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: Cognitive models propose that social anxiety arises from specific dysfunctional cognitions about the likelihood and severity of embarrassment. Relational frame theory (RFT), on the other hand, posits that social anxiety arises from the unwillingness to endure unpleasant internal experiences (i.e. experiential avoidance [EA]). Although cognitive models have garnered empirical support, it may be that newer models such as RFT can improve our ability to predict and treat social anxiety. Aims: We aimed to elucidate the relationship between dysfunctional cognitions and EA, as well as their independent and relative contributions to the prediction of social anxiety symptoms. We hypothesized that dysfunctional cognitions and EA would each be associated with social anxiety, as well as with each other. We also predicted that both EA and dysfunctional cognitions would remain independent predictors of social anxiety symptoms after controlling for each other and general distress. Method: Undergraduates high (n = 173) and low (n = 233) in social anxiety completed measures of social anxiety, dysfunctional cognitions, EA, and general distress. The overall sample was 66.3% female; mean age = 20.01 years (SD = 2.06). Results: Correlational analyses revealed that EA, dysfunctional cognitions, and social anxiety symptoms were moderately correlated with one another. Additionally, hierarchical regression analyses revealed that dysfunctional cognitions predicted social anxiety symptoms even after controlling for EA; the reverse was not found. Conclusions: Results suggest that EA and social anxiety specific cognitive distortions overlap to a moderate extent. EA does not add to the prediction of social anxiety symptoms above and beyond dysfunctional cognitions. Additional theoretical and treatment implications of the results are discussed.

Background: There is concern that diagnostic labels for psychiatric disorders may invoke damaging stigma, stereotypes and misunderstanding. Aims: This study investigated clinicians’ reactions to diagnostic labelling by examining their positive and negative reactions to the label borderline personality disorder (BPD). Method: Mental health professionals (n = 265) viewed a videotape of a patient suffering from panic disorder and agoraphobia undergoing assessment. Prior to viewing the videotape, participants were randomly allocated to one of three conditions and were given the following information about the patient: (a) general background information; (b) additional descriptive information about behaviour corresponding to BPD; and (c) additional descriptive information about behaviour corresponding to BPD, but explicitly adding BPD as a possible comorbid diagnostic label. All participants were then asked to note things they had seen in the videotape that made them feel optimistic or pessimistic about treatment outcome. Results: Participants in the group that were explicitly informed that the patient had a BPD diagnostic label reported significantly fewer reasons to be optimistic than the other two groups. Conclusions: Diagnostic labels may negatively impact on clinicians’ judgments and perceptions of individuals and therefore clinicians should think carefully about whether, and how, they use diagnoses and efforts should be made to destigmatize diagnostic terms.

One hundred and ninety two students from schools and university rated the acceptability of treatments for anorexia nervosa as presented in written vignettes. Psychologically-based treatments, such as counselling and behaviour therapy, were rated more acceptable than drugs; flooding occupied an intermediate position. Context variables such as problem severity and outcome did not significantly effect treatment acceptability.

The feasibility of using a self-help treatment manual to assist a cognitive behavioural therapy programme developed with the aim of improving pain coping ability and quality of life, and reducing psychological distress in sickle cell patients was evaluated. Adult patients attending a London hospital outpatient sickle cell clinic were invited to 12-week cognitive behavioural therapy. Outcome was assessed with measures of pain status, health service utilization, psychological coping (Coping Strategies Questionnaire-revised for Sickle Cell Disease), quality of life (Medical Outcomes Survey Short Form 36), and mood (Hospital Anxiety and Depression Scale). Baseline disease severity data were also collected. No significant differences in baseline data were observed between patients who completed cognitive behavioural therapy and “dropouts”. Improvements over baseline at 12 weeks in patients who completed cognitive behavioural therapy were significant. Active coping and use of physician advised methods for pain increased. Emotional responses decreased, general health and vitality improved, while anxiety reduced. This demonstrates that a brief manual-assisted cognitive behavioural therapy programme is feasible in sickle cell disease, and may help to improve coping, quality of life and mood.

