Beliefs about auditory hallucinations have been found to influence voice hearers' behavioural and emotional reactions to the hallucinations. It is currently unknown however, how these beliefs change over time in the absence of psychological intervention or if they remain stable, and how such changes may be related to changes in other symptoms. This study aimed to expand on previous research by exploring the beliefs of voice hearers concerning the malevolence or benevolence of voices in a longitudinal design. Forty-six individuals diagnosed with schizophrenia were assessed with the PANSS, the HAD, and an interview exploring hallucinatory experiences and beliefs about hallucinations over a period of 6 months. General psychopathology and the severity and frequency of hallucinations were found to improve. Voice hearers' beliefs about their voices, however, remained stable. Beliefs do not appear to change without a specific intervention aimed at them and may indeed serve as vulnerability factors. These findings can be interpreted to imply that psychological interventions aimed at modifying such beliefs, such as CBT, might be a necessary component of the treatment of auditory hallucinations.

This paper investigates two contrasting family therapy approaches in the treatment of alcoholism. Twelve families were randomly assigned to either a symptom-focused or systems-focused treatment. Measures of marital satisfaction, family satisfaction and alcohol dependency were recorded before treatment commenced, after treatment and at a six-month follow up. The results showed that both treatments were equally effective in producing desired change, thus offering clinicians increased choice in the range of effective family interventions.

Developments in behavioural group therapy over the past decade are described, with particular reference to a change in focus from administering individual treatment techniques to teaching coping skills for the management of anxiety. In spite of this growing interest there has been little empirical research reported. The current study was an attempt to develop a coping skills package and to evaluate it against the more traditional approach of group relaxation training. Three experiments were conducted, comprising a total of seven groups and they were run in either an N.H.S. psychiatric hospital outpatient setting or in General Practice.

Results were equivocal, both experimental and control groups showed treatment gains. These were superior in the coping skills group on one measure. Reasons for these findings are discussed in the light of the curriculum and the experimental design. And ways of making the coping skills package more potent are suggested.

Background: Panic disorder (PD) has a chronic nature, especially as a result of maladaptive coping strategies to deal with stressful events. Aims: To evaluate the impact of booster sessions with cognitive techniques on coping strategies, resilience, and quality of life (QoL) in patients previously submitted to standard cognitive-behavioural group therapy (CBGT) for PD. Method: A controlled clinical trial with 44 patients with PD (intervention = 20; control = 24) who had previously completed a 12-week CBGT protocol. PD, anxiety, and depression severity symptoms were assessed at baseline and 1, 6, and 12 months after the booster sessions. Coping strategies, resilience, and QoL were assessed by Coping Strategies Inventory (CSI), Resilience Scale, and WHOQOL-BREF respectively. Results: Over time, a significant improvement in PD and depression symptoms was observed in both groups. A significant increase in the QoL social relations domain was found in the booster group, considering a time/group interaction. Coping and other QoL domains did not change after the booster sessions. Changes in resilience were dependent on the intensity of symptoms, with negative but non-significant correlations. Conclusions: The improvement in PD and depression symptoms for both groups may be a result of the group format of the intervention. Group booster sessions after CBGT are useful to maintain the benefits obtained with CBGT.

Background: Little is understood about the relationship between therapist competence and the outcomes of patients treated for common mental health disorders. Furthermore, the evidence is yet to extend to competence in the delivery of low-intensity cognitive behavioural interventions. Understanding this relationship is essential to the dissemination and implementation of low-intensity cognitive behavioural interventions. Aims: The aim of this study was to explore the relationship between Psychological Well-being Practitioner (PWP) competence and patient outcome within the framework of the British government's Improving Access to Psychological Therapies (IAPT) initiative. Method: Forty-seven PWPs treating 3688 patients participated. Relationships between PWP scores on three observed standardized clinical examinations and reliable change in patients’ symptoms of anxiety and depression were explored at two time points: during the year-long training phase, and over a 12-month follow-up. Results: Results indicated that patients treated by qualified PWPs achieved superior outcomes than those treated by trainees. Little support was found for a general association between practitioner competence in delivering low-intensity cognitive behavioural interventions and patient outcome, either during or post-training; however, significantly more patients of the most competent PWPs demonstrated reliable improvement in their symptoms of anxiety and depression than would be expected by chance alone and fewer deteriorated compared with those treated by the least competent PWPs. Conclusion: Results were indicative of a complex, non-linear relationship, with patient outcome affected by PWP status (trainee or qualified) and by competence at its extremes. The implications of these results for the dissemination and implementation of low-intensity cognitive behavioural interventions are discussed.

