Eliciting, evaluating and changing core beliefs are established features of cognitive behaviour therapy (CBT). However, care must be taken when working at this level of cognition. This is because therapists are dealing with core constructs that, whether dysfunctional or otherwise, influence the patient's self-concept, her world and future. This paper examines when it is appropriate to work at this level and some of the specific problems regarding assessment and the consequences of belief change. It is evident that achieving lasting cognitive change is a difficult task, and this may be in part due to the poor quality of the literature and training in the area. In an attempt to address this, the final section of the paper offers a set of practical guidelines concerning the continuum technique, a well-known CBT method for targeting, evaluating and changing core beliefs. It highlights process features (e.g. planning, management, and interpersonal skills) as being crucial in creating contexts in which change can take place. The work has been written for trainee cognitive therapists and those with a working knowledge of CBT who are seeking to improve their abilities in the use of change methodologies.

This paper describes two cases involving the use of cognitive behavioural therapy (CBT) to treat the positive symptoms of schizophrenia. In both cases the individuals were experiencing acute psychotic symptoms during their first admission to hospital. Each case illustrates how CBT was used to tackle a particular issue pertinent to the delivery of treatment at this early stage in the development of an individual's experiences of psychotic symptoms. Case one describes therapy with a young person of 17 where developmental issues are pertinent; case two describes the use of therapy to engage a person whose symptoms have ostensibly remitted. In both cases the promotion of understanding of the origin of their experiences was vital to the conduct of therapy. The implications of these issues to conducting therapy with this client group and the methods used to overcome them are discussed with reference to the future developments of cognitive behavioural therapy for use with this client group.

There is a growing body of evidence that cognitive-behaviour therapy is an effective treatment in chronic psychosis for reducing the severity and distress associated with hallucinations and delusions. However, no work has been published that has applied cognitive-behaviour therapy (CBT) with inpatients within secure environments who may have co-existing problems with psychosis and aggression. This paper describes how CBT for psychosis has been integrated with a CBT approach for treating anger for this group of patients. Three case studies of inpatients on a low secure, high dependency facility are described with whom this approach was used. The paper highlights the unique problems of interventions with these types of clients, and describes how CBT can be applied within these environments.

In this pilot study the influences of the media on suicidal ideation and behaviour were investigated through interviews with patients who had recently engaged in an episode of self-harm. They were asked about the impact of individual media stories, how they had first learned about suicide and the role of the media in the formation of images related to self-harm. Twelve patients between the ages of 17 and 25 were interviewed using a semi-structured interview. Most of the patients reported being affected by a story presented in the media; four reported that a story had prompted them to self-harm. Some also reported beneficial effects of the media on self-harming behaviour, either in terms of preventing an act or encouraging help seeking. This study has shown that in-depth interviews using qualitative and quantitative methods can provide new information about influences of the media on suicidal behaviour.

Cognitive behavioural treatment manuals have increased in frequency, purpose and impact over the last 40 years. Despite numerous papers on the topic, few empirical studies regarding the constitution of treatment manuals have been conducted. A Delphi study examining the factors that constitute a good cognitive behavioural treatment manual is presented. This study generated a consensus of opinion of factors that therapists and researchers should consider when developing and appraising treatment manuals for cognitive behavioural interventions. Limitations of the study and the potential relevance of the research are discussed.

Models of panic and health anxiety are used to explore the possible psychological processes contributing to excessive fluid intake in kidney patients on a fluid restriction. Some simple figures concerning the role of attention in thirst intensity are presented.

This paper summarizes a recently developed model for understanding the genesis of visual hallucinations, shows how this can be incorporated into a cognitive behavioural framework, and then illustrates possible ways in which this may be used to successfully treat the emotional distress that some older people experience as a consequence of their hallucinations. These ideas have been developed as a model-based clinical response to patients distressed by their hallucinations. The purpose of this paper is to outline this approach in order to stimulate discussion and empirical evaluation.

Conventional medical treatment is often ineffective in the management of Irritable Bowel Syndrome (IBS). Although controlled trials of psychotherapy and hypnotherapy have been shown to be effective, psychological interventions are not widely available. The aim of this study was to assess the feasibility of the clinical provision of combined group cognitive-behaviour therapy (CBT) and hypnotherapy delivered by 13 therapists using a standardized protocol. Attempts were also made to disseminate the programme by patient graduates. A session-by-session instruction manual was compiled and the protocol was tested in a pilot group. Thereafter a total of 158 patients in 23 different groups took part in the 16-session intervention. Attrition rate was very low. Significant improvements in both gastrointestinal and psychosocial symptoms were observed following the intervention. The results suggest that professionally led group psychotherapy and hypnotherapy is a feasible option for the treatment of sufferers of IBS and increased efforts should be made in the training and supervision of user facilitators.

