This study reports on the effects of a cognitive-behavioral treatment program for two pre-adolescent children with chronic headaches. The program involved a combination of training the child in self-management skills (e.g. relaxation training, attention training, cognitive self-statements), and training for parents in how to prompt and reinforce children's self-help behaviors. Self-report assessment utilized a headache diary, a general activity measure, and a depression measure, whilst parental report measures were taken of the child's headache behavior and contingent parental care-giving behavior. Child headache behavior at school was also recorded by the child's teacher. The results indicated that by six months follow-up the subjects had improved in headache intensity 100% and 61% respectively, and in headache frequency 100% and 84% respectively. Both subjects also showed decreases in headache behaviors and reductions in contingent care-giving behavior by parents. Overall, the results suggest the potential usefulness of systematic involvement of parents in cognitive-behavioral treatment of children's chronic headaches.

This study reports the factorial structure and psychometric properties of a Spanish version of the Padua Inventory (PI) in a sample of 863 undergraduate students, 55 patients with Obsessive-Compulsive Disorder (OCD), and 20 patients with other anxiety disorders (OAD). A Principal Components Analysis suggested a 4-factor structure, which was comparable but not identical to that found in other versions of the PI involving non-clinical samples. The PI sub-scales showed good internal consistency, test-retest reliability, as well as convergent and discriminant validity. The “Washing” sub-scale of the PI failed to separate OCD and OAD patients, although this may have been due to small sample sizes. It is suggested that a revised version of the PI should include symptoms that are not currently represented in the scale, such as hoarding obsessions and compulsions.

Background: The relationship between Eating Disorders (ED) and Obsessive Compulsive Disorder (OCD) has been extensively studied in the last few years. However, little effort has been devoted to studying the link between these disorders with regard to their distorted beliefs. Aims: The first objective of the study was to analyze the differences in OCD-related beliefs among ED subtypes and the general population, controlling for age, Body Mass Index, and obsessionality. The second objective was to explore which OCD beliefs explain ED symptomatology. Method: Seventy-nine ED patients without OCD comorbidity, divided into diagnostic subtypes, and 50 community participants completed the Obsessive Beliefs Spanish Inventory-Revised and measures of ED and OCD symptomatology. Results: There were no differences found among clinical ED subtypes in obsessive beliefs, but the bulimia nervosa purgative subtype and binge eating groups obtained significantly different scores from the community group on Thought-Action-Fusion (TAF)-likelihood and TAF-moral, respectively. OCD symptomatology had the most important predictive effect on ED symptoms, followed by Overestimation of Threat, BMI and FPA-moral. Conclusions: The different patterns of beliefs among subtypes reflect what other studies have suggested about the relevance of the presentation of ED symptoms associated with restriction, purges and binge without purges. Our results agree with the transdiagnostic perspective of ED.

Background: Internalized stigma is a significant difficulty for those who experience psychosis, but it has never been conceptualized using cognitive theory. Aims: The aim of this paper is to outline a cognitive model conceptualizing internalized stigma experienced by people who also experience psychosis. Method: Previous literature is reviewed, critiqued and synthesized to develop the model. It draws upon previous social cognitive models of internalized stigma and integrates cognitive behavioural theory and social mentality theory. Results: This paper identifies key cognitive, behavioural and emotional processes that contribute to the development and maintenance of internalized stigma, whilst also recognizing the central importance of cultural context in creating negative stereotypes of psychosis. Moreover, therapeutic strategies to alleviate internalized stigma are identified. A case example is explored and a formulation and brief intervention plan was developed in order to illustrate the model in practice. Conclusion: An integrative cognitive model is presented, which can be used to develop individualized case formulations, which can guide cognitive behavioural interventions targeting internalized stigma in those who experience psychosis. More research is required to examine the efficacy of such interventions. In addition, it is imperative to continue to research interventions that create change in stigma at a societal level.

Seventeen female agoraphobic patients were treated in three groups by in vivo exposure over 10 sessions. Dependent measures comprised an assessment using a behavioural hierarchy and an assessment of subjective anxiety. Pre-treatment assessment of the number of problems and fears, interpersonal variables and personality as measured by the E.P.P.S. were also carried out. Correlational evidence was sought of relationships between pre-treatment assessment variables and treatment outcome. It was found that low scores for “Aggression” on the E.P.P.S. and the rated ability of designated significant others to manage the agoraphobics' behaviour successfully were predictive of good outcome. Possible reasons for and implications of these findings are discussed.

This paper describes an intervention with a man who has Prader-Willi Syndrome (PWS) and mild learning disabilities in a residential setting. PWS is a chromosomal disorder that is characterized by a wide range of behavioural characteristics including overeating and challenging behaviour. The intervention was based on a range of principles derived from a motivational interviewing approach, which were embedded in a broader behavioural framework that was designed to assist in weight reduction and reduce challenging behaviour. Records of weight and challenging behaviour kept over time suggest that the approach had relatively little impact on overall weight. However, levels of challenging behaviour were reduced quickly and have been maintained at a stable and lower level. Weight has also been maintained at a reasonably constant level without confrontation with staff or excessive restrictions on the individual concerned. Relationships between the individual and staff in the home also improved over the course of the intervention.

