Despite emotional stress being recognised as a key trigger for Raynaud’s phenomenon episodes, research in the area is still in its infancy.

This study investigated the role of psychological factors relating to symptom severity and quality of life, and differences between Raynaud’s types (primary and secondary) to further inform the development of intervention in this field.

A cross-sectional design was used. Two hundred and ten adults with Raynaud’s completed an online questionnaire measuring stress, anxiety, depression, anxiety sensitivity, beliefs about emotions, symptom severity and quality of life.

Primary and secondary Raynaud’s groups differed in anxiety (p < .004), symptom severity (p < .001) and quality of life (p < .001). Stepwise multiple regressions indicated anxiety and Raynaud’s type explained 23% variance in hand symptom severity (p < .001); anxiety, Raynaud’s type and anxiety sensitivity explained 29% variance in symptom severity (global impact, p < .001); depression, Raynaud’s type and anxiety sensitivity explained 32% variance in quality of life (p < .001).

Results highlight the importance of psychological factors in Raynaud’s phenomenon, indicating possible targets for treatment. Interventions such as cognitive behavioural therapy, which target both physical and psychological wellbeing, bear some promise as an adjuvant therapy for this group.

Grieve et al. (2022) tested the effects of an intervention designed to reduce perfectionism. Contrary to their hypotheses, the intervention reduced both perfectionism and excellencism. Furthermore, excellencism positively correlated with negative outcomes (e.g. anxiety).

A theory-driven framework (with five hypothetical scenarios) is proposed to reconsider how we interpret the effectiveness of interventions designed to reduce perfectionism. Our goal was to offer a constructive reinterpretation of the results of Grieve et al. (2022) using our new framework derived from the Model of Excellencism and Perfectionism.

Secondary data analyses using the experimental and correlational results are published in the randomized control trial of Grieve et al. (2022).

Our re-examination of the results reveals that excellencism was reduced by a smaller extent (approximately 25% less) than perfectionism. Based on our framework, such a ratio provides conclusive evidence for the effectiveness of this intervention. Students entered the intervention as perfectionists and they ended up somewhere between the zones of excellence striving and non-perfectionism. Furthermore, our multivariate re-analysis of the bivariate correlations indicates that excellence strivers experienced better adjustment (lower anxiety, depression, stress, body-related acceptance, and higher self-compassion) compared with perfectionists.

Future interventions should target the reduction of perfectionism and the maintenance of excellencism because excellencism relates to desirable outcomes. Our secondary data analysis was needed to inform researchers and practitioners about an alternative interpretation of Grieve and colleagues’ findings. Future interventions to reduce perfectionism should closely monitor excellencism and follow the interpretational guidelines advanced in this article.

Mental imagery, or ‘seeing with the mind’s eye’ (Kosslyn et al. 2001), provokes strong emotional responses (Ji et al., 2016). To date, there is a lack of data on the content and clinical characteristics (e.g. vividness, likelihood, emotional effects) of spontaneous mental images (MI) in people with bipolar disorder (BD) according to their thymic states.

The current study sought to assess the characteristics associated with the contents of MI in people with BD.

Forty-two euthymic individuals diagnosed with BD (American Psychiatric Association, 2013) were asked to self-report their MI during depression, (hypo)mania and euthymia. Participants also rated levels of vividness, likelihood and emotional activation related to MI (i.e. valence, arousal, type of emotion).

The contents of the MI revealed phenomenological aspects of BD. Different themes were associated with each thymic phase. In (hypo)mania and in euthymia, the mental images were assessed as being as vivid as probable (p>.05). (Hypo)manic and euthymic-related MI activated more pleasure than displeasure (p<.001) and were mainly associated with joy. In depression, MI were assessed as more vivid than likely (p<.05). In depression, MI activated more displeasure than pleasure (p<.0001) and induced mainly sadness.

Overall, a congruence between the contents of images and the three thymic phases was found. The content of the MI was related to self-reported emotional effects that were congruent with the thymic phases concerned. The results add new clinical information for the use of imagery-based cognitive therapy in individuals with BD.

