Background: Self-regulatory executive function theory (Wells and Matthews, 1994; Wells, 2008) stresses the role of metacognitions in the development of emotional disorders. Within this metacognitive model, positive beliefs about ruminative thinking are thought to be a risk factor for engaging in rumination and subsequently for depression. However, most of the existing research relies on retrospective self-report trait measures. Aims: The aim of the present study was to examine the theory's predictions with an Ecological Momentary Assessment approach capturing rumination as it occurs in daily life. Method: Non-clinical participants (N = 93) were equipped with electronic diaries and completed four signal-contingent momentary self-reports per day for 4 weeks. A multilevel mediation model was computed to examine associations between positive beliefs about rumination and ruminative thinking and negative affect in daily life. Results: Positive beliefs about rumination were significantly associated with ruminative thinking as it occurs in daily life. We further found evidence for a negative association with positive affect that was completely mediated via ruminative thinking in daily life occurring in response to negative emotions. Conclusions: Our results add ecologically valid corroborating evidence for the metacognitive model of emotional disorders within the framework of self-regulatory executive function theory.

Background: Health anxiety is common, impairing, and costly. The role of catastrophizing of bodily sensations (i.e. rumination about, overconcern with, and intolerance of bodily sensations) in maintaining health-related anxiety (i.e. anxiety about perceived health problems) is important, but understudied, in the health anxiety literature. Aims: The present study investigates the role of catastrophizing of bodily sensations as a maintenance factor for health-related anxiety over time. Method: Undergraduates (n = 226 women; n = 226 men) completed a baseline assessment, 14-day daily diary study, and 14-day longitudinal follow-up. Results: Path analysis indicated catastrophizing of bodily sensations maintains health-related anxiety from one month to the next in both men and women. Conclusions: The present study bridges an important gap between theory and evidence. Results support cognitive behavioral theories and extend cross-sectional research asserting catastrophizing of bodily sensations maintains health-related anxiety over time. A cyclical, self-perpetuating pattern was observed in the present study wherein catastrophizing of bodily sensations and health-related anxiety contribute to one another over time. Results also suggest targeting catastrophizing of bodily sensations may reduce health-related anxiety.

Training efforts for evidenced based treatments require evaluation, yet the value of practitioner self-reports of skills acquisition has been questioned. Thus, a key issue concerns how accurately practitioners assess their own clinical skills. In the current study, 23 community practitioners participated in training of Motivational Interviewing (MI), completed standardized patient (SP) interviews before and after training, and provided self-ratings of MI elements after each interview. Interview recordings were later coded independently. Results suggest training contributed to: 1) reasonable agreement between practitioner and independent ratings; and 2) more effective use of MI, despite a tendency for practitioners to underestimate training gains. This micro-analysis of training documents initial skill gains along with increased practitioner self-awareness. Further, it exemplifies how practitioner self-ratings and objective skill assessment methods may be used in tandem to more fully describe practitioner learning.

This paper reviews recent theoretical, conceptual and practice developments in cognitive-behaviour therapy (CBT) for anxiety disorders. The empirical status of CBT for anxiety disorders is reviewed and recent advances in the field are outlined. Challenges for the future development of CBT for the anxiety disorders are examined in relation to the efficacy, effectiveness and cost-effectiveness of the approach. It is concluded that the major challenge currently facing CBT for anxiety disorders in the UK is how to meet the increased demand for provision whilst maintaining high levels of efficacy and effectiveness. It is suggested that the creation of an evidence base for the dissemination of CBT needs to become a priority for empirical investigation in order effectively to expand the provision of CBT for anxiety disorders.

A 50-year-old married woman who had had a radical mastectomy was on the threshold of ceasing to take adjuvant chemotherapy because of a longstanding needle and blood phobia and a recently acquired conditioned nausea response to hospital and medical situations. A cognitive-behavioural therapy programme incorporating relaxation training, imaginal systematic densitization and video modelling, allowed her to complete the chemotherapy course and to feel less anxious in hospital and medical settings.

An audio-tape technique was used in the treatment of a 35-year-old male with a 13 year history of obsessional rituals and ruminations. His rituals responded to exposure and self-imposed response prevention but the ruminations remained as before.

