In a series of 51 previously sexually abused women who entered therapy 94% were found to be sexually dysfunctional. It is proposed that these dysfunctions may stem from certain mood disturbances, interpersonal problems, and sexual stresses, that are associated with the earlier traumatic experience of sexual abuse and its surrounding circumstances.

In a previous study (Felce, de Kock and Repp, 1986), appropriate client activity was found to be considerably higher in two community homes for severely and profoundly mentally handicapped adults than in a number of institutions. Client activity was also shown to be related to the extent of staff interaction. The method of this study was replicated in a two-year follow-up to investigate whether these desirable levels of staff interaction and client activity were maintained. Client engagement in appropriate activity remained similar for five subjects but had fallen slightly for a further five. The duration of instruction given to the majority of subjects by staff had declined but so too, for a variety of reasons, had staff–client ratios. Overall, the follow-up data give a general impression of the maintenance of client activity with some subjects engaging with greater independence. However, interpretation is dependent on the role that staff–client ratio may play in determining staff performance and in particular their level of interaction with clients.

This paper describes the development of protocols with interpreters employed in an East London psychological trauma clinic. The service treats traumatized refugee people with cognitive methods, according to the National Institute for Clinical Excellence (NICE) Guidelines for PTSD. NICE states that language should not be a barrier to treatment, but provides no further guidance to achieve this. These protocols for interpreting CBT are designed to be explicit, consistent and ethical. A telephone poll from a recent UK-wide trauma survey, a focus group with local interpreters, and practitioner reflection were all used to develop and refine the protocols and their rationale, which are described, together with implications for future culturally sensitive practice and research.

Background: It is often suggested that, in general, co-morbid personality disorders are likely to interfere with CBT based treatment of Axis I disorders, given that personality disorders are regarded as dispositional and are therefore considered less amenable to change than axis I psychiatric disorders. Aims: The present study aimed to investigate the impact of co-occurring obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) on cognitive-behavioural treatment for OCD. Method: 92 individuals with a diagnosis of OCD participated in this study. Data were drawn from measures taken at initial assessment and following cognitive-behavioural treatment at a specialist treatment centre for anxiety disorders. Results: At assessment, participants with OCD and OCPD had greater overall OCD symptom severity, as well as doubting, ordering and hoarding symptoms relative to those without OCPD; however, participants with co-morbid OCD and OCPD demonstrated greater treatment gains in terms of OCD severity, checking and ordering than those without OCPD. Individuals with OCD and OCPD had higher levels of checking, ordering and overall OCD severity at initial assessment; however, at post-treatment they had similar scores to those without OCPD. Conclusion: The implications of these findings are discussed in the light of research on axis I and II co-morbidity and the impact of axis II disorders on treatment for axis I disorders.

This paper presents two studies which attempt to clarify the processes by which families who have multiple problems respond to behavioural parent training procedures. Study 1 assessed a range of parent and child behaviours in diverse home and community childcare settings during baseline, child management training and 3-month follow-up. Results show that while treatment gains occurred in the home training setting with the therapist present, little generalization of therapeutic effects to other settings was found. At follow-up, the gains made in the training setting had largely reverted to baseline levels. Study 2 assessed the same parent and child behaviours across settings for another group of multidistressed families during baseline, child management training, generalization training (consisting of planned activities and a social-marital support intervention) and at follow-up. Results indicated that the generalization training was associated with further improvements in non-training settings for parent and child behaviour, and that these results had maintained or further improved at follow-up. The results are interpreted and discussed with reference to future research and clinical work with conduct disordered children and their families.

Twenty-four moderately asphasic stroke patients attending a rehabilitation centre were treated for 4 weeks with speech therapy and for 4 weeks with either an operant training procedure, based on that devised by Goodkin (1966), or an attention placebo non-specific treatment. Speech therapy was given first to half the patients, while a quarter received operant training first and a quarter non-specific treatment. Results indicated no significant differences between the treatments. These treated patients were also compared in improvements in language abilities with nine moderately aphasic patients from hospitals with very limited speech therapy services. No significant differences between “treated” and “untreated” groups were found over a 4-week period. All groups of patients, however, showed some significant improvements in language abilities.