Auditory verbal hallucinations (AVH), or voice-hearing, can be a prominent symptom during fluctuating mood states in bipolar disorder (BD).

The current study aimed to: (i) compare AVH-related distress in BD relative to schizophrenia (SCZ), (ii) examine correlations between phenomenology and voice beliefs across each group, and (iii) explore how voice beliefs may uniquely contribute to distress in BD and SCZ.

Participants were recruited from two international sites in Australia (BD=31; SCZ=50) and the UK (BD=17). Basic demographic-clinical information was collected, and mood symptoms were assessed. To document AVH characteristics, a 4-factor model of the Psychotic Symptoms Rating Scale and the Beliefs about Voices Questionnaire-Revised were used. Statistical analyses consisted of group-wise comparisons, Pearson’s correlations and multiple hierarchical regressions.

It was found that AVH-related distress was not significantly higher in BD than SCZ, but those with BD made significantly more internal attributions for their voices. In the BD group, AVH-related distress was significantly positively correlated with malevolence, omnipotence and resistance, However, only resistance, alongside mania and depressive symptoms, significantly contributed to AVH-related distress in BD.

Our findings have several clinical implications, including identification of voice resistance as a potential therapeutic target to prioritise in BD. Factoring in the influence of mood symptoms on AVH-related distress as well as adopting more acceptance-oriented therapies may also be of benefit.

Cognitive behavioural therapy (CBT) is an empirically supported treatment for generalized anxiety disorder (GAD). Little is known about the effectiveness of CBT for GAD in real-world treatment settings.

This study investigated the effectiveness of group CBT and predictors of treatment response in an out-patient hospital clinic.

Participants (n = 386) with GAD participated in 12 sessions of group CBT at an out-patient clinic. Of those who provided at least partial data (n = 326), 84.5% completed treatment. Most questionnaires were completed at pre- and post-treatment; worry severity was assessed weekly.

Group CBT led to improvements in chronic worry (d = –0.91, n = 118), depressive symptoms (d = –1.22, n = 172), GAD symptom severity (d = –0.65, n = 171), intolerance of uncertainty (IU; d = –0.46, n = 174) and level of functional impairment (d = –0.35, n = 169). Greater pre-treatment GAD symptom severity (d = –0.17, n = 293), chronic worry (d = –0.20, n = 185), functional impairment (d = –0.12, n = 292), and number of comorbid diagnoses (d = –0.13, n = 299) predicted greater improvement in past week worry over treatment. Biological sex, age, depression symptom severity, number of treatment sessions attended, and IU did not predict change in past week worry over time.

These findings provide support for the effectiveness of group CBT for GAD and suggest the outcomes are robust and are either not impacted or are slightly positively impacted by several demographic and clinical factors.

There is some initial evidence that attachment security priming may be useful for promoting engagement in therapy and improving clinical outcomes.

This study sought to assess whether outcomes for behavioural activation delivered in routine care could be enhanced via the addition of attachment security priming.

This was a pragmatic two-arm feasibility and pilot additive randomised control trial. Participants were recruited with depression deemed suitable for a behavioural activation intervention at Step 2 of a Talking Therapies for Anxiety and Depression service. Ten psychological wellbeing practitioners were trained in implementing attachment security priming. Study participants were randomised to either behavioural activation (BA) or BA plus an attachment prime. The diagrammatic prime was integrated into the depression workbook. Feasibility outcomes were training satisfaction, recruitment, willingness to participate and study attrition rates. Pilot outcomes were comparisons of clinical outcomes, attendance, drop-out and stepping-up rates.

All practitioners recruited to the study, and training satisfaction was high. Of the 39 patients that were assessed for eligibility, 24 were randomised (61.53%) and there were no study drop-outs. No significant differences were found between the arms with regards to drop-out, attendance, stepping-up or clinical outcomes.

Further controlled research regarding the utility of attachment security priming is warranted in larger studies that utilise manipulation checks and monitor intervention adherence.

Evidence suggests that cognitive behavioural therapy (CBT) can be a helpful approach for older adults experiencing anxiety and depression. Some research has suggested this is also the case for those caring for a family member with dementia. Little research has been conducted into the impact of CBT for older adults juggling the demands of caring for multiple family members with dementia.

