Behavioural and Cognitive Psychotherapy is growing

There has been a steady increase in the flow of manuscripts to this journal, and I'm glad to say that the quality of submissions has commensurately improved. However, these trends have obviously created a problem, which is that there was simply not enough space for the range of excellent articles we have been receiving. The Association has therefore decided to increase the size of the journal by 25%. This should allow us to sustain a relatively short publication lag, and to maintain the mix of high quality clinical, theoretical and research material that has been the hallmark of the journal. Thanks to Cambridge University Press, particularly Janet Miles, for continued support and in making the transition to the larger size so straightforward. Of course, one of the reasons that we receive so many manuscripts is the fact that we are now one of the largest circulation journals in the field.

As ever, there are other changes in the journal. Nick Tarrier leaves us after a very long and distinguished period as assistant editor. Thanks to you Nick (but don't assume that this means that you won't get more manuscripts!) Within the editorial office during 2000 we have had additional assistance from Patrick McKnight, who has now moved on, and we would like to thank him for the excellent work he put in. Caroline Bradley has retired from the post of assistant editor; we are grateful to her for her work in this capacity. By way of consolation for our editorial losses, Hermine Graham and Elizabeth Kuipers have joined the editorial team as assistant editors. I'm looking forward to working with them over the coming years.

People with sleep-onset insomnia commonly attribute their difficulty falling asleep to intrusive thoughts, worries, or “a racing mind”. Previous research has implicated strategies of thought control in the maintenance of symptoms in a number of psychological disorders. The purpose of the present study was to compare individuals diagnosed with insomnia (n = 30) and good sleepers (n = 29) for the strategies employed to manage cognitive activity during the pre-sleep period. Reappraisal, worry, and suppression were employed more by participants with insomnia than by good sleepers. Good sleepers employed social control, replacement, suppression, and reappraisal strategies most frequently, whereas the strategies most frequently employed by insomniacs were suppression and reappraisal. The results are discussed in terms of the role of strategies employed to manage pre-sleep cognitive activity in the maintenance and reversal of insomnia.

Relationships between obsessive-compulsive symptoms and several cognitive constructs that are theoretically related to such symptoms were investigated among university students. A total of 211 subjects filled in a measure of the frequency of intrusive thoughts based on Clark and de Silva (1985), Salkovskis' Responsibility Attitudes Scale (RAS) (Salkovskis et al., 2000), the Thought-Action Fusion Scale (TAF) (Shafran, Thordarson, & Rachman, 1996), Wegner and Zanakos' (1994) White Bear Suppression Inventory (WBSI), and the Maudsley Obsessive-Compulsive Inventory (MOCI) (Hodgson & Rachman, 1977). The main hypothesis addressed was that in accordance with Salkovskis' model (1996) responsibility and thought suppression serve as mediators between intrusive thoughts and obsessive-compulsive symptoms as measured with the MOCI. The results were consistent with the model.

Therapy process research has made surprisingly little headway during the past 25 years, which has been attributed to a range of methodological and conceptual problems. As a result, appeals have been made for fresh approaches to psychotherapy process research. Here we provide an experiential learning model as one promising way to crystallize conceptualizations of competence in therapy and to advance research. The model provides an integrative account of the moderators and mediators believed to explain the way that therapy achieves its outcomes. Its breadth takes it beyond the scope of its closest rival, the assimilation model. By way of illustration, the theoretical components of the experiential metaphor were operationalized and mapped onto an existing competence scale, the Cognitive Therapy Scale.

In a near miss experience, a person learns anxiety despite the fact that the feared outcome does not actually occur. Theories based on S-R links or direct encoding of emotional memories do not provide a good model of near miss learning because they fail to account for informational variables. An alternative cognitive model is outlined, based on expectancy of an inferred negative outcome. The model is applied to posttraumatic stress disorder, in which the critical feared outcome is often death, and panic disorder, in which a near miss inference may protect expectancies of harm from disconfirmation. Unlike direct emotional encoding models, the inferential/expectancy model provides multiple cognitive targets for treatment. Near miss learning may be usefully distinguished from other pathways to anxiety, and warrants further experimental investigation.

