Background: Intrusive imagery is experienced in a number of anxiety disorders, including Obsessive Compulsive Disorder (OCD). Imagery is particularly relevant to mental contamination, where unwanted intrusive images are hypothesized to evoke feelings of dirtiness and urges to wash (Rachman, 2006). Aims: The aim of this study was to examine the nature of imagery associated with mental contamination. Method: Fifteen people with contaminated-based OCD completed a semi-structured imagery interview designed specifically for this study. Results: Ten participants reported images associated with contamination. These images were vivid and distressing and evoked feelings of dirtiness. Participants engaged in a number of behaviours to neutralize their images, including compulsive washing. A small number of participants also reported images that protected them from contamination. Conclusions: In support of the theory of mental contamination (Rachman, 2006), images can lead to feelings of pollution and compulsive washing. Further research is needed to explore the role of imagery in maintaining contamination fears.

Background: Distressing intrusive images are frequently experienced by sufferers from chronic and acute pain. The images (Index images) are correlated with elevations in anxiety, threat, and a cognition that the imaged event might actually happen. The over-estimation that having a negative cognition about an adverse event will increase the probability of the negative event occurring - the likelihood bias - has been observed in a variety of psychological disorders. Preliminary research indicated this cognitive bias might occur in pain sufferers. Aims: To investigate the occurrence of a cognitive likelihood bias associated with imagery in acute and chronic pain sufferers, and to relate the postulated cognitive bias to psychological characteristics of participants, and four other important cognitive responses to their Index images. Method: Fifty-nine pain sufferers completed a newly developed questionnaire (Image-Event-Fusion-pain: IEF-p) to assess cognitive likelihood bias in pain sufferers. The internal consistency, reliability, factor structure and validity of the scale were evaluated. Psychological measures to assess anxiety, depression, PTSD symptoms, and levels of mental defeat were administered. Results: The IEF-p was found to be psychometrically robust with satisfactory test-retest reliability, good internal consistency, single factor structure and criterion validity. The IEF-p was significantly correlated with four key cognitive appraisals of the Index Images (responsibility, likelihood, premonition, and threat). Three of these correlations were independent of depression. High cognitive bias scores were significantly associated with elevated levels of anxiety symptoms, depression, PTSD symptoms, and mental defeat. Conclusion: Pain Index images were significantly associated with cognitive bias (IEF-p), increased threat levels, and raised estimate of the likelihood of imaged events actually occurring. The results indicate the prevalence of a cognitive bias associated with pain imagery cognitions, comparable to that established with intrusive cognitions in OCD, notably Thought-Action- Fusion.

Background: Individual Cognitive Behaviour Therapy for psychosis (CBTp) is the first line recommended psychological intervention for adults diagnosed with schizophrenia. However, little is yet known about service users’ subjective experiences of CBTp. Aims: This study aimed to conduct a systematic review of qualitative literature to examine service user perspective of CBTp. Method: A thematic synthesis of qualitative studies examining service users’ experiences of CBTp was conducted. A total of six studies were included in the analysis. Results: Three superordinate themes were identified: therapeutic alliance; facilitating change; and challenges of applying CBTp. Conclusion: Overall, CBTp is a helpful and acceptable therapeutic approach to service users. Developing a collaborative therapeutic relationship is essential. The applications of CBTp can be problematic and the therapist and client need to work together to overcome these difficulties.

Background: Increasing access to evidence-based talking therapies for people with psychosis is a national health priority. We have piloted a new, “low intensity” (LI) CBT intervention specifically designed to be delivered by frontline mental health staff, following brief training, and with ongoing supervision and support. A pilot feasibility study has demonstrated significant improvement in service user outcomes. This study is a qualitative analysis of the experiences of the staff and service users taking part in the evaluation. Aims: To evaluate the acceptability of the training protocol and the therapy, and to examine the factors promoting and restraining implementation. Method: All trained staff and service users completed a semi-structured interview that was transcribed and subjected to thematic analysis. Results: Service users spoke about learning new skills and achieving their goals. Staff spoke about being able to use a brief, structured intervention to achieve positive outcomes for their clients. Both groups felt that longer, more sophisticated interventions were required to address more complex problems. The positive clinical outcomes motivated therapists to continue using the approach, despite organizational barriers. Conclusions: For both trained staff and service users, taking part in the study was a positive experience. Staff members’ perceived skill development and positive reaction to seeing their clients improve should help to promote implementation. Work is needed to clarify whether and how more complex difficulties should be addressed by frontline staff.

Background: High quality randomized controlled trials (RCT) of psychotherapeutic interventions should ensure that the therapy being tested is what is actually delivered. However, contamination of one therapy into the other, a critical component of treatment adherence, is seldom measured in psychotherapy trials of psychosis. Aims: The aim of the study was to determine whether a purpose-designed measure, the ACE Treatment Integrity Measure (ATIM) could detect therapy contaminations within a controlled trial of cognitive behavioural therapy (CBT) versus Befriending for first-episode psychosis and to compare the ATIM to a more traditional adherence measure, the Cognitive Therapy Scale (CTS). Method: Therapy sessions were audio-recorded and at least one therapy session from 53 of the 62 participants in the RCT was rated by an independent rater using the CTS and ATIM. Results: Ninety-nine therapy sessions were rated. All Befriending sessions and all but three CBT sessions were correctly identified. The ATIM showed that 29 of the 99 (29%) sessions were contaminated by techniques from the other therapy. Within the CBT sessions, 19 of the 51 sessions (37%) were contaminated by one or more Befriending techniques. Of the Befriending sessions, 10 of 48 (21%) were contaminated by ACE techniques. The mean CTS score was higher in the CBT than the Befriending group. Conclusions: The ATIM was able to detect contaminations and revealed more meaningful, fine-grained analysis of what therapy techniques were being delivered and what contaminations occurred. The study highlights the benefit of employing purpose-designed measures that include contamination when assessing treatment adherence.

