Carers' beliefs about the controllability of challenging behaviour have been shown to be related to their emotional and behavioural responses to such behaviour. This paper describes the psychometric properties of a new 15-item scale that assesses such beliefs. The scale has good internal reliability and a two-factor structure representing positive and negative beliefs about controllability. The negative beliefs about controllability sub-scale correlate highly with a wishful-thinking coping style but not with a practical problem-solving coping style. The clinical use of this scale is discussed.

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.

The aims of the present study were to investigate whether selective attention in borderline personality disorder (BPD) is content-specific and influenced by treatment. Comparisons were made between emotional Stroop interferences of stimulus types that were related and unrelated to hypothesized BPD schemas (1) of patients with BPD (n = 24) and nonpatient controls (n = 23), and (2) of BPD patients (n = 16) at start and end of an intensive, 3-year lasting treatment. Patients with BPD showed general hypervigilance, i.e. attentional biases for both schema related and unrelated emotional stimuli. Hypervigilance was completely reduced to normalized levels in recovered patients (n = 6), but not in non-recovered patients (n = 10) at the end of treatment. The findings support the possibility of structural change in BPD.

Background: Based on the vulnerability model, several studies indicate that low self-esteem seems to contribute to depressive symptoms. Aims: The aim of this study was to treat depressive symptoms in a cognitive behavioural group therapy, focusing on the enhancement of self-esteem, and to explore co-variation in depressive symptoms and the level of self-esteem. Method: The Multidimensional Self-esteem Scale (MSWS) and the Beck Depression Inventory (BDI) were administered to 147 psychiatric in-patients with current depressive symptoms due to an affective disorder (major depression, bipolar I, dysthymia). Self-esteem was measured pre-treatment (t0) and post-treatment (t4, after 5 weeks of eight group sessions); the BDI was applied weekly. A linear mixed growth analysis was conducted to estimate the change in depressive symptoms including interactions with self-esteem. Results: Within the 5 weeks of group therapy, depressive symptoms showed a linear decline, which was stronger for patients with higher gains in self-esteem between t0 and t4. Self-esteem at t0 was unrelated to the change in depression but predicted self-esteem at t4. Conclusions: Treating depressive symptoms in a cognitive behavioural group therapy in a naturalistic setting might have a positive effect on the process of recovery. Moreover, depressive symptoms and level of self-esteem seemed to co-vary.

Background: Clinical perfectionism is a transdiagnostic process that has been found to maintain eating disorders, anxiety disorders and depression. Cognitive behavioural models explaining the maintenance of clinical perfectionism emphasize the contribution of dichotomous thinking and resetting standards higher following both success and failure in meeting their goals. There has been a paucity of research examining the predictions of the models and motivation to change perfectionism. Motivation to change is important as individuals with clinical perfectionism often report many perceived benefits of their perfectionism; they are, therefore, likely to be ambivalent regarding changing perfectionism. Aims: The aim was to compare qualitative responses regarding questions about motivation to change standards and cognitions regarding failure to meet a personal standard in two contrasting groups with high and low negative perfectionism. Negative perfectionism refers to concern over not meeting personal standards. Method: A clinical group with a range of axis 1 diagnoses who were elevated on negative perfectionism were compared to a group of athletes who were low on negative perfectionism. Results: Results indicated that the clinical group perceived many negative consequences of their perfectionism. They also, however, reported numerous benefits and the majority stated that they would prefer not to change their perfectionism. The clinical group also reported dichotomous thinking and preferring to either keep standards the same or reset standards higher following failure, whilst the athlete group reported they would keep standards the same or set them lower. Conclusions: The findings support predictions of the cognitive behavioural model of clinical perfectionism.

Background: There is little data to inform the treatment of severe obsessive compulsive disorder (OCD) in an inpatient or residential setting. Aims: This paper aimed to: a) describe treatment outcomes at a residential unit over 11 years; b) investigate whether treatment was successful for a subset of severe treatment refractory residents; c) compare an intensive treatment programme to a “standard” treatment programme; and d) find predictors of self or early discharge from the unit. Method: We compared treatment outcomes for (i) a minimum 12-week treatment (hereafter “standard”) programme versus a 2-week intensive programme and (ii) for severe treatment refractory cases on the standard programme. We identified 472 residents with OCD admitted to the Anxiety Disorders Residential Unit at the Bethlem Royal Hospital between 2001 and 2012. Outcomes were measured with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Obsessive Compulsive Inventory (OCI), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) obtained throughout treatment and up to one year after discharge. Results: Although residents had very severe OCD on admission, sequential assessment with the Y-BOCS, OCI, BAI and BDI demonstrated that scores on all outcome measures significantly decreased from pre to posttreatment and were generally maintained at follow-up. There was no significant difference between those on the standard or the 2-week intensive programme. Sixty-nine per cent of residents with OCD made significant improvements, with at least a 25% reduction on the Y-BOCS. There were predictors of self or early discharge but none for outcome on the Y-BOCS. Conclusions: The data support the principle of stepped care for severe OCD.