Background: The perceived control of intrusive thoughts is important in our understanding of a variety of psychological disorders, but particularly in Obsessive Compulsive Disorder (OCD). Little research has explored thought control strategies in younger populations, despite the frequent onset of OCD in childhood. Aims: This study examined thought control strategies and meta-cognitive beliefs in relation to Obsessive Compulsive (OC) interference scores in an adolescent sample. Method: A non-referred sample of 151 adolescents aged 13–16 completed the Thought Control Questionnaire, the Meta-Cognitions Questionnaire – Adolescent version, and the Leyton Obsessional Inventory – Child Version. Results: Adolescents reported using distraction and worry as thought control strategies as much as adults, but social control and reappraisal less frequently, with adolescent males also reporting less use of punishment as a strategy. The strategies of worry and punishment, and positive beliefs about worry, uncontrollability and danger beliefs (UCD) and superstition punishment and responsibility beliefs (SPR) predicted OC interference scores. Furthermore, these meta-cognitive beliefs mediated the relationships between punishment and worry and OC interference scores. Conclusions: Given the similarities between our results and those from research exploring these variables in adults, it is proposed that cognitive behavioural models of OCD that have been developed in adult populations may be relevant to adolescents, but that meta-cognitive beliefs about superstition, punishment and responsibility may be important in adolescence.

Background: Generating alternative interpretations is a widely used technique in cognitively-oriented treatments for psychosis, including social cognitive treatments. However, research on judgment and decision-making suggests that this technique may backfire among individuals with cognitive deficits. Aims: Mary/Eddie/Bill (MEB) was developed as an alternative approach to help improve Theory of Mind, attributional bias and Jumping to Conclusions in psychosis. An initial pilot trial was conducted to evaluate the tolerability and potential efficacy of MEB. Method: Twenty-four outpatients with psychotic disorders participated in an uncontrolled trial. Social cognition, social functioning, and participant feedback were assessed. Results: Treatment completers exhibited statistically significant improvements in Theory of Mind, social cognitive overconfidence and self-reported social engagement, and reported positive experiences with MEB. No improvements were observed in attributional bias. Conclusions: Given that there are risks associated with the use of traditional generating-alternatives techniques, the current findings support ongoing development of MEB and similar approaches.

Evaluations of computer-guided CBT (CCBT) suggest that this is a promising approach to closing the gap between the demand for, and the supply of, CBT. However, additional studies are required that are conducted by researchers independent of the programme developers, and include a wider range of participants. This independent study examined the viability of CCBT for panic and phobic anxiety in an unselected sample of referrals in remote and rural areas of Scotland. Outcome was assessed by a wide range of outcome measures, completed before and after treatment, and at 4-month follow-up. Participants experienced few difficulties in using the programme, and GPs and participants regarded CCBT as acceptable and useful. Major improvements were obtained, with several large effect sizes, which remained at follow-up. It was concluded that computer-guided CBT can play a useful part in delivering CBT services in rural areas; and that self-help CBT may be the only treatment option available to some sufferers.

Early interventions for psychosis have recently received a great deal of interest. This is because research findings have indicated the importance of duration of untreated psychosis (DUP) in influencing future prognosis. Most interventions have so far centered around the early identification of first episode cases in an attempt to minimize the DUP. A further development of the early intervention strategy aims to identify high-risk cases prior to the onset of psychosis. Treatment of this at risk group could potentially prevent the onset of psychosis. In this paper we describe three cases from a randomized controlled trial designed to test the feasibility of a cognitive therapy intervention, to prevent the onset of psychosis. These are presented with formulations based on a recent cognitive model conceptualizing the onset of psychosis. Implications of this approach for future research and clinical practice are also discussed.

Background: Post event processing (PEP) in social anxiety disorder involves rumination about social events after the fact, and is thought to be a crucial feature of the maintenance of the disorder. Aims: The current experiment aimed to manipulate the use of PEP in individuals with social anxiety disorder. Method: Forty-one individuals with social anxiety disorder completed a videotaped speech. Anxiety ratings and degree of PEP were measured after the task as well as the day following the experiment. Results: Individuals in the distract group reported a greater decrease in anxiety from baseline to post-experimental task than those asked to focus. Individuals in the distract group also reported higher PEP about the task than those instructed to complete a focus task, which appeared to be partially accounted for by baseline differences in symptom severity and state anxiety. Degree of PEP was positively correlated with anxiety ratings, both after the experimental task as well as 24 hours later. Conclusions: These findings suggest that naturalistic PEP is problematic for individuals with social anxiety disorder, especially for those with more severe symptoms. A distraction task, even with breakthrough PEP, appears to have useful short-term effects on anxiety reduction as compared to focus instructions.

