The National Institute for Clinical Excellence recently published their guidelines on the treatment of depression in children and young people. This article critically reviews these guidelines in terms of their likely impact on BABCP members and the services in which they work. The evidence base that underpins the guideline is very sparse. There is particularly limited information on which to base guidance to therapists working with younger children. The use that has been made of this evidence is discussed, and some controversial interpretations are criticized. Implications for services and therapists are outlined. In particular, attention is drawn to the pressing need for very substantial additional training if the guidelines are to be implemented correctly. Some suggestions for deployment of staff with differing levels of knowledge and expertise in CBT are offered. Finally, challenges for the field as a whole are discussed. In particular, a great deal more research is needed into the effectiveness of psychological therapies versus wait list and versus each other and medications, and into the levels of training required to provide competent CBT to children and adolescents.

The present study examined attentional disruption in the presence of negative automatic thoughts specific to panic and social anxiety. Participants with panic disorder (n = 18), participants with social phobia (n = 19), and nonanxious participants (n = 19) completed a dichotic listening task in which they shadowed ambiguous passages heard in their dominant ear while ignoring lists of panic-related, social anxiety-related, or control automatic thoughts that were presented in their non-dominant ear. In addition, they completed a simultaneous simple reaction time task. Both patient groups made more shadowing distortions than the nonanxious group. Panic participants committed more shadowing omissions in trials in which they heard panic-related automatic thoughts as compared to trials in which they heard other automatic thoughts. Results suggest that both patient groups experienced some disruption on this demanding task but that only panic patients exhibited an anxiety-specific attentional bias.

A new CBT based CD Rom (Williams, Taylor, Aubin, Harkin and Cottrell, 2002) was introduced as a way of offering a clinical psychology waiting-list initiative for patients with depression and depression with anxiety. This study evaluated the impact of this computerized cognitive behavioural therapy (CCBT) on consecutive referrals. Six hourly sessions of the interactive computer programme were offered to clients on the waiting list, to be completed by them with some support from a self-help support nurse. Seventy-eight consecutive referrals were offered an appointment for CCBT; 20 (26%) attended at least one session of CCBT and 14 (70% of starters) completed all six hour-long sessions. Beck Depression Inventory scores (BDI-II) fell from a mean of 28.15 (SD 11.41) to 20.00 (SD 10.41) (p = .000) over the 6-week intervention period using an intention to treat analysis. The discussion asks why only a quarter of patients on this psychology waiting list chose to use a CBT CD-Rom, but also notes that those who did use it had clinically and statistically significant reductions in their reported symptoms of depression.

Our field continues to grow and develop rapidly, not only in terms of the theory and research that underpins our clinical work but also in the breadth and richness of the clinical skills that allow us to apply this knowledge in ways that empower those who seek help from us. Recent submissions to this journal are testament to the growing technology evolving around issues such as training and supervision. The pace of development of the basic and applied science that underpins the work of CBT practitioners is unparalleled. The BABCP and this journal have contributed to and influenced these developments; we need to continue to do so.

A self-directed variant of the Positive Parenting Program (Triple P) was evaluated using 63 preschool-age children at-risk of developing conduct problems. Families were randomly assigned to either Self-directed Triple P (SD), a self-administered behavioural family intervention program, or a waitlist group (WL). The 10-unit SD program teaches parents 17 parenting skills to increase pro-social child behaviours and decrease problem behaviours in home and community settings. Using mothers' reports of child behaviour and parenting practices, mothers in the SD group reported significantly less child behaviour problems, less use of dysfunctional discipline strategies, and greater parenting competence than mothers in the WL group. On measures of parental adjustment, there was no significant difference in conditions at post-intervention based on mothers' reports of depression, anxiety, stress and conflict with partners over parenting issues. Mothers' reports at 6-month follow-up indicated that gains in child behaviour and parenting practices achieved at post-intervention were maintained.

A survey of individuals was conducted on self-diagnosed vomit phobics compared to panic disorder and non-clinical controls. Vomit phobics were overwhelmingly female and had had symptoms for over 25 years. They were significantly more likely to fear themselves vomiting (in public and private situations) than fear others vomiting. The vomit phobics interpreted sensations of nausea as impending vomit and had a wide range of safety seeking and avoidance behaviours that were maintaining their fear. Although the vomit phobics reported feeling nauseous more often, there was no difference in their frequency of vomiting compared to the control group. The clinical implications of the study for therapy are discussed.