The audio-tape treatment, which involved him listening to his own voice reciting his ruminative content, resulted in a rapid and substantial reduction in frequency of ruminations and this was maintained to one month follow-up.

The clinical and theoretical implications of this treatment approach are discussed.

Background: Measurement of cognitive behavioural therapy (CBT) competency is often resource intensive. A popular emerging alternative to independent observers’ ratings is using other perspectives for rating competency. Aims: This pilot study compared ratings of CBT competency from four perspectives – patient, therapist, supervisor and independent observer using the Cognitive Therapy Scale (CTS). Method: Patients (n = 12, 75% female, mean age 30.5 years) and therapists (n = 5, female, mean age 26.6 years) completed the CTS after therapy sessions, and clinical supervisor and independent observers rated recordings of the same session. Results: Analyses of variance revealed that therapist average CTS competency ratings were not different from supervisor ratings, and supervisor ratings were not different from independent observer ratings; however, therapist ratings were higher than independent observer ratings and patient ratings were higher than all other raters. Conclusions: Raters differed in competency ratings. Implications for potential use and adaptation of CBT competency measurement methods to enhance training and implementation are discussed.

A group of 54 clients with eating disorders who attended a college-based, group counselling service evaluated four treatments for eating disorders. Individual discussion of problems was uniformly rated as more acceptable than two behavioural treatments (systematic desensitization, and goals and relaxation) which were, in turn, rated as more acceptable than drug treatment. Methodological problems with this form of consumer evaluation and the need for further evaluation of behaviour therapy within a wider range of clinical populations are discussed.

A number of single case reports have made impressive claims for the efficacy of “eye movement desensitization” (EMD) in the treatment of traumatic memories. Many of these case reports claim that EMD reduces the unpleasant feelings associated with traumatic images. However, at present, there are no published controlled studies that provide evidence for these claims. The present experiment investigated whether EMD inhibits emotional responding during retrieval of aversive information. Normal Ss (N=40) were exposed to an aversive slide. During a next stage, half of the Ss underwent EMD while they rehearsed the slide information, whereas the other half underwent a control procedure (i.e., finger tapping) while rehearsing slide information. Before and after EMD or control intervention, heart rate and self-report data were obtained while Ss retrieved and visualized the aversive slide. No evidence was found to suggest that EMD inhibits emotional reactivity more than does finger tapping.

Behavioural psychotherapy has many roots, and experimental psychology is but one of many “idols of origin” which is in any case largely ignored by behavioural practitioners. The conditioning model of neurosis has shortcomings, and cognitive explanations alone are not satisfactory. It may be necessary to think in terms of failed extinction of phobias and rituals rather than of enhanced acquisition. Aetiological theories need not be related to effective treatment, nor are they necessary for clinicians to carry out successful behavioural treatment. For therapists, paradigms are more useful when derived from clinical experiments rather than from the laboratory. A critical task concerning treatments to reduce anxiety is to investigate those parameters which decide when exposure will be habituating and when it will be sensitizing. To this end, analogue research is less relevant than clinical experiments whose results can be used directly by clinicians. Ten theoretical problems with exposure are noted.

The demand for behavioural psychotherapy exceeds the supply of therapists. Paraprofessionals and self-help methods can help to bridge the gap, while preventive measures may prevent the development of some pathology. Most clinical psychologists and psychiatrists are overqualified merely to deliver behavioural services; there is no evidence that such qualifications add to effectiveness, though they are invaluable for research and teaching.

Sixty-four patients suffering from primary major depressive illness from hospital and general practice clinics were randomly allocated to three treatment groups: drug of choice, cognitive therapy and a combination of the two. Looking at end-point scores on two rating scales of depression, there was no difference in the proportion of responders to the three treatments in the hospital group, but in the general practice, significantly less patients treated with drugs improved. Looking at group mean changes from baseline, all groups improved significantly on most variables except for the general practice drug group. The potential value of cognitive therapy for therapy-resistant hospital patients and for general practice patients is discussed.

