Aims: This study aimed to assess the validity of two models which integrate the cognitive (satisfaction with life) and affective (symptoms of anxiety and depression) aspects of subjective well-being within the framework of rational emotive behaviour therapy (REBT) theory; specifically REBT's theory of psychopathology and theory of psychological health. Method: 397 Irish and Northern Irish undergraduate students completed measures of rational/irrational beliefs, satisfaction with life, and anxiety/depression symptoms. Structural equation modelling techniques were used in order to test our hypothesis within a cross-sectional design. Results: REBT's theory of psychopathology (χ2 = 373.78, d.f. = 163, p < .001; comparative fit index (CFI) = .92; Tucker Lewis index (TLI) = .91; root mean square error of approximation (RMSEA) = .06 (95% CI = .05 to .07); standardized root mean square residual (SRMR) = .07) and psychological health (χ2 = 371.89, d.f. = 181, p < .001; CFI = .93; TLI = .92; RMSEA = .05 (95% CI = .04 to .06); SRMR = .06) provided acceptable fit of the data. Moreover, the psychopathology model explained 34% of variance in levels of anxiety/depression, while the psychological health model explained 33% of variance. Conclusions: This study provides important findings linking the fields of clinical and positive psychology within a comprehensible framework for both researchers and clinicians. Findings are discussed in relation to the possibility of more effective interventions, incorporating and targeting not only negative outcomes, but also positive concepts within the same model.

Background: Numerous studies suggest that Internet-based self-help treatments are effective in treating anxiety disorders. Trials evaluating such interventions differ in their screening procedures and in the amount of clinician contact in the diagnostic assessment phase. The present study evaluates the impact of a pre-treatment diagnostic interview on the outcome of an Internet-based treatment for Social Anxiety Disorder (SAD). Method: One hundred and nine participants seeking treatment for SAD were randomized to either an interview-group (IG, N = 53) or to a non-interview group (NIG, N = 56). All participants took part in the same 10-week cognitive-behavioural unguided self-help programme. Before receiving access to the programme, participants of the IG underwent a structured diagnostic interview. Participants of the NIG started directly with the programme. Results: Participants in both groups showed significant and substantial improvement on social anxiety measures from pre- to post-assessment (dIG = 1.30–1.63; dNIG = 1.00–1.28) and from pre- to 4-month follow-up assessment (dIG = 1.38–1.87; dNIG = 1.10–1.21). Significant between-groups effects in favour of the IG were found on secondary outcome measures of depression and general distress (d = 0.18–0.42). Conclusions: These findings suggest that Internet-based self-help is effective in treating SAD, whether or not a diagnostic interview is involved. However, the pre-treatment interview seems to facilitate change on secondary outcomes such as depression and general distress.

Five variables were investigated with regard to their possible predictive value for cognitive behavioural treatment (CBT) outcome in a large sample of panic disorder (PD) patients. The variables were initial symptom severity, comorbid anxiety or depressive disorders, comorbid cluster C personality disorders, and initial motivation for treatment. A total number of 161 PD patients received a standardized CBT of 15 sessions. Assessments of predictive variables took place prior to treatment. Outcome measures were assessed at pre- and posttreatment. The patients had significantly improved after the treatment. None of the variables, separately or together, affected CBT outcome, save initial severity of panic disorder symptoms, which was positively associated with posttreatment symptom severity. Since research efforts failed to produce consistent predictors for CBT treatment outcome in panic disorder thus far, the usefulness of future outcome prediction research in panic disorder by pre-treatment demographic, disorder-related, psychological, or socio-psychological variables is put into question.

