Background: Cognitive behavioural therapy for insomnia (CBTI) has been successfully applied to those with chronic illness. However, despite the high prevalence of post-stroke insomnia, the applicability of CBTI for this population has not been substantially researched or routinely used in clinical practice. Aims: The present study developed a ‘CBTI+’ protocol for those with post-stroke insomnia and tested its efficacy. The protocol also incorporated additional management strategies that considered the consequences of stroke. Method: A single-case experimental design was used with five community-dwelling individuals with post-stroke insomnia. Daily sleep diaries were collected over 11 weeks, including a 2-week baseline, 7-week intervention and 2-week follow-up. The Insomnia Severity Index, Dysfunctional Attitudes and Beliefs About Sleep Scale, Epworth Sleepiness Scale, Fatigue Severity Scale and Stroke Impact Scale were administered pre- and post-treatment, as well as at 2-week follow-up. Results: At post-treatment, three participants no longer met diagnostic criteria for insomnia and all participants showed improvements on two or more sleep parameters, including sleep duration and sleep onset latency. Three participants showed a reduction in daytime sleepiness, increased quality of life and reduction in unhelpful beliefs about sleep. Conclusions: This study provides initial evidence that CBTI+ is a feasible and acceptable intervention for post-stroke insomnia. Furthermore, it indicates that sleep difficulties in community-dwelling stroke populations are at least partly maintained by unhelpful beliefs and behaviours. The development and delivery of the CBTI+ protocol has important clinical implications for managing post-stroke insomnia and highlights directions for future research.

Background: There is a small body of research indicating that mindfulness training can be beneficial for people with distressing psychosis. What is not yet clear is whether mindfulness effects change in affect and cognition associated with voices specifically. This study examined the hypothesis that mindfulness training alone would lead to change in distress and cognition (belief conviction) in people with distressing voices. Method: Two case studies are presented. Participants experienced long-standing distressing voices. Belief conviction and distress were measured twice weekly through baseline and mindfulness intervention. Mindfulness in relation to voices was measured at the start of baseline and end of intervention. Results: Following a relatively stable baseline phase, after 2–3 weeks of mindfulness practice, belief conviction and distress fell for both participants. Both participants' mindfulness scores were higher post treatment. Conclusion: Findings show that mindfulness training has an impact on cognition and affect specifically associated with voices, and thereby beneficially alters relationship with voices.

In the UK, recent guidelines on the treatment of depression and anxiety recommend CBT-based self-help materials as one important component of services. However, despite being based on specific CBT techniques or “empirically grounded interventions”, early optimism has been dented by data from recent studies that have cast doubt on the effectiveness of the current generation of these materials. As a consequence, it may be necessary to consider that other factors may contribute to the overall magnitude of CBT effects. Indeed, it is logically inconsistent to argue that specific factors are pre-eminent in CBT whilst maintaining that delivery via therapists is more likely to be effective than self-help. The contribution of “common factors” that operate in personal therapeutic encounters, for example, therapist responsiveness and the patient-therapist alliance, may be one possible overlooked reason for the reduced ef-fectiveness of self-help materials. The development of the next generation of self-help materials, therefore, may benefit from the testing of materials that combine common and specific factors, including specific measurement of the strength of common factors and their relationship to clinical outcomes. We discuss a model of such common factors and suggest how they could be incorporated into the next generation of CBT based self-help materials.

Sleeping difficulties are relatively common amongst normal young children at some stage in their development. It is estimated, for example, that approximately 20% of normal 1–2 year olds and 14% of 3 year olds wake regularly during the night (Bernal, 1973; Jenkins, Bax and Hart and Land-sown, 1980). Amongst handicapped children rates of sleeping disturbance tend to be even higher (Richman, Stevenson and Graham, 1975; Richman, Douglas, Hunt, Levere, 1982) and in autistic children, in particular sleeping difficulties are frequently severe and persistent. Thus, De Meyer (1979) found that almost all autistic children had shown sleeping problems at some stage in their development and at an average age of 5½ years, 49% still showed severe sleeping difficulties (as compared with only 3% of normal controls). This additional strain on parents, who already have to cope with many behavioural problems throughout the day, can be considerable, and frequently has a deleterious effect on many aspects of family and marital relationships.

