about specific CBT interventions and working with shared processes across anxiety disorders and depression in terms of formulation and treatment. Together with the opportunity to apply critical thinking to the knowledge acquired; and to develop clinical and reflective practice skills that enhance their effectiveness as CBT practitioners.

 

The learning and teaching methods include:

 

These three systems of learning will be utilised through lecture/workshop presentation of a key concept or method and the application of this to practice in role play of a specific therapeutic scenario, played by facilitators, other participants, or actors. Structured opportunities for reflection on this form of practice will be included, as will opportunities to self-practice (i.e., application of CBT methods to participants’ own lives). In addition to these methods the following will be employed.

• Class debate and discussion, Journal club, participant presentations, group exercises, skills practice, video and audio recordings, tutorials, self- directed enquiry, personal reflection, and guided reading.

The above methods allow for key skills learnt in other modules to be re-visited and tested in application. Critical evaluation and personal reflection is encouraged, drawing on research evidence and clinical experience and knowledge of self, fellow trainees and tutors.

Indicated Lecture Hours (which may also include seminars, tutorials, workshops and other contact time) are approximate and may include in-class tests where one or more of these are an assessment on the module. In-class tests are scheduled/organised separately to taught content and will be published on to student personal timetables, where they apply to taken modules, as soon as they are finalised by central administration. This will usually be after the initial publication of the teaching timetable for the relevant semester.

Reading list

https://readinglists.surrey.ac.uk
Upon accessing the reading list, please search for the module using the module code: PSYM165

Other information

The school/department of Psychology is committed to developing graduates with strengths in Employability, Digital Capabilities, Global and Cultural Capabilities, Sustainability, and Resourcefulness and Resilience. This module is designed to allow students to develop knowledge, skills, and capabilities in the following areas:

Digital capabilities:

Trainees are expected to digitally record therapy sessions for presentation in weekly supervision, and for their summative CTS-R submission. Trainees are encouraged to continually engage with materials on SurreyLearn, and tutors use a variety of digital means, such as videos, audio recording and podcasts to enhance teaching and engagement.
 

Employability:

This module aims to prepare trainees for the realities of work as a qualified CBT therapist in Talking Therapies services, where they will be expected to work effectively with increasingly complex, and comorbid presentation.  The module supports trainees to have greater awareness of the wider mental health system within which they will work, and to be able to effectively assess the level of care a client might require within that system. Trainees are expected to hold a clinical caseload within a talking therapies service, alongside participation in the course. This provides trainees with the opportunity to apply the knowledge and skills required to develop their clinical practice. Within the lectures, skills workshops, and clinical supervision, trainees will be encouraged to reflect on their progress and given multiple opportunities to receive feedback from tutors/supervisors to help them move toward the competency required for employment.
 

Global and cultural capabilities:

This module reflects some of the diversity that is represented in those seeking mental health support (including age, background, and diagnosis), and aims to equip trainees with the knowledge to consider each clients idiosyncrasies and the implication this has for therapy. Therapy formulations and treatment plans taught to trainees and used by trainees need to be adapted to client’s needs and consider the client’s idiosyncrasies and cultural background. The trainees are required to adapt interventions accordingly and consider diversity. Trainees are meant to be also working with patients/clients from diverse communities 

Resourcefulness and Resilience:

This module recognises the complex and co-morbid presentation that trainees will likely face in a Talk Therapies service. This module aims to equip trainees with the knowledge, skills and practice to work more confidently with these clients. The module aims to empower trainees to make informed clinical decisions in the face of complex and co-morbid presentations, and to find flexibility and creativity within their evidence-based practice. Trainees learn to be resourceful and resilient throughout this module as they need to adapt interventions and materials to suit client’s needs along with their cultural needs and learn to be resilient managing their own wellbeing and balancing work and studying and reflecting on their practice. The formative assignment involves trainees to present their work to their cohort that helps with building resilience to feedback and experience in responding to questions.

 

Protected study time is allocated through the module and trainees will have regular access to tutors, and supervisors to support them with the practical and emotional demands of the course.

Please note that the information detailed within this record is accurate at the time of publishing and may be subject to change. This record contains information for the most up to date version of the programme / module for the 2025/6 academic year.