Background: Computer assisted cognitive remediation (CACR) was demonstrated to be efficient in improving cognitive deficits in adults with psychosis. However, scarce studies explored the outcome of CACR in adolescents with psychosis or at high risk. Aims: To investigate the effectiveness of a computer-assisted cognitive remediation (CACR) program in adolescents with psychosis or at high risk. Method: Intention to treat analyses included 32 adolescents who participated in a blinded 8-week randomized controlled trial of CACR treatment compared to computer games (CG). Cognitive abilities, symptoms and psychosocial functioning were assessed at baseline and posttreatment. Results: Improvement in visuospatial abilities was significantly greater in the CACR group than in CG. Other cognitive functions, psychotic symptoms and psychosocial functioning improved significantly, but at similar rates, in the two groups. Conclusion: CACR can be successfully administered in this population; it proved to be effective over and above CG for the most intensively trained cognitive ability.

The hypothesis that elaboration of the phobic stimulus potentiates exposure in vivo treatment was put to the test in a clinical experiment. Forty-one female spider phobics, who applied for treatment, were randomly allocated to one of two conditions. In both conditions a 2.5 hour therapist-directed exposure treatment was given. In the elaboration condition Ss were required to attend to and describe the objective features of the spider constantly. In the non-elaboration condition the therapist tried to prevent this. A manipulation check suggested that Ss in the elaboration condition had indeed elaborated more extensively on the objective features of the spiders during exposure than Ss in the non-elaboration condition. However, Ss in the elaboration condition practised with somewhat fewer spiders than Ss in the non-elaboration condition, probably because of the time the elaboration took. Contrary to the hypothesis, elaboration did not potentiate either short-term or long-term effects of the exposure treatment. It seems superfluous to let patients elaborate on the phobic stimulus during exposure in vivo treatment: the processing of phobic stimulus information which is needed for an effective treatment seems to occur spontaneously when the patient engages in exposure in vivo exercises.

Background: It was recently proposed that feelings of dirtiness and pollution can arise in the absence of physical contact with a contaminant. At present, there is limited data regarding the qualitative features of this construct of “mental contamination”, although it is hypothesized to be particularly relevant to Obsessive Compulsive Disorder (OCD), where compulsive washing in response to contamination fear is a common symptom presentation (Rachman, 2006). Aims and method: The aim of this research was to explore the qualitative features of mental contamination in 20 people with contamination-based OCD, using a semi-structured interview. Results: All participants reported times when they had felt dirty or contaminated in the absence of physical contact with a dirty or dangerous object. Mental contamination generated diffuse feelings of internal dirtiness not localized to the hands, which evoked urges to wash (100% participants), neutralize (80% participants) and avoid (85% participants). Conclusions: In support of the theory outlined by Rachman (2006), mental contamination was found to take a number of forms, be primarily associated with a human source, generate internal dirtiness and cause emotional distress and urge to wash. The clinical implications of these findings are discussed and ideas for future research are proposed.

This paper reviews the effects of maternal distress on several aspects of parent—child interactions that were identified in the course of a parent training program for child non-compliance. Distress was measured by a number of self-report questionnaires examining depression, anxiety, marital relations, and extrafamilial relationships. The parent training program is initially reviewed. Subsequently, pretreatment relationships between maternal distress and parent—child interactions were examined. Distress appears to be related primarily to measures of parent perceptions of child maladjustment. Several relationships between distress and treatment outcome also were noted. A recent study designed to enhance parent training by modifying maternal distress factors is presented. Finally, implications and limitations of the data are discussed.

Background: Previous meta-analyses of cognitive-behavioural therapy (CBT) for children and young people with anxiety disorders have not considered the efficacy of transdiagnostic CBT for the remission of childhood anxiety. Aim: To provide a meta-analysis on the efficacy of transdiagnostic CBT for children and young people with anxiety disorders. Methods: The analysis included randomized controlled trials using transdiagnostic CBT for children and young people formally diagnosed with an anxiety disorder. An electronic search was conducted using the following databases: ASSIA, Cochrane Controlled Trials Register, Current Controlled Trials, Medline, PsycArticles, PsychInfo, and Web of Knowledge. The search terms included “anxiety disorder(s)”, “anxi*”, “cognitive behavio*, “CBT”, “child*”, “children”, “paediatric”, “adolescent(s)”, “adolescence”, “youth” and “young pe*”. The studies identified from this search were screened against the inclusion and exclusion criteria, and 20 studies were identified as appropriate for inclusion in the current meta-analysis. Pre- and posttreatment (or control period) data were used for analysis. Results: Findings indicated significantly greater odds of anxiety remission from pre- to posttreatment for those engaged in the transdiagnostic CBT intervention compared with those in the control group, with children in the treatment condition 9.15 times more likely to recover from their anxiety diagnosis than children in the control group. Risk of bias was not correlated with study effect sizes. Conclusions: Transdiagnostic CBT seems effective in reducing symptoms of anxiety in children and young people. Further research is required to investigate the efficacy of CBT for children under the age of 6.

