Background: Although worry is common in children, empirical models of worry remain largely untested in youth. A small number of studies have established preliminary links between cognitive variables and worry in children younger than 12 years old. These cognitive variables include positive and negative beliefs about worry, intolerance of uncertainty, and problem orientation. Aims: The current study examined these variables concurrently and their association with worry. We also examined the extent to which intolerance of uncertainty mediated the association between worry and beliefs about worry. Method: Eighty elementary school children aged 8 to 12 years completed a battery of self-report measures. Results: As a group, the cognitive variables significantly predicted worry scores; negative beliefs about worry was the only significant individual predictor. As a group, the four cognitive variables discriminated clinical from nonclinical levels of worry; positive beliefs about worry and intolerance of uncertainty were the only significant individual predictors. Finally, intolerance of uncertainty mediated the association between worry and both positive and negative beliefs about worry. Conclusions: Components of a cognitive model of worry are largely applicable to children. Negative beliefs about worry were associated with worry across the continuum, while intolerance of uncertainty and positive beliefs about worry were more strongly associated with clinical levels of worry. Intolerance of uncertainty accounted for a significant portion of the association between metacognition and worry and may be a particularly effective target for treatment. Further implications for conceptual models and treatment interventions are discussed.

David Westbrook, who died tragically in a road traffic accident in April, was a stalwart of the CBT world. He was a man of substantial physical and psychological heft and has left an equally substantial hole. He is missed by an extraordinarily range of people, as messages on the Oxford Cognitive Therapy Centre (OCTC) website from people whose lives he touched attest.

Background: Agoraphobia is disabling and clients find it hard to access effective treatment. Aims: This paper describes the development of an inexpensive service, delivered by trained volunteers in or near the client's own home. Method: We describe the development of the service, including selection, training and supervision. Outcomes were evaluated over 5 years, and compared with those available from the local psychology service. Results: Effect sizes on all measures were high. Benchmarking indicated that results on comparable measures were not significantly different from the local psychology service. As in many previous studies drop-out rate was fairly high. Conclusions: This model worked well, and was inexpensive and effective. Further research on long term outcome and methods of enhancing engagement is needed.

Background: There has been an increased effort to understand the nature of obsessive-compulsive disorder (OCD) in non-Western cultures. In particular, growing research has examined OCD in China, but there are no comprehensive instruments that measure both OCD severity and heterogeneity for characterizing samples. Aims: A validated, comprehensive measure that could be used in China would provide researchers with a useful instrument for evaluating severity and heterogeneity of OCD in a non-Western culture, allowing researchers to better understand the universal and cultural components that play a role in the nature of OCD. Method: The current investigation presents data on the reliability and validity of a Mandarin translation of the Obsessive-Compulsive Inventory-Revised (CH-OCI) using both a student (n = 1950) and clinical sample (n = 50 patients with OCD; n = 50 patients with anxiety as a comparison group). Results: Results support the factor structure, convergent and discriminant validity, criterion-related validity, test-retest reliability, and internal consistency of the CH-OCI. Conclusions: Validation of the instrument permits researchers and clinicians to measure OCD presentation in Mandarin-speaking samples.

Background: Distressing visual hallucinations (VH) are frequently present in schizophrenia. Despite their prevalence, limited research exists regarding effective clinical interventions. Cognitive models of VH state that distress results from threat appraisals of the hallucination. Method: This individual case study describes the use of a graded exposure approach following the discovery of phobic anxiety associated with visual hallucinatory content. Treatment involved 20 sessions of individual cognitive behaviour therapy (CBT), of which 12 sessions focused on graded exposure. Results: A reduction in frequency of visions and associated distress was reported and these changes were maintained at a 3-month follow-up. Conclusions: The findings are consistent with the cognitive model of VH. Through exposure to the hallucinatory content, the client re-appraised her VH as non-threatening, and her fear of them reduced. This reduction in anxiety led to a decrease in the occurrence of the VH.

Background: The efficacy of CBT for unipolar depressive disorders is well established, yet not all patients improve or tolerate treatment. Aims: To identify factors associated with symptomatic outcome, response, and drop-out in depressive patients under naturalistic CBT. Method: 193 patients with major depression or dysthymia were tested. Sociodemographic and clinical variables were entered as predictors in hierarchical regression analyses. Results: A higher degree of pretreatment depression, early improvement, and completion of therapy were identified as predictors for symptomatic change and response. Drop-out was predicted by concurrent personality disorder, less positive outcome expectancies, and by failure to improve early in treatment. Conclusions: Our results highlight the importance of early response to predict improvement in routine CBT. Attempts to refine the quality of treatment programs should focus on avoiding premature termination (drop-out) and consider motivational factors in more depth. Routinely administered standardized assessments would enhance symptom monitoring and help to identify persons at risk of not improving under therapy.

Background: Studies have shown that the intolerance of uncertainty may play a key role in the aetiology and maintenance of worry and generalized anxiety disorder. Aims: This study investigated the psychometric properties of the Chinese version of Intolerance of Uncertainty Scale (IUS), which had already been validated in French and English versions. Method: In a large college student sample (N = 940), the factor analysis and regression analyses were performed on the IUS. Results: The IUS had excellent internal consistency (α = 0.90) and good test-retest reliability (r = 0.75) over a 5-week period. Factor analysis showed that the IUS had a four-factor solution. Finally, the regression analysis demonstrated that IU contributed significantly to worry, after controlling for demographic variables and levels of anxiety and depression. Conclusions: The Chinese version of the IUS was a sound scale for assessing IU and the intolerance of uncertainty was an important influencing factor on worry.

Background: Drug-facilitated sexual assault (DFSA) has emerged as a distinct category of sexual victimization and precipitates posttraumatic stress disorder (PTSD). Few studies have examined the distinct psychological aspects of PTSD caused by DFSA. Gauntlett-Gilbert, Keegan and Petrak (2004) represent a notable exception and draw on cases, from their clinical experience, treated using Ehlers and Clarks' (2000) cognitive therapy (CT). Aims: This paper aims to further develop and refine clinical knowledge on CT for PTSD arising from DFSA and advance the findings of Gauntlett-Gilbert et al. (2004). Method: Systematic case based research was used to investigate the applicability of CT for PTSD related to DFSA. Three survivors were treated with CT within the South African context. Results: The case series corroborated existing findings but also documented the presence of somatic and visual intrusions among survivors with partial or complete amnesia for rape and illustrated the utility of imagery interventions in targeting intrusions. The study highlighted the role of physical paralysis in DFSA in compounding helplessness/powerlessness and the necessity of enhancing physical agency and building social support. Conclusion: Distinctive aspects of PTSD related to DFSA can be effectively treated by adapting CT to suit this population group.

Background: New technologies have slowly become a part of psychologists’ therapeutic office. However, many therapists still have doubts about the possibility of creating a good therapeutic relationship with patients in the presence of technology. Aims: This study evaluates the development of the therapeutic alliance in individuals with small animal phobia disorder who were treated with Augmented Reality Exposure Therapy or In Vivo Exposure Therapy. Method: Twenty-two participants received an intensive session of cognitive behavioural therapy in either a technology-mediated therapeutic context or in a traditional therapeutic context. Results: The results show no significant difference for the therapeutic alliance between two conditions. Conclusions: The results seem to show that technologies such as Augmented Reality do not represent a danger to negatively influence the therapeutic alliance.