Web-based interventions are increasingly used for the prevention, treatment and aftercare of mental disorders. A crucial factor to the efficacy of such online programmes is adherence to the intervention content and procedure. It has been frequently suggested that adherence in web-based interventions is low and little is known about which factors influence adherence. To increase intervention uptake and completion, studies increasingly include interventions with some form of guidance. Guided interventions have been shown to have higher efficacy, however, evidence for the impact on adherence is limited and mixed. This meta-analysis explored the impact of human guidance on intervention completion in web-based mental health interventions. A total of 22 studies were included with interventions primarily targeting symptoms of depression and anxiety disorders. Results showed that guidance significantly increases the average amount of intervention completion [g = 0.29, 95% confidence interval (CI) 0.18–0.40] and the proportion of intervention completers [log odds ratio (OR) = 0.50, 95% CI 0.34–0.66] with small effects. On average, full completion rates were 12% higher in guided intervention groups. This meta-analysis demonstrated that guidance in web-based mental health interventions does increase adherence, but more research is required to better understand the specific mechanisms between guidance, adherence and outcomes.

Identification of genetic variants associated with eating disorders is underway. The Anorexia Nervosa Genetics Initiative, an initiative of the Klarman Family Foundation, has contributed to advancing the field, yielding a large-scale genome-wide association study published in Nature Genetics. Eight genetic variants significantly associated with anorexia nervosa were identified, along with patterns of genetic correlations that suggest both psychiatric and metabolic origins of this serious and life-threatening illness. This article details the role of Professor Nick Martin in contributing to this important collaboration.

Background: Research indicates that psycho-education and cognitive behavioural interventions can reduce perfectionism but to date no group treatments have been examined. Aims: The current study utilized a case series design to compare psycho-education materials and subsequent eight-week group cognitive behaviour therapy (CBT) to a baseline waitlist in an outpatient community psychiatry sample (n = 21). Method: Participants were assessed on five occasions: baseline, 4 weeks later (waitlist), 4 weeks after receiving psycho-education material, post-treatment (8 weeks after receiving the group intervention), and 3-month follow-up. Results: There was a main effect of time for perfectionism and negative affect from baseline to post-group (effect sizes ranging from 1.46 to 1.91) that were maintained at 3-month follow-up. Conclusions: These results suggested that group CBT for clinical perfectionism may be beneficial, but that psycho-education alone is not effective for reducing perfectionism or negative affect.

The objective of the current study was to investigate the heritability of breast size and the degree to which this heritability is shared with BMI. In a sample of 1010 females twins (mean age 35 years; SD = 2.1; range 28–40), self-report data pertaining to bra cup size and body mass index (BMI) was collected in the context of self-report data and an interview relating to disordered eating respectively. In a sample of 348 complete twin pairs who completed data collection (226 MZ pairs and 122 DZ pairs and 360 incomplete pairs (170 MZ and 190 DZ)), we found that the heritability of bra cup size was 56%. Of this genetic variance, one third is in common with genes influencing body mass index, and two thirds (41% of total variance) is unique to breast size, with some directional evidence of non-additive genetic variation. The implications of these findings with respect to previous research linking breast size with reproductive potential are discussed.

This article presents a panel discussion on the integration of homework assignments into cognitive behaviour therapy sessions. The panel comprised experts in research and practice who had been invited as keynote presenters for the 32nd National Conference for the Australian Association of Cognitive and Behaviour Therapy. Experts responded to questions about the definition of homework, the mechanism by which homework produces its effects, and the relative importance of homework adherence for effective therapy. Interwoven through the discussion was an emphasis on a collaborative approach to homework, as well as specific recommendations for the integration of homework into sessions. Selected case illustrations were also discussed.

There were two aims of the research with 190 Australian clinical psychologists: (1) to investigate the construct validity of the Therapist Belief Scale (TBS), and (2) to examine the relative contribution of demographics, workplace variables, and individual factors to burnout. Construct validity was examined using exploratory and confirmatory factor analyses and associations between the variables. Multivariate regressions were used to examine the relative contributions to burnout. The TBS showed three factors related to distress, inflexibility, and control, all of which were significantly associated with lower levels of personal accomplishment. Multivariate analyses showed emotional exhaustion to be associated being a woman, working for the government, having less personal resources, and endorsing more therapist beliefs related to control. Higher levels of personal accomplishment were significantly associated with a lower annual income, not having a mixed caseload, having more personal resources, and endorsing lower levels of therapist beliefs related to inflexibility and control.

Background. Theory and evidence strongly suggest that perfectionism may be a risk factor for eating disorders. The purpose of the current study was to investigate a model that would explain the relationship between the cognitive diagnostic criterion for both anorexia nervosa and bulimia nervosa, namely undue influence of body weight or shape on self-evaluation, and dimensions of perfectionism. The model of particular interest was the common cause model, which hypothesizes that the phenotypes are caused by the same underlying genetic and environmental risk factors.

Method. Female twins (n=1002) from the Australian Twin Registry (ATR), aged 28 to 39 years, were interviewed using the Eating Disorder Examination (EDE). In addition, questions relating to the Equal Environment Assumption (EEA) and the Frost Multidimensional Perfectionism Scale, namely concern over mistakes (CM), personal standards (PS) and doubts about actions (DA), were assessed.

Results. There was no evidence of violation of the EEA for any of the four phenotypes. Univariate models showed all phenotypes to be influenced by both genetic and non-shared environmental action, where genetic estimates ranged from 25% to 39% of the variance. Multivariate analyses suggested the best explanation of covariation among the phenotypes was an independent pathways, rather than a common pathways, model.