Patient characteristics may partly explain individual differences in long-term maintenance of treatment gains in response to cognitive and behavioral therapies (CBT). This study evaluated the relative contribution of negative cognitive style, behavioral activation, and personality patterns, measured at the end of treatment among treatment responders, towards the risk of relapse of major depressive disorder over a 2-year prospective follow-up. The sample included depressed adults who were randomized and received an adequate dose of one of three forms of CBT, who then fully responded and completed a 2-year prospective follow-up (N = 93) (Jacobson et al., 1996; Gortner, Gollan, Dobson and Jacobson, 1998). Cox regression analyses revealed that for treatment responders, self-devaluative depressogenic cognitive style did not predict relapse during the 2-year follow-up. Separate cox regression analyses indicated that without considering the contribution of personality patterns, it was important to distinguish the level of behavioral activation (e.g. frequency of pleasant events) from its associated pleasure in predicting relapse. With the introduction of personality patterns; however, an integrated model revealed that only dependent personality pattern was associated with hazard of relapse during the 2-year prospective follow-up. Dependent personality pattern may increase relapse through behavioral passivity.

In the UK, recent guidelines on the treatment of depression and anxiety recommend CBT-based self-help materials as one important component of services. However, despite being based on specific CBT techniques or “empirically grounded interventions”, early optimism has been dented by data from recent studies that have cast doubt on the effectiveness of the current generation of these materials. As a consequence, it may be necessary to consider that other factors may contribute to the overall magnitude of CBT effects. Indeed, it is logically inconsistent to argue that specific factors are pre-eminent in CBT whilst maintaining that delivery via therapists is more likely to be effective than self-help. The contribution of “common factors” that operate in personal therapeutic encounters, for example, therapist responsiveness and the patient-therapist alliance, may be one possible overlooked reason for the reduced ef-fectiveness of self-help materials. The development of the next generation of self-help materials, therefore, may benefit from the testing of materials that combine common and specific factors, including specific measurement of the strength of common factors and their relationship to clinical outcomes. We discuss a model of such common factors and suggest how they could be incorporated into the next generation of CBT based self-help materials.

Obsessive-compulsive disorder (OCD) is associated with an inflated sense of responsibility to prevent harm. Increasingly, it has been recognized that inflated responsibility is a complex phenomenon. The purpose of this study was to examine how interpersonal aspects of responsibility are related to symptoms of OCD. Three new valid and reliable scales assessing beliefs about other people's responsibility, comparative beliefs about responsibility, beliefs about the allocation of responsibility, and beliefs about how others allocate responsibility were used to evaluate interpersonal influences on responsibility. Whereas personal beliefs about responsibility were related to all OCD symptom types, it appears that beliefs about other people's responsibility were related to only a subgroup of symptom types. Furthermore, the belief that one is more responsible than others predicts OC symptoms beyond commonly assessed personal beliefs about responsibility. Finally, individuals with OC symptoms tend to allocate more responsibility to themselves than others, compared to individuals without OC symptoms, despite the fact that individuals with OC symptoms believe that others tend to allocate responsibility equitably. Results are discussed in terms of cognitive models of OCD.

Befriending (BF) has received attention as a beneficial part of mental health care. For example, when compared with cognitive-behavioural therapy (CBT) for schizophrenia, BF was found to be as effective as CBT in terms of initial symptom improvement (Sensky et al., 2000). Why was the BF apparently so effective? Was the BF really a discrete and powerful intervention? Or was it simply an unrecognized aspect of regular CBT? We addressed these questions by first observing BF's convergence with “social support” (a plausibly discrete treatment) and, second, by examining its divergence from CBT, drawing on archival data. For the convergence prediction we correlated the speech content of therapists' in 10 BF sessions from the Sensky et al. study with previously published social support data from stylists working with people with severe mental health problems in a psychiatric hospital (Milne and Netherwood, 1997). For the second prediction the same 10 BF sessions were compared with a sample of 10 CBT sessions, also from the Sensky et al. study. The results indicated that BF was indeed significantly correlated (converged) with social support (r=0.7; p<.05), and also that it did differ (diverged) significantly from CBT (p<.05). As a treatment fidelity check, therefore, these findings indicate tentatively that the two treatments in the Sensky et al. (2000) study were appropriately implemented. As an analysis of effective interventions for schizophrenia, it cautiously suggests that “social support” merits serious attention, and is perhaps no mere placebo.