This project was undertaken in an attempt to reduce one of the many problems faced by a man with a severe memory deficit following a left temporal tumour. He was taught to remember the names of 10 people he regularly came into contact with by using rehearsal and visual imagery strategies. Rehearsal alone was ineffective, but within a few weeks he could remember all 10 names once a visual image had been introduced. The findings suggest that this procedure may be used to teach other people with severe memory deficits facts which are useful in their everyday lives. The major difference between this project and most of the others using visual imagery is that the present one is of some practical value for the subject. Most of the others simply demonstrate the ability of the neurologically damaged to use visual imagery.

Trauma within psychosis is often undiagnosed or untreated. There is a wide body of literature on the efficacy of cognitive behaviour therapy (CBT) for post-traumatic stress disorder (PTSD), but there has been no report of combining CBT for psychosis and CBT for PTSD in modular form. The authors discuss a combined treatment for two patients with psychosis and a history of trauma. The clinical features, process of therapy, and outcome are all described in relation to cognitive therapy models developed for use in PTSD. The implications for therapy, service development, and training are discussed.

The enuresis alarm is a very successful method of treating nocturnal enuresis. Nevertheless many children drop-out of treatment and many relapse once dryness has been achieved. This paper examines the relationship between 30 variables, measured during the pre-treatment assessment of 75 enuretic children, and treatment outcome (success, failure, drop-out and relapse). Treatment was either by the enuresis alarm alone or the enuresis alarm preceded by four weeks of retention control training. Two features of diurnal bladder control (frequency and urgency) were related to failure in treatment and two factors reflecting parental intolerance to wetting (early toilet training and parental urging to use the toilet) were related to treatment drop-out.

Background: Schema Theory proposes that the development of maladaptive schemas are based on a combination of memories, emotions and cognitions regarding oneself and one's relationship to others. A cognitive model of psychosis suggests that schemas are crucial to the development and persistence of psychosis. Little is known about the impact that schemas may have on those considered to be at clinical high risk (CHR) of developing psychosis. Aims: To investigate schemas over time in a large sample of CHR individuals and healthy controls. Method: Sample included 765 CHR participants and 280 healthy controls. Schemas were assessed at baseline, 6 and 12 months using the Brief Core Schema Scale (BCSS). Baseline schemas were compared to 2-year clinical outcome. Results: CHR participants evidenced stable and more maladaptive schemas over time compared to controls. Schemas at initial contact did not vary amongst the different clinical outcome groups at 2 years although all CHR outcome groups evidenced significantly worse schemas than healthy controls. Although there were no differences on baseline schemas between those who later transitioned to psychosis compared to those who did not, those who transitioned to psychosis had more maladaptive negative self-schemas at the time of transition. Associations between negative schemas were positively correlated with earlier abuse and bullying. Conclusions: These findings demonstrate a need for interventions that aim to improve maladaptive schemas among the CHR population. Therapies targeting self-esteem, as well as schema therapy may be important work for future studies.

Four pedophiles, one sado-masochist, and one rapist were treated by varying different aspects of a single paradigm of masturbatory conditioning. In the basic paradigm, subjects masturbate to ejaculation while speaking their fantasies aloud. Weekly blocks of five trials with a deviant theme are alternated with weekly blocks where the theme is nondeviant. Evaluation sessions to assess levels of response to deviant and nondeviant slide stimuli are typically conducted later in each treatment day. The usual result is an increase in nondeviant arousal with a concomitant decrease in deviant arousal.

Variations in the masturbation procedure included shortening the treatment week from 5 days to 2 or 3, alternating themes on a daily rather than weekly basis, and omitting the use of deviant imagery. In the evaluation sessions variations included the preparation of individually tailored audiotaped fantasies precisely expressive of the subjects' interests, the use of videotaped simulations of rape, assault, and consenting intercourse, and obtaining numerous measures of the subjects' cognitive changes during the treatment process. All six subjects showed the effect of decreasing their deviant sexual arousal and increasing their nondeviant arousal. The results were discussed from various viewpoints employing a cognitive-behavioral model.

