Background: Evidence for the efficacy of computer-based psychological interventions is growing. A number of such interventions have been found to be effective, especially for mild to moderate cases. They largely rely on psychoeducation and ‘homework tasks’, and are specific to certain diagnoses (e.g. depression). Aims: This paper presents the results of a web-based randomized controlled trial of Manage Your Life Online (MYLO), a program that uses artificial intelligence to engage the participant in a conversation across any problem topic. Method: Healthy volunteers (n = 213) completed a baseline questionnaire and were randomized to the MYLO program or to an active control condition where they used the program ELIZA, which emulates a Rogerian psychotherapist. Participants completed a single session before completing post-study and 2-week follow-up measures. Results: Analyses were per protocol with intent to follow-up. Both programs were associated with improvements in problem distress, anxiety and depression post-intervention, and again 2 weeks later, but MYLO was not found to be more effective than ELIZA. MYLO was rated as significantly more helpful than ELIZA, but there was no main effect of intervention on problem resolution. Conclusions: Findings are consistent with those of a previous smaller, laboratory-based trial and provide support for the acceptability and effectiveness of MYLO delivered over the internet for a non-clinical sample. The lack of a no-treatment control condition means that the effect of spontaneous recovery cannot be ruled out.

Although cognitive behavior therapy (CBT) has been shown to be generally effective in the treatment of social anxiety disorder (SAD), not all individuals respond to treatment, and among those who do respond the degree of improvement is sometimes far from optimal. Little research has examined the impact of variations in the format of treatment delivery in this area. Participants were randomly assigned to either a standard, 12-session CBT program for generalized SAD in which treatment was delivered in successive weekly sessions (standard treatment) or a similar program in which the 12 sessions were delivered over 18 weeks (extended treatment). Intent-to-treat analyses revealed that the standard treatment program resulted in superior outcome in terms of self-rated symptom and impairment levels, categorical ratings of responder status, and lower dropout rates. Analyses of treatment completers only revealed comparable gains between the two conditions by post-treatment. However, the standard treatment condition revealed a more rapid improvement in magnitude initially. These findings suggest no benefit from extending the course of CBT treatment over a greater length of time, and suggest that such extension may in fact substantially increase the likelihood of premature termination.

Background: Self-esteem is a major concern in the treatment of patients with personality disorders in general. In patients with borderline personality disorder, low self-esteem is associated with factors contributing to suicidal and self-injurious behaviour. At the moment there are no well-proven interventions that specifically target low self-esteem. Recently, a new approach, Competitive Memory Training or COMET, aimed at the enhancement of retrieving beneficial information from memory, appeared to be successful in addressing low self-esteem in different patient populations. Aims: To assess whether COMET for low self-esteem is also an effective intervention for patients with personality disorders. Method: 91 patients with personality disorders who were already in therapy in a regular mental health institution were randomly assigned to either 7 group sessions of COMET in addition to their regular therapy or to 7 weeks of ongoing regular therapy. These latter patients received COMET after their “7 weeks waiting period for COMET”. All patients that completed COMET were contacted 3 months later to assess whether the effects of COMET had remained stable. Results: Compared to the patients who received regular therapy only, patients in the COMET + regular therapy condition improved significantly and with large effect sizes on indices of self-esteem and depression. Significant differential improvements on measures of autonomy and social optimism were also in favour of COMET, but had small to intermediate effect sizes. The therapeutic effects of COMET remained stable after 3 months on three out of the four outcome measures. Conclusion: COMET for low self-esteem seems to be an efficacious trans-diagnostic approach that can rather easily be implemented in the treatment of patients with personality disorders.

Background: Many patients with non-cardiac chest pain or benign palpitations have poor prognosis in terms of symptom persistence, limitations in everyday activities, and reduced health-related quality of life (HRQOL). Aims: The aims of the study were to evaluate the changes and impact of illness perceptions during a three-session cognitive behavioural therapy (CBT) intervention for patients with non-cardiac chest pain or benign palpitations. Method: Patients with persistent complaints 6 months after a negative cardiac evaluation were invited to participate in a randomized controlled trial. Patients in the intervention group (n = 21) received three manualized sessions with CBT, including one physical activity exposure session; the control group (n = 19) received usual care from their general practitioner. Brief Illness Perception Questionnaire (BIPQ) was used to measure illness perceptions. Patients were assessed at start and end of the intervention and at 3- and 12-month follow-up. Results: The intervention and control group differed significantly on five of the eight items of BIPQ at least at one follow-up assessment. At end of treatment and at 3-month follow-up change in illness concern (Item 6 in BIPQ) mediated about 40% of the change in depression from baseline, and at 12-month follow-up about 50% of the change in depression was mediated by change in personal control (Item 3 in BIPQ). Conclusion: Illness perceptions measured with BIPQ may mediate the short and long term treatment effects of a three-session CBT-programme for patients with non-cardiac chest pain and benign palpitations.