Generalized anxiety patients were randomly allocated to Cognitive-Behaviour Therapy, Diazepam or Placebo and managed in a primary care setting. Treatments were balanced for degree of psychologist/patient contact. A range of outcome measures, including patient self report, psychologist assessor and general practitioner ratings were used. Large variations within group response to treatment emerged. At the end of active treatment the superiority of Cognitive-Behaviour Therapy was suggested. Post-study psychotropic prescription and psychological treatment was assessed at a 12-month follow-up. The Cognitive-Behaviour group revealed the lowest incidence of subsequent treatment interventions.

Background: Social anxiety disorder is common and typically starts in childhood or adolescence. Cognitive Therapy for Social Anxiety Disorder (CT-SAD) in adults is a well-established treatment that shows strong evidence of differential effectiveness when compared to other active treatments. In contrast, CBT approaches to social anxiety in young people have yet to demonstrate differential effectiveness and there is some evidence that young people with social anxiety disorder respond less well than those with other anxiety disorders. Aims: To adapt CT-SAD for use with adolescents and conduct a pilot case series. Method: Five adolescents, aged 11–17 years, with a primary DSM-5 diagnosis of social anxiety disorder received a course of CT-SAD adapted for adolescents. Standardized clinical interview and questionnaire assessments were conducted at pre and posttreatment, and 2 to 3-month follow-up. Results: All five participants reported severe social anxiety at baseline and achieved remission by the end of treatment. Significant improvements were also observed in general anxiety, depression, concentration in the classroom, and putative process measures (social anxiety related thoughts, beliefs and safety behaviours). Conclusions: An adapted form of CT-SAD shows promise as a treatment for adolescents.

In two linked studies we examined children's performance on tasks required for participation in cognitive therapy. In Study 1 we piloted some new tasks with children aged 5 to 11 years. In study 2 the effects of IQ, age and educational experience were examined in children aged 5 to 7 years. In study 1, 14 children aged 5 to 11 completed three tasks related to cognitive therapy; generating post-event attributions, naming emotions, and linking thoughts and feelings. Study 2 used a between-subjects design in which 72 children aged 5, 6, or 7 years from two primary schools completed the three tasks and the Block Design and Vocabulary sub-tests from the WISC III or WPPSI-R. Children were tested individually during the school day. All measures were administered on the same occasion. In study 2 administration order of the cognitive therapy task and the WISC III/WPPSI-R were randomized. The majority of children demonstrated some ability on each of the three tasks. In study 2, performance was associated with school and with IQ but not with age. There were no gender differences. Children attending a school with an integrated thinking skills programme and those with a higher 1Q were more successful on the cognitive therapy tasks. These results suggest that many young children could engage in cognitive therapy given age-appropriate materials. The effects of training in relevant meta-cognitive skills on children's ability to use concepts in CBT may warrant further research.