This study explored associations between maternal discipline, maternal trait anxiety and anxiety in preschool-aged children. The sample comprised 47 mothers and their children, aged 2–3 years. Maternal discipline was assessed by maternal self-report; and child anxiety by maternal and play leader report. Positive associations were found between self-reported, ineffective, maternal discipline and symptoms of anxiety in preschool-aged children. Associations were not found between self-reported “verbose” discipline (long reprimands or reliance on talking) and preschoolers' anxiety. There were also no associations between play leaders' reports of preschoolers' anxiety and any of the mothers' self-reported discipline measures. Positive associations were found between maternal trait anxiety and the use of self-reported ineffective disciplinary behaviours. Over-reactive discipline was shown to be a stronger predictor of preschoolers' anxiety symptoms than maternal anxiety or lax discipline. It was concluded that children's internalizing symptoms (according to mother report) may be associated with use of ineffective disciplinary strategies. Increased use of these strategies was also associated with anxiety in mothers, and it is suggested that use of ineffective discipline strategies might partially account for the association between maternal and child anxiety.

Background: The development and maintenance of gambling and problem gambling with its corresponding irrational beliefs may be fundamentally linked to patterns of wins and losses during electronic gaming machine (EGM) play. Method: The current study investigated the extent to which irrational thoughts and erroneous perceptions of chance differed based on individual wins or losses. Undergraduate students (n = 45) completed questionnaires assessing irrational beliefs and perceptions of chance prior to and following EGM play with credits rather than money. Results: It was found that players who lost reported a significantly greater decrease in irrational thoughts and erroneous perceptions of chance and significantly fewer superstitious beliefs than winning players following play. Conclusions: Future studies are needed to further investigate the relationship of winning to cognitive distortions to guide education and interventions.

The argument is presented that behavioural psychotherapy has long been infiltrated by cognitive ideas, whether at the level of underlying philosophy, assessment or practice. For example, none of the traditional laws of learning have withstood the test of time, but although modern learning theory has had to become increasingly cognitive, behaviour therapists have yet to integrate these advances into a better understanding of therapeutic techniques and practice. Examples are also presented of a range of cognitive tasks that may provide further insights into the nature of the affective disorders.

This paper describes five measures of behavioural skill that apply to the “generalist” level of therapy sophistication. This level was trained in a group of 65 qualified psychiatric nurses working in the rehabilitation sector of a large N.H.S. hospital. Three of the measures were administered before and after a 5 day in-service training course, followed by two measures of proficiency in using behaviour therapy on the ward. The results indicated that reliable and valid measurements could be made in this crucial domain. Also, a discriminant analysis showed that one test, a video-presented functional analysis task, accounted for most of the variance and predicted utilisation. It is therefore possible to use this brief assessment device to dependably gauge a vital area of behavioural skill.

Prior research has shown that psychology-trained practitioners use homework assignments, but no prior research has sought to survey the clinical practice of other mental health professionals. Three hundred and thirty-three mental health professionals from counselling, medical, nursing, psychology, and social work training backgrounds were surveyed regarding their use of homework assignments in psychotherapy. The vast majority of the sample (83%) reported the use of homework assignments, and those practising cognitive-behavioural therapy indicated a greater frequency and degree of specificity in assigning homework. However, it was noteworthy that all theoretical and professional groups in the present study reported some use of homework assignments.