Background: For elementary school-children with aggressive behaviour problems, there is a strong need for effective preventive interventions to interrupt the developmental trajectory towards more serious behaviour problems. Aim: The aim of this RCT-study was to evaluate a school-based individual tailor-made intervention (Stay Cool Kids), designed to reduce aggressive behaviour in selected children by enhancing cognitive behavioural skills. Method: The sample consisted of 48 schools, with 264 fourth-grade children selected by their teachers because of elevated levels of externalizing behaviour (TRF T-score > 60), randomly assigned to the intervention or no-intervention control condition. Results: The intervention was found to be effective in reducing reactive and proactive aggressive behaviour as reported by children, mothers, fathers or teachers, with effect sizes ranging from .11 to .32. Clinically relevant changes in teacher-rated externalizing behaviour were found: the intervention reduced behaviour problems to (sub) clinical or normative levels for significantly more children than the control condition. Some aspects of problems in social cognitive functioning were reduced and children showed more positive self-perception. Ethnic background and gender moderated intervention effects on child and teacher reported aggression and child response generation. Conclusions: The results of this study demonstrate the effectiveness on outcome behaviour and child cognitions of an individual tailor-made intervention across informants under real-world conditions.

Background: Body dysmorphic disorder (BDD) is relatively common in adolescents and can have serious negative consequences. However, the treatment of BDD in young people has received virtually no empirical attention to date, and the evidence-base for cognitive behaviour therapy (CBT) in this population is limited to a small number of single case reports. Aims: This study aimed to investigate treatment outcomes associated with CBT, primarily consisting of exposure and response prevention, in a group of young people with BDD. Method: Six adolescents with a diagnosis of BDD received a course of developmentally appropriate CBT for BDD with parental involvement. BDD and depressive symptoms were evaluated at pre-treatment, post-treatment and at 3- or 6-month follow-up, using the Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS) and the Beck Depression Inventory-Youth, respectively. Results: Scores on the BDD-YBOCS indicated a 44% improvement in BDD symptoms at post-treatment and a 57% improvement at follow-up for the group. Considering response as a ≥30% reduction in BDD-YBOCS score, four of the six adolescents were classified as treatment responders. Improvements in depressive symptoms were observed among the treatment responders, but not the non-responders. Conclusions: These findings indicate the potential efficacy of CBT, including exposure and response prevention for adolescents with BDD, and highlight the need for further controlled trials.

Background: Clinical supervision plays an essential role in the development of mental health professionals and is increasingly viewed as a discrete professional specialization. However, research has rarely addressed core issues such as the measurement and manipulation of clinical supervision, so there are very few direct comparisons between the different supervision methods. Aims: To operationalize two related approaches, cognitive-behavioural (CBT) and evidence-based clinical supervision (EBCS), demonstrate their fidelity, and then evaluate their relative effectiveness in facilitating the experiential learning of one supervisee. Method: Within a multiple-baseline, N = 1 design, we rated audiotapes of supervision on a competence rating scale. Results: Findings generally favoured the EBCS approach, which was associated with higher fidelity by the supervisor and increased engagement in experiential learning by the supervisee. Conclusions: This preliminary but novel evaluation indicated that CBT supervision could be enhanced. Implications follow for supervisor training and a more rigorous N = 1 evaluation.

Background: Attitudes of social service providers towards computerized CBT (cCBT) might affect use of cCBT by their clients and may provide important insights that should be considered in dissemination. There is no literature exploring the attitudes of providers of youth work services towards cCBT despite the likelihood of them having close relationships with young people at high risk of mental ill-health. Method: Focus groups and semi-structured interviews were undertaken with a total of 40 providers (21 youth workers and social service staff providing alternative schooling, justice or other intensive youth work programmes to adolescents, 6 youth service managers, 2 trainers, 5 peer leaders and 6 trainees). Results: Participants considered supporting young people who were distressed to be an important part of their role. They were generally interested in cCBT, especially those who were more mental health oriented and those who saw a cCBT programme in action. Their greatest concerns regarding cCBT related to it possibly displacing human contact, while advantages were seen as its appeal to young people and its potential therapeutic power. They would utilize cCBT in a range of ways, with many wishing to offer it in group settings. Training and resources would be required for them to use cCBT. Conclusions: Many providers of youth work services would like to be involved in the use of cCBT; this might extend the reach of cCBT to vulnerable young people. They would wish to utilize cCBT in ways that fit their current approaches. Providers’ opinions need to be considered in the dissemination of cCBT.

Background: Questions underpin all aspects of therapeutic assessment and intervention and are a vital component of the clinical process. Over recent years frameworks have started to be applied to obtain a greater understanding of questioning formats and processes. Method: This paper examines the use of questions in cognitive therapy (CT). An overview of the main types of questions identified in the literature is presented. In addition, we examine a range of client and therapist characteristics that may impact on the questioning process. Conclusions: Asking questions in therapy is a complex, yet under-taught, skill. This paper provides a set of frameworks to assist in identifying helpful and unhelpful questioning skills. Thus the article has implications for further training and research.

