Self-Practice/Self-Reflection (SP/SR) has been proposed both as an adjunct to therapy training programmes, and also as a means for therapist development among experienced therapists. Research suggests it develops aspects of knowledge and skill that may not be addressed through other training methods. With increasing interest in SP/SR, a growing evidence base regarding both participant benefits and potential risks from SP/SR, and the development of SP/SR programmes across a range of therapeutic modalities, we argue it is timely to identify a set of principles that can guide the design, adaptation and implementation of SP/SR programmes. At this stage, there is little empirical evidence to guide trainers wishing to implement SP/SR in different contexts. Accordingly, these principles have been derived from reflection on developing, testing and implementing SP/SR programmes as well as on other training and supervisory experience. The first set of principles detailed in Section 1 draw on various theories of learning and development and frame the processes involved, the next principles speak to the content of SP/SR programmes, and the final principles address structure. Within Section 2, the principles are then considered for their practical implications. In Section 3, the sharing of what are initially private self-reflections is then considered together with some implications for SP/SR programmes, especially when there is assessment involved. We argue that SP/SR will continue to progress with well-designed standard programmes, careful implementation, thoughtful adaptation, ongoing innovation, and especially more evaluation.

This paper describes a service development which arose from an adult mental health inpatient ward team who wanted to be able to work more effectively to help patients who had major difficulties with emotion regulation. It was proposed that enhancing mindfulness through a Mindfulness-based Cognitive Therapy (MBCT) programme within the core staff team would enhance therapeutic milieu and therefore general outcomes associated with engagement and recovery. The training delivered was an adapted 8-week MBCT programme. A double baseline design was used with measures taken at 1 month before training and immediately before the programme started. Standardized and non-standardized measures were administered at pre-, mid-, post-, and 1-month follow-up points. Workshops and interviews supported the investigation of staff experience and impact of MBCT training. Participants in the training were nursing and occupational therapy staff. The trainer was the first author (C.M.), who is a cognitive behavioural therapist and mindfulness teacher at Newcastle Cognitive and Behavioural Therapies Centre, specializing in emotion regulation and stabilization. Results showed that staff reported a significant increase in mindfulness which had a positive impact upon their wellbeing and perceived ability to respond skilfully to challenging situations at work and at home. Gains were mostly in the first half of training but were maintained to the end and to follow-up. This adapted mindfulness training course appeared to be effective in meeting the need for a group of clinical staff to develop mindfulness. The potential impact upon patient engagement has been identified but further research into this area is indicated.

Self-Practice/Self-Reflection (SP/SR) has been developed as a self-experiential training strategy to enhance CBT therapists’ skills. SP/SR gives therapists an experience of CBT through practising CBT techniques on themselves, and reflecting on the experience and its implications for clinical practice. Many practitioners report significant professional and personal gains from SP/SR; however, there is considerable individual variation. This study examined individual experiences of SP/SR in order to develop a better understanding of idiosyncratic variations in participants’ approaches to SP/SR, and to inform the design and implementation of future SP/SR programmes. A single-case design was employed to examine the experiences of four trainee cognitive-behaviour therapists who were undertaking SP/SR as part of their professional training in CBT. Quantitative data from self-ratings of skill, and qualitative data from participants’ reflections and attributions following completion of SP/SR were examined. Both the participants, and two additional reviewers were consulted in the interpretation of the results. The impact of SP/SR appeared specific to each participant, reflecting different ways that participants engaged with SP/SR materials. The study suggests that for optimal development, engagement of the personal self and therapist self may be required.

The present study examines worry themes and the tendency to worry in older adults. The sample, which is made up of 162 participants, is divided into three groups. The first group includes 47 participants aged from 55 to 64 years old (the youngest subjects). The second group consists of 56 participants aged from 65 to 74 years old. Finally, the third group includes 59 participants who are 75 years old or older (the oldest subjects). Participants completed the Worry and Anxiety Questionnaire, the Worry Domains Questionnaire for Older Adults and the Penn State Worry Questionnaire. For all subjects combined, the most frequently reported worry theme was health, followed by relationships with family and friends. The results show that participants in group 1 (the youngest subjects) worry more about their future, work and finances than those in the other two groups. The results also show that participants in the first two groups have a greater tendency to worry and report a greater number of worries than those in the third group (the oldest subjects). The study's findings are discussed in light of current knowledge of worry among the elderly.

Background: Research has clearly established the efficacy of pharmacotherapy and cognitive behaviour therapy (CBT) for depression. There is less literature addressing cessation of treatment, such as relapse during withdrawal from antidepressant medication. Aims: The current study examines the role of psychological constructs that may influence relapse or fear of relapse and lead to resumption of medication. This hypothesizes that during withdrawal individuals may misinterpret normal variations in mood and dysphoric or other symptoms as reduced levels of medication in their bodies in keeping with a simplistic rationale for antidepressants. Method: The study uses an intensive single case AB style design in three cases during the withdrawal process. All participants had been treated with CBT plus antidepressants and had previously attempted to withdraw from antidepressants. The first part of the study naturalistically tracks belief changes as medication decreases; the second examines changes in these if/when a CBT intervention is introduced due to relapse or potential near-relapse. Daily self-monitoring diaries were used to measure target variables, together with standardized questionnaires up to 6 months follow-up. Results: Changes in symptoms, appraisal of symptoms, and beliefs about medication changed throughout the study. All participants remained medication free at 6 months follow-up. Two cases received CBT intervention due to possible relapse; the third underwent an unproblematic withdrawal. Conclusions: Patterns of change are discussed in terms of current approaches to medication cessation and the role of CBT during withdrawal.

