A randomized controlled trial of a new intervention based on motivational interviewing and cognitive approaches to psychosis (Compliance Therapy) has shown improvements in insight, attitudes to medication and compliance in an unselected sample of consecutively admitted patients with acute psychotic disorders. In the introduction, previous research focusing on cognitive interventions in psychosis and systematically tested psychoeducational approaches to compliance are reviewed. The content of our intervention is described with examples of the principal techniques used, together with a description of the progress of therapy in two individual cases. We conclude that the intervention is eminently applicable in the typical clinical setting.

Background: Reassurance seeking is particularly prominent in obsessive-compulsive disorder (OCD) and may be important in OCD maintenance. Aims: This study used a new self-report questionnaire to measure the range of manifestations of reassurance-seeking behaviours, describing their sources from which they seek, frequency, process (how they seek), and consequences (as opposed to triggers and motivations). This study also attempts to identify the degree to which reassurance is specific to OCD as opposed to panic disorder. Method: Reassurance Seeking Questionnaire (ReSQ) was administered to 153 individuals with OCD, 50 individuals with panic disorder with/without agoraphobia, and 52 healthy controls. The reliability and validity of the measure was evaluated and found to be satisfactory. Results: Reassurance seeking was found to be more frequent in both anxiety disorders relative to healthy controls. Individuals diagnosed with OCD were found to seek reassurance more intensely and carefully, and were more likely to employ “self-reassurance” than the other two groups. Conclusions: Further investigation of reassurance will enable better understanding of its role in the maintenance of anxiety disorders in general and OCD in particular.

Background: “Stressbusters” is an interactive computer software programme based on a clinically effective face-to-face CBT protocol for young people with depression. It was designed for teenagers with mild to moderate depression, and comprises eight 45-minute sessions. Method: Twenty-three young people (aged 12–16; mean age 14.87 years) with symptoms of depression were recruited from CAMHS teams in Manchester and London, and received the Stressbusters treatment (range 1 – 8 sessions, mode 8 sessions). Results: On the K-SADS at initial assessment, 95% met diagnostic criteria for a depressive disorder, with a high group mean score of 35.48 (SD 9.84) on the MFQ. Post-treatment, 22% of young people met criteria for a depressive disorder, with the group mean score on the MFQ falling significantly below clinical cut-off to 20.32 (SD 11.75). These gains were maintained at 3-month follow-up. Significant improvements were also found in the adolescents' global functioning (CGAS), self-reported anxiety (RCMAS), depressive cognitions and attributions (ATQ and CTI-C), and in adolescent- and parent-reported emotional and behavioural difficulties (SDQ). Conclusions: Taken together, these results provide promising preliminary data for the clinical efficacy of Stressbusters as a valid form of CCBT for adolescents with depression.

Background: Evidence suggests that insomnia may be an important therapeutic target to improve mental health. Aims: Evaluating changes in symptoms of depression and anxiety after supported digital cognitive behavioural therapy (dCBT) for insomnia delivered via a community-based provider (Self Help Manchester) of the Improving Access to Psychological Therapies (IAPT) service. Method: Supported dCBT for insomnia was delivered to 98 clients (mean age 44.9 years, SD 15.2, 66% female) of Self Help Manchester. All clients received six support calls from an eTherapy coordinator to support the self-help dCBT. During these calls levels of depression (Patient Health Questionnaire, PHQ-9) and anxiety (Generalized Anxiety Disorder, GAD-7) were determined. Results: Depression (Mdifference-5.7, t(70) = 12.5, p < .001) and anxiety [Generalized Anxiety Disorder-7 (GAD-7), Mdifference-4.1, t(70) = 8.0, p < .001] were reduced following supported dCBT for insomnia. This translated into an IAPT recovery rate of 68% for depression and anxiety. Conclusions: These results suggest that dCBT for insomnia alleviates depression and anxiety in clients presenting with mental health complaints in routine healthcare.

Meta-analysis is a systematic and quantitative approach to reviewing empirical literature. Its claimed benefits of superior objectivity and dependability arise from its adoption of the methodological principles and methods of primary empirical research. This paper offers a critical appraisal of these claims, with special reference to the application of meta-analysis to the therapy outcome literature. Features examined include the numerical combination of results obtained in independent studies; search procedures and inclusion criteria; and the coding of objective and qualitative features of the source studies, which are then used to study the correlates of outcome via disaggregation and multiple regression analysis. The major criticisms reviewed include allegations of overgeneralization, indiscriminate inclusion of low quality data, and idiosyncratic and unacceptable conclusions. It is concluded that the continued application and refinement of meta-analysis in the field of therapy outcomes has an important contribution to make, although not to the exclusion of other methods of integrating data. It is predicted that methods and principles currently associated with meta-analysis will increasingly find a place in all reviews of extensive tracts of empirical literature.

