Background: It is well documented that mothers of children with intellectual disabilities experience elevated mental health difficulties and that these are exacerbated by the presence of challenging behaviour. However, comparatively little is known about the effect of specific coping strategies for managing such behaviours. Aims: This paper aims to document coping strategies used by mothers of children showing multiple forms of challenging behaviour and to explore how these relate to positive and negative maternal mental health. Method: Eighty-nine mothers of children with intellectual disabilities completed questionnaires assessing maternal mental health (Hospital Anxiety and Depression Scale, Positive and Negative Affect Scale) and maternal coping strategies (Brief COPE). Results: Coping strategies were not associated with child age or ability, but were associated with maternal mental health. Higher levels of problem- and positive-coping strategies were associated with higher positive affect. Although active-avoidance coping was the least frequently reported, it was associated with higher levels of negative affect and increased anxiety and depression. Moderated mediation analyses identified that active-avoidance coping mediated the relationship between the number of forms of challenging behaviour and poor maternal mental health, but only in mothers with lower levels of problem-focused coping. Conclusions: Active-avoidance coping is associated with poorer negative mental health in mothers of children with intellectual disabilities who have average to low levels of problem-focused coping. This is reflective of that noted within a range of populations, highlighting it as a key area for intervention.

This article reports a longitudinal study of the psychophysiological responses of a schizophrenic patient towards his parents, in relation to their Expressed Emotion status. Recordings were taken during periods of relapse and remission. The results are discussed in the context of environmental and vulnerability factors affecting the illness.

Background: The NICE Schizophrenia guidelines (NICE, 2009, Update) recommend that services should address cultural differences in treatment, expectations and adherence, and clients’ explanatory models of illness should be better understood. Service users from Black African and Black Caribbean communities are overrepresented in psychosis services in the UK, yet there is no literature on how wellness is understood by this group. Aims: This study explored perceptions of wellness in Black African and Black Caribbean individuals with an At Risk Mental State (ARMS) for psychosis. Method: A Q set of potential meanings of wellness was identified from a literature search and interviews with people at risk of developing psychosis. From this, 50 potential definitions were identified; twenty Black African and Black Caribbean ARMS clients ranked these definitions. Results: Following factor analysis of completed Q sorts, six factors emerged that offered insight into perceptions of wellness in this population. These factors included: sense of social purpose explanation, the surviving God's test explanation, the internalization of spirituality explanation, understanding and attribution of symptoms to witchcraft explanation, avoidance and adversity explanation, and seeking help to cope explanation. Conclusions: Although preliminary, differences between the factors suggests that there may be perceptions of wellness specific to these groups that are distinct from the medical view of wellness promoted within early detection services. These differences may potentially impact upon engagement, particularly factors that clients feel may facilitate or aide their recovery. It is suggested that these differences need to be considered as part of the assessment and formulation process.

In a hospital training unit for severely mentally handicapped adults, alternative methods of staff organization, Room Management (RM) and Small Groups (SG) were experimentally evaluated. Both procedures were found to be equivalent in ensuring that trainees had materials available to them, in promoting on-task behaviour and staff trainee interaction and minimizing staff–staff interaction. Group engagement was significantly higher during the SG condition. Room Management was nevertheless significantly more successful in facilitating individual training than the SG arrangement, trainees receiving four times more individual training during RM than SG.

The implications of these results for the appropriate use of training staff are discussed. The use of group engagement as a dependent variable is critically evaluated.

Recent research has shown that the verbal information and vicarious learning pathways to fear create long term fear cognitions and can create cognitive biases and avoidance in children. However, it is unlikely that these pathways operate in isolation in the aetiology of childhood fear and the interaction between these pathways is untested. Three preliminary experiments are reported that explore the combined effect of verbal threat information and vicarious learning on self-reported fear beliefs in 7–9-year-old children. Results showed that prior negative information significantly facilitated the effect of negative vicarious learning on children's fear beliefs (Experiment 1); however, there was not a significant combined effect of verbal threat information and vicarious learning when they the information was presented during (Experiment 2) or after (Experiment 3) vicarious learning. These results support the idea that verbal information can affect CS-US associations formed in subsequent vicarious learning events, but contradict the proposal that it can change fear beliefs already acquired through vicarious learning by changing how a person evaluates the vicarious learning episode.