Background: The efficiency of stepped care systems partly relies on systematic monitoring of patient outcomes and timely decisions to “step up” patients without any clear therapeutic gains to the next level of treatment. Qualitative evidence has suggested that this does not occur consistently, nor always congruently with clinical guidelines. Aims: To investigate factors that influence psychological therapists’ decisions to prolong or to conclude treatment in cases with little evidence of therapeutic gains. Method: Eighty-two clinicians in stepped care services completed questionnaires about the likelihood of “holding” non-improving patients in treatment, and factors associated with referrals and holding (FARAH-Q). The factor structure, internal consistency and test-retest reliability of the measures was examined prior to assessing correlations between FARAH-Q items and likelihood of holding. Results: A 4-factor solution indicated that clinicians’ decision making is influenced by a complex interplay between beliefs, attitudes, subjective norms and self-efficacy. Correlational analysis indicated that holding is more likely to happen if there are perceived barriers to refer the patient for further treatment, if the therapist likes the patient and has a good therapeutic alliance, and if the therapist feels confident that s/he has the ability to achieve a positive outcome by prolonging treatment. Conclusions: Decisions to prolong or conclude treatment are not only influenced by evidence and guidelines, but also subjective beliefs, norms and attitudes. Understanding this decision making process is relevant to clinicians and supervisors interested in enhancing the efficiency of stepped care.

Background: The exploration of Mindfulness-based Cognitive Therapy through qualitative investigation is a growing area of interest within current literature, providing valuable understanding of the process of change experienced by those engaging in this therapeutic approach. Aims: This meta-synthesis aims to gain a deeper understanding of how the features of Mindfulness-based Cognitive Therapy contribute to positive therapeutic change. Method: Noblit and Hare's (1988) 7-step meta-ethnography method was conducted in order to synthesize the findings of seven qualitative studies. Results: The process of reciprocal translation identified the following five major themes: i) Taking control through understanding, awareness and acceptance; ii) The impact of the group; (iii) Taking skills into everyday life; (iv) Feelings towards the self; (v) The role of expectations. Conclusion: The synthesis of translation identified the higher order concept of “The Mindfulness-based Cognitive Therapy Journey to Change”, which depicts the complex interaction between the five themes in relation to how they contribute to positive therapeutic change. The findings are discussed in relation to previous research, theory and their implications for clinical practice.

Background: Depressive symptoms are one of the main reasons for seeking psychological help. Shorter interventions using briefly trained therapists could offer a solution to the ever-rising need for early and easily applicable psychological treatments. Aims: The current study examines the effectiveness of a four-session Acceptance and Commitment Therapy (ACT) based treatment for self-reported depressive symptoms administered by Masters level psychology students. Method: This paper reports the effectiveness of a brief intervention compared to a waiting list control (WLC) group. Participants were randomized into two groups: ACT (n = 28) and waiting list (n = 29). Long-term effects were examined using a 6-month follow-up. Results: The treatment group's level of depressive symptoms (Beck Depression Inventory) decreased by an average of 47%, compared to an average decrease of 4% in the WLC group. Changes in psychological well-being in the ACT group were better throughout, and treatment outcomes were maintained after 6 months. The posttreatment “between-group” and follow-up “with-in group” effect sizes (Cohen's d) were large to medium for depressive symptoms and psychological flexibility. Conclusions: The results support the brief ACT-based intervention for sub-clinical depressive symptoms when treatment was conducted by briefly trained psychology students. It also contributes to the growing body of evidence on brief ACT-based treatments and inexperienced therapists.

Background: Evidence exists for a relationship between individual characteristics and both job and training performance; however relationships may not be generalizable. Little is known about the impact of therapist characteristics on performance in postgraduate therapist training programmes. Aims: The aim of this study was to investigate associations between the grades of trainee Low-Intensity and High-Intensity cognitive behavioural therapists and individual characteristics. Method: Trainee Low-Intensity (n = 81) and High-Intensity (n = 59) therapists completed measures of personality and cognitive ability; demographic and course grade data for participants were collected. Results: Degree classification emerged as the only variable to be significantly associated with performance across assessments and courses. Higher undergraduate degree classifications were associated with superior academic and clinical performance. Agreeableness was the only dimension of personality to be associated (positively) with clinical skill. Age was weakly and negatively associated with performance. Conclusions: Relationships between individual characteristics and training outcomes are complex and may be context specific. These results could have important implications for the selection and development of therapists for Low or High-Intensity cognitive behavioural therapy (CBT) training.

Please note the author of this book review is Dr Catherine Campbell, Clinical Psychologist, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, and not Collinson, C. (2015) as cited in the original article. The book review editors extend their sincere apologies to Dr Campbell for this error.