For some years now, working with long-stay populations such as the mentally handicapped and elderly mentally infirm has been a “Cinderella” area with difficulties in attracting high quality staff and resources. This has resulted in poor quality of care. There may be many reasons for the relative lack of interest shown by professionals in the problems of long-term care, but two stand out as potentially important:

(a) the rate of client behaviour change and

(b) the permanency of client behaviour change.

Within the areas of out-patient neuroses and other similar nonchronic problems, it is often expected that change can be brought about relatively quickly by trained therapists (cf. Marks, 1981a, b). With chronic problems, however, the situation is quite different. Usually change is only brought about slowly, if at all.

Secondly, with an out-patient population, given new ways with which to cope with their problems, we hope that somehow the natural contingencies will “trap” (Baer and Wolf, 1970) the new repertoires. The client gets better, stays better, and does not come back. From our own experience of this type of work, the situation is rarely so sanguine and with chronic populations, there isn't usually even much reason for hope. We are all too familiar with changes occurring and then the group of clients begins rapidly to slip back to where they started from (or beyond!). We have become accustomed to blaming poor motivation, inadequate training, organizational variables, Hawthorne effects, and so on. Almost anything except ourselves.

In this paper, we look at some failures and some relative successes in achieving desired change in long-stay institutions, and ask the questions “How?” and “Why?”. It should be obvious before we go any further that we do not have definite answers, but the questions are still worth asking. Work with long-stay populations can be extremely exasperating and demanding, but appeals to abandon the large institutions where such groups reside are defeatist.

Background: The Brief Core Schema Scales (BCSS) were developed to provide a theoretically coherent self-report assessment of schemata concerning self and others in psychosis. They provide a more useful measure of schemata about self and others than traditional measures of self-esteem. Aims: The aim of this study was to determine if these scales would be useful in a sample of individuals who are at clinical high risk of psychosis to help identify targets for intervention. Method: Thirty-eight individuals who are at high risk for psychosis were administered the Scale of Prodromal Symptoms, the Calgary Depression Scale, the Brief Core Schema Scales and the Young Schema Questionnaire–short version. Results: Results suggested that these scales are appropriate for this population and that negative evaluations of the self and others were significantly associated with attenuated psychotic symptoms and, in particular, suspiciousness.

Thirteen cases of Body Dysmorphic Disorder (BDD) were described. There were eight males (61.5%) and five females (38.5%) with ages ranging from 16 to 37 (mean=24.7). All patients were also diagnosed as obsessive compulsive disorder (OCD), according to DSM-III-R, with the exception of one. Patients were administered the Yale Brown Obsessive Compulsive Scale, Beck Depression Inventory, Wechsler Intelligence Scale, Over-valued Ideation Scale and MMPI. The Phenomenology of BDD, its relationship to OCD, and the patients' responses to the above tests were reported. Due to the bizarreness of the symptoms and the secretiveness of the patients, it was suggested that clinicians be thoroughly aware of the disorder and inquire as to its presence during the initial consultation. Otherwise, these patients go unnoticed and they resort to treatment from dermatologists and plastic surgeons.

The literature on the use of cognitively based anger control packages of treatment for people with learning disabilities is reviewed. It is found that the experimental evidence for the effectiveness of such treatment is weak. There is, however, good evidence that two of the components of the package, relaxation and self-monitoring, can be effective in their own right, with relaxation being found to reduce anger and self-monitoring to reduce other challenging behaviours. The use of cognitive procedures with people who have learning disabilities is discussed.

Background: Research concerning the role of attachment and social support in hoarding is currently under investigated. Aims: To investigate whether hoarders experience less social support and more problematic relationships, the degree to which attachment and social support predicts hoarding and whether attachment moderates the relationship between social support and hoarding. Method: Measures of hoarding, attachment and social support were taken in a cross-sectional methodological design. Hoarders were identified via scores reaching caseness on the Savings Inventory–Revised (SI-R). Results: Hoarders (N = 380) reported significantly higher levels of attachment anxiety and avoidance and significantly lower levels of social support than student (N = 670) and community (N = 379) controls. Attachment and social support predicted 13% of total SI-R scores for hoarders, and attachment anxiety (but not avoidance) moderated the inverse relationship between social support and hoarding. Conclusions: Attachment and social support appears problematic for hoarders. Clinical implications and methodological issues are noted.