The present study aimed to test the hypothesis that women with high shape concern would differ in their use of mirrors from women with low levels of shape concern. The “Mirror Questionnaire” was completed by 150 women, half of whom had high levels of shape concern. The findings support the notion that women with high shape concern differ from those with low concern in their use of mirrors, and argue for further investigation of the role of mirror cognitions and behaviours in the maintenance of body image disturbance.

A strategy involving urine-triggered alarm signals and prompts combined with positive reinforcement for appropriate urination was employed for promoting daytime urinary continence in a boy with severe intellectual disability. The strategy, which was applied only in the day centre the boy attended, seemed effective for promoting self-initiated toileting actions and for eliminating almost totally large urinary accidents. Some small urinary accidents (consisting of wetting small areas of the underpants) remained. Implications of the findings are discussed.

Background: Unwanted, intrusive thoughts of infant-related harm are a normal, albeit distressing experience for most new mothers. The occurrence of these thoughts can represent a risk factor for the development of obsessive compulsive disorder (OCD). As the early postpartum period represents a time of increased risk for OCD development, the transition to parenthood provides a unique opportunity to better understand OCD development. Aims: The purpose of this study was to assess components of cognitive behavioural conceptualizations of postpartum OCD in relation to new mothers’ thoughts of infant-related harm. Method: English-speaking pregnant women (n = 100) participated. Questionnaires were completed at approximately 36 weeks of gestation, and at 4 and 12 weeks postpartum. An interview to assess postpartum harm thoughts was administered at 4 and 12 weeks postpartum. Questionnaires assessed OC symptoms, OC-related beliefs, fatigue, sleep difficulties and negative mood. Results: Prenatal OC-related beliefs predicted postpartum OC symptoms, as well as harm thought characteristics and behavioural responses to harm thoughts. The severity of behavioural responses to early postpartum harm thoughts did not predict later postpartum OC symptoms, but did predict frequency and time occupation of accidental harm thoughts, and interference in parenting by intentional harm thoughts. Strong relationships between OC symptoms and harm thought characteristics, and concurrent sleep difficulties, negative mood and fatigue were also found. Conclusions: Findings provide support for cognitive behavioural conceptualizations of postpartum OCD and emphasize the importance of maternal sleep, fatigue and negative mood in the relationship between OC-related beliefs and maternal cognitive and behavioural responses to postpartum harm thoughts.

The present study examined characteristics of autobiographical memories retrieved by individuals with social phobia (n=15) and nonanxious individuals (n=17). Participants were presented with social threat, positive, and neutral cue words and instructed to retrieve the first specific personal memory that came to mind. Memories were coded for retrieval latency, overgenerality (vs. specificity), and affective tone. Nonanxious individuals, rather than social phobic individuals, demonstrated a bias toward the retrieval of specific negative memories when cued by social threat words. Significant omnibus results were attenuated when self-reported depression was included as a covariate in analyses. These results suggest that memories cued by social threat words are particularly salient for nonanxious individuals but not for individuals with social phobia and that depressive symptoms must be accounted for in studies examining cognitive biases toward threat.

Background: It has been suggested that the behavioural activation (BA) treatments for depression unfold their effects, at least partly, through changes in approach and avoidance tendencies. However, as yet, little research has examined the cognitive effects of these interventions. Aims: This study investigated the impact of a single session of BA on depressive symptomatology, self-reported avoidance, and behavioural approach and avoidance tendencies. Method: Forty-six patients with a diagnosis of Major Depression were recruited from primary care psychological therapies services and block randomized to either a single session of behavioural activation (n = 22) or waiting list control (n = 24) delivered by an unblinded therapist. Self-reports of symptoms and cognitive factors were assessed before and after the one-week intervention phase. Approach and avoidance behavioural tendencies were assessed using the Approach-Avoidance Task (AAT). Results: Data from 40 participants (n = 20 in each group) was available for analyses. Depressive symptoms significantly decreased, and activation significantly increased from before to after treatment in the treatment group, but not in the control group. Performance on the AAT showed a trend indicating increased approach to positive valence stimuli in the treatment group, but not in the control group. Mediational analyses indicated small indirect effects of self-reported change in activation as mediators of the effect of condition on symptoms. Conclusions: The findings suggest that a single session of BA can have significant effects on symptoms in clinically depressed patients. Results hint at the possibility that increased behavioural approach might mediate the effect of BA.

