Background: Previous research suggests that the distress experienced by clinical voice hearers is associated with the perceived relationship between voice and hearer, independent of beliefs about voices and depression. Aims: This study aimed to replicate these findings and generate further hypotheses by comparing the voice hearing experiences of clinical and non-clinical hearers. Method: A cross-sectional, quantitative design was employed and used between-subjects and correlational methods. Thirty-two clinical voice hearers and 18 non-clinical voice hearers were assessed using the PSYRATS, the Voice and You questionnaire, the Beliefs About Voices Questionnaire – Revised, and the Beck Depression Inventory-II. Results: For clinical voice hearers, distress was significantly associated with perceptions of the voice as dominating and intrusive, and hearers distancing themselves from the voice. However, these associations were not independent of beliefs about voices’ omnipotence or malevolence. Non-clinical voice hearers were significantly less distressed than clinical voice hearers and voices were perceived as less dominant, intrusive, malevolent and omnipotent. Non-clinical hearers were found to relate from a position of less distance to voices perceived as benevolent. Conclusions: Findings from previous research were only partially replicated. Clinically, the development of less maladaptive relationships between voice and voice hearer may reduce distress.

Background: This project aimed to explore the experiences of people who compulsively hoard and how they make sense of their own hoarding behaviours. Method: A total of 11 compulsive hoarders were recruited and interviewed using a simple semi-structured interview format, designed for the purposes of the study. The resulting transcribed interviews were analyzed using interpretive-phenomenological analysis. Results: Four super-ordinate discrete, but interacting, themes were found: (1) childhood factors; (2) the participants' relationship to their hoarded items; (3) cognitive and behavioural avoidance of discard; and (4) the impact of hoarding on self, others and the home environment. The themes as a whole described people entrapped in massively cluttered physical environments of their own making. Efforts at discard appeared consistently sabotaged by cognitive/behavioural avoidance, thereby creating maintaining factors of associated personal distress and environmental decline. Conclusions: The results are discussed in the context of the extant evidence concerning hoarding, the distinct contribution made by the current results and the identified methodological shortcomings of the research approach.

Background: The value of defining subtypes in obsessive compulsive disorder (OCD) has become an important issue for recent debate. Probably the most robust example of subtyping is the identification of hoarding as being different both in terms of psychopathology and response to treatment. Aims: To identify differences in psychopathology and treatment response in OCD patients with and without additional hoarding symptoms. Method: Patients who had undertaken CBT for OCD were selected as falling into either a high or a low hoarding group. The high hoarding group (n = 18) was selected on the basis of a high score on the hoarding subscale of a self-report measure of OCD symptoms in addition to reaching clinician judged “threshold” on the hoarding item of the Obsessive Compulsive Personality Disorder (OCPD) SCID-II module. The low hoarding group (n = 20) was selected on the basis of a low score on the hoarding subscale and a clinician judgement that the hoarding item of the OCPD SCID-II module was “absent”. Results: On some measures of pre-treatment psychopathology, patients with OCD with hoarding symptoms were more severely affected than those without hoarding symptoms. It was found that there was no difference in eventual treatment outcome between the two groups, although there was some evidence that the hoarding group showed greater symptom decreases. Conclusions: The presence of hoarding symptoms does not negatively impact on the treatment of OCD.

Background: Cognitive behavioural models of anxiety disorders often include visual representations of feedback loops that maintain the disorder. Cognitive therapy for depression is the prototype for therapy for many other disorders, and there is now good evidence for factors that maintain depression, yet there is still no accepted diagrammatic form of the maintenance model. Aims: To develop a simple, clinically acceptable and empirically based version of the “vicious flower” for depression. Method: Current theoretical developments in depression (Differential activation and Beck's concept of modes) and empirical findings on maintenance factors were reviewed. A model was developed based on clinical utility and current knowledge of the processes and maintenance factors in depression. This model was tested for its usefulness with a small sample of IAPT trainees. Results: The model contained 6 cycles comprising 2 cognitive cycles (automatic negative thinking and rumination/self-attacking), 2 behavioural cycles (withdrawal/avoidance and unhelpful behaviour), a mood/emotion cycle, and a motivation/physical symptoms cycle. Students found it a very useful tool for understanding maintenance factors. Conclusions: This diagrammatic maintenance model of depression, like similar “vicious flowers” for anxiety, may be helpful in conceptualization, socialization and treatment planning as well as teaching CBT.