This case study aimed to evaluate the application of CBT to ‘Mrs P’, a 68-year-old client experiencing anxiety and depression whilst caring for two family members with dementia.

A single case experimental design study was conducted to assess the effectiveness of CBT formulation and intervention, including cognitive restructuring of unhelpful thoughts about caregiving and increasing engagement in pleasurable activities.

Mrs P’s depression and anxiety scores improved significantly throughout treatment, and she met her goal of being able to manage when caregiving activities go wrong during daily life.

CBT may be a helpful approach to reducing anxiety and depression in dementia family caregivers.

Many people achieve positive outcomes from psychological therapies for anxiety and depression. However, not everyone benefits and some may require additional support. Previous studies have examined the demographic and clinical characteristics of people starting treatment and identified a patient profile that is associated with poor clinical outcomes.

To examine whether the addition of employment-related support alongside psychological therapy was associated with a greater chance of recovery for clients belonging to this patient profile.

We analysed 302 clients across three services, who were offered employment-related support alongside psychological therapy. The rate of clinical recovery (falling below clinical thresholds on measures of both anxiety and depression) was compared between individuals who accepted the offer and those who declined, while adjusting for potential confounders.

Logistic regression showed that receiving employment support was significantly associated with clinical recovery after controlling for baseline anxiety and depression scores, the number of psychological treatment sessions, and other clinical and demographic variables. The odds of recovery were 2.54 times greater if clients received employment support; 47% of clients who received employment support alongside psychological therapy were classified as recovered, compared with 27% of those receiving psychological therapy only.

Providing employment support alongside therapy may be particularly helpful for clients belonging to this patient profile, who represent approximately 10% of referrals to NHS Talking Therapies for Anxiety and Depression services. Services could consider how to increase the provision and uptake of employment-focused support to enhance clients’ clinical outcomes.

Cognitive behavioural therapy for insomnia (CBT-I) is an effective treatment for chronic insomnia that also improves non-sleep symptoms, such as mood and anxiety. Identifying sleep-specific variables that predict anxiety change after CBT-I treatment may support alternative strategies when people with generalized anxiety disorder (GAD) do not improve from standard GAD treatment.

To investigate CBT-I on changes in anxiety and evaluate whether changes in sleep-specific variables predict anxiety outcomes.

Seventy-two participants presenting with insomnia and GAD (GAD-I) completed four sessions of CBT-I. Participants completed daily diaries and self-report measures at baseline and post-treatment.

CBT-I in a co‐morbid GAD-I sample was associated with medium reductions in anxiety, and large reductions in insomnia severity. Subjective insomnia severity and tendencies to ruminate in response to fatigue predicted post-treatment anxiety change, in addition to younger age and lower baseline anxiety.

The findings suggest that younger GAD-I participants with moderate anxiety symptoms may benefit most from the anxiety-relieving impact of CBT-I. Reducing perceived insomnia severity and the tendency to ruminate in response to fatigue may support reductions in anxiety in those with GAD-I.

Despite the importance of assessing the quality with which low-intensity (LI) group psychoeducational interventions are delivered, no measure of treatment integrity (TI) has been developed.

To develop a psychometrically robust TI measure for LI psychoeducational group interventions.

This study had two phases. Firstly, the group psychoeducation treatment integrity measure-expert rater (GPTIM-ER) and a detailed scoring manual were developed. This was piloted by n=5 expert raters rating the same LI group session; n=6 expert raters then assessed content validity. Secondly, 10 group psychoeducational sessions drawn from routine practice were then rated by n=8 expert raters using the GPTIM-ER; n=9 patients also rated the quality of the group sessions using a sister version (i.e. GPTIM-P) and clinical and service outcome data were drawn from the LI groups assessed.

The GPTIM-ER had excellent internal reliability, good test–retest reliability, but poor inter-rater reliability. The GPTIM-ER had excellent content validity, construct validity, formed a single factor scale and had reasonable predictive validity.

The GPTIM-ER has promising, but not complete, psychometric properties. The low inter-rater reliability scores between expert raters are the main ongoing concern and so further development and testing is required in future well-constructed studies.