The aim of this case report is to describe the impact of an intervention for clinical perfectionism, derived from a new cognitive-behavioural analysis, in a patient with binge-eating disorder. It was hypothesized that clinical perfectionism was contributing to the maintenance of the eating disorder, and on this basis it was predicted that reducing clinical perfectionism would improve her eating disorder psychopathology. Standardized independent assessments were found to be consistent with this hypothesis, in that clinical perfectionism and eating disorder psychopathology improved over an eight-session intervention and improvements were largely maintained at 5-month follow-up.

This paper summarizes the best available information on the nature and prevalence of drug-facilitated sexual assault (DFSA) in the UK. Characteristics of the assault itself and the drugs used are described. The minimal available data on the psychological consequences of DFSA are considered. Our clinical experience suggests that DFSA has some psychological consequences that are distinct from those seen in sexual assault without drug involvement. The survivor's response to a fragmented or absent traumatic memory appears important. We suspect that specific characteristics of the assault (for example, obvious premeditation) may affect adjustment. Also, the involvement of alcohol, drugs and an incomplete memory in the survivor's account may affect the levels of validation and social support received. We review the model of post-trauma reactions that seems most useful in treating the consequences of DFSA and suggest additional treatment strategies that address the specific nature of this trauma.

A number of studies suggest that individual cognitive-behavioural therapy (CBT) is beneficial to patients suffering from Chronic Fatigue Syndrome (CFS). This study investigated the effectiveness of group CBT in reducing fatigue and distress in five outpatients with a diagnosis of CFS throughout therapy and at 3-month follow-up. The nature of the group, treatment outcomes and benefits of this approach are outlined. Group CBT was acceptable to participants and led to improvements in fatigue as well as cognitive functioning.

The aim of the study was to examine whether the personality dimensions of sociotropy and autonomy (Beck, Epstein, Harrison, & Emery, 1983) remained stable in older people with dementia. Sociotropy is characterized by the need for social reassurance, approval and contact. Autonomy reflects the need for control, self-determination and task-orientated achievement. A non-clinical normative sample (aged 17–87) confirmed Beck's theoretical dimensions of sociotropy and autonomy. This sample was used to determine cut-points for the two dimensions on the Sociotropy Autonomy Scale (SAS). The SAS was then used with 63 people with dementia to determine whether their personality profiles, in terms of sociotropy and autonomy, were similar to the earlier sample. Data obtained in the personality profiling were examined against mood and behavioural measures for people with dementia. Profiles for both samples were found to be similar, i.e. there were distinct minority sub-sets of high scoring sociotropic and autonomous individuals. Consistent with Beck's theoretical position, high scoring autonomy and sociotropy individuals with dementia were more likely to display mood and behaviour difficulties. It was therefore concluded that aspects of personality (i.e. temperament) remain stable in dementia. The SAS can identify older people with dementia who are vulnerable to mood and behaviour problems. This has direct clinical relevance to the targeting of effective care practices in residential settings.

This is report of the successful use of behavioral treatment in a medical crisis. The intubation process inadvertently punctured a patient's throat during the application of general anesthesia while having a routine arthroscopy. This resulted in a rapidly spreading infection, spiking temperature and dehydration. To locate the puncture, a barium swallow x-ray was necessary, but the patient's weakened condition made standing impossible. A friend and experienced therapist accompanying the patient helped him stand for the several minutes necessary to complete the barium swallow by countering the hypotensive state with angry imagery to stimulate an adrenalin surge. Several principles of effective therapeutic practice were demonstrated by this case, including the importance of the alliance, of technical eclecticism, of engaging the patient in the treatment process, and therapist experience.

This paper reports the process outcomes of a randomized trial of a one-session Motivational Interviewing (MI) intervention conducted with youth (12–20 years) in a hospital emergency department (ED) while undergoing medical care for an injury. The interventions targeted six behaviors placing youths at high risk for injury. Those youth whose counselors perceived their readiness to increase between the start and end of the MI session were 4.5 times more likely to have improved their use of seat belts 6 months later compared with youth who were not perceived to have increased in readiness during the session.

