Perfectionistic people set unrealistic goals and, when they fail to reach them, experience self-criticism and blame. Preliminary research revealed that perfectionism appears to be a characteristic of people who stutter (PWS) (Amster, 1995). The purpose of the present study was to explore perfectionism in PWS and to determine if a modified cognitive behavioral therapy approach alone and combined with Stuttering Modification could help reduce perfectionistic tendencies and stuttering behaviors. Degree of perfectionism and scores of stuttering severity were measured with eight adult PWS and compared at pre-treatment, mid-treatment, after 6-weeks of treatment, and at 15 weeks follow-up, after treatment was withdrawn. Initial open-trial testing showed promising results as perfectionism and stuttering severity were reduced and communication attitudes improved. CBT significantly reduced perfectionism by mid-point. Stuttering decreased significantly throughout all phases of the study. Possible implications are discussed.

Cognitive-behavioral models of obsessive compulsive disorder (OCD) assert that negative appraisals of obsessional thoughts lead to distress over the thoughts and drive ameliorative actions such as thought suppression and compulsions. These responses in turn play a role in the persistence of the disorder. However, past research has not examined (a) what factors lead individuals to suppress obsessional thoughts; (b) whether certain predictors and consequences relate to suppression uniquely or can be explained by general factors such as negative mood and neuroticism; or (c) individuals' natural active suppression of obsessions. The current study addresses these limitations by examining the roles of natural suppression and distress over thought intrusions in the thought-appraisal/OC symptoms relationship while controlling for general factors. Ninety-one nonclinical participants completed a variety of measures assessing theoretically relevant constructs. After their obsessional thought was primed, they recorded their thoughts for 6 minutes and then rated their suppression effort. Four hours later, longer-term outcomes were assessed. Path analyses supported most components of cognitive-behavioral models.

This study was a controlled clinical trial in which patients were offered a brief low cost, low intensity self-help intervention while waiting for psychological therapy. A CBT based self-help pack was given to patients with significant anxiety problems and no attempt was made to exclude patients on the basis of severity or co-morbidity. The treatment group received the intervention immediately following assessment and the control group after a delay of 8 weeks so comparisons between the two groups were made over 8 weeks. Although there was some support for the effectiveness of the self help intervention, with a significant time x group interaction for CORE-OM scores, this was not significant with the intention to treat analysis, nor for HADS anxiety and depression scores and the effect size was low. A follow up evaluation suggested some patients attributed significant goal attainment to the intervention. The findings suggest the routine use of self-help interventions in psychological therapies services should be considered although further more adequately powered research is required to identify the type of patients and problems that most benefit, possible adverse effects and the effect on subsequent uptake of and engagement in therapy.

Mindfulness is the latest addition to the armamentarium of cognitive behavioral therapists. Mindfulness methods from the wisdom traditions, as well as from current psychological theories, are beginning to be used as cognitive behavioral strategies for alleviating psychological distress and for personal transformation. The use of mindfulness as a clinical tool is in its infancy, with attendant growing pains in theory, research and practice. We briefly discuss the historical context of the use of mindfulness, recent developments in theory, research and practice, and future developments. We conclude that mindfulness shows a lot of promise as a clinical treatment modality, but there are inherent pitfalls in the developing approaches.

Mindfulness training was evaluated as a new treatment for attention and impulsivity problems in adolescents with a variety of different externalizing disorders: attention deficit-hyperactivity disorder, oppositional-defiant and/or conduct disorder, and autism spectrum disorder if characterized by externalizing problem behaviour. It was argued that the large overlap between these three disorders may be partially explained by common underlying attention and behaviour control deficits. Fourteen clinically referred adolescents suffering from externalizing disorders followed mindfulness training in a group format. Parallel, their parents received mindful parenting training. Adolescents and their parents were measured before and after waitlist, after 8-week training, and at 8-week follow-up. No improvement occurred during waitlist on most variables. After mindfulness training, children self-reported substantial improvement on personal goals, internalizing and externalizing complaints, attention problems, happiness, and mindful awareness, and performed better on a sustained attention test. Likewise, parents reported improvement on children's goals, externalizing and attention problems, self-control, attunement to others and withdrawal. In addition, parents improved on their own goals. Improvement was maintained 8 weeks after the training. Consistent with mindfulness theory, increased child awareness after training predicted longer-term improvement in parent-rated child symptoms. Concomitant parent and child mindfulness training appears to be a promising approach for clinic-referred adolescents with attention and impulsivity problems.

