Paranoia is often accompanied by distressing intrusions associated with traumatic memories, yet one of the best-evidenced interventions, imagery rescripting (IR), is not routinely offered. This is likely to be due to poor understanding of the effects of IR on postulated mechanisms of change as well as the absence of a robust evidence base.

This study aimed to establish proof of principle that IR impacts key cognitive-affective processes associated with distressing intrusions – memory characteristics and self-representations – and level of paranoia.

We used a within-subject repeated measures design to examine the effect of single-session IR on memory characteristics (level of intrusions, vividness, distress, encapsulated belief strength, emotion intensity and frequency), self-representation variables, affect and paranoia. Fifteen participants were seen once before and once after the IR session, to gather baseline and follow-up data.

As predicted, participants reported reductions in memory characteristics, improved self-esteem and positive affect, and reduced negative affect and paranoia, with large effect sizes. These effects were maintained at follow-up.

While a within-subject design is useful for initial exploration of novel interventions, controlled studies are needed to determine causality. This is the first study to examine mechanisms of IR in paranoia. A controlled trial is now warranted.

Therapist validation in treatment is theorized to be related to positive outcomes (Linehan, 1993), including keeping patients in therapy longer.

We sought to evaluate the role of therapist validation from both therapists’ and clients’ perspectives as a predictor of drop-out from psychotherapy in three cognitive behavioural training clinics.

Clients in psychotherapy (n = 50; 80% female; 82% Caucasian) and their trainee therapists (n = 22; 68% female; 86% Caucasian) rated validation by the therapist at each of four early sessions of therapy.

After accounting for symptom severity, clients who reported greater therapist validation were less likely to drop out of treatment. Therapist ratings of their own validating behaviours were unrelated to client drop-out. Therapist experience moderated the relation between client-rated validation and drop-out, such that validation was unrelated to drop-out for more experienced therapists.

Assessing and attending to client perceptions of validation by the therapist early in treatment, with brief self-report inventories, can alert therapists to clients at greater risk of drop-out.

A novel CBT-based intervention, tailored for young people, was developed in response to concerns about traditional diagnostically based approaches. Psychology of Emotions workshops use a normative approach to emotional difficulty instead of a diagnostic framework.

To evaluate the acceptability and efficacy of Psychology of Emotions workshops within an IAPT service for young people aged 16–25 years.

This was a mixed-methods study, evaluating routinely collected self-report measures of depression and anxiety, and qualitative feedback forms. The main outcomes were rates of attendance, change in symptom severity, and participant views of the intervention.

From January to September 2016, 595 young people were invited to attend the Psychology of Emotions workshops, of whom 350 (58.8%) attended at least one session. Young people who attended all six sessions (8.1%) experienced significant reductions in self-reported anxiety (d = .72) and depression (d = .58) and 35.5% were classified as recovered at completion. Those who attended at least two sessions (41.3%) reported smaller but significant improvements in anxiety (d = .42) and depression (d = .45); 22.0% were classified as recovered at the last session attended. Participants provided largely positive feedback about the intervention.

Psychology of Emotions is a promising treatment option, delivered outside of a diagnostic framework, for young people with mild to moderate mental health difficulties seen within IAPT services. Better understanding reasons for non-attendance might enable the intervention to be made accessible to more young people.

Post-traumatic stress but also aggressive attitudes and behaviour can be found in adolescents living in a context of ongoing community and gang violence in the low-income urban areas of Cape Town, South Africa.

We investigated the long-term effects (15–20 months after therapy) of (a) Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET) and (b) the cognitive behavioural intervention ‘Thinking for a Change’ (CBT) on post-traumatic stress disorder (PTSD) and aggression compared with a waiting list.

Fifty-four young males participated in the treatment trial, of which 17 completed the FORNET intervention, 11 the CBT intervention, and 26 were on a waiting list. The primary outcome was the change score for the Appetitive Aggression Scale; secondary outcomes were the PTSD Symptom Scale-Interview change scores, and the number of perpetrated violent event types.

The reduction in scores for PTSD that had been observed in FORNET completers at the first follow-up were still significant at the second long-term follow-up (Cohen’s d = 0.86). In this treatment arm (FORNET), the scores for appetitive aggression were also significantly reduced (Cohen’s d = 1.00). There were no significant changes observed for CBT or for the waiting list.

The study indicates that FORNET can successfully reduce post-traumatic stress as well as the attraction to violence even for individuals living under conditions of continuous traumatic stress.

Research has long investigated the cognitive processes in the treatment of depression, and more recently in panic disorder (PD). Meanwhile, other studies have examined patients’ cognitive therapy skills in depression to gain insight into the link between acquiring such skills and treatment outcome.

Given that no scale exists to examine in-session patient use of panic-related cognitive behavioural therapy (CBT) skills, the aim of this study was to develop a new measure for assessing patients’ cognitive and behavioural skills in CBT for PD.

This study included 20 PD patients who received 12 weekly individual therapy sessions. The Cognitive Behavioral Therapy Panic Skills (CBTPS) rating system was developed. Three independent raters coded tapes of therapy sessions at the beginning and end of treatment.

