Background: One of the primary differences between Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) for anxiety is the approach to managing negative thoughts. CBT focuses on challenging the accuracy of dysfunctional thoughts through cognitive restructuring exercises, whereas ACT attempts to foster acceptance of such thoughts through cognitive defusion exercises. Previous research suggests that both techniques reduce the distress associated with negative thoughts, though questions remain regarding the benefit of these techniques above and beyond exposure to feared stimuli. Aims: In the present study, we conducted a brief experimental intervention to examine the utility of cognitive defusion + in-vivo exposure, cognitive restructuring + in-vivo exposure, and in-vivo exposure alone in reducing the impact of negative thoughts in patients with social anxiety disorder. Method: All participants completed a brief public speaking exposure and those in the cognitive conditions received training in the assigned cognitive technique. Participants returned a week later to complete a second exposure task and self-report measures. Results: All three conditions resulted in similar decreases in discomfort related to negative thoughts. ANOVA models failed to find an interaction between change in accuracy or importance and assignment to condition in predicting decreased distress of negative thoughts. Conclusions: These preliminary results suggest that changes in perceived importance and accuracy of negative thoughts may not be the mechanisms by which cognitive defusion and cognitive restructuring affect distress in the short-term.

Previous research with an on-line processing task found that individuals without social anxiety generate benign inferences when ambiguous social information is encountered, but people with high social anxiety or social phobia do not (Hirsch and Mathews, 1997, 2000). In the present study, we tested if it is possible to induce a benign (or less negative) inferential bias in people who report anxiety about interviews by requiring them to take the perspective of an interview confident person, rather than their own. High interview anxious volunteers were allocated to read descriptions of job interviews, either taking their own perspective in the described situation or that of a confident interviewee. At certain points during the text, a target letter string appeared and participants were asked to indicate whether it formed a word or a non-word (lexical decision). Some of the lexical decisions occurred in the context of ambiguous text that could be interpreted in both a threatening and a benign manner. In a baseline condition, decisions were made following text for which there was only one possible inference (either threat or benign). The results indicated that, compared to the self referent condition, participants who adopted the perspective of a confident other person showed enhanced inhibition of threat inferences.

Background and Method: This naturalistic study was undertaken in routine settings and compared the clinical effectiveness, costs, treatment preference, attrition and patient satisfaction of Group and Individual CBT. Results: No significant differences were found in depressive and distress symptoms between group and individual CBT at post-treatment and follow-up. Individual CBT was 1.5 times more expensive to provide than Group CBT and the wider costs of other supports were similar between study arms suggesting a cost-effectiveness advantage for Group CBT. Patients preferred individual treatment at baseline but, despite this, there were no between-group differences in attrition or satisfaction. Conclusion: A larger RCT study is needed, but running CBT groups for depression could be considered more frequently by clinicians.

There is a growing body of evidence that cognitive-behaviour therapy is an effective treatment in chronic psychosis for reducing the severity and distress associated with hallucinations and delusions. However, no work has been published that has applied cognitive-behaviour therapy (CBT) with inpatients within secure environments who may have co-existing problems with psychosis and aggression. This paper describes how CBT for psychosis has been integrated with a CBT approach for treating anger for this group of patients. Three case studies of inpatients on a low secure, high dependency facility are described with whom this approach was used. The paper highlights the unique problems of interventions with these types of clients, and describes how CBT can be applied within these environments.

Impairment in mental control is a primary complaint of many sufferers of obsessive-compulsive disorder (OCD). Most OCD sufferers work very hard to rid themselves of their obsessions, to little avail. Although active resistance is a defining feature of obsessions, it is typically not assessed in measures of OCD severity and little is known about the frequency of attempts at thought control or its impact on functioning while control strategies are engaged. In the present study, 37 individuals diagnosed with OCD kept a diary of their suppression attempts over a 3-day period, recording the circumstances under which the attempt at suppression occurred, the suppression strategy used, its outcome, and its impact on concentration, mood, peace of mind, and ability to proceed with planned activities. Results indicated that individuals with OCD engage in frequent, strenuous, time-consuming and ultimately unsuccessful attempts to control thoughts. Suppression was used as a means of avoiding the hassles associated with experiencing an obsession and with performing a compulsive ritual. Consistent with other research, suppression was also used as a means of neutralizing harm potentiated by the obsession. These findings suggest that thought suppression efforts and their impact may contribute significantly to the severity of impairment associated with OCD, and that it might be useful for clinical and research purposes to evaluate suppression as a severity indicator.