This open study measured the proportion of routine referrals from primary care to a psychiatric sector team with symptoms of anxiety and/or low mood who chose to take up the option of attending a self-help room to use the CBT self-help manual Mind over mood during a 6-week waiting list period. It assessed changes in psychological health, dysfunctional attitudes and degree of hopelessness during the period of use of the self-help manual, as well as patient satisfaction with it. Twenty-two of 42 consecutive referrals attended the room (mean 3.55 sessions – SD 1.71). The Beck Hopelessness Scale (BHS), the General Health Questionnaire (GHQ), and Dysfunctional Attitudes Scale (DAS), as well as measures of patient participation and satisfaction, were completed at the beginning and end of the 6-week period for those patients who attended the room. All three scale scores fell significantly over the study period, and the DAS and BHS scores at 6 weeks were negatively correlated with the number of sessions attended. The patients generally judged that the self-help intervention was acceptable and effective, and that their knowledge in a number of key areas had been improved. Conclusions regarding effectiveness are limited by the absence of control group data; nonetheless, this study does suggest that the provision of a self-help room containing Mind over mood is useful for patients with anxiety and low mood on a waiting list for a psychiatric outpatient assessment.

Patients referred with anger problems often do not attend for treatment. The aim of this study was to determine if group Cognitive Behaviour Therapy (CBT) was feasible. Patients referred for help with their anger were assessed, given 6 sessions of group CBT and re-assessed. Of 119 patients referred, 49 (41%) did not attend the initial appointment. Patients who attended for interview were invited to participate in the group CBT. Only 11 patients (9%) of those referred for therapy attended for the full course of CBT. Thirty-four patients (29%) were exposed to at least one session of CBT, while 66 patients (56%) did not attend for any therapy. Patients who attended for some or all of the CBT treatment reported reductions in the frequency and intensity of their anger outbursts. There was also a significant reduction in measures of their anger traits. It could be concluded that group CBT is an appropriate way to deliver this therapy to patients with anger problems, but it is clear that many of those referred are ambivalent about therapy and will not attend. Figures are given that will allow the planning of a randomized controlled trial to evaluate the difference between individual and group based CBT for patients with anger problems.

Despite promising findings from problem-solving interventions in the treatment of parasuicide, little is known about problem-solving difficulties that distinguish “Non-Repeaters” from “Repeaters”. The present study examined whether problem-solving ability could be used to identify repeaters of parasuicide. Findings are presented from the follow-up part (N = 35) of a larger investigation (N = 146) of non-consecutive hospital-treated cases of parasuicide, interviewed by the National Suicide Research Foundation in Ireland as part of the WHO/EURO Multicentre Study on Suicidal Behaviour. The median interval from initial to follow-up interview was 15 months. The European Parasuicide Study Interview Schedule (EPSIS II) was used in the follow-up interview. Within this schedule, responses to a questionnaire measuring habitual problem-solving style were analysed. Repeaters scored significantly lower than non-repeaters on the following problem-solving dimensions: Active handling, Comforting cognitions and Seek social support. Repeaters scored significantly higher on the Passive reactions dimension. A logistic regression model including these four problem-solving dimensions correctly identified 79% of the repeaters and 82% of the non-repeaters. Despite the limitations of this sample size, these significant differences in problem solving have implications for the treatment of parasuicide. Further work, using larger samples, is required.

Eliciting, evaluating and changing core beliefs are established features of cognitive behaviour therapy (CBT). However, care must be taken when working at this level of cognition. This is because therapists are dealing with core constructs that, whether dysfunctional or otherwise, influence the patient's self-concept, her world and future. This paper examines when it is appropriate to work at this level and some of the specific problems regarding assessment and the consequences of belief change. It is evident that achieving lasting cognitive change is a difficult task, and this may be in part due to the poor quality of the literature and training in the area. In an attempt to address this, the final section of the paper offers a set of practical guidelines concerning the continuum technique, a well-known CBT method for targeting, evaluating and changing core beliefs. It highlights process features (e.g. planning, management, and interpersonal skills) as being crucial in creating contexts in which change can take place. The work has been written for trainee cognitive therapists and those with a working knowledge of CBT who are seeking to improve their abilities in the use of change methodologies.