Background: A key process in Cognitive Therapy (CT) is the development and sharing of a formulation. How clinicians develop formulations is under-researched, particularly in working with people with psychosis. Aims: This study investigated agreement between clinicians, when conceptualizing an individual's psychotic beliefs. It also explored whether agreement was dependent on qualifications and experience. Method: Eighty-two clinicians watched a video of an individual with delusional beliefs, and were asked to provide formulations using a CT template. These were compared with a “benchmark” formulation provided by three experts. Results: There was good agreement for overt behaviours, emotions, and some aspects of early experience. However, identification of theory driven components such as core beliefs or assumptions was poorer. Greater clinical experience improved the agreement with the benchmark formulation overall, and greater CT specific experience improved formulation of the theory driven items. The more experience a clinician had of working with people with psychosis the lower the rate of agreement with the expert formulation. Conclusions: Formulation of delusional beliefs from a cognitive perspective is dependant on overall experience in cognitive therapy and not knowledge of psychosis, which may hinder performance. The implications for training in CT and psycho-social interventions are considered.

Background: Mental imagery of the future has clear clinical importance, although little is known about intrusive, prospective imagery of personally-relevant events. Currently, no measure is available to assess this. Aims: The Impact of Future Events Scale (IFES) was created to assess the impact of intrusive, prospective, personally-relevant imagery. It was examined in relation to predictions about dysphoria. Method: To form the IFES, the IES-R (a measure of the impact of a past traumatic event on posttraumatic stress disorder symptomatology such as intrusive re-experiencing) was adapted item-by-item to assess intrusive “pre-experiencing” and imagery of specific, future events. Participants (N = 75) completed the IFES and assessments of depression, anxiety and general imagery use. Results: As predicted, the IFES significantly and positively correlated with depression scores. Analyses using subgroups of non-dysphoric and mild-dysphoric participants confirmed that the mild-dysphoric group reported significantly higher IFES scores, indicating higher levels of pre-experiencing of the future and related hyperarousal and avoidance. Conclusions: IFES provides a measure of the impact of “pre-experiencing” in the form of intrusive prospective, personally-relevant imagery, with sensitivity to group differences on the basis of depression scores. Further research is required to extend these finding into clinical depression and other psychopathological conditions.

Background: Microswitches are the most commonly used input device for people with multiple disabilities to control environmental stimulation. However, little is known about adopting the commercial trackball with a revised trackball driver as a more feasible input device. Aims: To assess whether two children with profound multiple disabilities and minimal motor skills would be able to control environmental stimulation using thumb poke ability through cordless trackballs installed with a newly developed mouse driver (i.e. a new mouse driver replacing a standard mouse driver, turning a trackball mouse into a precise thumb poke detector). Method: An ABAB design and a 2-month post-intervention check were adopted to perform the study. Results: Data showed that the two children improved significantly in their target response (thumb poke) to activate the control system to produce environmental stimuli during the B (intervention) phases. This performance was maintained at the post-intervention check. Conclusions: The use of thumb poke in connection with a trackball allowed the children with multiple disabilities and minimal motor skills to increase their level of response and stimulation control.

