Objective: In cognitive behavioural therapy (CBT), case formulation (CF) is an integral process in ensuring clinicians’ work is grounded in evidence-based practice (EBP). The objective of this study was to evaluate psychologists’ perceptions and self-reported applications of CBT-CF, and whether these differed according to clinician experience, training, and professional accreditation. Method: A scale was developed to assess CF beliefs and applications by clinicians who had been practising CBT for a minimum of 6 months. The development of scale items was based on two CBT-CF conceptual models. Seventy-nine psychologists registered in Australia took part in this online survey. Results: Psychologists’ beliefs pertaining to CBT CF supported a three-factor model. On average, psychologists perceived all activities related to CF at least moderately important, and were implemented at least some of the time. However, activities related to use of external evidence were rated as less important, and less frequently implemented. Clinical psychologists endorsed theory and EBP in structuring CF as more important, which also translated into self-reported practice of CF CBT implementation relative to generalist psychologists. Conclusions: The findings indicate some gaps in the knowledge and application of CF CBT in clinical practice and has implications in strengthening clinician training in CF CBT.

Translating existing internet-based cognitive-behavioural therapy (iCBT), along with the use of transdiagnostic and self-guided formats, may prove to be a cost-effective option of disseminating iCBT. Only recently have encouraging findings been reported for a self-guided delivery. This study assessed the feasibility of a French and self-guided version of an existing English iCBT course, called the Wellbeing Course, for the treatment of anxiety and depression. Existing ICBT programs have not yet been delivered in French, although this language is spoken worldwide. Thirty-one participants were included in a single group pre-post open trial with a 3-month follow-up. Feasibility outcomes were attrition, treatment adherence, acceptability, and preliminary efficacy. Primary outcome measures were the Patient Health Questionnaire 9-item (PHQ-9) and the Generalised Anxiety Disorder 7-item (GAD-7). Nearly 75% of the participants completed the program. Over 80% of the participants provided posttreatment and follow-up data. All study completers reported that they would recommend the Wellbeing Course to a friend having similar problems. Significant reductions in symptoms of anxiety and depression were found following treatment, consistent with earlier studies. These preliminary findings support the use of the assessed strategies to facilitate the cross-cultural dissemination of iCBT for a more universal access to quality psychological care.

This study aimed to compile existing evidence about the proposed relationships among variables at three stages of the model of therapeutic engagement (MTE): patient intention to engage in cardiac rehabilitation (CR), CR initiation, and sustained engagement. This model has not been tested in any rehabilitation setting. Therefore, this systematic literature review is key to future research and application of MTE to predict and enhance patient engagement in CR. Model-centric systematic literature reviews have been conducted for each stage of the MTE. A coherent approach to understanding and monitoring the process of patient engagement in CR is absent. Few relevant studies included in the model-centric reviews met the criteria: eight in stage 1, four in stage 2, and six in stage 3 of the MTE. In total, the tenets of the MTE were supported in patient intention to engage in CR. However, there was less evidence quantifying the proposed relationships among variables that impact on CR initiation and sustained engagement. There is a scarcity of research examining rehabilitation engagement in depth to better understand the complicated process contributing to behavioural outcomes. No decision-support models currently exist to alert patients and healthcare provider to the factors that influence non-engagement.

Understanding the underlying mechanisms of recovery from insomnia is an important goal for improving existing treatments. In a randomised controlled trial, 57 participants with insomnia disorder were given either cognitive therapy (CT) or mindfulness-based therapy (MBT) following 4 sessions of CBT. Each participant was assessed on process measures related to CT and MBT. MBT resulted in improvement on mindfulness process measures and the size of the improvement was significantly greater than achieved in the CT condition. Interestingly, CT and MBT both resulted in significant improvement on the cognitive process measures. Treatment outcome on the primary outcome measure (Insomnia Severity Index) was not predicted by type of treatment but was predicted by posttreatment scores on the cognitive process measures. The results suggest that changes in cognitive processes are especially important in treating insomnia, and that there are different therapeutic modalities through which this can be achieved.

Social anxiety is a common, debilitating psychological problem. In the present study, two meta-analyses examined the efficacy of virtual reality exposure therapy for social anxiety. The first meta-analysis tested whether virtual reality exposure therapy reduces social anxiety more than a waitlist control condition. The results of the first meta-analysis, consisting of six studies and 233 participants, showed a significant overall effect size, indicating that virtual reality exposure therapy was effective in reducing social anxiety. The second meta-analysis tested whether the standard treatment for social anxiety, which includes in vivo or imaginal exposure, leads to greater effects than virtual reality exposure therapy. The second meta-analysis, consisting of seven studies and 340 total participants, showed essentially no difference in effect sizes between virtual reality exposure and in vivo or imaginal exposure. The results of the two meta-analyses support the use of virtual reality in the treatment of social anxiety.