Background: Although cognitive-behavioral therapy (CBT) is established as a first line treatment for anxiety disorders in children and adolescents, there is little evidence about the effectiveness of CBT protocols in cases identified in the community in low and middle income countries (LaMICs). Aims: To evaluate the effectiveness of group CBT protocol for youths with anxiety disorders identified in a community sample in LaMICs. Method: A total of 14 sessions of group CBT for youths and 2 concurrent sessions for parents based on Kendall's Coping Cat program were offered. Participants were selected from a cross-sectional community study; 45 subjects fulfilled inclusion criteria and 28 agreed to participate in the open clinical trial. Treatment effectiveness was evaluated with standard clinical, self- and parent-rated measures of anxiety, depression, externalizing symptoms and quality of life (QoL). Results: Twenty youths completed the protocol. All scales showed an improvement of anxiety and reduction in externalizing symptoms over time, with a moderate to large effect size (d = 0.59 to 2.06; p < .05), but not in depressive symptoms or QoL. Conclusions: Consistent with previous evidence, group CBT is effective in treating anxiety disorders in youths. Results encourage further randomized clinical trials using CBT protocols adapted and developed to be used in LaMICs.

Auditory hallucinations comprise the most common symptoms of schizophrenia. Although antipsychotic medications are helpful, in that they reduce symptoms and the likelihood of relapse, many patients do not benefit from their use. In recent years, psychological interventions have been developed in the West to help such patients. However, cross-cultural studies have shown that the nature and form of auditory hallucinations are affected by cultural differences, suggesting that a patient's cultural background needs to be considered when applying psychological methods. In this study, three schizophrenic patients from Saudi Arabia whose auditory hallucinations persisted despite the administration of antipsychotic medications were given a modified psychological intervention designed to alter the characteristics and content of their hallucinations. The modifications included an emphasis on Islamic doctrine and religion. Two patients benefited from the interventions. The third patient was reluctant to engage with the therapist, probably because the content of his voices was benign. The importance of such modifications when employing psychological intervention for patients from non-Western backgrounds is discussed.

Background: There is a growing need for non-medical treatments for women experiencing problematic menopausal symptoms such as hot flushes and night sweats (HF/NS). A recent randomized control trial (RCT) (MENOS2) provides evidence of the effectiveness of Group CBT and Self-Help CBT for HF/NS. Aims: This study examines MENOS 2 participants’ experience of the CBT treatments. Method: Twenty women who had experienced CBT for HF/NS (10 Group CBT and 10 Self-Help CBT) were interviewed at the end of the trial to explore how they experienced the treatment and its effects. The interviews were analysed using interpretative phenomenological analysis. Results: Women experienced both treatment formats as positive and helpful, increasing their ability to cope and their sense of control over HF/NS. Four super-ordinate themes were identified: making sense of symptom change, new ways of coping and regaining control, acknowledging and challenging the menopause taboo, and social interaction and support versus individual learning. Conclusions: These qualitative results are consistent with those of the main trial in that women found both CBT formats helpful in reducing the impact of HF/NS. However, the results also suggest possible mechanisms of change and provide useful information on women's responses to the different treatment components and formats.

Background: Research suggests that core schemas are important in both the development and maintenance of psychosis. Aims: The aim of the study was to investigate and compare core schemas in four groups along the continuum of psychosis and examine the relationships between schemas and positive psychotic symptomatology. Method: A measure of core schemas was distributed to 20 individuals experiencing first-episode psychosis (FEP), 113 individuals with “at risk mental states” (ARMS), 28 participants forming a help-seeking clinical group (HSC), and 30 non-help-seeking individuals who endorse some psychotic-like experiences (NH). Results: The clinical groups scored significantly higher than the NH group for negative beliefs about self and about others. No significant effects of group on positive beliefs about others were found. For positive beliefs about the self, the NH group scored significantly higher than the clinical groups. Furthermore, negative beliefs about self and others were related to positive psychotic symptomatology and to distress related to those experiences. Conclusions: Negative evaluations of the self and others appear to be characteristic of the appraisals of people seeking help for psychosis and psychosis-like experiences. The results support the literature that suggests that self-esteem should be a target for intervention. Future research would benefit from including comparison groups of people experiencing chronic psychosis and people who do not have any psychotic-like experiences.

Background: Paranoia is a common experience in the non-clinical population. We use a novel experimental methodology to investigate paranoid ideas in individuals without a history of mental illness. Aims: We aimed to determine whether this paradigm could elicit unfounded paranoid thoughts and whether these thoughts could be predicted by factors from a cognitive model. Method: Fifty-eight individuals took part and completed measures assessing trait paranoia, mood, self and other schema and attributional style. They were exposed to two experimental events: 1) an interruption to the testing session by a stooge, and 2) a recording of laughter played outside the testing room and subsequently asked about their explanations for these events. Results: 15.5% (n = 9) of the sample gave a paranoid explanation for at least one of the experimental events. The remainder reported generally neutral explanations. Individuals with a paranoid explanation reported significantly higher levels of trait paranoia. Factors predictive of a paranoid interpretation were interpersonal sensitivity and attributional style. Conclusions: The results show that spontaneous paranoid explanations can be elicited in non-clinical individuals, even for quite neutral events. In line with current theories, the findings suggest that emotional processes contribute to paranoid interpretations of events, although, as a novel study with a modest sample, it requires replication.

