Discussing Religion in NHS Talking Therapies
Research type
Research Study
Full title
Discussing Religion in NHS Talking Therapies: A Mixed-Methods Study of Therapists’ and Service Users’ Perceptions and Experiences
IRAS ID
348432
Contact name
Hira Sharif
Contact email
Sponsor organisation
Oxford Health NHS Foundation Trust
Duration of Study in the UK
1 years, 4 months, 7 days
Research summary
Cognitive-behavioral therapy (CBT) is the main psychological approach used to address mental health difficulties in NHS Talking Therapies services. A key part of CBT is exploring a person’s core beliefs (deeply held views about themselves, others, and the world, often shaped by life experiences). Research shows that the formation of these beliefs is influenced by one’s culture, including their religious and/or spiritual values. Therefore, it is important to consider how much individuals wish to discuss their religious values in a therapeutic setting in order to determine whether and how they should be included into their treatment plans.
This study examines whether therapists and patients (service-users) agree on how important it is to address religious values in therapy. It uses a mixed-methods approach, combining surveys and interviews. The study will:
1. Look at how therapists in Oxford Health NHS Foundation Trust (OHFT) Talking Therapies services view the importance of discussing religion in therapy and how they think it affects the trust between therapist and patient (called the therapeutic alliance) and the perceived effectiveness of treatment (treatment credibility).
2. Compare therapists’ views to those of their patients.
3. Interview therapists about their experiences of talking about religion during therapy sessions.If the study finds that therapists and patients have different views, it might suggest problems for the therapeutic relationship (the trust and understanding between them). These findings could lead to recommendations for improving how OHFT Talking Therapies services approach their work with religious service-users, ensuring that therapy feels more supportive and relevant for this client group.
Lay summary of study results: We would like to thank all the service users and therapists who gave their time to take part in this research.
Study title: Discussing Religion in NHS Talking Therapies: A Mixed-Methods Study of Therapists’ and Service Users’ Perceptions and Experiences
This research was carried out within Oxford Health NHS Foundation Trust (OHFT) NHS Talking Therapies by Hira Sharif (Trainee Clinical Psychologist) under the supervision of Prof Paul Salkovskis, Dr Graham Thew and Dr Hibah Hassan. The study took place between May 2025 and April 2026.
The research was sponsored by Oxford Health NHS Foundation Trust. There were no competing interests.
Four PPI contributors were involved in study design, including two service-users who met eligibility criteria and had previously accessed NHS Talking Therapies services, and two CBT therapists from Talking Therapies services not involved in the study. PPI contributors reviewed the draft survey to assess the relevance, clarity, and length, and co-developed the interview schedule. They were not study participants and received a £15 voucher in recognition of their time and expertise.
Why was this research needed?
Religion can be an important part of a person’s identity and may influence how they understand and cope with emotional difficulties. Previous research suggests that considering a person’s religious beliefs within psychological therapy can be helpful. However, less is known about whether and how religion is discussed within NHS Talking Therapies.
This study therefore explored how CBT therapists and religious service users viewed and experienced the discussion of religion within CBT at OHFT Talking Therapies. It identified similarities and differences between therapists and service users on the impact of discussing religion on therapeutic alliance and treatment credibility. It also explored therapists’ experiences of discussing religion in therapy.
Who took part?
A total of 44 high-intensity CBT therapists and 23 religious service users completed surveys. In addition, 12 therapists took part in individual interviews to explore their experiences in more detail.
Service users were not asked to receive any new or different treatment as part of the research. The study focused on their experiences of CBT they had already received within the service.What happened during the study?
Therapists and service users completed surveys about their experiences of religion being discussed during CBT. The surveys also asked about their relationship with their therapist and their views of the treatment.
Twelve therapists took part in interviews where they were asked about their experiences of discussing religion with service users.
As this was an observational study and no treatment or intervention was provided as part of the research, there were no treatment-related side effects or adverse reactions to report.
What did the study find?
The study found some important differences between therapists’ and service users’ experiences. Therapists reported that religion was discussed more often than service users felt it had been. Service users also reported a weaker therapeutic relationship than therapists did. However, these differences in the therapeutic relationship did not appear to be related to whether religion was discussed. Instead, service users who reported greater satisfaction with the discussion of religion reported a stronger therapeutic relationship.
Interviews with therapists identified three main findings:
First, whilst therapists generally believed that discussing religion could be valuable to therapy, most felt anxious or uncertain about raising the subject themselves. As a result, therapists often waited for service users to bring up religion rather than starting the conversation.
Second, therapists’ own religious identity appeared to influence these conversations. Therapists who considered themselves religious often felt more comfortable discussing religion, whereas therapists who were not religious felt less confident and were more likely to avoid raising the subject.
Finally, therapists described uncertainty about how religion fitted within CBT and its underlying principles. They also described wider challenges within NHS Talking Therapies, including limited training, time pressures and a lack of clear guidance. These factors could make it difficult to consider religion consistently within therapy.
How could this research help service users and therapists?
The findings suggest that therapists recognise that religion can be important to some service users, but may need more support to feel confident discussing it.
The study highlights a need to move beyond relying on service users to raise religion themselves. Providing therapists with appropriate training and guidance could help them explore religion sensitively when it is relevant to the individual.
The findings helped inform recommendations for OHFT Talking Therapies about how religious beliefs can be considered more consistently within CBT.
What happens next?
The findings will be disseminated at the 2026 European Association for Behaviour and Cognitive Therapies, and published in an academic journal.
Where can I find out more?
For further information about this study, please contact:
Hira Sharif
University of Oxford
hira.sharif@hmc.ox.ac.uk
Has the registry been updated to include summary results?: No
If yes - please enter the URL to summary results:
If no – why not?: My study is not a clinical trial, and therefore not on a registry.
Did you follow your dissemination plan submitted in the IRAS application form (Q A51)?: Pending
If yes, describe or provide URLs to disseminated materials:
If pending, date when dissemination is expected: 30/11/2026
If no, explain why you didn't follow it:
Have participants been informed of the results of the study?: Yes
If yes, describe and/or provide URLs to materials shared and how they were shared: A lay summary was sent by the service leads to the therapists who took part in the study. Findings have not been shared with service user participants, however, they were informed that they would have access to the study once it was published, as opposed to directly sharing results with them. This was to avoid storing service user personal information for longer than the study duration.
If pending, date when feedback is expected:
If no, explain why they haven't:
Have you enabled sharing of study data with others?: Yes
If yes, describe or provide URLs to how it has been shared: nonymised research data will be securely stored on the OXICPTR (Oxford Institute for Clinical Psychology Training and Research) Sharepoint and held for up to five years after study completion.
If no, explain why sharing hasn't been enabled:
Have you enabled sharing of tissue samples and associated data with others?: NoREC name
South Central - Hampshire B Research Ethics Committee
REC reference
25/SC/0096
Date of REC Opinion
11 Apr 2025
REC opinion
Further Information Favourable Opinion