Safety-seeking behaviours are seen as playing a key role in the maintenance of various anxiety disorders. This article examines their role in panic disorder and social phobia and suggests that, whilst there are clear theoretical differences between safety-seeking behaviours and adaptive coping strategies, the difficult issue in clinical practice is being able to distinguish between the two. It builds on previous work by Salkovskis and colleagues and provides a detailed discussion of the problems in distinguishing between safety-seeking behaviours (direct avoidance, escape and subtle avoidance) and adaptive coping strategies in clinical practice. The suggestion is made that topology can only be a guide to categorizing the two types of responses and they can only be fully distinguished by taking into account the intention of the individual and their perceived function to that individual in the specific context. It is suggested that further analysis of the use of safety-seeking behaviours aimed at avoiding a variety of outcomes at differing levels of catastrophe may provide useful information that would clarify our understanding of the role of such behaviours in maintaining anxiety disorders.

Self-help interventions in mental health are increasingly seen as one way of overcoming problems with access to psychological therapy, but there is insufficient evidence of effectiveness in routine care settings. This paper investigates the process and outcome of a non-guided self-help manual for anxiety and depression compared to a waiting list control in a primary care setting. Patients with mild to moderate mental health problems were recruited from routine GP referrals to the local Primary Care Mental Health Team. Thirty patients were randomly assigned to either non-guided self-help or a waiting list control group. Patients completed outcome measures at baseline, 6 weeks and 12 weeks. Intention to treat analysis found no significant differences between the two groups on measures of anxiety or depression at 12 weeks. Between 40% to 50% of patients in both groups were no longer clinical cases at the end of the trial. However, there was a high level of satisfaction with the self-help manual. Within the limitations of the small sample size, the study does not support the hypothesis that non-guided self-help is superior to waiting list control in the treatment of anxiety and/or depression in primary care.

A literature search yielded no studies investigating Wegner's (1989) proposal that repeated suppression attempts and rebound opportunities (indulgence cycles) lead to an escalation of intrusions, providing a mechanism whereby an unwanted intrusive thought may develop into a clinical obsession. It was predicted, based on Wegner's (1994) ironic process theory of mental control, that individuals high in trait obsessionality would exhibit an increase in thought frequency as a function of indulgence cycle and that those low in trait obsessionality would display a corresponding decrease in thought frequency. Participants (N=40) were asked to suppress and then express a personally relevant obsessive intrusive thought through two indulgence cycles. There was no significant escalation in thoughts across indulgence cycles for the high obsessionality group, but the low obsessionality group were significantly more successful at suppression. The results confirm previous research suggesting that trait obsessionality has an impact upon the effectiveness of thought suppression.

This paper reviews empirical research on cognitive factors associated with the experience of trauma and with the development of posttraumatic stress, Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) in children and adolescents. The review covers three main areas: cognitive experimental and neuropsychological studies; large scale studies on representative samples; and, randomized clinical trial data examining cognitive-behaviour therapy (CBT) interventions. Overall, the conclusions are that progress in all three areas lags far behind that in adult work and that, perhaps, the studies to date raise more questions than they provide answers provided by the studies to date. The paper concludes with detailed empirical recommendations for future research in the three chosen domains.

The successful treatment of extreme shape concern in patients with eating disorders has been shown to be important for their sustained recovery. This case series reports a preliminary investigation of the effects of a new brief cognitive-behavioural intervention for extreme shape concern. The intervention, which is implemented in a single 2-hour session, addresses four mechanisms hypothesized to contribute to the maintenance of extreme shape concern and is designed to be suitable as an adjunct to existing treatments for eating disorders. Participants were five women with extreme shape concern and three female patients with eating disorders. The results indicate that the intervention was effective to various degrees in each participant, and suggest that the intervention warrants further investigation. In particular, methods of increasing the potency of the intervention should be investigated, and its efficacy tested in a larger controlled study.