Background: Studies have shown that the intolerance of uncertainty may play a key role in the aetiology and maintenance of worry and generalized anxiety disorder. Aims: This study investigated the psychometric properties of the Chinese version of Intolerance of Uncertainty Scale (IUS), which had already been validated in French and English versions. Method: In a large college student sample (N = 940), the factor analysis and regression analyses were performed on the IUS. Results: The IUS had excellent internal consistency (α = 0.90) and good test-retest reliability (r = 0.75) over a 5-week period. Factor analysis showed that the IUS had a four-factor solution. Finally, the regression analysis demonstrated that IU contributed significantly to worry, after controlling for demographic variables and levels of anxiety and depression. Conclusions: The Chinese version of the IUS was a sound scale for assessing IU and the intolerance of uncertainty was an important influencing factor on worry.

Background: Recent advances have been made in the application of cognitive training strategies as interventions for mental disorders. One novel approach, cognitive control training (CCT), uses computer-based exercises to chronically increase prefrontal cortex recruitment. Activation of prefrontal control mechanisms have specifically been identified with attenuation of emotional responses. However, it is unclear whether recruitment of prefrontal resources alone is operative in this regard, or whether prefrontal control is important only in the role of explicit emotion regulation. This study examined whether exposure to cognitive tasks before an emotional challenge attenuated the effects of the emotional challenge. Aims: We investigated whether a single training session could alter participants' reactivity to subsequent emotional stimuli on two computer-based tasks as well as affect ratings made during the study. We hypothesized that individuals performing the Cognitive Control (CC) task as compared to those performing the Peripheral Vision (PV) comparison task would (1) report reduced negative affect following the mood induction and the emotion task, and (2) exhibit reduced reactivity (defined by lower affective ratings) to negative stimuli during both the reactivity and recovery phases of the emotion task and (3) show a reduced bias towards threatening information. Method: Fifty-nine healthy participants were randomized to complete CC tasks or PV, underwent a negative mood induction, and then made valence and arousal ratings for IAPS images, and completed an assessment of attentional bias. Results: Results indicated that a single-session of CC did not consistently alter participants' responses to either task. However, performance on the CC tasks was correlated on subsequent ratings of emotional images. Conclusions: While overall these results do not support the idea that affective responding is altered by making healthy volunteers use their prefrontal cortex before the affective task, they are discussed in the context of study design issues and future research directions.

Properties of “traditional service systems” are compared with properties that might be expected to produce “consumer-orientated” services. Identification of necessary goals and processes to change traditional services to consumer-orientated services is a complex activity. Blueprints for individual systems are not offered; however, an attempt has been made to identify general guidelines which may be of use to practitioners who wish to initiate change.

Thirty-two extremely anxious dental patients were given a modified form of systematic desensitization. In order to evaluate the importance of cognitive factors, a procedure of cognitive coping was added to the therapy program for half of the patients. Results show that treatment outcome was significantly better for the group without the addition of coping elements. It is suggested that the adverse effect observed may reflect an interference by the cognitively-oriented therapeutic activities with an otherwise effective therapeutic process.

Previous research has associated the development of social phobia with parental rearing practices, learning influences such as conditioning, vicarious transmission and verbal acquisition, and the individual's own response to social situations. The present study aimed to further investigate these possible antecedents of social phobia. A Learning History Questionnaire (LHQ) was completed by patients with social phobia (n=55), patients with posttraumatic stress disorder (PTSD; n=30), and non-patient controls (n=30). The LHQ focused on events that occurred before the age of 14 (the median age of onset for social phobia). The results indicated the importance of parental rearing practices such as not actively encouraging participation in social situations and emotional coldness. Difficulties with peer group were highlighted as important contributors to conditioning experiences. Individual response factors, especially post-event rumination, are potentially associated with the development of social phobia. Four of the 12 significant variables were unique to the social phobia group when the results from the PTSD group were taken into account. Further research is required to clarify the extent to which the environmental factors assessed in this study specifically contribute to the development of social phobia or to the development of anxiety more generally.