Background: Attributions for hallucinations in the “schizophrenia” spectrum disorders have been subject to extensive investigation; however, in comparison very little is known about attributions for hallucinations in the bipolar disorders spectrum. Aims: This preliminary study is an attempt to investigate attributions for hallucinations in bipolar disorder with regard to prevalence, modality and mood state. Method: Forty participants were recruited from a larger randomized control trial into CBT for bipolar disorder and asked to provide information related to attributions for hallucinations both in and out of episode. Data was collected using a specially designed instrument based on the Belief about Voices Questionnaire (BAVQ). Results: Just under half of the participants reported experiencing true hallucinations during their illness. Participants tended to report visual hallucinations in mania and auditory hallucinations in depression. The vast majority of participants attributed hallucinations to illness when out of episode, and unlike in previously reported analyses of attributions for hallucinations in the schizophrenia spectrum, malevolent/omnipotent attributions were comparatively rare. Conclusions: Attributions for hallucinations in bipolar disorder may be clinically distinct from attributions previously observed in the schizophrenia spectrum, and CBT aimed at reducing the distress associated with these attributions may have to be tailored accordingly.

Background: Very few studies have compared the efficacy of individual and group cognitive behaviour therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) by taking into consideration the change in OCD severity in both the short and long term. Aims: To conduct an open trial of individual versus group CBT for OCD, comparing the clinical and statistically significant changes in severity both at post-treatment and one year later. Method: Forty-two OCD subjects were assigned to individual (n = 18) or group CBT (n = 24, in four groups). Sixteen and 22 subjects completed the treatment in the individual and group conditions, respectively. The Yale-Brown Obsessive Compulsive Scale was recorded at pre-treatment, post-treatment and at the one-year follow-up. Results: At the end of treatment, the clinically significant change was comparable for the two treatment conditions and remained stable at the one-year follow-up. Of the 16 participants who completed the individual CBT treatment, 68.75% were classified as recovered at post-treatment, compared to 40.9% of those receiving group CBT. At follow-up the rate of recovery decreased to 62.5% in individual CBT and to 31.8% in group CBT. Conclusions: Group CBT is effective in decreasing OCD severity. The post-treatment changes were maintained one year later. Nevertheless, these changes were higher in the individual delivery of CBT.

Background: The study aimed to assess the effectiveness of group and individual formats of a combined motivational interviewing and cognitive behavioral treatment (CBT) program for problem gamblers (PGs) using a randomized controlled design. Method: One hundred and two PGs were randomly assigned to individual or group CBT conditions. Twenty-eight of these participants were randomly allocated to a 6-week waitlist control condition prior to receiving the designated treatment. Results: At post-treatment, there were significant improvements in all dependent variables (frequency and amount gambled, gambling urges, gambling cognitions, negative psychological states, and life satisfaction) for both the treatment conditions but not for the waitlist condition. Individuals that completed the individual (compared to group) treatment condition generally had higher effect sizes for gambling correlates. Therapeutic gains for gambling correlates were generally maintained at 6-month follow-up. Conclusions: A combined motivational interviewing and CBT program applied in group or individual format can improve PG behaviors, as well as gambling correlates.

Background: While Motivational Interviewing (MI) is effective in reducing client problem behaviours, including health-related behaviours, there is little evidence about how MI training enhances practitioner skills. Aims: The current pilot study addressed this lack by training two health practitioners (Diabetes Nurse Educators) in MI, and evaluated the effect of MI training on both practitioner and patient behaviour when MI was delivered in a clinical settting, with patients experiencing difficulties with diabetes self-management. Methods: Comparisons were made between the practitioners’ skills in a baseline condition (Patient Education; PE) and after training in Motivational Enhancement Therapy (MET), a four-session form of MI. At the same time, the effects of the two interventions on patient in-session behaviour were compared. Practitioner and patient data were obtained from transcripts of all PE and MET sessions, which were independently coded using Motivational Interviewing Skills Code therapist and client behaviour counts. Results: Compared with their baseline performance, practitioners, when trained to practice MET, behaved in ways consistent with MI, and this appears to have evoked beneficial in-session behaviour from the patients. Conclusions: These results suggest that the MI training was effective.

Behavioural and Cognitive Psychotherapy is an international multidisciplinary journal for the publication of original research, of an experimental or clinical nature, that contributes to the theory, practice and evaluation of behaviour therapy. As such, the scope of the journal is very broad and articles relevant to most areas of human behaviour and human experience, which would be of interest to members of the helping and teaching professions, will be considered for publication.