Childhood obesity treatment programs only result in moderate outcomes in the short term and do not reduce risk for future weight gain. Therefore, in the current study, Approach Avoidance Training (AAT) with motivational game elements will be added to an inpatient childhood obesity program with the aim of improving outcomes. Forty-one children (10–15 years) in the final months of an inpatient treatment program were randomised to either the AAT plus care-as-usual condition group or to a care-as-usual-only control group. During the 10 sessions, the children were trained to approach healthy food stimuli and to avoid unhealthy food stimuli. Treatment outcomes were child performances on tasks of AAT, implicit attitudes and attentional bias, self-report ratings on craving symptoms, and weight loss maintenance after leaving the clinic (12-week follow-up). Changes over time were not significantly different between conditions for the measures of automatic processes, craving, and weight loss maintenance. Possible accounts for the null findings, including sample size, influence of game elements, point of time in therapeutic process, limitations of the setting, and the control group are discussed. More research is needed before firm conclusions can be drawn about the clinical usefulness of CBM for weight control in childhood obesity.

A staple theme in clinical psychology, emotion regulation, or the ability to manage one's emotions, is directly linked with personal wellbeing and the ability to effectively navigate the social world. Until recently, this concept has been limited to a focus on intrapersonal processes, such as suppression. Less emphasis has been placed on developmental, social, and cultural aspects of emotion regulation. We argue here that as social beings, our engagement in emotion regulation may often occur interpersonally, with trusted others helping us to regulate our emotions. This review will highlight recent research on interpersonal emotion regulation processes.

Explicit measures of disgust and threat overestimation have consistently been found to be involved in contamination aversion. However, evidence of the involvement of these factors at the implicit level is mixed, and the role of both responses has not been looked at concurrently. This study aimed to compare the ability of implicit and explicit measures of disgust and threat overestimation to predict contamination aversion and whether this depends on the type of contaminant. Sixty-five participants completed explicit and implicit measures of disgust and threat overestimation, as well as several measures of contamination aversion, including obsessive-compulsive tendencies, and contamination fear and avoidance of contaminants directly associated with disease (direct contaminants) and harmful substances (harm contaminants). It was found that both explicit disgust and explicit threat overestimation predicted contamination-fear obsessive-compulsive tendencies. Explicit disgust predicted contamination fear and avoidance of direct contaminants, whereas explicit threat overestimation predicted contamination fear and avoidance of harm contaminants. The involvement of implicit processes was weak, with some suggestion of difficulty disengaging predicting avoidance of contaminants. Implications for understanding dysfunctional contamination aversion are discussed.

The depressive-realism effect refers to a phenomenon in which depressed individuals are more realistic at assessing the relationship between two events than non-depressed individuals. Recent evidence suggests that the depressive realism hypothesis is weaker than first thought. Thus, we sought evidence for depressive-realism under conditions that we hypothesised would maximise the effect. We tested a clinically depressed sample of participants who were administered a rumination induction. Twenty-eight clinically depressed and 39 non-depressed participants were randomly allocated to either a rumination condition (focused on the causes, consequences, and meaning of their mood) or a distraction condition (focused on external objects/events such as a classroom). Participants then completed a contingency task in which there was no relationship between their responses and an outcome, and they were asked to make a judgment of how much control they had over an outcome. Both groups and conditions did not differ in their judgments of control; participants in all conditions showed a non-normative judgment of control. The depressive-realism effect was not observed in this study, even when depressed participants were encouraged to ruminate. Rather, the present study clearly demonstrates the robustness of the illusion of control.

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and different versions of the Padua Inventory (PI) are frequently used instruments to measure symptoms of obsessive-compulsive disorder (OCD). However, little is known of how these different versions of the PI compare to each other in their sensitivity to measuring treatment outcome, and there is currently no adequate explanation to account for the weak relationships between self-report measures and the Y-BOCS. This study aimed to investigate the sensitivity of these measures to treatment outcome, and to examine whether differences in how they measure symptom severity can explain the weak relationships. Hypotheses were: (1) the Y-BOCS would be significantly more sensitive to measuring treatment outcome than the PI versions; (2) correlations between the measures would be significantly stronger for change scores as compared to relations measured at a single point in time; (3) weak relationships can be explained by the PI measuring symptom severity based on content and the Y-BOCS measuring symptoms, independent of content. Results showed that the Y-BOCS was significantly more sensitive to measuring treatment outcome than the PI versions, while differences between the questionnaires in which severity is measured can provide a partial account for why weak relations are observed between these measures.