Background: Adolescents are prone to sleep problems that have unique developmental aspects and contribute to physical, emotional, and behavioural problems. Aims: This study evaluated an individualized, multicomponent intervention that considered developmental factors, and promoted age-appropriate autonomy in three adolescent females with disrupted sleep. Method: Adolescents recorded sleep data on daily logs. A nonconcurrent multiple baseline design was used to evaluate a cognitive-behavioural intervention including sleep hygiene training, bedtime routine development, cognitive restructuring, relaxation training, stimulus control, sleep restriction, bedtime fading, and problem-solving, along with clinically indicated individualization. Results: Outcomes demonstrated clinically meaningful improvements and decreased variability in sleep parameters following intervention. Each participant's sleep log data indicated improvement in, or maintenance of, adequate total sleep time (TST), decreased sleep onset latency (SOL), improved sleep efficiency (SE), improvement in time of sleep onset, and decreased or continued low frequency of night awakenings (NA). Anecdotally, adolescents and parents reported improvement in daytime functioning, coping, and sense of wellbeing. Conclusions: These cases highlight the potential for cognitive-behavioural interventions to facilitate healthy sleep in adolescents with challenging sleep problems.

Background and Aims: There is good reason to consider the role of social anxiety processes in paranoia; both the research and clinical literature indicate significant overlap between the two presentations. The aim of this study was to explore cognition and behaviour that are typically associated with social phobia, in people with paranoia, and then to draw out theoretical and clinical implications. Method: We used a cross-sectional between-subjects design to compare participants with persecutory delusions (without social phobia), social phobia, a clinical control group with panic disorder, and a non-clinical control group. Ten to 15 people were recruited to each of four groups, with a final total of 48 participants. Each person completed measures of automatic thoughts, underlying assumptions, core beliefs and behaviour, and took part in a semi-structured interview designed to assess process (self-consciousness and attentional focus) and metacognitive beliefs. Results: Surprisingly, measures of cognition and behaviour yielded no systematic differences between people with persecutory delusions and social phobia. Conclusions: People with persecutory delusions may experience overt and underlying cognition typically associated with social phobia, and behave in similar ways in response to perceived social threat. These initial results indicate: (i) that larger scale research is now warranted in order to draw firm conclusions about social anxiety processes in paranoia; (ii) more specific hypotheses to be tested; and (iii) a clinical model of paranoia, based on the cognitive model of social phobia, which might now usefully be validated.

Background: Several studies have evaluated the (cost) effectiveness of schema therapy for personality disorders, but little research has been done on the perspectives of patients and therapists. Aim: The present study aims to explore patients’ and therapists’ perspectives on schema therapy. Method: Qualitative data were collected through in-depth semi-structured interviews with 15 patients and a focus group of 8 therapists. A thematic analysis was performed. Results: Most patients and therapists agreed that helpful aspects in schema therapy were the highly committed therapeutic relationship, the transparent and clear theoretical model, and the specific schema therapy techniques. About unhelpful aspects, several patients and some therapists shared the opinion that 50 sessions was not enough. Furthermore, patients lacked clear advance information about the possibility that they might temporarily experience stronger emotions during therapy and the possibility of having telephone contact outside session hours. They missed practical goals in the later stage of therapy. With regard to imagery, patients experienced time pressure and they missed a proper link between the past and the present. For therapists, it was hard to manage the therapeutic relation, to get used to a new kind of therapy and to keep the treatment focused on personality problems. Conclusions: Patients and therapists found some aspects of the schema therapy protocol helpful. Their views about which aspects are unhelpful and their recommendations need to be taken into consideration when adjusting the protocol and implementing schema therapy.

Background: Recent research into positive experiences in caregivers has begun to redress the traditional focus on negative aspects of caregiving experiences. Method: This exploratory study used a cognitive-behavioural approach – namely, the transactional stress model (Lazarus and Folkman, 1984) – to investigate associations between appraisals, coping, and gains over a 6-week period in a small sample (N = 4; case series) design involving stroke caregivers. Analysis involved visual inspection of graphs, supported by descriptive statistics, and co-variation analysis. Results: Participants reported high levels of positive experiences, and these increased over the study period, a previously unreported trend. The study also found individual differences in the interactions between appraisal, coping, and caregiving gain variables, findings explained by the transactional stress model. Conclusions: Implications for clinical practice and future research are addressed.