The coefficient alphas and inter-rater reliability were high for the cognitive and behavioural subscales. Improvement in the patients’ CBTPS scores on both subscales indicated overall symptom improvement, above improvement in anxiety sensitivity.

To our knowledge, this is the first study examining the impact of patient acquisition of CBT PD skills on treatment outcome. A new measure was developed based on the observations and was deemed reliable and valid. The measure facilitates the examination of the mechanisms of change in treatment for PD. An in-depth examination of the CBTPS may refine our understanding of the impact of each skill on PD treatment outcome. Further research relating to acquiring CBT skills could shed light on the mechanisms of change in treatment.

To better understand the maintenance of chronic fatigue syndrome (CFS), a valid and reliable measure of cognitive and behavioural responses to symptoms is required. Such a measure could also assess beliefs and coping behaviours in the context of fatigue in other somatic conditions.

We aimed to establish the psychometric properties of both the Cognitive and Behavioural Responses Questionnaire (CBRQ) and its shortened version (CBRQ-S) in adolescents with CFS.

The full questionnaire was completed by a clinical cohort of adolescents (n = 121) presenting to specialist CFS units in the UK.

Both the CBRQ and CBRQ-S had good internal consistency. The CBRQ scores were strongly associated with depression, anxiety, school and social functioning, but weakly associated with fatigue and physical functioning, providing evidence of validity.

Both the 40-item and the 18-item versions of the CBRQ were found to be reliable and valid in adolescents with CFS. To minimize unnecessary burden, the 18-item version is favoured. Using this assessment tool in future studies, including intervention studies, may help to better target interventions during clinical practice and improve outcomes.

‘DISCOVER’ one-day cognitive behavioural therapy (CBT) workshops have been developed to provide accessible, developmentally sensitive psychological support for older adolescents experiencing emotional difficulties. Previous school-based evaluations of the DISCOVER model have shown positive outcomes.

The current study aimed to test the model for clinically referred adolescents, in real-world settings.

A randomized controlled trial (RCT) assessed feasibility, acceptability and preliminary outcomes of the DISCOVER intervention, in comparison with usual care, for 15- to 18-year-olds with emotional difficulties. Participants were recruited from outpatient clinic waiting lists in UK child and adolescent mental health services (CAMHS). Research feasibility indicators included rates of recruitment, randomization, intervention participation (group workshops and individualized follow-up telephone calls), and data collection (at baseline and 8-week follow-up). Intervention acceptability was assessed using a structured service satisfaction questionnaire and semi-structured qualitative interviews with intervention participants. Preliminary clinical outcomes were explored using adolescent-reported validated measures of depression, anxiety and well-being.

n = 24 participants were randomized to intervention and usual care groups. Workshop attendance was good and high levels of treatment satisfaction were reported, although feasibility challenges emerged in recruitment and randomization. Trends were found towards potential improvements in anxiety and well-being for the intervention group, but the effect estimate for depression was imprecise; interpretability was also limited due to the small sample size.

DISCOVER appears to be a feasible and acceptable intervention model for clinically referred 15- to 18-year-olds with emotional difficulties. A full-scale RCT is warranted to evaluate effectiveness; protocol modifications may be necessary to ensure feasible recruitment and randomization procedures.

Social feedback in the virtual environment is a critical part of successful virtual reality exposure therapy (VRET), and identifying the influences of virtual social feedback on social anxiety patients is necessary.

The present study aimed to explore the influences of ambiguous and negative virtual social feedback on social anxiety patients and a health control group (HCG).

Twenty-six social anxiety patients and 26 healthy participants were recruited. All participants were exposed to a virtual public speaking scenario. The participants were required to make two 3-minute speeches while the virtual audiences gave them either ambiguous feedback or negative feedback. The subjective units of discomfort (SUD) and heart rate were collected during the process.

The results showed that SAD individuals reported higher levels of subjective anxiety than those in the HCG, and the between-group differences were larger in the mild ambiguous condition than in the intense negative condition.

This study indicates that social anxiety patients have an interpretation bias towards ambiguous virtual social feedback. Therefore, it is important for VR-based interventions to take into account not only the valence of the feedback but also the ambiguity aspect.

Acceptance and commitment therapy (ACT) is a psychological treatment that has been found to increase weight loss in adults when combined with lifestyle modification, compared with the latter treatment alone. However, an ACT-based treatment for weight loss has never been tested in adolescents.

The present pilot study assessed the feasibility and acceptability of a 16-week, group ACT-based lifestyle modification treatment for adolescents and their parents/guardians. The co-primary outcomes were: (1) mean acceptability scores from up to 8 biweekly ratings; and (2) the percentage reduction in body mass index (BMI) from baseline to week 16. The effect size for changes in cardiometabolic and psychosocial outcomes from baseline to week 16 also was examined.

Seven families enrolled and six completed treatment (14.3% attrition). The mean acceptability score was 8.8 for adolescents and 9.0 for parents (on a 1–10 scale), indicating high acceptability. The six adolescents who completed treatment experienced a 1.3% reduction in BMI (SD = 2.3, d = 0.54). They reported a medium increase in cognitive restraint, a small reduction in hunger, and a small increase in physical activity. They experienced small improvements in most quality of life domains and a large reduction in depression.