This study aimed to investigate factors associated with persistent Post-Traumatic Stress Disorder (PTSD) in people with Spinal Cord Injury (SCI). In the context of a cognitive model, it sought to determine how influential cognitive appraisals were in predicting persistent PTSD when compared to other known predictor variables in the literature such as injury severity. A sample of 50 inpatients receiving rehabilitation for SCI who were 3–24 months post-injury were interviewed using a series of standardized measures of PTSD symptoms and diagnosis, post-traumatic cognitive appraisals, social support, and injury severity. For PTSD symptoms, significant relationships were found for greater injury severity, lower satisfaction with social support and more negative cognitions. Negative cognitions were found to predict variance in PTSD symptoms over and above the non-cognitive variables, although gender and injury severity were also predictors. The only significant predictor of PTSD diagnosis was the cognitive sub-scale “negative cognitions about the self”. Cognitive appraisals were found to be important predictors of persisting PTSD in an SCI population. This supports the cognitive model of PTSD and the development of cognitive therapies for PTSD in this population.

Background: Post-traumatic stress disorder (PTSD) is a common and debilitating consequence of natural disaster in children and adolescents. Accumulating data show that cognitive behavioural therapy (CBT) is an effective treatment for PTSD. However, application of CBT in a large-scale disaster in a setting with limited resources, such as when the tsunami hit several Asian countries in 2004, poses a major problem. Aims: This randomized controlled trial aimed to test for the efficacy of the modified version of CBT for children and adolescents with PSTD. Method: Thirty-six children (aged 10–15 years) who had been diagnosed with PSTD 4 years after the tsunami were randomly allocated to either CBT or wait list. CBT was delivered in 3-day, 2-hour-daily, group format followed by 1-month posttreatment self-monitoring and daily homework. Results: Compared to the wait list, participants who received CBT demonstrated significantly greater improvement in symptoms of PTSD at 1-month follow-up, although no significant improvement was observed when the measures were done immediately posttreatment. Conclusions: Brief, group CBT is an effective treatment for PTSD in children and adolescents when delivered in conjunction with posttreatment self-monitoring and daily homework.

Past research has demonstrated that anxiety disorders represent a significant mental health concern. A review of the literature in the area indicates that there is limited information regarding gender differences on the basis of cognitions in clinical or nonclinical samples. The current investigation sought to determine whether any observable gender differences existed in the expression of symptoms, cognitions, and anxiety sensitivity for a nonclinical sample of 48 males and 49 females. Multivariate analyses of variance revealed support for gender differences in the expression of physiological hyperarousal, catastrophic cognitions and a general level of anxiety sensitivity in a nonclinical population. The strengths, limitations, and directions for future research are discussed.

Background: Randomized controlled trials have established that individual cognitive therapy based on the Clark and Wells (1995) model is an effective treatment for social anxiety disorder that is superior to a range of alternative psychological and pharmacological interventions. Normally the treatment involves up to 14 weekly face-to-face therapy sessions. Aim: To develop an internet based version of the treatment that requires less therapist time. Method: An internet-delivered version of cognitive therapy (iCT) for social anxiety disorder is described. The internet-version implements all key features of the face-to-face treatment; including video feedback, attention training, behavioural experiments, and memory focused techniques. Therapist support is via a built-in secure messaging system and by brief telephone calls. A cohort of 11 patients meeting DSM-IV criteria for social anxiety disorder worked through the programme and were assessed at pretreatment and posttreatment. Results: No patients dropped out. Improvements in social anxiety and related process variables were within the range of those observed in randomized controlled trials of face-to-face CT. Nine patients (82%) were classified as treatment responders and seven (64%) achieved remission status. Therapist time per patient was only 20% of that in face-to-face CT. Conclusions: iCT shows promise as a way of reducing therapist time without compromising efficacy. Further evaluation of iCT is ongoing.

A survey of individuals was conducted on self-diagnosed vomit phobics compared to panic disorder and non-clinical controls. Vomit phobics were overwhelmingly female and had had symptoms for over 25 years. They were significantly more likely to fear themselves vomiting (in public and private situations) than fear others vomiting. The vomit phobics interpreted sensations of nausea as impending vomit and had a wide range of safety seeking and avoidance behaviours that were maintaining their fear. Although the vomit phobics reported feeling nauseous more often, there was no difference in their frequency of vomiting compared to the control group. The clinical implications of the study for therapy are discussed.