Harvey (2002) developed a model of insomnia that has advanced the understanding of cognitive processes involved in the maintenance of this problem. Despite the high co-morbidity of insomnia with mental health problems, such as anxiety, the relevance of the cognitive processes specified in the model to people with insomnia as well as other mental health problems is yet to be established. This was the subject of investigation in the present study. A between-subjects design was used to compare people with insomnia and co-morbid anxiety (insomnia plus anxiety) with people with insomnia only (insomnia only), and with good sleepers on measures of mental arousal prior to sleep, thought control strategies employed, and unhelpful beliefs about sleep. Results showed that participants with insomnia plus anxiety were comparable to participants with insomnia only, and significantly different from good sleepers on all measures. The research suggests that the cognitive processes thought to maintain insomnia in people without other co-morbid mental health problems may also maintain insomnia in people with co-morbid anxiety disorders.

The Children's Revised Impact of Event Scale (CRIES) is a brief child-friendly measure designed to screen children at risk for Posttraumatic Stress Disorder (PTSD). It has good face and construct validity, a stable factor structure, correlates well with other indices of distress, and has been used to screen very large samples of at-risk-children following a wide range of traumatic events. However, few studies have examined the scale's validity against a structured diagnostic interview based on the DSM-IV criteria for PTSD. In the present study, the CRIES and the PTSD section of the Anxiety Disorders Interview Schedule-Child and Parent Version (ADIS-CP) were administered to a sample of children and adolescents (n=63) recruited from hospital accident and emergency rooms and the validity of the CRIES as a screening tool evaluated. Cutoff scores were chosen from this sample with a low base-rate of PTSD (11.1%) to maximize sensitivity and minimize the likelihood that children with a diagnosis of PTSD would fail to be identified. Cutoff scores were then cross-validated in a sample of 52 clinically referred children who had a high base-rate of PTSD (67.3%). A cutoff score of 30 on the CRIES-13 and a cutoff score of 17 on the CRIES-8 maximized sensitivity and specificity, minimized the rate of false negatives, and correctly classified 75–83% of the children in the two samples. The CRIES-8 (which lacks any arousal items) worked as efficiently as the CRIES-13 (which includes arousal items) in correctly classifying children with and without PTSD. Results are discussed in light of the current literature and of the need for further development of effective screens for children at-risk of developing PTSD.

The manner in which parents adapt to the experience of caring for a child with an intellectual disability is generally thought to depend upon a range of variables typically conceptualized within multi-dimensional models. This review briefly describes three such models that share significant common features, incorporating child variables, environmental characteristics, and parental cognitive processes as contributors to parental coping styles or parenting stress. The effects of child and environmental characteristics on parenting stress and coping in parents of children with disabilities have been well documented. It is argued, however, that some aspects of cognitive processes in parents of these children have received less attention from researchers. In particular, there has been a large amount of research into parenting self-esteem, parental attributions, and parental locus of control with parents of other groups of children. This research is reviewed, and it is argued that further research into similar cognitions in parents of children with intellectual disabilities is warranted. Finally, the potential clinical implications of such research are examined in relation to behavioural interventions for children's behavioural difficulties. It is suggested that parental cognitions may influence the acceptability of such interventions and also be associated with their effectiveness.

In two linked studies we examined children's performance on tasks required for participation in cognitive therapy. In Study 1 we piloted some new tasks with children aged 5 to 11 years. In study 2 the effects of IQ, age and educational experience were examined in children aged 5 to 7 years. In study 1, 14 children aged 5 to 11 completed three tasks related to cognitive therapy; generating post-event attributions, naming emotions, and linking thoughts and feelings. Study 2 used a between-subjects design in which 72 children aged 5, 6, or 7 years from two primary schools completed the three tasks and the Block Design and Vocabulary sub-tests from the WISC III or WPPSI-R. Children were tested individually during the school day. All measures were administered on the same occasion. In study 2 administration order of the cognitive therapy task and the WISC III/WPPSI-R were randomized. The majority of children demonstrated some ability on each of the three tasks. In study 2, performance was associated with school and with IQ but not with age. There were no gender differences. Children attending a school with an integrated thinking skills programme and those with a higher 1Q were more successful on the cognitive therapy tasks. These results suggest that many young children could engage in cognitive therapy given age-appropriate materials. The effects of training in relevant meta-cognitive skills on children's ability to use concepts in CBT may warrant further research.