An examination was made of the extent to which maternal anxiety predicted response to treatment of children presenting with an anxiety disorder. In a sample of 55 children referred to a local NHS CAMH service for treatment of an anxiety disorder, systematic mental state interview assessment was made of both mothers and children, and both completed self-report questionnaires to assess aspects of anxiety, both immediately before the children received treatment and following treatment. Children of mothers with anxiety disorder overall responded less well to treatment than children of mothers with no anxiety disorder. There was some diagnostic specificity in this in that children of mothers with GAD did as well in treatment as children whose mothers had no anxiety, whereas children of mothers with social phobia did poorly. The outcome for children with anxiety appears to be related to the presence and nature of maternal anxiety. It would seem prudent that treatment of children with anxiety involves assessment of maternal anxiety. It is important to establish in systematic investigation whether treatment of maternal anxiety improves the outcome for child anxiety.

A cognitive approach to understanding mood swings and bipolar disorders is provided, with the interpretation of changes in internal state as a central explanatory factor. The model explains how attempts at affect regulation are disturbed through the multiple and conflicting extreme personal meanings that are given to internal states. They prompt exaggerated efforts to enhance or exert control over internal states, which paradoxically provoke further internal state changes, thereby feeding into a vicious cycle that can maintain or exacerbate symptoms. Counterproductive attempts at control are classified as either ascent behaviours (increasing activation), or descent behaviours (decreasing activation). It is suggested that appraisals of extreme personal meaning are influenced by specific sets of beliefs about affect and its regulation, and about the self and relations with others, leading to an interaction that raises vulnerability to relapse. Pertinent literature is reviewed and found to be compatible with such a model. The clinical implications are discussed and compared to existing interventions.

Background: The origins of childhood obesity invariably need to be looked at within a family context and several reviews have concluded in favour of parental involvement in the treatment of paediatric obesity. However, there is little consensus on the format, and next to weight outcomes behavioural outcomes also merit more attention when assessing program effectiveness. Method: In this pilot study, a total of 50 families with overweight children (aged 6–12) were randomly allocated to a parent-led intervention group (cognitive behavioural training) or to a waiting list control group (Study 1). Afterwards, the parents of the waitlist control group also followed the intervention. All children were included in a follow-up study and were compared with a reference group (Study 2). Results: The intervention group as well as the waitlist group (who had not yet received treatment) showed a decrease in adjusted BMI over a 6-month period, although the decrease was only significant for the intervention group (Study 1). All children showed a decrease of 7% in adjusted BMI from pre to one-year follow-up measurement (Study 2), while the reference group showed an increase in adjusted BMI over that period. Parents reported significant positive changes in children's eating behaviour and a significant positive increase in familial health principles. Conclusions: Weight and behavioural outcomes suggest potential for intervention effectiveness. Long-term follow-up is needed to reveal residual benefits of enhanced parenting skills on environmental lifestyle changes.

Background: Mindfulness-based cognitive therapy (MBCT) has evidence of efficacy in a range of populations, but few studies to date have reported on MBCT for treatment of anxious and depressive symptoms in Parkinson's disease (PD). Aims: The aim of this study was to examine the efficacy of modified MBCT in reducing symptoms of anxiety and depression and improving quality of life in PD. Method: Thirty-six individuals with PD were randomly assigned to either modified MBCT or a waitlist control. Changes in symptoms of anxiety, depression and quality of life were compared at group level using generalized linear mixed models and at individual level using reliable change analysis. Results: At post-treatment, there was a significant reduction in depressive symptoms for people undertaking modified MBCT at both group and individual levels compared with controls. There was no significant effect on anxiety or quality of life at the group level, although significantly more people had reliable improvement in anxiety after modified MBCT than after waitlist. Significantly more waitlist participants had reliable deterioration in symptoms of anxiety and depression than those completing modified MBCT. Most participants stayed engaged in modified MBCT, with only three drop-outs. Discussion: This proof-of-concept study demonstrates the potential efficacy of modified MBCT as a treatment for depressive symptoms in Parkinson's disease and suggests further research is warranted.