Recent years have witnessed the gradual emergence of a technology of nonaversive behavioural support for people with severe learning disabilities and seriously challenging behaviours. Three key aspects of these developments are reviewed, including: the functional perspective to analysis and intervention; the incorporation of the analysis and modification of setting events into behavioural practice; and the use of experimental techniques to conduct functional analyses of the contextual control of challenging behaviours. Attention is drawn to the practical implications and limitations of these developments.

Ehlers and Clark (2000) hypothesize that persistent PTSD is explained by a predominance of data-driven processing and a lack of conceptually-driven processing of the trauma. Data-driven/conceptually-driven processing is thought to relate to perceptual memory representations and memory fragmentation. The present study measured the result of data-driven/conceptually-driven processing in three ways: on utterance level by assessing 1) the ratio between perceptual and conceptual memory representations and 2) utterance disorganization, and 3) on narrative level by assessing the incoherence of the trauma narrative. Twenty-nine patients discharged from the Intensive Care Unit (ICU) were assessed within two weeks after ICU discharge and at 4 months follow-up. The present study tested whether perceptual memory representations, narrative disorganization and narrative incoherence immediately after ICU discharge are related to post-trauma symptomatology. If so, whether these variables are specific for PTSD as compared to depression. Data-driven/conceptually-driven processing was related to PTSD and Depression symptoms on utterance level. Although narrative incoherence did not predict PTSD symptoms, it was predictive of depression symptoms. The present study showed the viability of the data-driven/conceptually-driven conceptualization in explaining post-trauma symptomatology.

Two opiate abusers and a solvent abuser were exposed to drug-related cues. Self-rated craving showed habituation within all sessions, although there was considerable variability between subjects in the time-course. Habituation between sessions also occurred, although this was less consistent. The level of craving was reduced in one case by a distraction procedure. Cognitive factors were investigated. For one subject anticipation of the stimulus led to high craving while for all three subjects drug-related imagery was associated with high levels of craving. Dysphoric mood states led to a re-emergence of craving (dishabituation) in two cases. One subject showed objective signs, and reported symptoms of opiate withdrawal during the exposure sessions. He had also shown needle-freak behaviour where the syringe and needle produced drugagonistic effects (pleasant, comfortable feelings or excitement). Implications of these results for the treatment of addiction are discussed.

Background: Despite the global impact of bipolar disorder (BD), treatment success is limited. Challenges include syndromal and subsyndromal mood instability, comorbid anxiety, and uncertainty around mechanisms to target. The Oxford Mood Action Psychology Programme (OxMAPP) offered a novel approach within a cognitive behavioural framework, via mental imagery-focused cognitive therapy (ImCT). Aims: This clinical audit evaluated referral rates, clinical outcomes and patient satisfaction with the OxMAPP service. Method: Eleven outpatients with BD received ImCT in addition to standard psychiatric care. Mood data were collected weekly from 6 months pre-treatment to 6 months post-treatment via routine mood monitoring. Anxiety was measured weekly from start of treatment until 1 month post-treatment. Patient feedback was provided via questionnaire. Results: Referral and treatment uptake rates indicated acceptability to referrers and patients. From pre- to post-treatment, there was (i) a significant reduction in the duration of depressive episode relapses, and (ii) a non-significant trend towards a reduction in the number of episodes, with small to medium effect size. There was a large effect size for the reduction in weekly anxiety symptoms from assessment to 1 month follow-up. Patient feedback indicated high levels of satisfaction with ImCT, and underscored the importance of the mental imagery focus. Conclusions: This clinical audit provides preliminary evidence that ImCT can help improve depressive and anxiety symptoms in BD as part of integrated clinical care, with high patient satisfaction and acceptability. Formal assessment designs are needed to further test the feasibility and efficacy of the new ImCT treatment on anxiety and mood instability.

Five 18 week skills training groups based on Dialectical Behaviour Therapy (DBT) were provided for 34 participants with parasuicidal behaviours; 26 participants completed the programme. Monthly support/education groups for their keyworkers were also provided. Inpatient admissions decreased by 30% and out-patient appointments for those without admission by 61% over the 18 months from the initial pre-group formulation meeting, compared with the preceding 18 months. Statistical analysis (N = 17) showed significant reduction in CORE scores over the intervention period, and a similar effect in scores on the Work and Social Adjustment Scale. User satisfaction was high and drop out low (23.5%). Results indicate DBT skills group might be a useful service where full DBT is unavailable.