Self-help materials can be offered to clients/patients either for use alone (unsupported self-help) or to support work with a health care practitioner (supported self-help). Structured self-help materials that use a Cognitive Behaviour Therapy (CBT) treatment approach have been shown to be clinically effective. We report a national survey of all 500 cognitive and behavioural psychotherapists registered with the British Association for Behavioural and Cognitive Psychotherapies, the lead organisation for CBT in the United Kingdom. A total of 265 therapists responded (53%). Self-help materials were used by 88.7% of therapists and were mostly provided as a supplement to individual therapy. Self-help was most frequently used to help patients experiencing depression, anxiety and obsessive compulsive disorder and was largely delivered using paper-based formats. The majority of self-help materials used a CBT approach. Only 36.2% of therapists had been trained in how to use self-help treatments, and those who had received training recommended self-help treatments to more clients/patients per week and rated self-help approaches as being significantly more helpful than those who had not received training.

The objective of this study was to evaluate a multi-component behavioral intervention for child distress during repeated needle sticks. An AB single-subject experimental design with replication of procedures across five subjects was used to assess intervention effects on distress and procedure duration for five children (age 3–7 years). Playing preferred activities, signaled button pressing, and following directions were positively reinforced first during simulated then actual needle procedures. The results indicate that distress decreased substantially for three children, slightly for a fourth and was unchanged for one. Heart rate (HR) data obtained from one child provided preliminary evidence of counterconditioning. For three children with follow-up data, benefits were maintained after intervention transfer to caregivers. In conclusion, distraction and counter-conditioning appear to be compatible conceptualizations for designing interventions to reduce the distress of experienced children who undergo repeated invasive procedures. The independent and synergistic effects of behavioral interventions based on these two theories should be examined in future studies.

The reformulated balanced states of mind (BSOM) model (Schwartz, 1997) proposed new cognitive-affective set-point ratios based on a mathematical model of consciousness (Lefebvre, 1990) to differentiate among pathological, normal and optimal balances. Using data derived from the Affects Balance Scale (Derogatis, 1975), the reformulated set-points were empirically evaluated by tracking changes in affect balance SOM (ratio of positive to total affect) in 66 depressed male outpatients undergoing cognitive-behavior therapy (n = 45) or pharmacotherapy (n = 21). Confidence interval estimations indicated that across treatments both remitted (SOM = .35) and unremitted (SOM = .35) patients had pathological pretreatment affect balances near the predicted set-point (.38). At post-treatment, affect balance for remitted patients (SOM = .74) progressed to a normal dialogue near the predicted set-point (.72), whereas unremitted patients maintained a negative balance (SOM = .41). Using Hamilton and Global Assessment Scale ratings, remitted patients were classified into average and optimal responders. At post-treatment, average responders achieved an affect balance (SOM = .70) near the normal dialogue set-point (.72), whereas optimal responders progressed to an affect balance (SOM = .81) at the optimal dialogue set-point (.81), supporting the theoretical distinction between normal and optimal balance. A mathematically generated measure that distinguishes normality and optimality permits increased quantitative precision in comparative psychotherapy outcome research.

The historical origins of the case formulation approach to assessment and treatment are described and its role in clinical practice and research discussed. It is argued that treatment based on individual case formulations should not be precluded from clinical trials. The empirical evidence for the reliability and efficacy of case formulation is reviewed. The evidence that an idiosyncratic case formulation approach to treatment has any advantage over a standard protocol is equivocal; however, the studies that have been carried out are under powered and potentially suffer from a Type II error. The standard procedure for case formulation is briefly described and the argument advanced that this method of clinical assessment should be soundly based upon empirical evidence and hypothesis testing and not on speculation. Three modifications are suggested to the current practice of case formulation. These are: 1) the conceptualization of dysfunctional systems in the maintenance of clinical problems; 2) the historical background of a clinical problem should be described in terms of vulnerabilities and epidemiological evidence-base; and 3) the pivotal role of social behaviour and context should be emphasized and accommodated in a formulation. The advantages of a case formulation, in providing an understanding of the maintenance of clinical problems, in providing an integrated approach to intervention are outlined.