Little is known about the skills involved in clinical formulation. The individual case formulation (ICF) approach, based on functional analysis, employs clinical descriptions that are theory-free and depicts formulations constructed according to a set of basic conventions.

We report a test of whether this method could be taught and if the quality of the resulting diagrams could be reliably rated.

Participants (n=40) participated in a training course in formulation. A draft rating scale was refined in the course of rating formulation diagrams and basic inter-rater reliability established.

Results of the study support further development of the ICF approach.

Anxiety sensitivity (AS) and disgust sensitivity (DS) are transdiagnostic vulnerability factors for anxiety. Both correlate with blood-injection-injury (BII) phobia symptoms in several studies; however, there is ambiguity about their relative contributions, and studies investigating this have relied on unselected samples. Furthermore, although DS reliably predicts BII in studies that do not account for AS, this may be limited to domain-specific DS rather than DS more broadly.

The aims of this study were to examine AS and DS as separate and simultaneous predictors of BII fears in a sample with a wide range of BII symptoms, and with attention to the specificity of DS to BII-relevant domains.

Fifty-three participants who scored above a clinical threshold on a validated measure of dental anxiety, and who represented a wide range of BII severity, completed measures of AS, DS and BII symptoms.

AS and DS were moderately to strongly correlated with BII severity (r = .40 and .47, p = .004 and <.001), and both independently predicted BII severity when entered as simultaneous predictors (β = .32 and .35, p = .045 and .015). Furthermore, after omitting DS about injections and blood draws, domain-general DS was still moderately correlated with BII severity (r = .33, p = .017). However, domain-general DS did not significantly predict BII severity after accounting for AS (β = .20, p = .164).

AS and DS both predict BII symptoms, and prospective research is warranted to examine them as potential vulnerability factors.

Prevention programs that target resilience may help youth address mental health difficulties and promote well-being during public health crises.

To examine the preliminary efficacy of the Resilient Youth Program (RYP).

The RYP was delivered remotely from a US academic medical centre to youth in the community via a naturalistic pilot study. Data from 66 youth (ages 6–18, Mage = 11.65, SD = 3.02) and their parents were collected via quality assurance procedures (May 2020 to March 2021). Pre/post-intervention child/parent-reported psychological and stress symptoms as well as well-being measures were compared via Wilcoxon signed rank tests. Child/parent-reported skills use data were collected.

Among child-reported outcomes, there were significant decreases in physical stress (p = .03), anxiety (p = .004), depressive symptoms (p < .001) and anger (p = .002), as well as increased life satisfaction (p = .02). There were no significant differences in child-reported psychological stress (p = .06) or positive affect (p = .09). Among parent-reported child outcomes, there were significant decreases in psychological (p < .001) and physical stress (p = .03), anxiety (p < .001), depressive symptoms (p < .001), and anger (p < .002) as well as increased positive affect (p < .001) and life satisfaction (p < .001). Effect sizes ranged from small to medium; 77% of youth (73% of parents) reported using RYP skills. Age and gender were not associated with outcome change.

The RYP may help reduce psychological/stress symptoms and increase well-being among youth; further research is needed.

Intrapersonal aspects of emotion regulation have been at the forefront of research, while interpersonal aspects have received less attention. The Interpersonal Emotion Regulation Questionnaire (IERQ) was developed to address this issue. However, this scale was neither adapted nor validated for European Portuguese.

The present study aims to adapt the IERQ to European Portuguese and explore the preliminary psychometric properties of the IERQ in a community sample, through confirmatory factor analysis (CFA). Construct validity was further supported by examining convergent validity with ERQ subscales.

Using a cross-sectional design, individuals were recruited online. Self-report questionnaires were used, namely the IERQ and the Emotion Regulation Questionnaire (ERQ).

The four-factor structure was confirmed through CFA. IERQ subscales correlated positively with the dimensions of the ERQ of cognitive reappraisal and correlated negatively with experiential suppression.

This preliminary study showed that the IERQ has adequate psychometric properties in a Portuguese sample and supports that this instrument can be used to assess interpersonal emotion regulation strategies in non-clinical samples.