Background: Panic attacks and anticipatory anxiety are considered to be inter-correlated, yet distinctive, features of panic disorder, both contributing to its onset and maintenance as well as to the associated impairment. Given the difficulty to yield ecologically valid data on these fluctuating symptoms the natural course of anticipatory anxiety and its correlates have seldom been addressed with adequate methods. Aims: The current study aimed at further exploring the natural variance of anticipatory anxiety and its interdependence with panic-related variables. In addition, impact of anxiety sensitivity, and perceived ability to cope with panic on the relation between panic attacks and subsequent anxiety was inspected. Method: Based on an Ecological Momentary Assessment approach, 21 patients with panic disorder rated study variables continuously over one week; 549 question sets were completed. Results: Anticipatory anxiety followed a diurnal pattern and was associated with situational and internal variables typically linked to panic experiences. Preceding panic attacks intensified anticipatory anxiety and associated negative emotional states; however, perceived ability to cope attenuated these effects. Conclusion: Based on natural observation data, results largely support the importance of cognitive appraisals for anticipatory anxiety, and its interplay with panic attacks as it has been suggested by cognitive theory and recent findings in extinction learning research.

Background: Chronic pain is a common condition among older adults. While cognitive behaviour therapy (CBT) has been tested in numerous studies on adults and children there are fewer studies on older persons. The objective of this study was to investigate the effects of a six-session CBT group treatment for older persons with chronic pain. As a secondary aim we investigated whether treatment credibility was associated with outcome. Method: We included 21 persons (mean age = 72.0 years) who were randomly allocated to either a waitlist condition or treatment consisting of applied relaxation, with the addition of problem solving, assertiveness, communication strategies, sleep management, and relapse prevention. Results: Few statistically significant effects were found on measures of pain, mood, anxiety, and quality of life; however, a significant treatment effect with a between group effect size of d = 1.0 was observed with respect to perceived ability to function despite the discomfort of pain. Conclusion: The study provides some preliminary support for the use of group-based CBT with a focus on applied relaxation for older adults with chronic pain.

Background: Computer-guided CBT has been shown to be a potentially useful way of closing the gap between the demand and supply for CBT. Moreover, this approach has additional benefits in terms of less travel times for treatment, accessibility in remote and unusual locations, increased confidentiality, easier disclosure of sensitive information, and more egalitarian therapist-client interactions. Research on computerized CBT has concentrated on clinical outcomes, but the views of clients on this treatment approach have been relatively neglected. Aims: The aims were to assess client satisfaction, professionals' views, and ease of programme use after completion of treatment via an internet-based CBT programme for panic and phobic anxiety (FearFighter). Method: A feasibility and effectiveness study of FearFighter was conducted in remote and rural areas of Scotland. Treatment data are available for 35 clients at post-treatment, of whom 29 completed an 18-item set of rating scales designed to assess satisfaction, including ease of use, accessibility, how far needs were met, whether changes to the programme were required, the benefits and drawbacks of not having a therapist, and quality of support. Open-ended questions were included. Referring agencies were also asked to rate their views on FearFighter. Results: Clients reported moderate to high levels of improvement and of overall satisfaction; very few difficulties in logging on to and using the programme were encountered. Similar levels of satisfaction with the programme were reported by referrers. Conclusions: It is concluded that computer-guided CBT is acceptable to clients and to professionals, and that it could play a valuable part in a “stepped care” system of delivering CBT.

Therapy process research has made surprisingly little headway during the past 25 years, which has been attributed to a range of methodological and conceptual problems. As a result, appeals have been made for fresh approaches to psychotherapy process research. Here we provide an experiential learning model as one promising way to crystallize conceptualizations of competence in therapy and to advance research. The model provides an integrative account of the moderators and mediators believed to explain the way that therapy achieves its outcomes. Its breadth takes it beyond the scope of its closest rival, the assimilation model. By way of illustration, the theoretical components of the experiential metaphor were operationalized and mapped onto an existing competence scale, the Cognitive Therapy Scale.

Recently, several RCTs have provided preliminary evidence that cognitive-behavioural therapy (CBT) is effective in the treatment of people suffering from schizophrenia. However, none of these trials has provided complete demonstrations of therapist adherence. Since no suitable scale existed already, the authors devised the Cognitive Therapy for Psychosis Adherence Scale (CTPAS). The main aim of the present research was to test whether the 12 items of this scale could be rated reliably. Ratings were made on 29 sessions of CBT for schizophrenia by two raters independently and their agreement was found to be at least adequate on 10 of the items of the CTPAS. Ratings were also made on relevant items of the Collaborative Study Psychotherapy Rating Scale and agreement was found to be more than adequate for three factor-based subscales derived from these items. The results suggest therapist adherence to CBT for psychosis can be rated reliably and that the CTPAS is likely to be useful in future research on this form of treatment.