In the absence of good quality evidence for the effectiveness of specific aspects or formats of Cognitive Behavioural Therapy (CBT) supervision, it is necessary to consider what is recommended as good quality CBT supervision. This review of the literature aims to provide an overview of the recommended practice of CBT supervision by considering general principles and goals of CBT supervision; the format of individual supervision sessions; the course and stages of CBT supervision; attending to supervisees' cognitions and affects; the importance of the supervisory relationship as well as the recording and rating of therapy sessions. This could provide a framework for setting standards to aspire to and stimulate further research in this field. Conforming to such practice would be an important step toward quality assurance in CBT supervision.

There is increasing evidence that cognitive behavioural therapy (CBT) is efficacious in treating psychosis. However, very little attention has been paid to the nature of the control treatments used in studies of this. Befriending has been used as a control treatment in several randomized control trials (RCTs) of CBT for psychosis as it is simple to learn and administer. The aim of the present study was to examine whether Befriending controlled for important non-specific aspects of therapy when compared to CBT in a RCT for acute first episode psychosis (FEP). These non-specific factors included time in, expectancy created by, and acceptability of therapy. Expectations and enjoyment of therapy were measured by questionnaire. Time in therapy and the number of drop-outs were also recorded. Results showed that Befriending was comparable to CBT on measures of expectancy, enjoyment of therapy and drop-out rate, but significantly different with regard to time in therapy. This suggests that Befriending is a credible and acceptable control therapy for FEP with modification to increase time in therapy sessions. Methodological issues are raised, and suggestions for future research are made regarding control treatments.

Although there has been a long interest in the personality traits associated with obsessive-compulsive disorder (OCD), few studies have examined differences on normal, dimensional personality traits for individuals with OCD compared with other clinical disorders. The purpose of this study was to replicate and extend upon the work of Rector et al. (2002) who found unique associations between OCD and trait domains and facets of the five-factor model of personality (FFM) when compared with a clinical sample of depressed individuals. The current study compared individuals with a current diagnosis of OCD (n=21) with individuals with a current diagnosis of anxiety or depression but no OCD symptoms (n=39) on the Revised NEO Personality Inventory (NEO PI-R Form S). Of particular interest was whether individuals with OCD would differ from other clinically anxious/depressed individuals on the actions facet of the FFM, as this facet is known to be related to harm and risk avoidance, and previous research suggests specific relationships between these forms of avoidance and OCD. Individuals with OCD were found to have lower scores on the actions, competence and self-discipline facets. These results add further support to previous research that suggests unique associations between trait domains and facets of the FFM and OCD.

People with Asperger syndrome (AS) appear to have higher than expected rates of co-morbid psychiatric disorder. The main co-morbid diagnoses are anxiety disorders and depression, but eating disorders, obsessive compulsive disorder, substance abuse and bipolar affective disorder have all been reported. Cognitive Behaviour Therapy (CBT) is used effectively to treat these conditions, so could it be used in people who also have Asperger syndrome? This paper reviews important components and characteristics of cognitive behaviour therapy in relation to its use with people who have Asperger syndrome with reference to the relevant literature and to feedback from people with AS. The use of CBT in people with Asperger syndrome appears promising, but further work is needed to evaluate its effectiveness and to examine which particular aspects of therapy are helpful.

Improving the long-term psychological health of the population is an ambitious but consistent goal in the National Service Framework for Mental Health (MHNSF). Large-scale self-referral psycho-educational Stress workshops, run in one geographical area for members of the general public, had been shown to be effective and to reach those who had not consulted their GPs about their stress problems. A key aim of this study was to explore whether this workshop format, which may help achieve the MHNSF goal, can be generalizable to other areas of differing deprivation. We compared outcome and levels of take-up of Stress workshops run in three geographical areas, differing in degrees of deprivation, as well as characteristics of self-referrers, including baseline scores, sociodemographic details and treatment-seeking patterns. In all three areas, experimental group participants showed less anxiety, stress and distress at 3-month follow-up compared to waiting list control group participants, with no geographical differences in effectiveness. No differences in initial stress and anxiety scores were found. GP consultation rates varied between 50–72%, with the highest consultation rates in the most deprived area. Surprisingly, enquiries about workshops correlated negatively with area deprivation indices. Some sociodemographic differences were found. A certain amount of self-selection for these workshops seems to have occurred; this may be a function of help-seeking for psychological help in deprived areas being different to that in less deprived areas. Nevertheless, large-scale Stress workshops have been found to be equally effective for those who self-referred in areas differing in deprivation, reaching people with stress problems who may not have consulted their GPs. While they did not reach all groups of people, they may have the potential to help improve the psychological health of the population.