This paper provides a brief account of Bill-Watchers Anonymous, an unofficial organization dedicated to the task of observing, and reporting on, a major figure in British clinical psychology. The aims and objectives are summarized. Some of the findings made by the members, based on direct observation and investigation, are highlighted. The essentially rewarding nature of this work is emphasized.

The feasibility of a brief home based cognitive behavioural intervention for depression associated with Parkinson's Disease (PD) was evaluated. Five depressed patients with PD participated. Their ages ranged from 54 to 82 and they all attended a movement disorder clinic. Outcome was assessed using mood and quality of life inventories (Beck Depression Inventory; Geriatric Depression Scale; Parkinson's Disease Quality of Life Questionnaire). Four individuals demonstrated a clinically reliable reduction of symptoms according to the GDS scores, with greater improvement reported for the two individuals with more severe pre-therapy levels of depression. The BDI findings suggested most of the improvement related to the cognitive dimensions of guilt, pessimism and failure. Overall, the change in mood was not accompanied by an enhancement of perceived quality of life, and little variation in the frequency of activities was reported over the course of therapy. Possible explanations for the findings are considered along with implications for theory and clinical practice.

Injectable medications are commonplace but injection phobia can have a detri-mental impact on the utilization of health care by patients with subsequent adverse clinical outcomes. This systematic review aimed to identify the various psychological treatments for injection phobia and to assess their effectiveness. A systematic literature search was conducted using Cochrane, PsycINFO, EMBASE, MEDLINE, and AMED databases. Studies with five or more cases that investigated psychological treatment outcomes were selected and assessed in terms of methodological quality, type of intervention and outcomes. Eighty-four publications were identified by the search. Only three studies fulfilled the selection criteria and all used cognitive-behavioural techniques, including exposure to the feared object through a traditional graded hierarchy. Methodology differed but all had optimistic outcomes. Psychological treatments for injection fear or phobia exist, but the overall quality of evidence for treatment effectiveness is poor and outcome measures need consensus and further development.

Three exploratory studies evaluated group mindfulness training (which aims to facilitate non-judgmental attention to present moment experience through the practice of meditation) in patients waiting for cognitive behaviour therapy for Chronic Fatigue Syndrome (CFS). The approaches used were based on Mindfulness Based Stress Reduction, and Mindfulness Based Cognitive Therapy. The first group showed that such training is acceptable to patients and that it results in significantly improved subjective measures of anxiety, and improvements in subjective levels of fatigue that approached significance, when compared to waiting list controls. A second uncontrolled study replicated the findings of the first study and also demonstrated an improvement in quality of life as measured by the Fatigue Impact Scale (FIS). More wide-ranging effects were demonstrated in the final study in which significant improvements in subjective levels of fatigue, anxiety, depression, quality of life and physical functioning were observed following the training programme. These effects were sustained for 3 months. Overall, the findings of the three exploratory studies indicate that MBSR/MBCT has potential for the treatment of patients with CFS.

The study's objective was to assess the impact on clinical functioning of group based mindfulness training alongside standard psychiatric care for people with current, subjectively distressing psychosis. Data are presented from the first 10 people to complete one of four Mindfulness Groups, each lasting six sessions. People were taught mindfulness of the breath, and encouraged to let unpleasant experiences come into awareness, to observe and note them, and let them go without judgment, clinging or struggle. There was a significant pre-post drop in scores on the CORE (z=−2.655, p=.008). Secondary data indicated improvement in mindfulness skills, and the subjective importance of mindfulness to the group process (N=11). The results are encouraging and warrant further controlled outcome and process research.

