The effect on psychological and immune function measures of a 6-week psychological intervention for anxiety states was evaluated in cancer patients who had already completed medical treatment for a tumor. Ten patients were treated with anxiety management and stress inoculation training while another ten served as a waiting list control group. The treated group showed a slight improvement in psychological variables but there were no group differences in immunological measures. Changes in the latter were, however, correlated with changes in psychological variables, notably, an increase in the T4/T8 ratio, with an improvement in the Quality of Life index.

This paper introduces Acceptance and commitment Therapy (ACT) as one of the newer contextualist behaviour therapies. A brief history of the development of ACT is outlined. The concepts of equivalence and laterality and the important relationship between Relational Frame Theory and ACT are then described. The “hexagram” summary of the six core linked processes in ACT is presented and, finally, the research evidence to support the effectiveness of ACT applied to a range of clinical conditions and client groups is summarized.

Background: It is unclear as to the extent to which psychological interventions focusing specifically on depression and anxiety are helpful for people with physical health conditions, with respect to mood and condition management. Aims: To evaluate the effectiveness of a modified evidence-based psychological intervention focusing on depression and anxiety for people with type 2 diabetes mellitus (T2DM), compared with a control intervention. Method: Clients (n = 140) who experienced mild to moderate depression and/or anxiety and had a diagnosis of T2DM were allocated to either diabetes specific treatment condition (n = 52) or standard intervention (control condition, n = 63), which were run in parallel. Each condition received a group intervention offering evidence-based psychological interventions for people with depression and anxiety. Those running the diabetes specific treatment group received additional training and supervision on working with people with T2DM from a clinical health psychologist and a general practitioner. The diabetes specific treatment intervention helped patients to link mood with management of T2DM. Results: Both conditions demonstrated improvements in primary outcomes of mood and secondary outcome of adjustment [95% confidence interval (CI) between 0.25 and 5.06; p < 0.05 in all cases]. The diabetes specific treatment condition also demonstrated improvements in secondary outcomes of self-report management of T2DM for diet, checking blood and checking feet, compared with the control condition (95% CIs between 0.04 and 2.05; p < 0.05 in all cases) and in glycaemic control (95% CI: 0.67 to 8.22). The findings also suggested a non-significant reduction in NHS resources in the diabetes specific treatment condition. These changes appeared to be maintained in the diabetes specific treatment condition. Conclusions: It is concluded that a modified intervention, with input from specialist services, may offer additional benefits in terms of improved diabetic self-management and tighter glycaemic control.

Two patients with longstanding dysmorphic ideas and associated social avoidances refused exposure treatment. A role-play requiring them to research and debate beliefs contrary to their over-valued ideas effected attitude change and facilitated compliance with exposure treatment. In both patients, marked improvement in beliefs and avoidance occurred during treatment and was maintained at follow-up.

Background: This study reports the development and revision of the Beliefs about Paranoia Scale (BaPS), a self-report measure to assess metacognitive beliefs about paranoia in non-patients. We aimed to confirm the factor structure of a revised 50-item version of the measure and test the specific hypotheses that positive beliefs about paranoia would predict frequency of paranoia, and that negative beliefs about paranoia would predict distress associated with paranoia. Method: 185 non-patient participants completed questionnaires assessing beliefs about paranoia, thought control, self-consciousness, anxiety, depression and paranoia. Results: The results showed that the original four-factor solution could not be replicated. Instead a three-factor solution comprising Negative Beliefs about Paranoia, Paranoia as a Survival Strategy, and Normalizing Beliefs was developed. The revised 18-item measure showed good internal consistency. Stepwise regression analysis showed that, BaPS-negative beliefs accounted for 34% of the variance with R2 of 0.339, with a multiple R of 0.585 in relation to frequency of paranoia. In relation to distress arising from paranoia, stepwise regression analysis showed that BaPS-negative beliefs accounted for 34% of the variance with R2 of 0.339, with a multiple R of 0.585. In both analyses, BaPS-Survival strategy showed a small but significant incremental increase in the variance accounted for in the overall model. Conclusions: These findings suggest that a metacognitive approach to the conceptualization of paranoia as a strategy for managing interpersonal threat may have some utility. The clinical implications of the findings are also discussed.

Background: Policy developments in recent years have led to important changes in the level of access to evidence-based psychological treatments. Several methods have been used to investigate the effectiveness of these treatments in routine care, with different approaches to outcome definition and data analysis. Aims: To present a review of challenges and methods for the evaluation of evidence-based treatments delivered in routine mental healthcare. This is followed by a case example of a benchmarking method applied in primary care. Method: High, average and poor performance benchmarks were calculated through a meta-analysis of published data from services working under the Improving Access to Psychological Therapies (IAPT) Programme in England. Pre-post treatment effect sizes (ES) and confidence intervals were estimated to illustrate a benchmarking method enabling services to evaluate routine clinical outcomes. Results: High, average and poor performance ES for routine IAPT services were estimated to be 0.91, 0.73 and 0.46 for depression (using PHQ-9) and 1.02, 0.78 and 0.52 for anxiety (using GAD-7). Data from one specific IAPT service exemplify how to evaluate and contextualize routine clinical performance against these benchmarks. Conclusions: The main contribution of this report is to summarize key recommendations for the selection of an adequate set of psychometric measures, the operational definition of outcomes, and the statistical evaluation of clinical performance. A benchmarking method is also presented, which may enable a robust evaluation of clinical performance against national benchmarks. Some limitations concerned significant heterogeneity among data sources, and wide variations in ES and data completeness.