Results are presented from a randomized controlled trial indicating which psychotic symptoms respond to cognitive behaviour therapy. The aim of the study was to investigate whether different types of psychotic symptoms are more or less responsive to cognitive-behaviour therapy compared to treatment received by control groups. Seventy-two patients suffering from chronic schizophrenia who experienced persistent positive psychotic symptoms were assessed at baseline and randomized to either cognitive-behaviour therapy and routine care, supportive counselling and routine care, or routine care alone and were re-assessed after 3 months of treatment (post-treatment). Independent and blind assessment of outcome indicated delusions significantly improved with both cognitive behaviour therapy and supportive counselling compared to routine care. Hallucinations significantly decreased with cognitive-behaviour therapy compared to supportive counselling. There was no difference in the percentage change of hallucinations compared to delusions in patients treated by cognitive behaviour therapy. There was little change in measures of affective symptoms but there was no evidence that a reduction in positive symptoms was associated with an increase in depres sion. In fact, a reduction in positive symptoms was positively correlated with a reduction in depression. There were significant differences in the reductions in thought disorder and negative symptoms with an advantage of cognitive-behaviour therapy compared to routine care.

This research investigated the efficacy of an operantly cognitive-behavioural trauma treatment protocol (TTP) in two cases that had previously been treated unsuccessfully with EMDR. In line with previous research, both participants improved following TTP, to the extent where one of the participants was asymptomatic at post-treatment and 3 month follow-up. These cases also demonstrate the ability of a cognitive-behavioural intervention to successfully treat childhood sexual abuse victims later in life.

This study describes the treatment of severe obsessive-compulsive disorder in a 14-year-old male with an experimental single case design. Onset of OCD was at age 12. He had been hospitalized for 6 months the year before consulting. Almost all life spheres were affected by OCD. An initial behavioural intervention, which targeted tooth brushing, was used as a springboard to understand OCD and the process of change was framed within a cognitive account of OCD. The approach was then applied to a number of different targets within a unified framework. There was a 46% reduction in Y-BOCS score at post-treatment and 67% reduction through to 11-month follow-up. Points discussed include the involvement of other professionals, the changing role of the family as treatment progressed and as the patient started to seek more autonomy, and the choice of the initial target.

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.

Memory bias for weight and shape, and for food related words, was investigated in women with bulimia nervosa (12), women with depression (12) and female nonclinical controls (18). The aim of this study was to investigate whether women with bulimia nervosa demonstrate memory biases congruent with their primary concerns. Participants listened to target and control words. They performed a self-referent encoding task and recall memory was assessed. The results indicated that women with bulimia nervosa demonstrated a bias to recall positive and negative weight and shape related words compared to emotional words, but not compared to neutral nouns and body words. Memory biases for food related words were not found to be specific to women with bulimia nervosa, but were also found in women with depression. Contrary to previous research the recall bias for food related words was related to levels of hunger, in both groups. The findings provide partial support for memory biases for weight and shape, but not food related information in bulimia nervosa. These findings and their implications for existing research on information processing in eating disorders are discussed.

We used a negative priming paradigm to test for deficits in cognitive inhibition in patients with obsessive-compulsive disorder (OCD), and to examine whether they exhibit greater inhibitory deficits when lexical targets are threat-related than when they are neutral. The results indicated that OCD patients, relative to healthy control participants, exhibited only marginally significant (p < .10) deficits in negative priming at short (100 ms), but not long (500 ms), stimulus onset asynchronies. There was no evidence that OCD patients exhibited disproportionate difficulty inhibiting negative words, nor was there any evidence that negative priming deficits differed between OCD checkers and OCD noncheckers.

This study (part of a larger one whose main outcomes were reported by Marks, Lovell, Noshirvani, Thrasher, & Livanou, 1998) investigated the impact of exposure therapy and cognitive restructuring alone and combined on the individual symptoms of PTSD and on associated features. Exposure therapy was expected to act mainly on fear and avoidance, and cognitive restructuring mainly on detachment, restricted range of affect, and associated features of PTSD. Seventy-seven PTSD outpatients were randomly allocated to one of four treatments: 1) exposure alone; 2) cognitive restructuring alone; 3) combined exposure and cognitive restructuring; or 4) relaxation (placebo control). The active treatments were superior to relaxation in improving clusters of PTSD symptoms and associated features and some but not all individual symptoms and associated features of PTSD. Exposure and cognitive restructuring improved almost all individual symptoms similarly.

This study investigated the effectiveness of an Internet-based intervention for people with panic disorder. Twenty-two participants met criteria for panic disorder and were randomly assigned to either the treatment or a self-monitoring control condition. The study took place over 3 weeks and consisted of one week of self-monitoring prior to the intervention group accessing the program for one week, followed by one week of post-intervention assessment. Participants were assessed on measures pertaining to panic, negative affect, body vigilance, anxiety sensitivity and self-efficacy in managing panic. The treatment condition was associated with significant reductions in all variables except anxiety sensitivity and depressive affect. This type of intervention for people with fearful panic attacks holds promise as an efficacious and economical method for treating spontaneous panic.