These preliminary findings indicate that ACT plus lifestyle modification was a highly acceptable treatment that improved weight, cognitive restraint, hunger, physical activity, and psychosocial outcomes in adolescents with obesity.

One method for appraising the competence with which psychological therapy is delivered is to use a structured assessment tool that rates audio or video recordings of therapist performance against a standard set of criteria.

The present study examines the inter-rater reliability of a well-established instrument (the Cognitive Therapy Scale – Revised) and a newly developed scale for assessing competence in CBT.

Six experienced raters working independently and blind to each other’s ratings rated 25 video recordings of therapy being undertaken by CBT therapists in training.

Inter-rater reliability was found to be low on both instruments.

It is argued that the results represent a realistic appraisal of the accuracy of rating scales, and that the figures often cited for inter-rater reliability are unlikely to be generalizable outside the specific context in which they were achieved. The findings raise concerns about the use of these scales for making summative judgements of clinical competence in both educational and research contexts.

Metacognition refers to the ability to evaluate and control our cognitive processes. While studies have investigated metacognition in schizophrenia and clinical high risk for psychosis (CHR), less is known about the potential mechanisms which result in metacognitive deficits.

We aimed to investigate whether neurocognitive functions including attention, working memory, verbal learning and executive functions predicted the tendency to focus on one’s thoughts (cognitive self-consciousness) and beliefs in the efficacy of one’s cognitive skills (cognitive confidence).

Participants (130 CHR individuals) were recruited as part of the multi-site PREDICT study. They were assessed using the Metacognitions Questionnaire (MCQ) as well as measures of executive function (WCST), attention (N-Back), working memory (LNS) and verbal learning (AVLT).

Cognitive competence was negatively correlated with N-Back while cognitive self-consciousness was positively correlated with N-Back and LNS. Linear regression analysis with N-Back, AVLT, LNS and WCST as predictors showed that neurocognition significantly predicted cognitive self-consciousness, with N-Back, LNS and WCST as significant predictors. The model accounted for 14% of the variance in cognitive self-consciousness. However, neurocognition did not result in a significant predictive model of cognitive competence.

Neurocognition was associated with an increased focus on one’s thoughts, but it was not associated with higher confidence in one’s cognitive skills. Neurocognition accounted for less than one-sixth of the variance in metacognition, suggesting that interventions that target neurocognition are unlikely to improve metacognitive abilities.

The cognitive restructuring of maladaptive beliefs within many cognitive behavioural psychotherapies typically encourages the client to undertake self-reflection. However, whilst self-consciousness can aid self-regulation, it is also implicated in a broad Grange of psychopathologies. The extent to which self-consciousness is associated with psychological distress is yet to be fully determined, but recent literature suggests that irrational beliefs, as proposed within rational emotive behaviour theory (REBT) may play an important role.

The aim of the study was to test the mediational effects of self-consciousness, specifically reflection and rumination, on the relationship between irrational beliefs and psychological distress. Based on past research, it was hypothesized that reflection and rumination would mediate the positive relationship between irrational beliefs and psychological distress. We expected irrational beliefs to interact with rumination to positively predict psychological distress, and irrational beliefs to interact with reflection to negatively predict psychological distress.

The present research tested a structural equation model (SEM) in which rumination and reflection mediated the relationship between irrational beliefs and psychological distress.

Results indicated that rumination mediates the positive relationship between irrational beliefs and psychological distress. However, in contrast to our hypotheses, significant mediation did not emerge for reflection.

This study is the first to show how irrational beliefs and rumination interact to predict psychopathology using advanced statistical techniques. However, future research is needed to determine whether similar mediational effects are evident with rational beliefs as opposed to irrational beliefs.

There is limited research into the experiences of receiving and providing help in the context of hoarding disorder.

The present study aimed to explore the experiences of older people with hoarding difficulties receiving help and volunteers providing support to people with hoarding problems.

Qualitative methods were adopted to investigate the lived experience of participants. A total of seven volunteer helpers and four people with hoarding disorder were recruited and interviewed using a semi-structured interview, designed to explore experiences of providing and receiving help. Qualitative analysis of the interview data was performed using interpretive phenomenological analysis.

Four superordinate themes were identified: relationship between client and volunteer; ‘live life again’; challenges; and supporting volunteers. The relationship was crucial in providing a trusting foundation from which clients felt able to move forward. Volunteers provided a space for clients to talk and appropriate self-disclosure helped to build a relationship. The informal and ‘non-professional’ status of volunteers enabled clients to take the lead and feel more in control of the therapeutic process. Volunteer flexibility and lack of time constraints contributed to clients ‘making space’ for themselves, both in their home and their lives. The support from volunteers enabled clients to ‘live life again’ and created a domino effect, bringing about improvements in other areas of their lives.

The findings are discussed in relation to the training of health professionals to work with people with hoarding difficulties and the implications of the findings for treatment approaches and service provision.