This study describes the development and initial evaluation of a cognitive schema questionnaire for children. The Schema Questionnaire for Children (SQC) was designed to capture the 15 early maladaptive schemas proposed by Young (1990). Face validity of the questionnaire items as assessed by a group of CBT experts (n=16) was good. Concurrent validity was assessed by asking 47 school children aged 11–16 years of age to complete both the (SQC) and a British version of the 75 item Young's Schema Questionnaire short form (YSC-S). Significant correlations were obtained for 10 of the 15 schemas, with a further two approaching statistical significance. Although some of the correlations were modest, these initial results suggest that the SQC may be a valid quick and developmentally appropriate way of assessing Young's maladaptive schema in children.

We assessed the efficacy of cognitive behaviour therapy (CBT) delivered by general practitioners (GPs) to fatigued employees on sick leave. CBT had no substantial effect on clinical outcomes. In the present study, we aim to describe the treatment protocol and present an analysis of the delivery of the intervention. To assess protocol execution, GPs used standardized registration forms in each treatment session. A quality check was performed to assess whether CBT was completed according to protocol. Of the 71 patients starting CBT, 51 patients completed the intervention. There were no striking differences in protocol execution between those who recovered after CBT and those who did not recover. Although there were differences in the performance and delivery of CBT, there was no association between protocol execution and treatment results of individual GPs. Despite the lack of efficacy, the intervention received a positive evaluation from both patients and GPs. CBT completers who recovered did not receive a clearly different treatment than those who did not recover. In addition, successful GPs did not deliver a clearly different treatment than less successful GPs. The lack of efficacy can at least partly be attributed to the inadequacy of the intervention, whether it is the intervention itself or its delivery by GPs.

Self-harm and externally-directed impulsive behaviours are relatively common in psychiatric populations. Different explanations have been advanced for the presence of these behaviours, including the suggestion that they are driven by unconditional beliefs (schema-level cognitions) and that they are related to dissociation (a reduction in processing of intolerable cognitions and affect). This brief study begins to test a model based on the hypothesis that unconditional core beliefs are associated with the use of impulsive behaviours, and that dissociation is a key factor that mediates the relationship. An unselected group of 50 psychiatric inpatients completed standardized self-report measures of core beliefs, dissociation and impulsive behaviours. For female patients only, the results of mediational multiple analysis were compatible with a model where the relationship between unconditional abandonment beliefs and self-harming behaviours is perfectly mediated by dissociation. The strengths, limitations and directions for further research are discussed.

A behavioural approach was utilized in the assessment and treatment of severe self-injurious behaviour (SIB) in a woman with Smith-Magenis Syndrome (SMS). The results showed a marked reduction in the frequency of SIB following the introduction of functional assessment driven behavioural interventions (differential reinforcement of other behaviour, self-monitoring and social reinforcement, and extinction). There were also considerable reduc-tions in the frequencies of aggressive behaviour towards others, the use of rapid tranquilization and the use of control and restraint. The results of this study suggest environmental factors may play a significant role in maintaining some self-injurious behaviour shown by people with Smith Magenis Syndrome. The results are discussed in relation to emerging models of SIB in SMS.

A cognitive-behavioural analysis of clinical perfectionism has recently been proposed. The aim of this study was to explore the phenomenology of clinical perfectionism and its putative maintaining mechanisms. Of the 21 participants, 15 were judged to have the core psychopathology of clinical perfectionism. The data obtained were largely consistent with the model. In particular, self-imposed dysfunctional standards, continual striving and adverse consequences appeared to be highly salient features of those people who had the core psychopathology of clinical perfectionism but not of those without. A number of other possible maintaining factors not originally described in the model were also identified.