The aim of this study was to develop and evaluate the feasibility of a cognitive behavioural treatment for unexplained chest pain (UCP), based on the cognitive model of UCP. Ten patients were treated. The diagnosis had been made by a cardiologist two years before the start of treatment. The treatment incorporated breathing and relaxation training, identifying and challenging beliefs about the cause of UCP, behavioural experiments and problem solving for social problems. Patients improved significantly with regard to intensity and duration of chest pain, anxiety and functional limitations. Moreover, the reduction of scores for fear of bodily sensations and of credibility ratings of idiosyncratic disease related negative automatic thoughts was significant. The changes in scores for the inclination to interpret bodily sensations catastrophically almost reached the level of significance. These results suggests that therapy results may be cognitively mediated.

Some of the weaknesses and ambiguities of the currently accepted definition of a functional analysis (Owens and Ashcroft, 1982) are outlined. Functional analysis is re-defined in order to try and overcome some of these difficulties. The utility of this new definition is discussed in relation to the assessment and treatment of challenging behaviours. A possible structure for the more general use of a functional analysis in the assessment and treatment of problems is outlined. The implications of this type of approach are discussed.

Background: Homework assignments are considered an essential component for a successful outcome of cognitive behavioural therapy for youths with anxiety disorders. However, only two studies have examined the association between homework adherence and outcome of cognitive behavioural therapy for youths with anxiety disorders. Aims: The study examined the association between homework adherence and treatment outcome following a generic group cognitive behaviour treatment program (Cool Kids) for anxiety disordered youths and their parents. Method: The treatment program was completed by 98 children and adolescents (ages 7–16). Homework adherence was measured as time spent doing homework assignments between each session, reported by youths as well as parents. Outcome criteria consisted of youth-reported anxiety symptoms and clinician rated severity of primary anxiety diagnosis at posttreatment and 3-month follow-up. Results: Results did not support an association between homework adherence and treatment outcome when controlling for pretreatment severity. Conclusions: The study found no convincing evidence that homework adherence predicted outcome of cognitive behavioural therapy for youths with anxiety disorders. Reasons for divergent findings on homework adherence in cognitive behavioural therapy for youths compared to adults are discussed.

Empirical findings and theoretical models posit a central role for an inhibited temperament in the development of anxiety. In turn, this suggests that reduction of withdrawn and inhibited characteristics in very young children may prevent the later development of anxiety disorders. To date, no programs have targeted inhibited temperament as a focus of treatment and it is often assumed that temperament is an immutable phenomenon. The current study piloted a brief education program for the mothers of seven temperamentally withdrawn 4-year-old boys. Results showed marked changes in mothers' perceptions of withdrawn temperament and anxious symptoms that continued over the following 6 months. These data encourage a larger-scale investigation of parent education for the reduction of inhibited temperament in pre-school children.

Background: A better understanding of relationships between adolescent depression and family functioning may help in devising ways to prevent development of depression and design effective therapeutic interventions. Aims: This study explored the relationship of parental emotional attitudes, (perceived criticism and expressed emotion) to adolescent self-evaluation and depression. Methods: A sample of 28 clinic-referred adolescents and their mothers participated. The Five Minute Speech Sample was used to measure parental expressed emotion, and the adolescents completed the Children's Depression Inventory, Self-Perception Profile for Children global self-worth scale, a self-criticism scale and a perceived parental criticism scale. Results: There was partial support for a model of adolescent negative self-evaluation as a mediator in the relationship between parental emotional attitudes and adolescent depressive symptoms. The data also supported an alternative hypothesis whereby adolescent depressive symptoms are related to negative self-evaluation. Conclusions: The overall pattern of results emphasizes the significance of adolescents' perceptions of parental criticism, rather than actual levels, in understanding the relationship between parental emotional attitudes and adolescent depressive symptoms.