Background: There is a growing quest for anger management techniques especially in underserved populations. Patients with a substance abuse history often have untreated anger problems. Aims: To test a new comprehensive program for prevention, intervention, and remediation of anger in chemically-dependent patients. A secondary aim was to explore any anger differences between males versus females. Method: Twenty-six participants (13 male, 13 female) completed three phases of treatment plus follow-up. Dependent measures were six subscales of the (STAXI) questionnaire and self-monitored frequency, duration, and intensity of anger. Results: A significant multivariate effect of phase of study accounted for 42% of the variance in STAXI scores. Univariate F-tests confirmed significant changes on all STAXI subscales. Most of these were between pre and post phases of the study, the effect sizes = +0.8 for state anger and +0.99 for trait anger. For self-monitored variables, significant reductions emerged between treatment phases, the average pre-post effect size = +1.02. Gender did not affect STAXI scores although females had more self-monitored anger, particularly anger episodes. Conclusions: Findings suggest cumulative efficacy of the anger treatment program. That trait anger declined more than state anger may indicate characterological change in addition to situational change; anger frequency and duration declined more than intensity in keeping with other reports that intensity peaks suddenly and is less modifiable. That males and females were generally similar in anger is worth noting in relation to other studies. Finally, participant attrition is discussed as a problem and a possible index of treatment outcome.

Background: Mental contamination is a phenomenon whereby people experience feelings of contamination from a non-physical contaminant. Rachman (2006) proposes that standard cognitive behavioural treatments (CBT) need to be adapted here and there is a developing empirical grounding supporting the concept, although suggestions on adapting treatment have yet to be tested. Method: A single case study is presented of a man with a 20-year history of severe treatment resistant Obsessive Compulsive Disorder (OCD) characterized by mental contamination following the experience of “betrayal”. He was offered two consecutive treatments: standard CBT and then (following disengagement with this) a cognitive therapy variant adapted for mental contamination. Clinician and patient rated OCD severity was measured at baseline and the start and end of both interventions. Results: Six sessions of high quality CBT were initially attended before refusal to engage with further sessions. There were no changes in OCD severity ratings across these sessions. A second course of cognitive therapy adapted for mental contamination was then offered and all 14 sessions and follow-ups were attended. OCD severity fell from the severe to non-clinical range across these sessions. Conclusions: The need to consider adapting standard treatments for mental contamination is suggested. Limitations and implications are discussed.

Five obsessive—compulsives who had previously benefited from individual behaviour therapy, but had subsequently relapsed, were included in 10-week group therapy programme designed to re-establish this behavioural approach with particular emphasis upon those factors which appeared to have been related to relapse.

Considerable reductions in ratings of ritualistic behaviour and obsessional thinking were achieved and maintained at one year follow-up, with associated generalization to other areas of personal functioning. Possible prognostic variables were systematically examined. The results are discussed with reference to previous research studies.

Memory bias for weight and shape, and for food related words, was investigated in women with bulimia nervosa (12), women with depression (12) and female nonclinical controls (18). The aim of this study was to investigate whether women with bulimia nervosa demonstrate memory biases congruent with their primary concerns. Participants listened to target and control words. They performed a self-referent encoding task and recall memory was assessed. The results indicated that women with bulimia nervosa demonstrated a bias to recall positive and negative weight and shape related words compared to emotional words, but not compared to neutral nouns and body words. Memory biases for food related words were not found to be specific to women with bulimia nervosa, but were also found in women with depression. Contrary to previous research the recall bias for food related words was related to levels of hunger, in both groups. The findings provide partial support for memory biases for weight and shape, but not food related information in bulimia nervosa. These findings and their implications for existing research on information processing in eating disorders are discussed.

The present study examined the efficacy of eye movement desensitization and reprocessing (EMDR) in the treatment of a specific phobia. Twenty-four spider phobic subjects were randomly assigned to either (1) an EMDR group (n=8), (2) an imaginal exposure group (n=8), or (3) a control group (n=8). Both the EMDR and the imaginal exposure group underwent a one-hour treatment. The control group initially received no treatment, and waited for one hour. Next, all groups received exposure in vivo. Treatment outcome was evaluated with a standardized Behavioural Avoidance Test (BAT). No evidence was found for EMDR being more effective than imaginal exposure or waiting list control. In fact, only exposure in vivo therapy resulted in significant improvement on the BAT.

Several authors have suggested that threat schemata of high worriers may differ from those of less worried individuals with regards to the manner with which information is structured in the Long Term Memory (LTM) or the content of the information stored in the LTM. The present study tested this hypothesis using the catastrophizing interview technique (c.f., Vasey & Borkovec, 1992). Results revealed that high worriers evaluated the likelihood of the occurrence of feared consequences generated for each worry as more likely to actually happen than low worriers did. Second, the ultimate outcome generated in the catastrophizing sequence for a given worry was more severe for high worriers. Finally, high worriers generated ultimate outcomes that were more similar in content, presumably reflecting tightly organized threat schemata. It is argued that activation of these threat schemata in the LTM contributes to the maintenance of worry and anxiety in anxious individuals.

Parenting styles and the parent-child bond are associated with anxiety in children. Despite this association, little is known about the mechanism through which parenting has its effect. One possibility is that parenting interacts with other known pathways to fear. Two experiments are reported that look at the interaction between parenting styles and parent-child relationships and the verbal information pathway to fear. In Experiment 1, a punitive maternal parenting style was found to interact with the effect of threat information about a novel animal in 6–9-year-old children. Maternal warmth, neglect, overprotection and accurate monitoring were not found to have a significant effect. Experiment 2 showed that children reporting a greater number of negative interactions with their fathers had greater increases in fear beliefs about novel animals after both threat and no information. The quality of mother-child relationships did not significantly interact with the verbal information pathway. These experiments offer preliminary evidence that parenting practices influence how children react to negative information, which offers some insight into the potential causes of the association between parenting and anxiety in children.