Recently, several RCTs have provided preliminary evidence that cognitive-behavioural therapy (CBT) is effective in the treatment of people suffering from schizophrenia. However, none of these trials has provided complete demonstrations of therapist adherence. Since no suitable scale existed already, the authors devised the Cognitive Therapy for Psychosis Adherence Scale (CTPAS). The main aim of the present research was to test whether the 12 items of this scale could be rated reliably. Ratings were made on 29 sessions of CBT for schizophrenia by two raters independently and their agreement was found to be at least adequate on 10 of the items of the CTPAS. Ratings were also made on relevant items of the Collaborative Study Psychotherapy Rating Scale and agreement was found to be more than adequate for three factor-based subscales derived from these items. The results suggest therapist adherence to CBT for psychosis can be rated reliably and that the CTPAS is likely to be useful in future research on this form of treatment.

The feasibility of using a self-help treatment manual to assist a cognitive behavioural therapy programme developed with the aim of improving pain coping ability and quality of life, and reducing psychological distress in sickle cell patients was evaluated. Adult patients attending a London hospital outpatient sickle cell clinic were invited to 12-week cognitive behavioural therapy. Outcome was assessed with measures of pain status, health service utilization, psychological coping (Coping Strategies Questionnaire-revised for Sickle Cell Disease), quality of life (Medical Outcomes Survey Short Form 36), and mood (Hospital Anxiety and Depression Scale). Baseline disease severity data were also collected. No significant differences in baseline data were observed between patients who completed cognitive behavioural therapy and “dropouts”. Improvements over baseline at 12 weeks in patients who completed cognitive behavioural therapy were significant. Active coping and use of physician advised methods for pain increased. Emotional responses decreased, general health and vitality improved, while anxiety reduced. This demonstrates that a brief manual-assisted cognitive behavioural therapy programme is feasible in sickle cell disease, and may help to improve coping, quality of life and mood.

We applied Narrative Exposure Treatment (NET) to a severely traumatized Kosovar refugee living in a Macedonian refugee camp during the Balkan War. NET is a pragmatic short-term approach that integrates effective therapeutic components deriving from Cognitive Behaviour Therapy and Testimony Therapy. Outcome was evaluated by clinical examination and the Posttraumatic Stress Diagnostic Scale (PDS). Three sessions of NET were enough to afford considerable relief, although some PTSD symptoms remained. Our experience indicates that Narrative Exposure is a promising and realistic approach for the treatment of even severely traumatized refugees living in camps. In addition, it can prove valid testimonies about human rights violations without humiliating the witness.

A consecutive series of six adolescents referred for obsessive compulsive disorder were treated using a cognitive behavioural approach that included procedures intended to: (1) reach a shared understanding of the psychological nature of the problem; (ii) normalize intrusive thoughts; (iii) help the patient to reappraise notions of responsibility; and (iv) help the patient re-evaluate the basis of their fears. The effects of treatment were measured using standardized questionnaires designed to elicit beliefs about responsibility, and symptoms of anxiety, depression, and obsessive compulsive disorder. During the course of treatment, appraisals of responsibility changed at the same time as changes in symptom levels. The results suggest a more cognitive approach to treatment can be helpful for this age group, and that cognitive change is associated with clinical improvement.

Based on a behavior-analytic interpretation of the skills acquisition process, a rationale is presented for augmenting a currently available cognitive-behavioral treatment (The Adolescent Coping With Depression course: CWD-A) with a newly developed therapy focusing on the interpersonal interactions and learning occurring in-session (Learning through In-Vivo Experience: LIVE). A description of the practice of LIVE is offered and the results from an initial feasibility study are presented. Using a single-subject methodology, two groups each consisting of 5 adolescents with significant symptoms of depression received the treatment. The intervention consisted of 16 2-hour group sessions occurring over an 8-week period. The first 1-hour of each meeting was taken directly from the CWD-A manual. The second hour was based on the LIVE manual. The adolescents who completed the treatment (n = 8) improved from pretreatment to posttreatment and those who discontinued treatment (n = 2) did not. Improvements were maintained at 3 months follow-up. The treatment produced strong group cohesion and both adolescents and their guardians rated the intervention positively. These results provide initial evidence of the efficacy of complementing CWD-A with LIVE.