Background: Paranoia may build directly upon negative thoughts about the self. There have been few direct experimental tests of this hypothesis. Aims: The aim of the study was to test the immediate effects of manipulating self-esteem in individuals vulnerable to paranoia. Method: A two condition cross-over experimental test was conducted. The participants were 26 males reporting paranoid ideation in the past month. Each participant experienced a neutral immersive virtual reality (VR) social environment twice. Before VR participants received a low self-confidence manipulation or a high self-confidence manipulation. The order of manipulation type was randomized. Paranoia about the VR avatars was assessed. Results: The low self-confidence manipulation, relative to the high self-confidence manipulation, led to significantly more negative social comparison in virtual reality and higher levels of paranoia. Conclusions: Level of self-confidence affects the occurrence of paranoia in vulnerable individuals. The clinical implication is that interventions designed to improve self-confidence may reduce persecutory ideation.

Background: Accumulating research indicates posttraumatic stress disorder (PTSD) is a universal phenomenon. However, it remains substantially unknown as to whether the processes implicated in the aetiology and maintenance of PTSD are culturally similar. Aims: This study investigated the impact of cultural differences in self on negative cognitive appraisals in those with and without PTSD. Method: Trauma survivors with PTSD and without PTSD from independent and interdependent cultures (N = 106) provided trauma narratives. Narratives were coded for negative cognitive appraisals (mental defeat, control strategies, alienation and permanent change) as in Ehlers and colleagues' previous work. Results: Replicating Ehlers and colleagues' work, trauma survivors with PTSD from independent cultures reported more mental defeat, alienation, permanent change and less control strategies than non-PTSD trauma survivors from independent cultures. In contrast, for those from interdependent cultures, only alienation appraisals differentiated between trauma survivors with and without PTSD. Those with PTSD had more alienation appraisals than those without PTSD. Conclusions: The findings suggest cultural differences in self impact on the relationship between appraisals and posttraumatic psychological adjustment. Theoretical and clinical implications are discussed.

Background: Cognitive-behaviour therapy (CBT) is the recommended psychological treatment for obsessive compulsive disorder (OCD) in young people. Access to CBT may be limited by a number of factors, including lack of trained therapists, and geographic or financial factors preventing access to a specialized service. Telephone delivery of CBT represents one way of overcoming some of these accessibility issues. This pilot study describes outcomes for a telephone-based cognitive-behavioural treatment for obsessive-compulsive disorder (OCD) in young people. Method: Ten participants, aged 13 to 17 years, and their parents received up to 16 sessions of telephone CBT (TCBT). Measures of OCD symptoms were obtained using multiple informants and a repeated measures design. Assessments were conducted at pre-treatment, post-treatment, and at 6- and 12-month follow-up. Results: Improvements were found for OCD symptoms across all informants. Family satisfaction with treatment over the telephone was high. Conclusions: The findings suggest that TCBT is a clinically effective, feasible and acceptable means of service delivery that offers the potential to make CBT a more accessible treatment for young people. TCBT requires further evaluation in randomized, controlled trials to compare effectiveness with face-to-face CBT, which currently represents the usual care model.

This investigation was designed to evaluate the utility of a behaviour therapy programme provided on an outpatient basis for the management of chronic pain. Twenty-eight chronic pain patients were randomly assigned to one of three groups. The first group served as a waiting-list control and had minimal contact with the clinic during the study, while the second group received the regular treatment regime provided by the rehabilitation clinic. The behaviour therapy group also received some of the regular treatment techniques offered by the clinic, but in addition, these patients were given: (1) training in applied relaxation (coping) to control the pain, and (2) an operant activities programme to increase relevant activities at home. Results indicated that the behaviour therapy group had significantly greater reductions in pain than the other two groups, and moreover, the behaviour therapy group had the best results for variables of sleep, activity and medication levels. These findings suggest that applied relaxation and an activities training programme may be valuable tools for the remediation of chronic pain.