The importance of self-esteem in the development and maintenance of psychotic experiences has been shown in previous research. However, there has been little research into the role this plays in individuals with psychosis and forensic histories. The current study investigated the effectiveness of a standardized group programme for improving self-esteem in individuals with psychosis living in high security settings. Fifteen participants were included in the group programme and measures were taken to record changes in self-esteem and symptomatology. The results demonstrated significant improvements in self-esteem over the course of the group intervention, with some effects maintained at 3-month follow-up. Improvements in depressed mood were also found. The results demonstrated the effectiveness of a group intervention for self-esteem in individuals with psychosis. The findings of this study, alongside implications for further research, are discussed.

A pilot controlled study was designed to evaluate the efficacy of the thought-stopping technique (T.S.) as a treatment for persecutory delusions and auditory hallucinations with chronic schizophrenics already treated with neuroleptics and to compare this combination with patients only treated with antipsychotic drugs. Medication was standardized for each patient and psychological measurements were recorded before and after treatment and during a 6-month follow-up. Results show significant differences in favor of the T.S. group mainly after treatment. Although T.S. was beneficial for chronic psychotics, other studies should be conducted with patients whose illness would be less severe and less chronic. The length of treatment as well as the cues that would serve to stop delusions and hallucinations also merit further investigation.

Background: The Improving Access to Psychological Therapies (IAPT) initiative has depended on the training of a new NHS mental health workforce. At step 3 of the stepped care model, capacity building has required the recruitment of a wide range of mental health professionals into high intensity therapists training posts. This shift naturally entails role transition on the part of trainees into delivering cognitive behavioural psychotherapy (CBP), but no previous research has examined the experience of such transitions. Aim: To describe the lived experience of transition from mental health nurse to IAPT high intensity therapist and to identify possible factors which moderate effective role conversions. Method: Six qualified high intensity therapists were interviewed using a semi-structured interview and the subsequent interviews transcribed. Thematic content analysis (TCA) was used to analyze personal accounts of role transition. All participants had previously been mental health nurses and attended the same IAPT high intensity therapist (HIT) training programme. Results: Six key themes were apparent from the TCA. Three interconnected themes concerning supervision (style, impact of approach and historical context) and three additional themes of the challenge of learning a new clinical approach, high need for support, and forming a new psychotherapist identity. Conclusions: Findings suggest supervision is the most important factor in supporting complex psychotherapy role transitions. Clinical supervisors may need to incorporate dedicated time on role and identity shift during CBP training to ensure effective assimilation and transition. Methodological short-comings are identified and discussed.

A case is described of an 11-year-old schoolgirl with both obsessive-compulsive rituals and tics of sudden onset following a traumatic event at the age of five. Treatment consisted of exposure in vivo and response prevention directed mainly towards her obsessive-compulsive rituals as they were considered the primary problem. Following the initial therapist–patient out-patient session and home treatment with her mother, the obsessive-compulsive rituals disappeared and the tics decreased. Three weeks later the tics disappeared without specific treatment and the patient has maintained her improvement at follow-up, 52 weeks later. The actual therapist–patient time was about an hour.

Background: Mental contamination is a psychological sense of contamination that involves an internal, emotional feeling of dirtiness that may be evoked by unwanted thoughts and images, such as sexual assaults. Aims: This study aimed to investigate which types of unwanted sexual experiences evoke the strongest mental contamination, and to test the hypothesis that cognitive appraisals of an unwanted sexual experience predict indices of mental contamination (i.e. feeling of dirtiness, urge to wash, internal negative emotions, and external negative emotions). Method: 148 female participants were asked to recall their most distressing unwanted sexual experiences. Indices of mental contamination and cognitive appraisals of the experience were then assessed. Results: Our findings indicated that individuals recalling experiences related to rape felt more intense feelings of dirtiness than individuals recalling other types of unwanted sexual experience, such as verbal sexual assault, visual sexual assault, and forcible touching/frottage. In addition, hierarchical regression analyses demonstrated that a cognitive appraisal of perceived violation predicted all of the indices of mental contamination after controlling anxiety, depression, and fear of contact contamination. Conclusions: The present study demonstrated that an individual is at greatest risk of mental contamination if she has experienced rape/attempted rape, and if she makes a cognitive appraisal of violation regarding the incident.