Conclusions. Undue influence of body weight or shape on self-evaluation shared about 10% of its sources of genetic and environmental variance with perfectionism, thus suggesting that a common cause model does not represent the best explanation of the relationship between perfectionism and this cognitive diagnostic criterion for eating disorders.

The present study surveyed a sample of 116 Australian therapists who identified themselves as working primarily with traumatized clients. Outcome variables were measures of vicarious traumatization (VT), burnout and trauma symptomatology (intrusion and avoidance). A measure of beliefs about the therapeutic process was constructed for the present study and examined along with other predictor variables, namely years of experience as a therapist, percentage of time spent in clinical work with clients, predominant client group, and recent and direct exposure to trauma in the therapist. Therapist beliefs were found to predict vulnerability to VT and burnout, supporting a cognitive model of therapist distress. Implications of the findings for maintaining therapist health are discussed.

Attention deficits and inflated perceptions of responsibility have been identified as characteristics of people with obsessive-compulsive disorder (OCD). The present study examined the relative importance of responsibility and attention in predicting non-clinical levels of obsessionality. Three hundred Australian university students were screened using the Maudsley Obsessional-Compulsive Inventory (MOCI), and students who scored in the top and bottom 10% of the distribution were selected for participation. The selected participants completed the Responsibility Attitude Scale (RAS) and the Test of Everyday Attention (TEA), along with measures of trait-anxiety and depression. High MOCI scorers exhibited a greater perception of responsibility, and poorer overall attention than low MOCI scorers. These differences remained significant after controlling for trait-anxiety and depression. Logistic regression analyses revealed that responsibility was a stronger predictor of non-clinical obsessionality than was attention. Moreover, attention did not make a significant contribution to the prediction of obsessionality once responsibility had been controlled. Correlations between responsibility and TEA visual selective attention subtests remained significant after controlling for obsessionality. These findings suggest that measures of attention (particularly measures of visual selective attention) may be confounded by responsibility attitudes, thus highlighting the importance of controlling for meta-cognitive variables such as responsibility when investigating attention in OCD.

The objective was to investigate the genetic epidemiology of figural stimuli. Standard figural stimuli were available from 5,325 complete twin pairs: 1,751 (32.9%) were monozygotic females, 1,068 (20.1%) were dizygotic females, 752 (14.1%) were monozygotic males, 495 (9.3%) were dizygotic males, and 1,259 (23.6%) were dizygotic male-female pairs. Univariate twin analyses were used to examine the influences on the individual variation in current body size and ideal body size. These data were analysed separately for men and women in each of five age groups. A factorial analysis of variance, with polychoric correlations between twin pairs as the dependent variable, and age, sex, zygosity, and the three interaction terms (age x sex, age x zygosity, sex x zygosity) as independent variables, was used to examine trends across the whole data set. Results showed genetic influences had the largest impact on the individual variation in current body size measures, whereas non-shared environmental influences were associated with the majority of individual variation in ideal body size. There was a significant main effect of zygosity (heritability) in predicting polychoric correlations for current body size and body dissatisfaction. There was a significant main effect of gender and zygosity in predicting ideal body size, with a gender x zygosity interaction. In common with BMI, heritability is important in influencing the estimation of current body size. Selection of desired body size for both men and women is more strongly influenced by environmental factors.

Cognitive-behavioural models of psychosis have been widely discussed in the literature, with a focus on the beliefs about the voices that are a component of auditory hallucinations. This study examines the ability of beliefs about the voices to predict the course of psychiatric symptomatology in psychosis over a 1-month period, compared with changes in depressive symptomatology. Thirty people with schizophrenia or schizo-affective disorder participated in this study. Their mental state functioning, depression, and beliefs about their voices were assessed in interview. Mental state functioning and depression were assessed again after 1 month, in addition to antipsychotic medication compliance over the previous month (rated by self and the psychiatrist). The strongest predictor of a worsening of psychiatric symptoms over the month was increased depression in the previous month. Using p < 0.1 criteria to offset possible Type II errors in the small sample, a person's belief that their voices were very powerful was also predictive of psychiatric deterioration. The ways in which beliefs about the power of the voices can be challenged in cognitive-behaviour therapy with psychosis is discussed, as are directions for future research.

Background. Previous studies of parental discipline have identified little influence of heritability on parental control, and some influence of gene–environment correlations, shared environment and child temperament.

Method. Using interview data from 2003 female twins from a population-based twin registry and 1472 of their parents, we examined reports of parental discipline from four perspectives: (1) father and mother reporting separately on the type of discipline they provided for their offspring; (2) each twin reporting on the type of discipline they received from their parents; (3) each parent reporting on the discipline provided by their spouse; and, (4) each twin reporting on the discipline they provided for their own offspring. Using factor analysis and univariate structural equation modelling, we examined the structure of parental discipline, and the genetic and environmental influences thereon.

Results. The seven discipline items yielded two factors, physical discipline and limit setting, which were moderately positively correlated. Parents perceived discipline as largely a common environmental experience for the twins, whereas the twins indicated that discipline was influenced by unique environmental factors and the genotype of the child. Twins as parents indicated no influence of shared environment on discipline, with the majority of influence accounted for by non- shared environment and parental genotype.

Conclusions. Parents recall providing similar discipline to their children, whereas children emphasize the differences in parental discipline. Sources of individual variation in parental discipline vary according to which family member report is examined. In total, parental discipline is partially influenced by the genotype of both the parent and child, and by environmental factors shared by the twins and unique to the individual.