Previous research has shown that long-term mindfulness training has beneficial effects on cognitive functioning and emotional regulation, but results are mixed regarding single mindfulness exercises, especially on attention and memory tasks. Thus, the present study aimed to analyse the effects of the Focused Breathing Exercise (FB) on cognitive performance, using standardised tests. Forty-six healthy undergraduate students were randomly assigned either to a FB or a Control condition. Two cognitive tasks (the Concentrated Attention task of the Toulouse-Pierron Factorial Battery and the Logical Memory Subtest I from the Wechsler Memory Scale III), along with mood evaluations (the Positive and Negative Affect Scale), were implemented both before and after the interventions. Results showed no significant differences for the attention task and mood evaluations. Nonetheless, the FB enhanced performance for the memory task significantly more than the Control exercise. The findings highlight that mindfulness does not affect equally all types of cognitive performances. Task characteristics may be important and their analysis can help to disentangle how mindfulness interferes with cognitive processes.

Cognitive theories of generalised anxiety disorder (GAD) posit that cognitive and behavioural factors maintain the disorder. This study examined whether avoidance and safety behaviours mediated the relationship between cognitive factors and GAD symptoms. We also examined the reverse mediation model; that is, whether cognitive factors mediated the relationship between maladaptive behaviours and GAD symptoms. Undergraduate psychology students (N = 125 and N = 292) completed the Worry Behaviours Inventory (a recently developed measure of maladaptive behaviours associated with GAD), in addition to measures of intolerance of uncertainty, cognitive avoidance, metacognitive beliefs, and symptoms of GAD and depression. Analyses supported the reliability and validity of the WBI. We consistently found that engagement in maladaptive behaviours significantly mediated the relationship between cognitive factors and symptoms of GAD. The reverse mediation model was also supported. Our results are consistent with the contention that cognitive and behavioural factors contribute to GAD symptom severity.

Little is known about mental images (cognitive representations with sensory qualities) in body integrity identity disorder (BIID). This study aimed to determine whether individuals with BIID experience mental images and, if so, whether they differ to those experienced by individuals with body dysmorphic disorder (BDD) and healthy controls. A semi-structured interview on mental images and their qualities was delivered to a sample of 22 individuals with BIID and 19 with BDD, and 22 healthy controls. Both the BIID (n = 15, 68.2%) and BDD (n = 14, 73.7%) groups reported significantly more mental images than healthy controls (n = 3, 13.6%), but no differences between the two clinical groups were found. While mental images in BDD were focused on ‘flawed’ body parts, images in BIID involved the desired handicap. Mental images in BIID were experienced as less distressing and more sexually arousing compared to BDD. No further differences were found between the groups (e.g., regarding sensory multimodality, dominance of a specific body part). Although the two groups reported a similar frequency of mental images, images appear to serve different functions across conditions. Clinically, it may be necessary to target the positive mental images in BIID to improve treatment outcome.

Little is known about the change processes in gambling disorder-specific cognitive therapy (CT) and exposure therapy (ET). These therapies are underpinned by the cognitive approach (i.e., restructuring gambling cognitions) and the psychobiological approach (i.e., elimination of gambling urges) to treating problem gambling. Here, piecewise-linear modelling is used in a secondary analysis of randomised trial data for a CT group (n = 44) versus an ET group (n = 43) with the aim to open a discourse on how individuals respond to CT and ET relative to theory. Measures were administered between therapy sessions (average = 6.2 per individual) across 18 weeks for gambling urge (GUS) and gambling cognitions (GRCS). Results indicated the ET group had a stronger reduction in GUS (p < .01) in the first 4 weeks of treatment. Between 4–12 weeks, improvement in GUS (p < .01) and GRCS (p = .02) was more rapid in the CT group. Both groups experienced comparable improvements from 12–18 weeks. These findings have implications for further treatment development, including a combined cognitive and exposure approach that is flexibly adapted to the patient. A larger trial is needed to formally establish change processes and identify differences in problem gambler subgroups. This would provide therapists capacity to offer each patient a clear direction and an expedited pathway to their preferred outcome.