In recent years, there has been considerable debate about how accurately people remember emotionally significant information. Early studies concerned with “flashbulb memories” claimed that emotional memories are accurate and persistent. However, recent studies indicate that flashbulb memories are subject to deterioration over time. This finding fits with the idea that individuals who have experienced a traumatic event do not retain all the details of the trauma equally well. Instead, they have relatively good memory for central detail information and relatively poor memory for peripheral details of the traumatic situation. Using self-report data of a normal, healthy sample, Christianson and Loftus (1990) found evidence for this idea. The current study is an attempt to replicate Christianson and Loftus' finding in a normal student population (N = 106). Subjects were asked to describe their most traumatic situation. They rated the vividness of the memory, the intensity of emotion at the time of the trauma and at the time of recall, the amount of reliving, and the amount of central and peripheral detail information remembered. Results indicate that subjects who reported strong emotion at the time of the trauma remembered significantly more central detail information than subjects with relatively low past emotionality ratings. However, no differences in the amount of peripheral detail information remembered were found.

This study presents the results of a preliminary investigation into the effectiveness of treating people with obsessive compulsive disorder (OCD) in group. Twenty-four clients in four groups run consecutively participated in the study. Outcome measures of statistical and clinical significance suggest that specific effects on the reduction of OCD symptoms were small. However, important positive non-specific effects were achieved relating to enhanced mood, reduction of the disabling effects of the symptoms, and clients self reported increased sense of hope, understanding and control. Initial improvements were maintained at six month follow-up. Clients' rating of helpfulness for the different contents of the group programme were highest for non-specific aspects. The author suggests that the presented group programme may have an important pre-treatment role in helping OCD clients prior to individual therapy.

Background: The experience of having a child diagnosed with type 1 diabetes mellitus (T1DM) can negatively impact on the mother's well-being and trigger posttraumatic stress symptoms. To date, only one study has examined the role of non-cognitive factors in predicting the occurrence of PTSD in parents of children diagnosed with diabetes. However, in the broader PTSD literature is has been shown that both non-cognitive variables and cognitive variables predict PTSD in traumatized populations. Aims: The current study aimed to investigate the relationship of both non-cognitive (trauma severity, psychiatric history and social support) and cognitive variables (negative cognitive appraisals and dysfunctional cognitive appraisals) with PTSD in mothers of children recently diagnosed with diabetes. Method: A single group survey design and self-report questionnaires were used to investigate the relationship between both non-cognitive (trauma severity, psychiatric history and history of trauma, and social support) and cognitive factors (negative cognitive appraisals and dysfunctional strategies) and PTSD symptoms in mothers of children who had been diagnosed with type 1 diabetes in the last 5 years. Results: All cognitive variables were positively associated with PTSD symptoms. In contrast, of the non-cognitive variables, only social support was significantly (negatively) associated with PTSD symptoms. Moreover, regression analysis found that cognitive variables explained variance in PTSD symptoms over and above that contributed by the non-cognitive variables. Conclusions: This supports the cognitive model of PTSD. The implications of the study with regards to early detection of and therapies for PTSD in this population are discussed.

Background: A prominent area of advancement in the psychological treatment for people with persisting psychosis has been the application of mindfulness-based therapies. Recent literature has recommended the investigation of focused mindfulness interventions for voices (auditory hallucinations) as a specific experience. To date, only mindfulness programs in group format have been examined. Aims: This non-randomized pilot study aimed to assess the acceptability, feasibility and potential outcomes of an individual mindfulness program for persistent voices on the negative impact of voices on the subjective experience of mental health and wellbeing, depression and voice-related distress and disruption. Also, it aimed to identify potential psychological and neurocognitive mechanisms of change. Method: A new 4-week individual Mindfulness Program for Voices (iMPV) was developed, and piloted with a group of 14 participants with a schizophrenia-spectrum disorder and persisting voices. Participants completed clinical and neurocognitive measures pre- and post-intervention and at 2-month follow-up. Results: Results revealed low attrition rates, high formal practice engagement levels and positive participant feedback. Pre–post outcomes suggested small to moderate effects for a reduction in the negative impact of voices on experience, depression and disruption. Large effects for changes in mindful responding and attentional switching were also identified. Conclusions: Our findings suggest that this novel treatment protocol is appropriate, engaging and safe for persistent voice hearers. Findings for mindful responding and attentional switching suggest these to be potential mechanisms of change for further investigation. Further RCTs are warranted to ascertain the feasibility and efficacy for focused mindfulness interventions for voices of individual format.