Individual cognitive behavioural interventions for psychosis are rapidly developing and are being shown to be effective. This paper examines the application of these interventions on a group basis. The nature of the group, treatment outcome and potential benefits of using this format are described. After the group intervention, all patients were less depressed, most had higher self-esteem and greater knowledge of schizophrenia, and half the group felt better able to cope with their symptoms. Patients reported feeling less isolated and two of the four group members stated a preference for group over individual treatment.

Background: In the UK, bibliotherapy schemes have become a widespread source of support for people with common mental health disorders such as depression. However, the current evidence suggests that bibliotherapy schemes that are offered without guidance are not effective. It may be possible to improve the effectiveness of self-help books by incorporating into them some of the “common factors” that operate in personal therapeutic encounters, for example therapist responsiveness. Aim: The aim was to test whether and to what extent authors have incorporated common factors into self-help books. Method: A model of how common factors might be incorporated into CBT-based self-help books was developed and a sample of three books were examined against the model criteria. Results: The sampled self-help books were found to have common factors to a greater or lesser extent, but some types of common factors were more prevalent than others. Factors addressing the development and maintenance of the therapeutic alliance were less often apparent. Conclusions: Self-help books have the potential to provide a valuable service to people with depression, but further work is necessary to develop them. It is suggested that future generations of self-help books should pay explicit attention to the use of common factors, in particular developing and investigating how factors such as flexibility, responsiveness and alliance-rupture repair can be woven into the text.

The purpose of this study was to evaluate a new brief training programme in Cognitive Behavioural Therapy (CBT) within a waiting list control group design. A consecutive sample of 90 mental health professionals were allocated routinely by their managers to be trained in CBT. Over 12 week training periods, these 90 professionals received a total of 48 hours of shared learning, covering core CBT theory and techniques for depression and anxiety. An experiential workshop format was utilized throughout and a comprehensive outcome evaluation was conducted, using multiple measures and methods. The findings indicated that the training was effective in terms of the favourable reactions of the participants, the knowledge and skills they gained, and the generalization of this learning to their work environment. It is concluded that brief shared training in CBT can be successful, in line with current NHS priorities.

Background: Recent research has indicated that individuals with social interaction anxiety make biased interpretations of positive social interactions, with greater general apprehension in response to such events and more negative predictions about the future. There has also been some preliminary evidence for a second facet of interpretation bias, namely a failure to accept others’ positive reactions at face value, but this has so far not been adequately studied. Method: The present study developed a new measure of this “discounting” dimension and utilized a nonclinical sample of undergraduate students to provide an initial analysis of the scale. Results: Results provide early support for the psychometric properties of our scale, and indicate that discounting mediates the relationship between social interaction anxiety and low positive affect, over and above the previously studied aspect of positive event interpretation bias. Conclusions: The implications for treatment interventions and further research are discussed.

This was a cognitive-behavioural therapy (CBT) group for formulation and treatment of low self-esteem, with emphasis on the use of creative approaches (stories, metaphors and experiential exercises) to enhance memory and learning. Evaluation of outcome for 72 clients attending these groups indicates that this is a successful intervention in terms of self-esteem, anxiety and depression. Qualitative feedback has been very positive and there has been a steady and increasing demand in terms of referrals.

The aim of this study was to compare the trauma sensitive beliefs of individuals who had never experienced an assault with the preassault and postassault beliefs of assault victims. Seventy-two individuals who had never experienced an assault completed a questionnaire designed to assess trauma sensitive beliefs (including beliefs about self-worth, safety and the trustworthiness of others). The beliefs of this group were then compared with the preassault and postassault beliefs of assault victims with persistent PTSD and assault victims who had never experienced PTSD, recruited for previous studies (Dunmore, Clark, & Ehlers, 1999, 2001). Results showed that victims who did not develop PTSD following assault reported significantly more positive preassault beliefs in comparison with those who had never been assaulted. The postassault beliefs of the persistent PTSD group were significantly more negative than the beliefs of the never assaulted group and the no PTSD assault group. Findings support evidence that suggests a relationship between negative beliefs after assault and the development of PTSD. In addition, positive preassault beliefs might play a “buffering” role, minimizing the impact of assault for those assault victims who do not subsequently develop PTSD.