This study investigated whether reasoning biases are specific to people with delusions and the role of emotional material on “jumping to conclusions”. Associations between reasoning and cognitive factors as well as other top-down factors such as metacognition were also explored. A comparative design was used to investigate group differences between people with persecutory delusions, people with panic disorder and non-patient controls. A probabilistic reasoning task involving three types of material was utilized to investigate the effect of emotional content on reasoning. Participants also completed questionnaire measures to explore whether hasty decision making was associated with measures of mood or cognitive processes. The results of the reasoning task showed that there was no main effect of group. However, all participants requested significantly less information on the two types of emotional material. None of the questionnaire measures were associated with performance on the reasoning task. Aspects of metacognition were found to be associated with ratings of delusions. This study suggested that between group differences in reasoning were small but that emotional content increases haste of decision making across all groups.

The experience of stigma by individuals with schizophrenia can impact on self-esteem and potential for recovery. Previous attempts to reduce stigma within society have reported variable success. The present study aimed to formulate and evaluate a therapeutic intervention for those who perceive themselves as stigmatized by their mental illness and who suffer low self-esteem. A waiting-list control design with repeated measures within participants was used. Treatment efficacy was evaluated by a principal outcome measure of self-esteem. Ancillary outcome measures included a measure of perceived stigmatization, and two symptom measures. Assessments were completed on four occasions, which covered a waiting list period, a treatment period and a follow-up. All participants (N = 21) received group Cognitive Behavioural Therapy (CBT) focused on stigma and self-esteem. Self-esteem improved significantly following treatment. Levels of depression, positive and negative symptoms of schizophrenia and general levels of psychopathology decreased significantly. A longer-term effect was found for positive and negative symptoms of schizophrenia, and general levels of psychopathology. Participant feedback was predominantly positive. In addition to societal interventions, the potential for limiting the effects of stigma within a therapeutic context should be investigated.

This study aimed to investigate factors associated with persistent Post-Traumatic Stress Disorder (PTSD) in people with Spinal Cord Injury (SCI). In the context of a cognitive model, it sought to determine how influential cognitive appraisals were in predicting persistent PTSD when compared to other known predictor variables in the literature such as injury severity. A sample of 50 inpatients receiving rehabilitation for SCI who were 3–24 months post-injury were interviewed using a series of standardized measures of PTSD symptoms and diagnosis, post-traumatic cognitive appraisals, social support, and injury severity. For PTSD symptoms, significant relationships were found for greater injury severity, lower satisfaction with social support and more negative cognitions. Negative cognitions were found to predict variance in PTSD symptoms over and above the non-cognitive variables, although gender and injury severity were also predictors. The only significant predictor of PTSD diagnosis was the cognitive sub-scale “negative cognitions about the self”. Cognitive appraisals were found to be important predictors of persisting PTSD in an SCI population. This supports the cognitive model of PTSD and the development of cognitive therapies for PTSD in this population.

The purpose of this study was to examine whether counselor adherence to Motivational Interviewing (MI) principles was associated with more productive within-session client behavior in a smoking cessation trial for African American smokers. For these analyses 89 baseline counseling sessions of the trial were audiotaped and coded using the Motivational Interviewing Skill Code (MISC). Counselor adherence indicators included a global subjective rating of MI adherence and the frequency of MI-consistent and MI-inconsistent counselor behaviors described in the MISC. Indicators of productive client behaviors included global subjective ratings of within-session client functioning and counselor-client interaction, as well as the frequency of statements by the client favorable toward changing behavior (“change talk”) and resistant regarding changing behavior (“resist-change talk”). Results provided support for the principles of MI. Counselor adherence indexed by both the global subjective rating and MI-consistent behavior frequency was significantly positively associated with global ratings of within-session client functioning and counselor-client interaction, as well as more change talk.

In cognitive-behavioural therapy with children, young people and families, formulation-based practice ensures that interventions are based on underlying causative and maintaining processes. Importantly, however, developmental, attachment, family, systemic and other perspectives must be incorporated into therapy. This paper describes a template for systemic cognitive-behavioural formulation that facilitates incorporation of the necessary range of perspectives including processes more traditionally expressed through other psychotherapeutic modes of working. Case formulation based on this template is sufficiently comprehensive, yet simple enough to derive collaboratively and leads to a distinct clinical process for working with individuals, families and wider support systems. This generic formulation process is appropriate for use across the range of presentations encountered in child and adolescent mental health practice and provides a structure for therapist training. It requires formal evaluation and has implications for future research.