Deliberate practice training approach could improve effectiveness of psychological therapy

Findings from the TheRapeutic Interactions in Psychological therapy Of anxiety and Depressive disorders (TRIPOD) study suggest that this structured training approach could improve therapy outcomes, even when delivered through manageable, weekly sessions. 

The deliberate training method follows four core steps designed to enhance performance: observing real performance, identifying personalised skill gaps, practising those skills intensively outside the therapy room and assessing the impact on real‑world outcomes. 

Despite major advances across healthcare, evidence suggests that psychological therapists do not necessarily become more effective through experience alone, with outcomes often plateauing or, in some cases, declining over time. 

The TRIPOD team sought to address this gap by developing a 10‑week training programme grounded in deliberate practice principles, based on a practical handbook for therapists. 

To further support therapists in identifying individual skill deficits, the team also developed a machine‑learning model capable of predicting whether a therapy session was likely to lead to patient improvement, correctly identifying ‘off‑track’ sessions with around 90 per cent accuracy.

This work was hosted by Nottinghamshire Healthcare NHS Foundation Trust and funded through Sam Malins’ Health Education England (HEE) and National Institute for Health and Care Research (NIHR) Clinical Lectureship. The lectureship was supported by the NIHR ARC East Midlands. 

The clinical outcomes from a total of 176 patients were assessed to evaluate the impact of the 10-week training programme on the nine treating NHS therapists. Key findings indicate strong acceptability among NHS therapists, who reported that deliberate practice was both useful and feasible, even within demanding clinical workloads.

Substantial improvements in therapist skills linked to long‑term clinical effectiveness were also observed, alongside early indications of improved patient outcomes. Anxiety improvement rates increased from 65 per cent to 75 per cent, while depression improvement rates rose from 58 percent to 61 percent.

These improvements were achieved through a total of 32 hours of deliberate practice – the equivalent of four-to-five days training, spread over 10 weeks.

If replicated at scale and sustained over time, this approach could offer the NHS a powerful and cost‑effective way to enhance the impact of psychological therapies. 

Sam Malins, Consultant Clinical Psychologist at Nottinghamshire Healthcare NHS Foundation Trust and Honorary Associate Professor at the University of Nottingham, said: “A key challenge in psychological therapies is that we therapists don’t typically get more effective over time, but this study shows a promising way of addressing this issue.”

He added: “We hope the results set up ways to refine the intervention and test it on a larger scale.”

The TRIPOD study is an NIHR-funded research project hosted by Nottinghamshire Healthcare NHS Foundation Trust and the Institute of Mental Health, in partnership with the University of Nottingham. The project team included patient and public involvement contributors.

It aims to develop automated machine-learning tools to identify what helpful aspects of therapy conversations look like and improve therapist effectiveness. 

Read the latest findings from the TRIPOD study. For more information about the TRIPOD study, email Sam Malins on sam.malins@nottingham.ac.uk.