Service user satisfaction with Cognitive Behavioural Therapy (CBT) for psychosis was examined with the Satisfaction with Therapy Questionnaire (STQ; Beck, Wright, Newman and Liese, 1993). Sixty-five service-users completed the STQ at the end of therapy, and 40 3-month post therapy. Overall, the majority of service-users were satisfied with therapy. Satisfaction was unaffected by service-user demographics or service issues, and remained stable over the 3-month follow-up. Belief in the extent to which CBT skills/knowledge had been gained predicted overall satisfaction at the end of therapy, while there was a near-significant effect for belief about the usefulness of homework(s) to predict overall satisfaction at 3-month follow-up. These results suggest that (i) CBT for psychosis is an acceptable intervention to service-users, regardless of their demographic characteristics or service issues; (ii) the specific aspects of CBT, not the non-specific attributes of therapy, predict overall satisfaction; (iii) homework setting may be important in ensuring ongoing satisfaction post-therapy.

Background: In contrast to a wealth of research on the treatment of Obsessive Compulsive Disorder (OCD), there is a relative paucity of work examining how OCD begins. Available data suggest that there is often a slow progression from the onset of symptoms to meeting criteria for a diagnosis of OCD. Aims: The current study sought to add to existing data documenting the slow-development of OCD, and to extend previous findings by examining potential moderators of this symptom phase and to examine patients’ explanations for the transition from symptoms to disorder. Method: One hundred and ninety-nine individuals with OCD reported on the start of their symptoms and the disorder via an internet-based survey. Results: Over two-thirds of respondents reported that the development of their OCD was gradual. Further, participants reported having experienced obsessions and/or compulsions for an average of 5 years before experiencing full-blown OCD. This extended symptom phase was observed in individuals with early- and late-onset OCD, with an even more protracted symptom phase in the later group. Female gender and onset of compulsions prior to obsessions were also associated with slower progression to full-blown OCD. Finally, explanations for the transition from symptoms to disorder suggest that changes in daily routines and general stress may be particularly important in this transition for individuals that develop clinical OCD at age 18 or later. Conclusions: Existence of a protracted symptom phase may present opportunities for elucidating risk factors for OCD disease progression and a window of opportunity for indicated prevention programs.

Background: This study adds to the limited evidence concerning the benefits of Interpersonal Psychotherapy (IPT) with depressed adolescents. It evaluates the long-term effects of group versus individual delivery of this treatment approach. Aims: To conduct a small-scale examination of the long-term efficacy of group versus individual delivery of IPT for depressed adolescents. Method: Thirty-nine adolescents, aged 13–19 years, with a primary diagnosis of Major Depressive Disorder, were randomly assigned in blocks to either group or individual delivery of IPT. Standardized clinical interview and questionnaire assessments were conducted at pre- and posttreatment, and 12-month follow-up. Results: Intent-to-treat (ITT) analyses indicated significant improvements in depression, anxiety, youth-reported internalizing problems, and global functioning from pre- to posttreatment for those receiving IPT, with no significant differences in outcome between group and individual formats of delivery. Improvements were maintained at 12-month follow-up. Completer analyses also revealed significant and sustained improvements on these measures for those receiving IPT, with no differences in outcome between therapy formats for most measures. Individual IPT showed significantly greater improvements than group IPT in parent-reported internalizing problems for the completer but not the ITT analyses. Conclusions: Both individual and group formats of IPT offer promise in producing long-term benefits in the treatment of depression among adolescents.

This study investigated whether reasoning biases are specific to people with delusions and the role of emotional material on “jumping to conclusions”. Associations between reasoning and cognitive factors as well as other top-down factors such as metacognition were also explored. A comparative design was used to investigate group differences between people with persecutory delusions, people with panic disorder and non-patient controls. A probabilistic reasoning task involving three types of material was utilized to investigate the effect of emotional content on reasoning. Participants also completed questionnaire measures to explore whether hasty decision making was associated with measures of mood or cognitive processes. The results of the reasoning task showed that there was no main effect of group. However, all participants requested significantly less information on the two types of emotional material. None of the questionnaire measures were associated with performance on the reasoning task. Aspects of metacognition were found to be associated with ratings of delusions. This study suggested that between group differences in reasoning were small but that emotional content increases haste of decision making across all groups.