Background: The phenomenological heterogeneity of auditory hallucinations (AHs) means individual models struggle to account for all aspects of the experience. One alternative is that distinct subtypes of AHs exist, with each requiring their own unique explanatory model and tailored cognitive behavioural intervention strategies. Aims: This exploratory study tested for the presence of one specific potential AH-subtype, hypervigilance hallucinations (HV-AHs). Method: Four specific aspects of the phenomenology of AHs (chosen on the basis of the predicted phenomenology of HV-AHs) were assessed using a semi-structured interview in 32 individual AHs taken from reports from 15 patients with psychosis. Results: Cluster analysis (at the level of the individual AH-experience) offered support for the existence of a distinct HV-AH subtype, characterized by hearing threatening, externally-located voices when attention was externally-focused. Other clusters identified all shared the contrasting properties of occurring in quiet contexts when patients’ attention was internally focused. Conclusions: The results offered tentative support for the existence of an HV-AH subcategorization and justifies future research in larger samples. Potential implications for models of AHs are also considered.

Self-help interventions in mental health are increasingly seen as one way of overcoming problems with access to psychological therapy, but there is insufficient evidence of effectiveness in routine care settings. This paper investigates the process and outcome of a non-guided self-help manual for anxiety and depression compared to a waiting list control in a primary care setting. Patients with mild to moderate mental health problems were recruited from routine GP referrals to the local Primary Care Mental Health Team. Thirty patients were randomly assigned to either non-guided self-help or a waiting list control group. Patients completed outcome measures at baseline, 6 weeks and 12 weeks. Intention to treat analysis found no significant differences between the two groups on measures of anxiety or depression at 12 weeks. Between 40% to 50% of patients in both groups were no longer clinical cases at the end of the trial. However, there was a high level of satisfaction with the self-help manual. Within the limitations of the small sample size, the study does not support the hypothesis that non-guided self-help is superior to waiting list control in the treatment of anxiety and/or depression in primary care.

Background: Controlled qualitative methods complement quantitative treatment outcome research and enable a more thorough understanding of the effects of therapy and the suspected mechanisms of action. Aims: Thematic analyses were used to examine outcomes of cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) in a randomized controlled trial of individuals diagnosed with military-related PTSD (n = 15). Method: After sessions 1 and 11, participants wrote “impact statements” describing their appraisals of their trauma and beliefs potentially impacted by traumatic events. Trained raters coded each of these statements using a thematic coding scheme. Results: An analysis of thematic coding revealed positive changes over the course of therapy in participants’ perspective on their trauma and their future, supporting the purported mechanisms of CPT. Conclusion: Implications of this research for theory and clinical practice are discussed.

This paper describes and compares two relaxation training procedures with moderately and severely mentally handicapped people. Abbreviated Progressive Relaxation is a widely used procedure while Behavioural Relaxation Training is a relatively recent development which the authors felt might be more suitable for mentally handicapped people since it does not require a conceptual awareness of internal states of anxiety. While both relaxation procedures produced improvements, Behavioural Relaxation Training was significantly better than Abbreviated Progressive Relaxation. In addition to this the results during treatment showed Abbreviated Progressive Relaxation to produce very variable effects from session to session. In contrast the effects of Behavioural Relaxation Training were quick and consistent.

Long recognized as an important modifier in the relationship between stress and illness, social support appears in the light of recent research to include emotional, informational and practical components available from a variety of lay and professional sources. Health and mental health disturbances are more closely associated with inadequate than with unavailable social support. Individuals who report inadequate social support may lack skills in support-elicitation, of which this paper specifies several based on what is known of interpersonal style in depression and loneliness. The implications of this analysis for the helping professions refer to both therapeutic practice and the helper's work satisfaction.