Mindfulness training has been proposed as a potentially important new approach for the treatment of generalized anxiety disorder (GAD). However, to date only a few studies have investigated mindfulness training for GAD. The aim of this study was to further investigate symptom change and recovery in pathological worry after mindfulness-based cognitive therapy (MBCT) using an uncontrolled pre-post design. Twenty-three adults with a primary diagnosis of GAD participated in the study. The MBCT program involved 9 weekly 2-hour group sessions, a post-treatment assessment session, and 6-week and 3-month follow-up sessions. Intent-to-treat analysis revealed significant improvements in pathological worry, stress, quality of life, and a number of other symptoms at post-treatment, which were maintained at follow-up. Attrition was also low, and MBCT was perceived as a credible and acceptable intervention. However, when applying standardized recovery criteria to pathological worry scores, the rate of recovery at post-treatment was very small, although improved at follow-up. Overall, the findings suggest MBCT is definitely worthy of further investigation as a treatment option for GAD, but falls well short of outcomes achieved by past research. Possible reasons for the poor rate of recovery, implications, and limitations are briefly outlined.

This paper describes the rationale for and development of an online cognitive-behavioural treatment for child and adolescent anxiety (BRAVE–ONLINE). It highlights the challenges involved in adapting a clinic-based intervention for delivery using the internet, with separate sessions for parents and their children (or adolescents). We outline strategies to ensure that young people remain engaged in online therapy, and describe techniques designed to optimize the alliance between clients and the online therapist. Two case studies are presented that illustrate the practical and technical aspects of implementing the intervention, and demonstrate the feasibility of achieving successful outcomes using online delivery of CBT for child and adolescent anxiety. However, firm conclusions regarding the efficacy of this approach cannot be drawn until the results of randomized controlled trials are available. The paper identifies directions for future research.

An examination was made of the extent to which maternal anxiety predicted response to treatment of children presenting with an anxiety disorder. In a sample of 55 children referred to a local NHS CAMH service for treatment of an anxiety disorder, systematic mental state interview assessment was made of both mothers and children, and both completed self-report questionnaires to assess aspects of anxiety, both immediately before the children received treatment and following treatment. Children of mothers with anxiety disorder overall responded less well to treatment than children of mothers with no anxiety disorder. There was some diagnostic specificity in this in that children of mothers with GAD did as well in treatment as children whose mothers had no anxiety, whereas children of mothers with social phobia did poorly. The outcome for children with anxiety appears to be related to the presence and nature of maternal anxiety. It would seem prudent that treatment of children with anxiety involves assessment of maternal anxiety. It is important to establish in systematic investigation whether treatment of maternal anxiety improves the outcome for child anxiety.

This paper introduces Acceptance and commitment Therapy (ACT) as one of the newer contextualist behaviour therapies. A brief history of the development of ACT is outlined. The concepts of equivalence and laterality and the important relationship between Relational Frame Theory and ACT are then described. The “hexagram” summary of the six core linked processes in ACT is presented and, finally, the research evidence to support the effectiveness of ACT applied to a range of clinical conditions and client groups is summarized.

To date, little research has endeavoured to discriminate between cognitive and somatic dimensions of trait anxiety and, consequently, it remains uncertain whether these anxiety dimensions can be reliably distinguished at the trait level. The four studies presented here support the validity of the distinction between cognitive and somatic anxiety at both state and trait levels. The research involved the development and validation of a self-report questionnaire, the State-Trait Inventory for cognitive and somatic anxiety (STICSA). The nature of the anxiety dimensions assessed by this new measure was then investigated. The results indicate that the state scales of this new measure assess the degree of cognitive and somatic anxiety experienced at a particular point in time. The trait scales of the STICSA predict the situations in which different individuals will display elevations in cognitive and somatic state anxiety. Trait cognitive and somatic anxiety are indeed distinct constructs that can be reliably and validly assessed. Theoretical and applied implications of this finding are discussed.