Background: This study investigated which factors are associated with the therapeutic relationship in Cognitive-Behavioural Therapy for psychosis (CBTp). Method: Measures were taken between sessions two to nine in 24 therapist-client dyads. Clients and therapists completed the Working Alliance Inventory and measures of client (gender, age, ethnicity, positive and negative symptoms of psychosis, length of illness, admissions, social contacts, employment, cognitive insight, reaction to hypothetical contradiction), therapist (empathy, expertness, attractiveness, trustworthiness, number of years qualified and previous CBTp clients seen, confidence in CBTp), and therapy (number of sessions and CBTp interventions carried out, presentation of a formulation) factors. Results: On average, clients and therapists rated the therapeutic relationship as good, with clients giving higher ratings. None of the client variables was related significantly to the quality of the relationship. However, a number of therapist and therapy factors were linked to a better therapeutic relationship, namely clients' ratings of therapist empathy, expertness, attractiveness, and trustworthiness and, at trend level, a greater number of sessions and of CBTp interventions, and the presentation of a formulation. Conclusions: These results suggest that therapists are able to develop a good therapeutic relationship with clients with psychosis, regardless of the severity of the psychosis and the confidence and experience of the therapist, although non-significant findings need interpreting with caution due to the lack of a full range of therapeutic alliances. The findings also suggest that the basic tenets of CBTp, such as empathy and collaborative goals, may be important factors for the development of the therapeutic relationship.

Background: To date there is promising, yet limited, evidence to suggest that differences exist between older and younger adults’ emotion regulation styles. Aims: The study aimed to explore emotion regulation style across the adult lifespan by assessing whether self-reported reappraisal, or suppression, differs across age groups, and how these emotion regulation strategies may impact upon psychological distress. Method: Three hundred and seventeen younger, 175 middle-aged and 85 older adults’ emotion regulation styles and levels of psychological distress were measured using self-report questionnaires and examined using a cross-sectional design. Results: The findings suggest that, compared to younger adults, older adults make greater use of suppression, the emotion regulation strategy. This greater use of suppression by older adults was not related to increased levels of psychological distress. By contrast, younger adults who reported high levels of suppression reported higher levels of psychological distress. In addition, older adults reported less anxiety and stress than younger adults, with no age differences in depression. Conclusions: Findings suggest a possible decoupling of the use of emotional suppression and psychological distress with age. Suppression may be a useful form of emotion regulation for the stressors experienced in later life and, arguably, therefore may not be associated with the negative outcomes observed in younger adults.

Background: Our view is that sleep disturbance may be a contributory causal factor in the development and maintenance of psychotic experiences. A recent series of randomized controlled intervention studies has shown that cognitive-behavioural approaches can improve sleep in people with psychotic experiences. However, the effects of psychological intervention for improving sleep have not been evaluated in young people at ultra-high risk of psychosis. Improving sleep might prevent later transition to a mental health disorder. Aims: To assess the feasibility and acceptability of an intervention targeting sleep disturbance in young people at ultra-high risk of psychosis. Method: Patients were sought from NHS mental health services. Twelve young people at ultra-high risk of psychosis with sleep problems were offered an eight-session adapted CBT intervention for sleep problems. The core treatment techniques were stimulus control, circadian realignment, and regulating day-time activity. Participants were assessed before and after treatment and at a one month follow-up. Results: All eligible patients referred to the study agreed to take part. Eleven patients completed the intervention, and one patient withdrew after two sessions. Of those who completed treatment, the attendance rate was 89% and an average of 7.6 sessions (SD = 0.5) were attended. There were large effect size improvements in sleep. Post-treatment, six patients fell below the recommended cut-off for clinical insomnia. There were also improvements in negative affect and psychotic experiences. Conclusion: This uncontrolled feasibility study indicates that treating sleep problems in young people at ultra-high of psychosis is feasible, acceptable, and may be associated with clinical benefits.

A cognitive-behavioral treatment package aimed at alleviating trichotillomania, or hair-pulling, is presented. It consists of habit reversal and stimulus control to control hair-pulling, and relaxation, cognitive techniques, and role-play to manage the stress that often exacerbates pulling. Relapse prevention is addressed. This program has been applied successfully with several clients.