Background: Cognitive-behavioural models of chronic fatigue syndrome (CFS) suggest that personality factors such as perfectionism and high moral standards may contribute to the development of CFS. Aims: To investigate cognitive, behavioural and emotional processing risk factors for CFS. Method: CFS patients (n = 67) at a UK specialist clinic completed questionnaires about psychological characteristics both currently and retrospectively (6 months pre-CFS onset). Responses were compared with those of healthy individuals (n = 73) who rated their current characteristics. Forty-four relatives retrospectively rated the pre-morbid psychological characteristics of the CFS participants. Results: CFS patients showed similar levels of current perfectionism to controls, though higher pre-morbid perfectionism. CFS patients showed greater self-sacrificial beliefs and more unhelpful beliefs about experiencing and expressing negative emotions, both currently but more markedly prior to onset. In the 6 months pre-illness onset, CFS patients showed more disruption to their primary goal and greater general stress than controls. Ratings of pre-morbid psychological characteristics by relatives were consistent with patients’ self-reports. The extent of overinvestment in one goal was significantly associated with fatigue. Conclusions: Perfectionism, self-sacrificial tendencies, unhelpful beliefs about emotions, and perceived stress may be present to a greater extent pre-morbidly in CFS patients compared with healthy individuals.

This study compares the effectiveness of a standard cognitive-behavioural treatment for panic disorder with a reduced therapist contact program supported by self-help materials. This program shortens the total therapy length (from 10 to 5 weeks) and the contact time with the therapist (from 10 to 5 sessions). The sample was mostly referred from a public mental health unit, and it had a low level of education (average of 9.7 years). The subjects were assessed according to several variables related with panic disorder at pre- and post-test, and at 12-month follow-up. The results demonstrated that both programs produced significant improvements for all variables at post-test, the benefits were maintained at follow-up assessment, and even heightened for some of the measures. Also, both treatment programs obtained comparable improvements for most measures. These results suggest that the programs that reduce the contact with the therapist, supported by self-help materials, and shorten the time that the patient suffers from this problem (Margraf, Barlow, Clark, & Telch, 1993) may be a good intervention for the treatment of panic disorder. These programs can help to overcome some of the cost-benefit therapeutic limitations of standard cognitive-behavioural programs.

Although the emotion of anger has, in recent years, been the subject of increasing theoretical analysis, there are relatively few accounts of how interventions designed to reduce problematic anger might be related to cognitively oriented theories of emotion. In this review of the literature we describe how a cognitive-behavioural approach to the treatment of those with anger-related problems might be understood in relation to conceptualizations of anger from a cognitive perspective. Three additional interventions (visual feedback, chair-work, forgiveness therapy) are identified that aim to improve the perspective-taking skills of angry clients. It is concluded that such interventions might be considered for use within the context of cognitive-behavioural treatment.

Background: Adapted DBT programmes have been well documented but little has been published on such programmes in the perinatal period. Aim: To assess the effectiveness of a stand-alone DBT skills group for perinatal women with emotion dysregulation. Method: A stand-alone DBT-informed skills training group was offered to 21 women with emotional dysregulation under the care of a perinatal community mental health team; 14 completed the programme. Staff received support via a consultation group. Modules included mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness adapted to the specific demands of parenting infants. Outcome measures were collected at three time points: assessment, start of the group and at the end. Results: Statistical analysis showed significant reduction in CORE scores over the intervention period (t (13) = 5.32, p < .001; Cohen's d = 0.83), with similar effects on the Mental Health Confidence Scale (t (13) = ‒8.03, p < .001, Cohen's d = 0.83) and Living with Emotions Scale (t (13) = ‒9.42, p < .001, Cohen's d = 0.93). There were no significant changes on these three measures from assessment to start of the group. Conclusions: In this uncontrolled study, the intervention period was associated with reduced distress, increased confidence and ability to regulate emotion. Recommendations for continuing this model of service delivery are made. Further research is needed.

This paper forms the second in a series of three articles on conceptualizations of older people's distress. The focus is on simple and concrete “mini-formulations” that keep the amount of information in them to a minimum, yet retain explanatory and predictive power. Such formulations can be used as the basis for action plans for intervention, while avoiding overburdening the cognitive capacity of the client or therapist. Simple linear and cyclical models are described, as are cognitive triad and dyad models. The uses of “mini-formulations” for group and individual settings are illustrated in a case example of a lady caring for her husband who has dementia.