This study explored associations between maternal discipline, maternal trait anxiety and anxiety in preschool-aged children. The sample comprised 47 mothers and their children, aged 2–3 years. Maternal discipline was assessed by maternal self-report; and child anxiety by maternal and play leader report. Positive associations were found between self-reported, ineffective, maternal discipline and symptoms of anxiety in preschool-aged children. Associations were not found between self-reported “verbose” discipline (long reprimands or reliance on talking) and preschoolers' anxiety. There were also no associations between play leaders' reports of preschoolers' anxiety and any of the mothers' self-reported discipline measures. Positive associations were found between maternal trait anxiety and the use of self-reported ineffective disciplinary behaviours. Over-reactive discipline was shown to be a stronger predictor of preschoolers' anxiety symptoms than maternal anxiety or lax discipline. It was concluded that children's internalizing symptoms (according to mother report) may be associated with use of ineffective disciplinary strategies. Increased use of these strategies was also associated with anxiety in mothers, and it is suggested that use of ineffective discipline strategies might partially account for the association between maternal and child anxiety.

The present study explored whether and how self-injurers attempt to resist urges to harm themselves. Participants were 39 young adults with a history of skin cutting and other non-suicidal self-injurious behaviors. A structured interview assessed the prevalence and perceived helpfulness of 48 methods for resisting self-injurious urges. Ninety percent of participants indicated that they had made efforts to resist urges to self-injure. These individuals had used an average of 16 different methods, and reported that they were successful in resisting the urges most of the time. “Keeping busy” and “Being around friends” were the most common methods used to resist self-injurious urges. However, “Doing sports or exercise” and “Removing the means/instruments typically used to self-harm from the home” were rated as being the most helpful for resisting self-injurious urges. Findings have implications for enhancing treatment and guiding future research.

This study reports an evaluation of a 10-day training course in cognitive behaviour therapy (CBT). The course comprised both formal CBT workshops and clinical case supervision, and was evaluated on measures of trainee satisfaction, trainee- and assessor-rated measures of CBT skill, and clinical outcomes for a subgroup of trainees' patients. The course was well received by trainees and their post-training therapy tapes were rated significantly higher on both trainee- and assessor-rated measures of CBT skills. In addition, trainees achieved significantly better outcomes with their patients after the training course than before, suggesting that the training impacted not only on their skills but also on their effectiveness in routine clinical practice. The limitations of the study and implications for future research in training are discussed.

The delivery of cognitive behaviour therapy (CBT) in the UK has moved through two phases. In the first phase specialist practitioners delivered bespoke CBT to individuals often experiencing complex and longer-lasting problems. This phase has been characterized by waiting lists and a high quality service delivered to a few. In the second phase of service delivery CBT has begun to be delivered in all sorts of different formats, including CBT self-help/guided CBT, behavioural activation, computerized CBT and group based CBT that aim to increase access to CBT delivered in these ways. It remains unclear how these varying models – “high intensity” (phase 1) and “low intensity” (phase 2) should relate – and even who does best with each. There are implicit assumptions by practitioners reflected in language such as “stepping up/down” that assumes high intensity working is superior in some way to low intensity. Few studies have however examined this in depth and what studies there are suggest these beliefs may be incorrect for many. How these new ways of working will be introduced, evaluated and integrated into existing services currently remains a challenge. A helpful way of resolving some of these issues is to view CBT using a learning/teaching paradigm. In this the focus is primarily on how the client wishes to learn to tackle their problems. This provides a helpful way for both introducing different and new ways of working, and also maintaining a focus on the client's needs at the centre of service development. Crucially, phase two CBT working does not replace phase one. How the two approaches complement each other and compare will be two of the interesting questions to be addressed over the next few years.