A long series of earlier studies demonstrated that fearful subjects selectively allocate attention to sources of perceived threat. Such attentional bias may not be limited to negative cues. It is hypothesized that attentional bias serves to enhance early identification of action-relevant cues and that such bias also occurs when subjects are confronted with positive valenced cues that evoke an urge to act immediately. In order to determine whether or not the attentional bias effect is limited to unpleasant stimuli, we studied the effects of 24 hours of fasting, focusing our attention on a possible attentional bias for (positively evaluated) food stimuli. The experiment controlled for emotionality effects. It is shown that fasting results in a positive evaluation of food stimuli and an increased desire for these stimuli. The attentional bias effects found were slight and more likely attributable to the increased urge to act than to general emotionality effects. The power of the experimental manipulation and the computerized Stroop task are discussed.

A consecutive series of six adolescents referred for obsessive compulsive disorder were treated using a cognitive behavioural approach that included procedures intended to: (1) reach a shared understanding of the psychological nature of the problem; (ii) normalize intrusive thoughts; (iii) help the patient to reappraise notions of responsibility; and (iv) help the patient re-evaluate the basis of their fears. The effects of treatment were measured using standardized questionnaires designed to elicit beliefs about responsibility, and symptoms of anxiety, depression, and obsessive compulsive disorder. During the course of treatment, appraisals of responsibility changed at the same time as changes in symptom levels. The results suggest a more cognitive approach to treatment can be helpful for this age group, and that cognitive change is associated with clinical improvement.

This study tested the hypothesis that trauma memories are disjointed from other autobiographical material in posttraumatic stress disorder (PTSD). Assault survivors with (n = 25) and without PTSD (n = 49) completed an autobiographical memory retrieval task during script-driven imagery of (a) the assault and (b) an unrelated negative event. When listening to a taped imagery script of the worst moment of their assault, survivors with PTSD took longer to retrieve unrelated non-traumatic autobiographical information than those without PTSD, but not when listening to a taped script of the worst moment of another negative life event. The groups also did not differ in general retrieval latencies, neither at baseline nor after the imagery tasks. The findings are in line with suggestions that traumatic memories are less integrated with other autobiographical information in trauma survivors with PTSD than in those without PTSD.

Effects of structured worry interviews were examined among analog-GAD and nonanxious college students. Thirty-four analog-GAD and 29 nonanxious control participants generated sequences of possible catastrophic outcomes for each of six worry topics using the Catastrophizing Interview Technique (Vasey and Borkovec, 1992). Threat ratings for each topic were collected, and ratings of subjective distress, likelihood of the feared outcome, and perceived control over the feared outcome were obtained immediately following each interview. Results indicated that the analog-GAD group rated the worry topics of achievement, social relations, and economics as more threatening than their nonanxious counterparts. The analog-GAD group also generated more catastrophizing steps and reported higher levels of negative mood following the worry interviews. In addition, the eventual fear underlying each worry was determined by coding the content of the final outcome step from each interview. Results from the coded interview responses indicated that fears of negative emotion and of failure were the most frequently coded categories in each of the six topical domains for the analog-GAD group. Although there was no difference in the proportion of negative emotion codes between analog-GAD and nonanxious groups, the analog-GAD group did receive a greater proportion of failure codes than the nonanxious control group. Results largely replicated the findings of Vasey and Borkovec in an analog-GAD sample. In addition, results suggest that fear of negative emotion underlies worry in general, regardless of diagnostic status, while fears of failure or ineffectiveness are more specific to GAD.

A pilot RCT of cognitive therapy (CT; based on Fowler, Garety, and Kuipers, 1995) for early psychosis adjunctive to treatment as usual (TAU) compared to TAU alone is presented. Recruitment is problematic and numbers are small. Levels of symptomatology are low at baseline; and both CT (n = 12) and TAU (n = 9) groups improve, with few significant group differences and high levels of individual variation. This pattern is common to other studies (Jackson et al., 1998; Lewis et al., 2002). The body of evidence to date seems to suggest that CT for early psychosis is not strongly indicated as an adjunctive treatment for all people with early psychosis, but should perhaps focus on the sub-group of patients whose recovery is incomplete.