The present study aimed to test the hypothesis that women with high shape concern would differ in their use of mirrors from women with low levels of shape concern. The “Mirror Questionnaire” was completed by 150 women, half of whom had high levels of shape concern. The findings support the notion that women with high shape concern differ from those with low concern in their use of mirrors, and argue for further investigation of the role of mirror cognitions and behaviours in the maintenance of body image disturbance.

Aggression, including physical assault, is a significant problem in providing services for older people with mental health problems. A range of bio-psycho-social correlates of aggressive behaviour have been explored in this client group, but little attention has been given to the role of anger as an activator of aggression, despite its demonstrated predictive association with aggression in other clinical populations. In this pilot study, a staff-rated anger measure was administered to 27 inpatients in a specialist service for older people with mental health problems. The Anger Index was found to have high internal consistency and inter-rater reliability, and it showed robust concurrent and discriminant validity with comparison measures completed by independent raters. Higher anger scores were associated with organic diagnoses, history of aggression, and hospital assault data. The potential role of anger in the activation of aggression, the utility of anger assessment in the evaluation of risk, and the value of therapeutic approaches for aggression problems in older adult patients are discussed.

The present study tested the effectiveness of Vaughan and Tarrier's (1992) Image Habituation Training (IHT) in the treatment of posttraumatic stress disorder (PTSD) using a single case experimental design. The intervention was a brief exposure treatment involving one therapist-led training session and 12 self-directed homework sessions. Assessment measures were taken at pre-treatment, post-treatment, and 3-month follow-up. Decreases demonstrated in direct standardized measures of PTSD, anxiety, and depression were consistent with previous research. The mechanisms underlying the treatment effect were also investigated. Measures of image intensity, image-related anxiety, and belief in a dysfunctional cognition were taken at session-start, mid-session, and session-end. Decreases in between and within homework sessions using these three measures suggested that the processes responsible for change are complex and interactive. The findings from this study demonstrate the effectiveness of IHT as a brief exposure therapy for PTSD and highlight the need for further research aimed at eliciting the mechanisms of change.

Within Primary Care, clients presenting with mental health problems are most likely to report the presence of an anxiety disorder. Referrals to mental health services can result in waiting lists due to the prevalence of individual models of intervention. A service delivery innovation to this organizational impasse has been White's group-based “Stresspac” approach. The current project attempted to increase the effectiveness of such service delivery via the application of practice-based evidence (PBE) guidelines. Clients completed a battery of psychometric tests prior to engaging in and on completion of a six-session group cognitive-behavioural intervention. A satisfaction survey was completed on termination of the group. Two groups were completed, the second of which was conducted using a PBE derived selection criterion. The application of the PBE selection criterion appeared to increase the effectiveness of the intervention provided, with clients in both groups being widely satisfied with the group approach. The active employment of PBE in the design and implementation of services appears to offer the opportunity for increasing the range, format and effectiveness of psychological interventions offered.

Low self-esteem in psychosis is common and has been found to be significantly related to a number of clinical variables and to symptom severity. This report describes the follow-up evaluation of a simple time-limited cognitive behavioural intervention aimed to improve feelings of low self-worth in the treatment of psychotic symptoms. A previous small scale pilot project found encouraging results for the efficacy of the novel intervention following its delivery and at 3-month follow-up. This report examines the benefits of the technique at 12 months following delivery of the intervention. These preliminary results suggest that the intervention may promote improved levels of self-esteem, psychotic symptomatology and social functioning over the longer term. Implications for practice and future research are discussed.

This article provides a cognitive-behavioral model for psychotherapeutic interventions with suicidal elders. The approach is based on a general model of cognitive behavioral therapy (CBT) with older adults described in Laidlaw, Thompson, Dick-Siskin and Gallagher-Thompson (2003), with specific application to suicidal older adults (Coon & Gallagher-Thompson, 2001). The appeal of CBT in working with older clients is its practical nature and psychoeducational orientation aimed at empowering elderly clients to utilize the techniques outside the psychotherapeutic relationship, with the goal of helping elders develop skills that lead toward better daily self-management and increased life satisfaction. In addition, CBT can be effective in either an individual or group format (DeVries & Coon, 2002). This article begins with a brief review of the characteristics associated with suicide in this population, then describes a CBT model appropriate for use with elders struggling with affective disorders, suicidal ideation, or suicidal behaviors, and ends with a case example illustrating the model's use with suicidal older adults.