Mindfulness training (MT) is a meditation-based approach that, on its own or in alliance with cognitive therapy, can effectively impact on several therapeutic targets such as recurrent depression, some anxiety problems, and chronic physical pain. This article outlines how mindfulness training complements cognitive-behavioural therapy (CBT), and why it may be particularly useful to older people. The range of potential applications of MT is examined, followed by considerations of the evidence to date and both the advantages and dangers of current developments within the various MT programmes. The author's ongoing research on Mindfulness-based Cognitive Therapy (MBCT) for older people with recurring depression is described, as is the use of Mindfulness-based Stress Reduction (MBSR) in routine clinical practice. Suggestions are provided regarding future research into the range of applications of MT with older people.

This study reports the development of a self-report measure to assess metacognitive beliefs about paranoia in non-patients. We aimed to test the specific hypotheses that positive beliefs about paranoia would predict frequency of paranoia, and that negative beliefs about paranoia would predict distress associated with delusional ideation. Three-hundred and seventeen non-patient participants were asked to complete questionnaires assessing beliefs about paranoia, paranoia, dimensions of delusional ideation and trait anxiety. The results showed that four empirically distinct subscales were measured by the beliefs about paranoia scale (negative beliefs about paranoia, beliefs about paranoia as a survival strategy, general positive beliefs and normalising beliefs). The scales possessed acceptable internal consistency and were associated with the measures of paranoia, delusional ideation and anxiety. Consistent with predictions, it was found that beliefs about paranoia as a survival strategy were associated with frequency of paranoia, and negative beliefs were associated with distress associated with delusional ideation. These findings suggest that a metacognitive approach to the conceptualization of paranoia as a strategy for managing interpersonal threat may have some utility. The clinical implications of the findings are also discussed.

Recent cognitive behavioural models of obsessive compulsive disorder (OCD) suggest that the misinterpretation of the meaning of intrusive thoughts plays a pivotal role in the escalation of these thoughts to clinical obsessions, but less attention has been paid to why only certain intrusive thoughts become the focus of these misappraisals. Theoretical speculation suggests that thoughts that have relevance for an individual's value system or sense of self may be particularly salient and upsetting for people. The role of thought appraisal and contradiction of valued aspects of self were examined in a nonclinical population. It was hypothesized that participants reporting on upsetting intrusive thoughts would appraise these thoughts negatively and would report that these thoughts contradict important aspects of self to a greater degree than participants reporting on less upsetting intrusive thoughts. Participants (N = 64) were randomly assigned to report on either the most or least upsetting intrusive thought they had experienced. They completed questionnaires on appraisals of these thoughts, valued aspects of self, and contradiction of self. Consistent with predictions, participants reporting on more upsetting thoughts appraised these thoughts in a more negative manner and reported that these thoughts contradicted valued aspects of self to a greater degree than participants in the least upsetting thought group. These results support Salkovskis' (1985) and Rachman's (1997, 1998) cognitive behavioural models of OCD, and suggest that the degree of contradiction of self may help us understand why some obsessional thoughts are much more upsetting than others.

Emotional images may be viewed as propositional structures (Lang, 1977), and involve a range of modalities, including cognitive processes. Early memories, however, are often experienced non-verbally (Pillemer, 1998). Self-generated and spontaneous images were investigated in a spider anxious group (N=29) and a non spider anxious group (N=30). Participants completed self-report measures and a detailed semi-structured interview. The spider anxious, compared to the control group, reported more modalities, particularly skin and internal body sensations, in a self-generated spider image than in a control image. Their spider image was also associated with more anxiety, greater intent and vividness, and skin and body sensations that lasted longer. It was also associated with more negative self and other related core beliefs. Themes in core beliefs included loss of control, negative self-evaluation and vulnerability. Most of the spider anxious group reported spontaneous, recurrent images associated with their fear of spiders. Visual, body, skin and auditory sensations were noted. These images were linked to negative self and other related beliefs. Over half identified an associated early memory containing content, emotional meaning and modalities similar to that identified in the initial image. Implications for the treatment and cognitive theory of phobias are considered.