Background: Sleeping difficulties are an increasing problem for youths, but there is a lack of treatment research for this age group. Aim: The aim of this study was to investigate the effects of Cognitive Therapy for Insomnia (CT-I) on youths with primary insomnia; this treatment has never been tested on youths before. Method: The study was conducted according to an AB single-case experimental phase design, with pre-tests and post-tests. After 7–10 days of baseline assessment, three youths aged 16–18 (2 male) with primary insomnia participated in a 7-week long treatment. A sleep diary was used throughout the treatment. A follow-up assessment including one week with a sleep diary was conducted 3 months later. Visual inspection was used to analyze outcome. Results: Insomnia severity was greatly reduced for all participants after treatment. Daily measures showed that sleep onset latency was reduced for two participants but no change in total sleep time was confirmed. Daytime symptoms fluctuated for the participants. The insomnia-specific psychological processes were reduced to varying extents. These results were maintained at the follow-up measure. Conclusions: CT-I may be a promising treatment for youths with insomnia and the treatment should be tested further in randomized controlled studies.

A multiple linear regression analysis was made on behavioral, questionnaire and other data from 40 agoraphobic patients, who participated in a behavioral outcome study. The dependent variable was treatment outcome as determined by changes in behavioral, subjective and physiological data after treatment and at 7-month and 15-month follow-up. The main predictors of outcome were self-rated anxiety and heart-rate at a behavioral test, and scores on the Autonomic Perception Questionnaire and Fear Survey Schedule-III, all related to the phobia. However, both level of depression and marital relationship were found to be weak predictors.

Several clinical deductions drawn from a 3-systems analysis of obsessions were tested in an experiment on 12 patients, each of whom received four sessions of habituation training or thought-stopping. The major predictions received only weak and inconsistent support. Moreover, the intrasession changes tended to fade in the inter-session intervals, and there were few signs of therapeutic advance.

Background: Metacognitive Group Training for Schizophrenia Patients (MCTg) focuses on dysfunctional thinking styles (e.g. cognitive biases) putatively involved in the formation and maintenance of delusions. Recently, the Individualized Metacognitive Therapy Program for Patients with Psychosis (MCT+), an extension of the group training, was released. MCT+ sessions aim to correct false metacognitive beliefs, which in turn should challenge a patient's personal delusional convictions. Aims: The present study demonstrates how MCT and MCT+ can be combined and how the contents are conveyed to the patient. Method: We present a single case study of a patient undergoing a combined treatment of MCT and MCT+. Before intervention and 4 weeks later the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scales (PSYRATS) were administered. Results: The patient showed a substantial symptom reduction after 4 weeks of combined therapy of MCTg and MCT+ as measured with PANSS and PSYRATS. Conclusions: The present case history lends preliminary evidence for the feasibility of this new treatment approach in psychosis.

Background: Self-critical thinking is common across psychological disorders. This study hypothesized that it may play an important role in ‘overgeneralization’, the process of drawing general implications from an isolated negative experience. Aims: To explore the impact of two experimental tasks designed to elicit self-critical thoughts on the endorsement of general negative self-views of clinical and non-clinical populations. Method: Three groups (depression, eating disorders and non-clinical controls), completed standardized questionnaires and the two tasks. Participants rated their self-critical thinking and general negative self-beliefs before and after each task. Results: Following a failure experience, both clinical groups showed a greater increase in general negative self-views compared with controls, indicating greater overgeneralization. Both habitual and increases in state self-critical thinking were associated with overgeneralization while negative perfectionism was not. Overgeneralization was more strongly associated with post-task reduced mood than self-criticism. Conclusions: Self-critical thinking may be an important factor in the process of overgeneralization, and the increase in general negative self-views may be particularly crucial for lowering of mood.

In two separate commentaries, Withers and Seager offer constructive critiques of “The Ethics of Motivational Intervention.” It is difficult to render ethical judgments regarding a method apart from the goals and contexts within which it is to be applied. A clearer and transtheoretical understanding of the mechanisms underlying the efficacy of motivational interviewing may better inform future discussions of these ethical concerns that pertain to psychotherapy more generally.

Background: A large body of research has identified that many therapists do not use research to inform their practice, but few studies investigate the reasons behind this. Aims: The current study seeks to understand what sources therapists use to inform their practice and why they are chosen. Method: Thirty-three interviews with psychological therapists in the UK were undertaken. These were transcribed and analysed using Interpretative Phenomenological Analysis. Results: Two superordinate themes emerged. The former focused on the nature of evidence and the latter described why certain sources were used to make clinical decisions. When discussing evidence, participants felt that research studies, specifically Randomized Controlled Trials (RCTs), used unrepresentative samples. Therapists felt that research other than RCTs, particularly qualitative research, was important. Therapist specific factors were felt to be as, or more, important than the technique used to treat patients. When discussing the sources they used, therapists preferred to use their clinical experience or their patients’ experience to make clinical decisions. Theoretical or practical information was preferred to empirical research. The presentation of information was felt to be important to encourage the implementation of research, and therapists also felt tools such as outcome measures and manuals were too rigid to be useful. Finally, patients’ choice of treatment was felt to be important in treatment decisions. Conclusions: The views of therapists were heterogeneous, but this study highlighted some of the barriers to closing the gap between science and practice. This knowledge can be used to increase the translation of science into practice.