Background: There is a developing literature into Anger Management interventions for people with intellectual disability. While initial reports suggest that these interventions are effective there are few evaluations examining what aspects of the therapeutic process contribute to effectiveness. Method: Individuals with an intellectual disability and anger control difficulties who were referred to community psychology services were allocated to either experienced clinical psychologists or a less experienced assistant psychologist who followed the same intervention framework. Results: Significant reductions in self-reported anger intensity were reported; however, the group who were treated by more experienced therapists reported more change and more individuals reported clinically significant change. Conclusions: While effective change was reported by both groups, these results suggest that clinical experience and training may be an important variable in determining the magnitude of change. This has implications for the design of intellectual disability mental health services.

This study derives from an earlier one (Sutton, 1992) which examined the efficacy of training parents to manage difficult pre-school children via four methods: group, home visit, telephone, and waiting list/delayed intervention control. It is a replication of the telephone method of training; the author has never met any of the parents or children involved. Twenty-three children, seventeen boys and six girls, participated; of these one was aged 8, two were 7, one was 6, two 5 and the rest were under 5. They were randomly allocated to an immediate intervention group and a waiting list/delayed intervention control group.

Background: Recent work on cognitive-behavioural models of obsessive-compulsive disorder has focused on the roles played by various aspects of self-perception. In particular, moral self-ambivalence has been found to be associated with obsessive-compulsive phenomena. Aims: In this study we used an experimental task to investigate whether artificially priming moral self-ambivalence would increase participants’ deliberation on ethical problems, an index that might be analogous to obsessive-compulsive behaviour. Method: Non-clinical participants completed two online tasks designed to prime either moral self-ambivalence, general uncertainty, or neither. All participants then completed a task requiring them to consider solutions to moral dilemmas. We recorded the time participants took to respond to the dilemmas and the length of their responses; we then combined these variables to create a measure of deliberation. Results: Priming moral self-ambivalence led to increases in deliberation, but this was only significant among those participants who scored highly on a baseline measure of moral self-ambivalence. Priming general uncertainty had no significant effect upon deliberation. Conclusions: The results suggest that moral self-ambivalence may play a role in the maintenance of obsessive-compulsive behaviour. We propose that individuals who are morally self-ambivalent might respond to situations in which this ambivalence is made salient by exhibiting behaviour with obsessive-compulsive characteristics. These findings have implications for the incorporation of ideas about self-concept into theories of obsessive-compulsive disorder.

One way of trying to minimize the problems arising from long waiting lists for psychological treatment is to see patients for assessment soon after referral, with the aims of making some contact, helping to reduce demoralization, and perhaps providing some practical coping advice. There is some evidence that such procedure may produce better outcomes in subsequent treatment, but also relevant is how people feel about these procedures and whether they meet patients' perceived needs. This paper reports some data on these questions. The data suggest that such an early contact procedure was strongly preferred by patients, but less strongly by therapists, particularly if the therapist treating a patient was not the same person who made the early contact. What patients liked about the early contact seemed to be mainly “non-specific” components such as reduced isolation and increased understanding. As such procedures seem to produce at least as good outcomes, and are preferred by patients, it is suggested that they should be the treatment of choice for clinics with long waiting lists.

Empirical evidence for the efficacy of Cognitive Therapy (CT) treatments for older adults, when compared with other psychotherapies, is inconclusive (Davies & Collerton, 1997). The current authors suggest that one reason for the equivocal findings lies in the failure to adapt the cognitive rationale sufficiently to cater for the different presentation of depression in older people; particularly for those experiencing first-episode late onset-depression. It is argued that existing models tend to focus on the negative aspects of self-appraisal, and fail to fully conceptualize the functional role of positive beliefs (i.e. functional beliefs that have maintained the self-esteem over many years). The work presents an alternative conceptualization of depression for older people, along with implications for therapy. This framework does not represent a brand new approach, but emphasizes specific aspects of existing psychological conceptualizations.

Training in cognitive therapy includes a grounding in relevant empirical research, and the development of a range of clinical skills. It is recognized that this training will need to be continually updated in line with new developments. Several postgraduate training courses in cognitive therapy or cognitive behaviour therapy exist in the United Kingdom. Such courses are expensive in terms of both direct and indirect costs. A postal survey was employed to investigate the effects of the one-year post-qualification course in cognitive therapy at the Newcastle Cognitive Therapy Centre on trainees who had attended the course. The questionnaire examined trainees’ views about the course, of their current clinical skills in cognitive therapy and their use of cognitive therapy since leaving the course. Finally, continuing professional development, on-going supervision and further training in cognitive therapy were examined.

Parent training is one of the most effective interventions for behaviour problems in young children. Most models of parent training are largely behavioural in content and have been developed from social learning theory. As with developments in treatments for adult disorders, it is proposed that parent training implementation and parental engagement may be improved by the introduction of a cognitive component. In particular, the use of the “thoughts, feelings, behaviour cycle” throughout parent training is proposed as a tool for challenging parental beliefs and attributions regarding children's behaviour and increasing parental uptake of the behavioural strategies that are taught. Preliminary findings are discussed with reference to clinical implications and future research.