Background: Although psychosocial treatments for pain have been found to be effective in reducing self-reported pain, physician visits, and in improving mood, the research has largely focused on younger persons. As such, there is a paucity of related studies involving older adults. Method: We implemented and evaluated a 10-session psychosocial (i.e. cognitive behavioural orientation) pain management program that was specifically designed for older adults. The intervention was delivered either in the participants' homes or in bookable rooms in seniors' residence buildings. Ninety-five community dwelling seniors with at least one chronic pain condition were assigned to either a treatment or a wait-list control condition. An assessment battery was administered to treatment participants immediately before the program started, immediately post-treatment, and 3-months post-treatment. Comparable data were obtained from control group participants, although 3-month follow-up data were not available for the control group. Outcome variables included pain intensity, coping strategy usage, pain beliefs/appraisals, and perceived life stressors. Results: Although decreases in pain intensity were observed in both the treatment and wait-list control groups, the intervention was found to result in fewer maladaptive beliefs about pain and greater use of relaxation, which is considered to be an adaptive coping strategy. Conclusions: Although some treatment benefits were identified (e.g. change in pain-related beliefs), future research should test the effectiveness of a cognitive behavioural treatment program tailored for seniors with participants who are experiencing higher pain intensities than those reported by our sample (i.e. those who experience a higher level of pain at baseline may represent a more suitable sample for assessing the effectiveness of our intervention in reducing pain intensity).

Background: Interventions focusing on positive experiences have moderate effects on distress, protective factors and quality of life. Aims: To evaluate the ‘Personal Model of Resilience’ (PMR) intervention by Padesky and Mooney (2012) with a focus on resilience strategies the person already possesses. Method: In a pre–post design, intervention and control samples of college students (n = 53) are compared with regard to distress, protective factors and quality of life. Results: Compared with the control group, the PMR group shows significant improvements in distress, protective factors and quality of life with medium to large effect sizes. Conclusions: The PMR is a promising intervention module. It requires further evaluation in clinical contexts, with larger samples, and long-term follow-up assessments.

Background and Aims: The cognitive models indicate that people with social phobia and paranoia share a common fear of others. While we recognize clinical differences, it is likely that some of the same psychological processes contribute to the maintenance of both presentations, yet the nature and extent of these similarities and differences are not yet clearly understood. This study explored threat experiences in people with social phobia and persecutory delusions in order to elucidate these aspects of the respective cognitive models. Method: Accounts of interpersonal threat experiences were examined in nine people with social phobia and nine people with persecutory delusions. Verbatim transcripts were analyzed using thematic analysis. Results: Three major themes emerged from the data: participants’ experience of threat, reactions while under threat, and subsequent reflections. Narrative coherence emerged as a superordinate theme. Typical fear responses were found in both groups, particularly in their reactions to threat. The key differences were in participants’ perceptual experiences, ability to stand back from the threat following the event, and narrative coherence. Conclusions: The findings are discussed in relation to current cognitive models of social phobia and paranoia. Theoretical and clinical implications are drawn out, and highlight the need to examine attentional and metacognitive processes more closely if we are to understand the maintenance of perceived threat in these groups, and means of alleviating associated distress.

Ten psychiatric patients with a DMS-III-R diagnosis of schizophrenia and persistent auditory hallucinations of at least 12 months' duration entered the study, and nine completed it. Subjects used portable audiocassette players with headphones to listen to two music audiotapes that they had selected, one for relaxing and the other for a stimulating/arousing effect. It was hypothesized that the relaxing music would reduce the frequency of auditory hallucinations more than the stimulating music. Subjects rated the effects of the music on nine scales for seven consecutive mornings. Analysed individually, six subjects reported significant response changes to the music, but the response pattern was heterogeneous, and the results of group analysis did not confirm the experimental hypotheses. Generally, the relaxing tape had more beneficial effects than the stimulating/arousing tape. Five subjects reported overall benefits from the experimental procedure, and in all five the content of their hallucinations was innocuous. One subject was adversely affected by the audiotapes, and three failed to respond; these subjects tended to have unpleasant or frightening hallucinations. It was concluded that headphone music was of some value as a non-pharmacological treatment for schizophrenic patients with persisting auditory hallucinations that were innocuous in content. Overall, the findings justify further research in the area.

This paper presents data from a sample of 21 pilot cases and six control cases arising from an ongoing project evaluating cognitive-behavioural therapy in two-plus-one sessions within an NHS clinical psychology department. The major issue addressed concerns the general effectiveness of the two-plus-one-model as an ethical intervention model within a service delivery system. It is concluded that the data provide ethical and clinical support for a major field study as well as indicating provisional support for the implementation of this service delivery model in NHS settings in pursuance of more cost-effective models of psychological interventions to selected clients.