We conducted a pilot group intervention for negative symptoms, particularly targeting avolition/apathy. A baseline control design was used. Six patients were recruited, and four completed the group. The main inclusion criteria were clinically significant negative symptoms, plus associated distress and concern. The group involved 16 sessions, which were cognitive behavioural in approach. The main outcome measures were the Scale for the Assessment of Negative Symptoms, and the Subject Experience of Negative Symptoms Scale. Patients showed a reduction in avolition/apathy, and two patients reported reduced distress. These preliminary results suggest that group CBT is a possible intervention for negative symptoms.

Empirical findings and theoretical models posit a central role for an inhibited temperament in the development of anxiety. In turn, this suggests that reduction of withdrawn and inhibited characteristics in very young children may prevent the later development of anxiety disorders. To date, no programs have targeted inhibited temperament as a focus of treatment and it is often assumed that temperament is an immutable phenomenon. The current study piloted a brief education program for the mothers of seven temperamentally withdrawn 4-year-old boys. Results showed marked changes in mothers' perceptions of withdrawn temperament and anxious symptoms that continued over the following 6 months. These data encourage a larger-scale investigation of parent education for the reduction of inhibited temperament in pre-school children.

Seventy-seven mental health professionals completed a 3-day cognitive behavioural training course for managing hallucinations and delusions in schizophrenia. A questionnaire measuring attitudes and empathy towards working with people who have these symptoms was administered before and after the course. Significant increases in feelings of adequacy, legitimacy, employment related self-esteem, and expectations of work satisfaction were observed after the course and participants displayed high levels of motivation for working with this clinical population at both time points. In addition, the participants showed significant increases in perceived empathy for the experience of hallucinations and delusions. This was a predicted outcome as the course included exercises designed to enhance therapists' understanding of the subjective experience of psychotic symptoms. Empathy is recognized in the wider psychotherapy outcome literature as a therapeutically important variable that influences the formation of a therapeutic alliance but it is a relatively unexamined construct in CBT for psychosis. Further investigations in this area will potentially enhance psychological treatment delivery and subsequent outcomes for people who experience hallucinations and delusions. Furthermore, explication of such “non-specific” therapeutic factors may help to explain some of the transient but beneficial effects of unstructured “control” therapies observed in recent CBT for psychosis outcome trials.

The study examined the effect of guided imagery on overt social behavior of children during free play. Forty withdrawn and rejected first-graders (6 to 8 years of age) were randomly assigned to one of five conditions. Four of them were guided imagery conditions: mastery plus peer acceptance, mastery with no social contingency, coping, and gradual rehearsal. A fifth control condition involved no intervention. It was predicted that the four imagery conditions would increase and maintain positive socialization, but the coping condition would be the most effective. Children under the coping condition, which involved guided imagery of failure to get peer acceptance, but progressively mastering the social interaction and finally being accepted by peers, consistently increased positive socialization behaviors from baseline to post-treatment and follow-up, as compared to gradual rehearsal and control. Both mastery conditions increased socialization at post-treatment, but reverted to baseline levels during follow-up.

This case study deals with the effect of treatment of social phobia on psychotic symptoms in a patient with a diagnosis of schizophrenia. Stress vulnerability models were used to provide a rationale for treatment. The phobia was treated using standard CBT techniques while the therapist avoided any direct treatment of the psychotic symptoms. Scores for social phobia reduced to a sub clinical level over the course of treatment and the psychotic symptoms rapidly abated. Although only a single case study and therefore impossible to generalize to a wider patient group the study would seem to suggest that treatment of comorbid anxiety disorders can effect psychotic symptoms. Some thoughts are presented as to why this might be the case.