Background: The study aimed to assess the effectiveness of group and individual formats of a combined motivational interviewing and cognitive behavioral treatment (CBT) program for problem gamblers (PGs) using a randomized controlled design. Method: One hundred and two PGs were randomly assigned to individual or group CBT conditions. Twenty-eight of these participants were randomly allocated to a 6-week waitlist control condition prior to receiving the designated treatment. Results: At post-treatment, there were significant improvements in all dependent variables (frequency and amount gambled, gambling urges, gambling cognitions, negative psychological states, and life satisfaction) for both the treatment conditions but not for the waitlist condition. Individuals that completed the individual (compared to group) treatment condition generally had higher effect sizes for gambling correlates. Therapeutic gains for gambling correlates were generally maintained at 6-month follow-up. Conclusions: A combined motivational interviewing and CBT program applied in group or individual format can improve PG behaviors, as well as gambling correlates.

Recent research indicates the apparent paradox that social anxiety may be associated with both self-focused attention and selective attention to external social threat cues. A naturalistic paradigm was designed to explore both processes. High and low socially anxious individuals were asked to make a speech to a monitor displaying six people whom they believed to be watching them live. Two audience members exhibited only positive behaviours, two only neutral ones and two only negative behaviours. In contrast to the low social anxiety group who selectively discriminated positive audience members, the high social anxiety group selectively discriminated the negative individuals, yet they were no more accurate at discriminating the negative behaviours the audience members had performed and they reported more self-focused attention than the low social anxiety group. The effects remained while covarying for differences in dysphoria. The results indicate that socially anxious individuals base their judgements of being disapproved by others on limited processing of their social environment.

Frequent checkers with obsessive-compulsive disorder (OCD; n=24), high checking controls (n=24) and low checking controls (n=48) were instructed to learn action phrases such as “to open the book” by performing the action themselves with imaginary objects (motor encoding), by imagining how one performs the action oneself (motor-imaginal encoding), by imagining seeing somebody else performing the action (visual-imaginal encoding) and by subvocal rehearsal. Compared to low checking controls, OCD checkers showed poorer free recall of motorically encoded actions and poorer reality monitoring, i.e. they confused motor and motor-imaginal encoding more frequently. The results are consistent with a specific motor memory deficit in OCD checkers. Moreover, memory performance of OCD checkers differed from that of high checking controls.

The National Institute for Clinical Excellence has recommended cognitive behaviour therapy (CBT) for a number of common child and adolescent mental health disorders. The aim of this study was to clarify the practice of CBT within specialist child and adolescent mental health services in the United Kingdom. A survey was distributed to specialist child mental health workers through national organizations and professional bodies. Approximately 10% of specialist CAMHS professionals replied (n = 540). One in five reported CBT to be their dominant therapeutic approach, whilst 40% rarely used CBT. Specialist post-qualification training had been undertaken by 21.0% of respondents, with over two-thirds identifying training needs in the core skills of CBT. This survey suggests that the capacity of specialist CAMHS to meet the requirements of NICE in terms of the availability of CBT skills is doubtful. There is a need to develop CBT training and supervision infra-structures.

Deliberate self-harm (DSH) presents a significant health problem, especially as treatments have not been particularly successful in reducing repetition. Dialectical behaviour therapy (DBT; Linehan, 1993) is one approach that has reported some success in reducing self-harm rates in borderline personality disorder patients, who self-harm frequently, though it remains largely untested outside its original setting. The present study aimed to assess the effectiveness of DBT in self-harming women in an institutional setting in the United Kingdom where self-harm is common. Female patients at Rampton Hospital who were displaying self-harming behaviour and met criteria for borderline personality disorder (N = 10) participated in the full one-year treatment package of DBT. Patients were assessed on self-harm rates and on a number of psychological variables, pre-, during- and post-therapy, including a 6-month follow-up. There was a significant reduction in DSH during therapy, which was maintained at 6-month follow-up. This was paralleled by a reduction in dissociative experiences and an increase in survival and coping beliefs, alongside improvements in depression, suicide ideation, and impulsiveness. The findings are preliminary but the results suggest that DBT might provide an effective treatment for severe self-harm in institutional settings, and also highlight some of the psychological mechanisms that might mediate these improvements in self-harming behaviour.