Background: Increasing attention has been given to subtyping OCD with respect to different clinical profiles, response to drug treatments, comorbidity and age of onset. There are a number of studies looking at predictors of treatment outcome in OCD, but so far not for OCD subtypes. Method: Prediction of outcome after cognitive-behavioural therapy was evaluated in 63 inpatients with early obsessive-compulsive disorder (EOCD ≤ 12 years of age) and 191 patients with late obsessive-compulsive disorder (LOCD > 15 years of age). Results: For EOCD patients factors predicting a good outcome included high motivation and high initial Y-BOCS scores. Factors associated with a bad outcome were higher age at assessment, a longer duration of psychiatric inpatient treatment before assessment and a low level of social functioning (BSS). For LOCD patients living in a stable relationship, high motivation and completing treatment predicted a favourable therapy outcome, while a low level of psychological functioning (BSS) and a longer duration of inpatient psychiatric treatment before assessment were associated with an undesirable therapy outcome. Conclusions: Subtyping OCD patients according to age of onset seems to be a promising avenue towards improving and developing more specified treatment programs.

Background: This pilot study was designed to investigate the efficacy of a cognitive behavioral treatment for anger. Method: Twelve (5 men and 7 women) outpatient adults completed 2-hour group sessions for 16 sessions. Participants were diagnosed with 29 Axis I and 34 Axis II disorders with high rates of comorbidity. Empirically supported techniques of skills training, cognitive restructuring, and relaxation were utilized. In this protocol, cognitive restructuring emphasized the use of the ABC model to understand anger episodes and the Rational Emotive Behavior Therapy (REBT) techniques of disputing irrational beliefs and rehearsing rational coping statements, but additional cognitive techniques were used, e.g. self-instructional training (SIT). Skills training included problem-solving and assertiveness. Relaxation training was paced respiration. Motivational interviewing, imaginal exposure with coping, and relapse prevention were also included. Results: Significant improvements were found from pre- to post-treatment on the following measures: the Trait Anger Scale of the State-Trait Anger Expression Inventory-II; and Anger Disorder Scale total scores; idiosyncratic anger measurements of situational intensity and symptom severity; and the Beck Depression Inventory-II; Conclusions: In order to extend the significant research findings of this pilot study, future investigations should involve larger sample sizes, populations drawn from various settings, and contact control groups.

Background: Little is known about the effect of case-formulation based cognitive behaviour therapy (CBT) for anxious children. Aim: The present study explores the feasibility of case-formulation driven CBT for anxious children. Parents were involved in treatment as either co-facilitators (involved only as the child's assistants, treatment being primarily directed at the child), or as co-clients (parents received therapy targeting theoretically established maintaining mechanisms; children received half of the sessions, parents the other half). Method: Feasibility of the case-formulation driven CBT was established by comparing the completion rate and the percentage of children free of anxiety after treatment, with manualized treatments reported in existing meta-analyses. Children aged 7–12 years and their parents participated (n = 54). Families were assessed at pre- and posttreatment and at 6-month follow-up. Results: All families completed treatment and the percentage of recovery in the case-formulation driven approach was comparable to results obtained in manualized treatments. Conclusion: The findings from this stage I study supports the notion that a case-formulation driven approach to CBT may be a feasible option when selecting treatment for anxious children; however, further studies must be conducted before firm conclusions can be drawn.

Background: There has been an increased effort to understand the nature of obsessive-compulsive disorder (OCD) in non-Western cultures. In particular, growing research has examined OCD in China, but there are no comprehensive instruments that measure both OCD severity and heterogeneity for characterizing samples. Aims: A validated, comprehensive measure that could be used in China would provide researchers with a useful instrument for evaluating severity and heterogeneity of OCD in a non-Western culture, allowing researchers to better understand the universal and cultural components that play a role in the nature of OCD. Method: The current investigation presents data on the reliability and validity of a Mandarin translation of the Obsessive-Compulsive Inventory-Revised (CH-OCI) using both a student (n = 1950) and clinical sample (n = 50 patients with OCD; n = 50 patients with anxiety as a comparison group). Results: Results support the factor structure, convergent and discriminant validity, criterion-related validity, test-retest reliability, and internal consistency of the CH-OCI. Conclusions: Validation of the instrument permits researchers and clinicians to measure OCD presentation in Mandarin-speaking samples.