Background: A previous study of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) for generalized anxiety (Paxling et al., 2013) identified eight distinct therapist behaviours in ICBT (task reinforcement, self-efficacy shaping, task prompting, alliance bolstering, psychoeducation, empathetic utterances, deadline flexibility, and self-disclosure). It is unknown how generalizable these behaviours are across ICBT programs. Aims: We systematically examined the frequency of these eight therapist behaviours and additional newly identified behaviours in e-mails sent to patients during the course of ICBT for depressive symptoms. We also conducted exploratory analyses to examine relationships between therapist behaviours, symptom improvement, and therapeutic alliance. Method: Data was obtained from a previously published open trial (Hadjistavropoulos et al., 2014). A total of 1013 e-mails sent from therapists (n = 24) to patients (n = 41) during ICBT for depressive symptoms were analyzed. Therapist behaviours were correlated with symptom change scores and ratings of therapeutic alliance at mid- and post-treatment. Results: Therapist behaviours described by Paxling et al. were reliably identified in the e-mails using qualitative content analysis; the frequencies of these behaviours differed, however, from the Paxling et al. study and three additional therapist behaviours were identified (administrative statements, questionnaire feedback, asking clarifying questions). Several therapist behaviours (e.g. administrative statements, task prompting) were associated with lower symptom improvement at post-treatment. Questionnaire feedback and task reinforcement were associated with higher patient ratings of therapeutic alliance. Conclusions: The study provides partial support for the generalizability of therapist-assistance across ICBT programs. Experimental research is needed to examine the impact of varying therapist-assistance on patient outcomes.

Three methods of physical restraint were videotaped and presented to two groups of subjects (undergraduate students and teenagers). Two of the methods recommended restraining a person with a learning difficulty on the ground; the other method proposed seating the individual in a chair. Subjects were asked to rate the social acceptability of the procedures using the Treatment Evaluation Inventory (TEI). Both undergraduate students and teenagers rated the chair method as more acceptable. The implications of these findings for the use of physical restraint procedures were discussed.

There is uncertainty about the role of avoidance behaviours in recovery from loss. Some authors have noted that avoidance exacerbates grief, whereas others have claimed that avoidance, at some times during the grieving process, can foster recovery. In the current study, it was hypothesized that avoidance behaviours are particularly detrimental when mourners have threatening misinterpretations about the consequences of confronting the loss, but less detrimental when mourners do not have such misinterpretations. To test this hypothesis, 400 mourners completed questionnaires tapping threatening misinterpretations, avoidance, and complicated grief (CG) and depression. In support of the prediction, situational avoidance, ruminative avoidance, and efforts to maintain ties with the deceased were only linked with depression in those who strongly endorsed misinterpretations. In addition, misinterpretations magnified the associations of ruminative avoidance and efforts to continue ties, with CG. Findings suggest that avoidance interacts with threatening misinterpretations in affecting particular emotional problems after loss.

Background: Of young people with first episode psychosis (FEP), over half report exposure to childhood trauma and consequent co-morbid post-traumatic stress disorder (PTSD) or symptoms. Currently no evidence-based interventions exist for PTSD in FEP. Clinicians report concerns that trauma-focused interventions with young people with FEP could result in distress and symptom exacerbation. Scant research suggests that talking about trauma in therapy can be distressing for some people. Aims: To explore young people's reactions to a trauma-focused treatment for PTSD in FEP. Method: Semi-structured interviews were conducted with eight participants (age 18–27 years) with co-morbid PTSD and FEP, after completing a trauma-focused intervention. Transcripts were analysed using an interpretative phenomenological approach. Participants’ baseline and end-of-treatment PTSD and psychotic symptoms were assessed. Results: Three themes related to participants’ reactions were identified from the analysis: (1) distress in session; (2) feeling relieved in and out of session; and (3) symptom exacerbation out of session. All but one participant reported experiencing increased distress in session. Four participants described PTSD, psychotic symptoms and/or suicidal ideation worsening in immediate reaction to talking about trauma in therapy sessions. 86% of participants showed improvement in their PTSD and psychotic symptoms at end of treatment. All participants described the intervention as beneficial and worthwhile. Conclusions: Results suggest that feelings of distress are to be expected from individuals with PTSD and FEP during trauma-focused treatment. Psychotic and PTSD symptom exacerbation can occur in PTSD treatment in FEP. Clinicians should be aware of, plan for, and clearly inform their clients of treatment risks.

The tendency to dissociate is characterized by deficits in autobiographical memory. Poor reality monitoring, i.e., the ability to decide whether an event truly happened or was imagined may give rise to autobiographical memory problems. It was hypothesized that the tendency to dissociate, as measured by the Dissociation Experience Scale (DES), is related to deficiencies in reality monitoring. Yet, the results of two laboratory measures of reality monitoring showed no such relationship in a sample of undergraduate students scoring high on the DES. The tendency to dissociate was found to be related to self-reports of traumatization. This association, however, was mediated by a measure of deliberate attempts to suppress memory elements from entering consciousness. This finding suggests that memory problems relating to trauma may be due to “willful forgetting”.

Wilson's recent critique of the authors' appraisal of meta-analysis appears to misunderstand them as claiming more for meta-analysis than they intended. The present paper seeks to clarify consequent confusions concerning selection of studies, the quality of the literature reviewed, the classification of therapies, and the non-identical results of different meta-analyses. It is acknowledged that no single meta-analysis is definitive.