Each year a large number of children and adolescents develop significant posttraumatic symptoms after being involved in road traffic accidents (RTA). Consequently there is a need to develop effective interventions to prevent or minimize such reactions. The use of symptom monitoring with adults has found promising results. This pilot study explores the use of symptom monitoring with children and young people involved in RTAs. Twelve young people who met criteria on screening questionnaires for significant posttraumatic symptoms completed symptom monitoring diaries. Following completion of a diary once a day for 3 weeks, 3/12 children (25%) fell below criteria, suggesting significant posttraumatic symptoms. Feedback about self-monitoring was generally positive and suggests that symptom monitoring may be a helpful yet simple intervention for use with child trauma victims.

This study investigated the role of metacognitions in high-dependency smokers, low-dependency smokers and non-smokers. A sample of high-dependency smokers (n = 27), low-dependency smokers (n = 33), and non-smokers (n = 43) completed self-report measures of negative emotion, metacognitions and smoking dependence. Results indicated that high-dependency smokers scored higher than non-smokers on Positive Beliefs about Worry. Furthermore on Beliefs about the Need to Control Thoughts high and low-dependency smokers scored higher than non-smokers. A logistic regression analysis indicated that Beliefs about the Need to Control Thoughts were the only predictor of classification as a dependent smoker when controlling for negative emotion. These results are consistent with a metacognitive conceptualization of smoking dependence.

Mental health work is now core to primary care practice, and CBT shows promise as a guiding approach. However, dissemination to primary care practitioners has not yet been demonstrated. A training intervention (a brief CPD workshop of 3–4 hours) plus four case discussion groups lasting 1.5 hours each, plus manual, was evaluated with a convenience sample of N = 25 primary care practitioners. Five adapted self-report questionnaires measured their reactions, learning, and transfer, within a pre-post research design. The participants regarded the training and materials as acceptable. Their performance on declarative and procedural quizzes improved significantly by the post-test, as did their reported transfer of CBT to their primary care work. These positive findings indicate that the training package may be able to produce transferable impacts on primary care practitioners' use of CBT. But the reliance on self-report and the simple design preclude definitive conclusions. Suggestions for an improved research design are offered, together with suggestions on dissemination.

Attention Training (ATT) is an auditory attention-focusing technique that attempts to reduce the perseverative self-focused processing characteristic of anxiety and mood disorders. The present study investigated the effects of one session of ATT in the reduction and reappraisal of intrusive thoughts in a university sample reporting high levels of obsessive-compulsive symptoms. One-hundred and eight participants identified their most distressing intrusive thought and spent 7 minutes monitoring their stream of consciousness while recording occurrences of the identified thought. They then rated the unpleasantness of the intrusive thought, their attempts to dismiss the thought from consciousness, and their perceived success in reducing the frequency of the thought. Participants were then randomly assigned to receive one session of ATT, thought replacement instructions (TR), distraction instructions (DI), or no intervention (CONT). Participants then repeated the thought monitoring interval and ratings. ATT was expected to be the most effective in decreasing the frequency and unpleasantness of intrusive thoughts. However, contrary to hypotheses, all groups reported similar decreases across intervals. Implications of these findings are discussed.

This paper provides a selected review of recent studies highlighting key aspects of mood disorders research. Cognitive models and clinical trials of cognitive therapy of depression are evolving and adapting to increase applicability to the spectrum of depressive symptoms and syndromes experienced by clients, as well exploring beyond acute phase treatment to relapse prevention. In contrast, cognitive models of bipolar disorders and the effectiveness of the therapy are unclear and there are more questions than answers for researchers in this area.

There has been some support for the applicability of the Clark and Wells’ model of Social Phobia within an adolescent population. To date, however, there is limited research to support the existence of the main perpetuating element (i.e. observer perspective) in this population. One hundred and twenty-four adolescents (12–18 years) completed an anxiety-provoking social task. They were asked to generate an image in their mind of what they felt they were like during this situation. The study investigated whether adolescents could report the perspective that they took in this task, and whether increased levels of social anxiety were associated with an “observer” perspective. The study also explored whether age moderated this relationship. It was found that as social anxiety increased, the perspective of the participants moved towards that of an observer. Age was not found to influence the reporting of perspective, nor the association between this and social anxiety. This study provides evidence for the existence of observer perspective within an adolescent population and indicates that this is associated with social anxiety. It provides some indirect support for the continued use of video feedback strategies with this age group.