Background: Recent research into positive experiences in caregivers has begun to redress the traditional focus on negative aspects of caregiving experiences. Method: This exploratory study used a cognitive-behavioural approach – namely, the transactional stress model (Lazarus and Folkman, 1984) – to investigate associations between appraisals, coping, and gains over a 6-week period in a small sample (N = 4; case series) design involving stroke caregivers. Analysis involved visual inspection of graphs, supported by descriptive statistics, and co-variation analysis. Results: Participants reported high levels of positive experiences, and these increased over the study period, a previously unreported trend. The study also found individual differences in the interactions between appraisal, coping, and caregiving gain variables, findings explained by the transactional stress model. Conclusions: Implications for clinical practice and future research are addressed.

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.

Background: Generalized Anxiety Disorder (GAD) is one of the most prevalent anxiety disorders among the elderly. Estimates of prevalence vary from around 3% to 12%, depending on the minimum age considered and the assessment instruments. The present study tests a GAD-specific treatment recently validated among adults (Ladouceur et al., 2000) and adapted for older adults.

Method: Eight older adults (aged from 60 to 71) were included in a single-case experimental multiple-baseline design across subjects. Assessments were conducted at pre-test, post-test and at 6- and 12-months follow-ups. The treatment consisted of awareness training, worry interventions and relapse prevention. The worry interventions targeted intolerance of uncertainty, beliefs about worry, problem-solving and cognitive avoidance.

Results: According to daily self-monitoring of worry, ADIS-IV ratings and self-reported questionnaire scores, seven out of eight participants showed clinically significant improvement at post-test. These therapeutic gains were maintained at 6- and 12-month follow-ups.

Conclusions: This study shows that a cognitive-behavioral treatment that targets intolerance of uncertainty, erroneous beliefs about worry, poor problem orientation and cognitive avoidance is effective for treating GAD among elderly people.

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.

Comorbidity data between Generalized Anxiety Disorder (GAD) and Social Phobia, studies of frequently reported worry themes, and various correlational studies have led to the idea that worries may have a social basis. This study investigates the social basis of worry in three samples with different ages. The samples consisted of 224 high-school students, 607 undergraduate students, and 125 older adults. All participants completed the Worry Domains Questionnaire (WDQ) and the Penn State Worry Questionnaire (PSWQ). We hypothesized that for each sample, the first factor extracted following factor analysis on WDQ items would reflect the most social content, and that social-related factors would be the best predictors of the global tendency to worry as measured by the PSWQ. Results supported the hypotheses with the exception of older adults, for whom the first extracted factor was not as obviously social as for the other two samples. Possible explanations are considered and theoretical and clinical implications are discussed.

This study describes the treatment of severe obsessive-compulsive disorder in a 14-year-old male with an experimental single case design. Onset of OCD was at age 12. He had been hospitalized for 6 months the year before consulting. Almost all life spheres were affected by OCD. An initial behavioural intervention, which targeted tooth brushing, was used as a springboard to understand OCD and the process of change was framed within a cognitive account of OCD. The approach was then applied to a number of different targets within a unified framework. There was a 46% reduction in Y-BOCS score at post-treatment and 67% reduction through to 11-month follow-up. Points discussed include the involvement of other professionals, the changing role of the family as treatment progressed and as the patient started to seek more autonomy, and the choice of the initial target.

This case describes the cognitive-behavioural treatment of a 40-year-old woman with a 22-year history of infrequent fainting episodes. It highlights three features: 1) the potential importance of undiagnosed medical conditions in people presenting for anxiety disorders; 2) a somewhat unusual comorbid diagnosis of Agoraphobia Without History of Panic and Panic Disorder with Agoraphobia; and 3) the importance of modifying attitudes about performance and responsibility to reduce the chance of relapse.

Several authors have suggested that threat schemata of high worriers may differ from those of less worried individuals with regards to the manner with which information is structured in the Long Term Memory (LTM) or the content of the information stored in the LTM. The present study tested this hypothesis using the catastrophizing interview technique (c.f., Vasey & Borkovec, 1992). Results revealed that high worriers evaluated the likelihood of the occurrence of feared consequences generated for each worry as more likely to actually happen than low worriers did. Second, the ultimate outcome generated in the catastrophizing sequence for a given worry was more severe for high worriers. Finally, high worriers generated ultimate outcomes that were more similar in content, presumably reflecting tightly organized threat schemata. It is argued that activation of these threat schemata in the LTM contributes to the maintenance of worry and anxiety in anxious individuals.

Intrusive thoughts are variously reported as images, thoughts, doubts, impulses etc. Recent accounts of emotional processing make important distinctions between cognitive activity in verbal form and images. The comparison of verbal intrusions and images was made on archival data about intrusive cognitions from 628 university students. Images and doubts (a verbal form) occurring together were perceived as more difficult to dismiss than either images or doubts alone. In addition, images and doubts together were more frequent, more probable, and required more effort to counter than images alone. Likewise, images and doubts together and doubts alone were more worrisome and more frequently triggered by various stimuli than images alone. These results suggest that cognitive intrusions identified as a mixture of doubts and images are qualitatively different and more troublesome than those identified as either doubts or images. These findings are discussed in terms of current accounts of emotional processing.