The psychometric properties of the Stages of Change scales (McConnaughy, Prochaska, & Velicer, 1983) were examined in a clinical sample of clients referred for psychotherapy. Sixty clients completed the Stages of Change scales and the Brief Symptoms Inventory before their first session of psychotherapy. The scales means, standard deviations and high internal consistency (all coefficients exceeding 0.7) compared favourably with previous research conducted by McConnaughy et al. (1983, 1989). The study investigates two methods of interpreting the Stages of Change scales. It discusses the methodological limitations in interpreting the highest scale score, and recommends instead the interpretation of the samples mean scores for the scales. It further assesses the theoretical underpinnings of the scales intercorrelations and argues in support of the “states” of change model proposed by Sutton (1996).

A single case study is described of a cognitive behavioural approach with an elderly man with a delusional disorder of 6 years. Successful treatment, case conceptualization and engagement issues are reported. The delusion was that household electrical equipment was giving out dangerous rays and giving him cancer. Self-report measures and a cognitive challenge test evaluated results. Rapid and positive results were achieved. Recommendations for future research are made.

The aim of this study was to demonstrate the effectiveness of cognitive behavioural treatment (CBT) with a focus on academic skills and conduct problems and to increase parents' educational skills in managing aggressive and oppositional behaviour in a subsequent parent training (PMT). For this purpose 18 children with a diagnosis of ADHD combined type participated in the study. In an A-B study design the effects of a 12-week treatment phase (6 weeks CBT; 6 weeks PMT) were compared with a preceding 4-week baseline. Core symptoms of ADHD, conduct problems and individual problem behaviour were assessed by weekly administration of parent and teacher questionnaires. The results indicate a significant and generalized reduction of ADHD core symptoms, conduct problems and homework problems during CBT at home and at school. PMT resulted in a further amelioration of the cited symptoms. We conclude that CBT may be a promising component in the treatment of ADHD provided that aspects of generalization are considered during the treatment. PMT may be a useful adjunct in most cases as it is effective in situations where the ADHD child still has problems of self-guidance.

Clinical supervision is an integral aspect of training and is essential for accreditation as a cognitive behavioural psychotherapist. A questionnaire survey of a random sample of accredited British Association of Behavioural and Cognitive Psychotherapists (n = 280) is reported, 61% (N = 170) responded by describing their supervision practices in a number of areas. These included the organization of supervision, content, satisfaction, techniques, models, interdisciplinary working and supervision of others. The results indicate that satisfaction levels with supervision were high amongst accredited therapists and that the ratio of time spent in supervision to therapeutic contact is, on average, higher than recommended minimum levels. Supervision was less structured and active than therapy and little use was made of audio/video tapes of therapy sessions within supervision. The level of training for supervisors was highly variable with a substantial proportion having received no formal training in cognitive behavioural psychotherapy supervision. Dual role relationships were also common. Finally, recommendations for further research and practice are made.

The unusual case of a young mathematics student is described. While studying and at other times he was troubled by intrusive thoughts about the logical foundations of mathematics. A treatment package involving the use of thought stopping, emotional processing and training in study skills is described and some ideas about the treatment of intrusive thought are considered.

The present study sought to clarify the role of cognitive change in Cognitive Behavioural Therapy (CBT) by examining the relationship between depression outcome and changes to automatic thoughts and dysfunctional attitudes at different points of therapy. Thirty patients suffering from Major Depression (MDD) or Dysthymia attended the 12 sessions of a group CBT program. Multiple regressions found total scores on the Automatic Thoughts Questionnaire (ATQ) and cumulative change scores on the Dysfunctional Attitudes Scale (DAS) to predict scores on the Beck Depression Inventory (BDI) at later stages of therapy, though neither form of cognition was predictive from earlier stages of therapy. Only scores on the ATQ were significantly related to both cognitive and somatic subscales of the BDI, indicating that automatic thoughts are more directly related to cognitive change than dysfunctional attitudes. Overall findings suggest that significant reductions in both automatic thoughts and dysfunctional attitudes are related to non-clinical levels of depressive symptoms at the end of the treatment.