Forty primary nocturnally enuretic children were randomly assigned to one of four experimental conditions over a ten week period. These were (a) standard Pad-and-Buzzer Training (PBT), (b) Stop—Start Training (SST), involving practice in interrupting the flow of urine during micturition, (c) Dry Bed Training (DBT) and (d) Waiting List Control (WLC). Numbers of dry nights were assessed during a 14 days pre-treatment baseline period, and again during 14 days at the end of treatment and at 12 weeks follow-up. At the end of treatment the proportions of subjects in each condition achieving 14 consecutive dry nights were: PBT 44.4%, SST 16.6%, DBT 50% and WLC 0%. Each of the three treatments produced more dry nights than the WLC, but did not significantly differ from one another. The results were discussed in terms of their generalizability and in the context of superior results previously reported for DBT.

Background: Negative cognitive errors are important in the etiology and treatment of youth internalizing problems, but less is known about their unique relations with anxiety and depression. Aims: The major purpose of this study was to examine associations between distinct negative cognitive errors and anxiety and depression in youth. Method: In a community sample of children and adolescents (aged 9–17; N = 278) negative cognitive errors were assessed using the revised version of the Children's Negative Cognitive Error Questionnaire (CNCEQ-R). Anxiety and depression were assessed with the Multidimensional Anxiety Scale for Children and Children's Depression Inventory, respectively. Results: The strongest predictors of anxiety were the negative cognitive errors “underestimation of the ability to cope” and “mind reading”. The strongest predictors of depression were the errors “selective abstraction” and “overgeneralizing”, with the first error explaining most variance. Analyses of age effects showed that, in comparison to adolescents, children reported higher scores on the total CNCEQ-R score, and on the errors “overgeneralizing”, “personalizing”, and “mind reading”. Conclusions: The findings underscore the importance of researching the role of distinct cognitive processing in youth with anxiety and depression and further development of the CNCEQ-R. Implications for clinical practice are discussed.

This study considered the role of schema-level cognitive processes in alcohol and opiate abuse. It examined the hypothesis that alcohol abuse will be associated with the use of “blocking” behaviours to reduce the experience of emotions (secondary avoidance of affect), while opiate abuse will be associated with a tendency to avoid emotions being activated in the first place (primary avoidance of affect). The sample consisted of 30 patients who abused alcohol, and 30 who abused opiates. Each completed the Young Compensatory Inventory (YCI) and the Young-Rygh Avoidance Inventory (YRAI). There were no differences between the groups in their absolute levels of schema processes (YCI and YRAI scores). However, they differed in the way in which the severity of use was associated with the level of YRAI behavioural-somatic avoidance. Among alcohol abusers only, severity of use was greater in those who were more likely to avoid affective arousal in this way. This association with severity was not found among opiate abusers. Implications are discussed for existing treatments and for the use of schema-level cognitive behavioural interventions with substance-using populations.

The successful treatment of a client with a handicapping fear of other people vomiting is described. This involved exposure to “vomiting”, using a simulation procedure. It is suggested that the appropriate stimulus in such cases may be someone vomiting rather than vomit itself.

Four women with cyclical changes in negative emotions related to their menstrual cycle were treated individually with a combination of psychological interventions, These included problem solving, autogenic training, and anxiety and anger control strategies. Cognitive issues and attributional patterns were also considered. Analysis of symptoms using permutation statistics indicated significant improvements. The problems of open trials and extrapolation from case reports are noted. Important clinical issues which arise in psychological intervention for premenstrual emotional symptoms are also considered.

Background: Ruminative negative thinking has typically been considered as a factor maintaining common emotional disorders and has recently been shown to maintain persecutory delusions in psychosis. The Perseverative Thinking Questionnaire (PTQ) (Ehring et al., 2011) is a transdiagnostic measure of ruminative negative thinking that shows promise as a “content-free” measure of ruminative negative thinking. Aims: The PTQ has not previously been studied in a psychosis patient group. In this study we report for the first time on the psychometric properties of Ehring et al.'s PTQ in such a group. Method: The PTQ was completed by 142 patients with current persecutory delusions and 273 non-clinical participants. Participants also completed measures of worry and paranoia. A confirmatory factor analysis was performed on the clinical group's PTQ responses to assess the factor structure of the measure. Differences between groups were used to assess criterion reliability. Results: A three lower-order factor structure of the PTQ (core characteristics of ruminative negative thinking, perceived unproductiveness, and capturing mental capacity) was replicated in the clinical sample. Patients with persecutory delusions were shown to experience significantly higher levels of ruminative negative thinking on the PTQ than the general population sample. The PTQ demonstrated high internal reliability. Conclusions: This study did not include test-retest data, and did not compare the PTQ against a measure of depressive rumination but, nevertheless, lends support for the validity of the PTQ as a measure of negative ruminative thinking in patients with psychosis.