This article presents a panel discussion on the development of collaborative empiricism in cognitive behaviour therapy. The panel comprised experts in research and practice who had been invited as keynote presenters for the 33rd National Conference for the Australian Association of Cognitive and Behaviour Therapy. Experts responded to questions about the definition of collaborative empiricism, how this specific relationship construct facilitates meaningful therapeutic changes, and their discussion conveyed the importance of collaborative empiricism for effective therapy. The dialogue included suggestions and strategies for developing therapeutic relationships strong in collaboration and empiricism.

Aims: Problem or pathological gambling is associated with significant disruption to the individual, family and community with a range of adverse outcomes, including legal, financial and mental health impairment. It occurs more frequently in younger populations, and comorbid conditions are common. Cognitive–behaviour therapy (CBT) is the most empirically established class of treatments for problematic gambling. This article reports on a systematic review and evaluation of randomised clinical trials (RCTs) concerning two core techniques of CBT: cognitive and behavioural (exposure-based) therapies. Methods: PsycINFO, MEDLINE and the Cochrane library were searched from database inception to December 2012. The CONsolidated Standards Of Reporting Trials (CONSORT) for non-pharmacological treatments was used to evaluate each study. Results: The initial search identified 104 references. After two screening phases, seven RCTs evaluating either cognitive (n = 3), exposure (n = 3) or both (n = 1) interventions remained. The studies were published between 1983 and 2003 and conducted across Australia, Canada, and Spain. On average, approximately 31% of CONSORT items were rated as ‘absent’ for each study and more than 52% rated as ‘present with some limitations’. For all studies, 70.83% of items rated as ‘absent’ were in the methods section. Conclusions: The findings from this review of randomised clinical trials involving cognitive and exposure-based treatments for gambling disorders show that the current evidence base is limited. Trials with low risk of bias are needed to be reported before recommendations are given on their effectiveness and clinicians can appraise their potential utility with confidence.

CBT guided self-help (CBTgsh) can produce treatment outcomes comparable to therapist-administered CBT (CBTta) for the treatment of anxiety and depression. The efficacy of CBTgsh compared to gold standard CBTta, however, remains to be examined. The current article addresses this issue, as well as how CBTgsh may have unique benefits over CBTta. It further highlights ways in which CBTgsh may be used for disorders of increasing severity, using eating disorders and personality pathology for illustrative purposes. A literature review of PsycINFO, PsyARTICLES, and PubMED was conducted to identify relevant studies published since 1990. Studies directly comparing CBTgsh to gold standard CBTta for anxiety and depression, as well as bulimia nervosa, revealed no significant differences between the two interventions. Furthermore, CBTgsh may have unique benefits by encouraging continued improvement over time. Innovative eating disorder studies also show that CBTgsh can be used for more severe disorders as a supplementary treatment, and produces treatment outcomes superior to CBTta or treatment as usual alone. Based on these findings, CBTgsh applications to personality pathology are suggested. Traditional stepped care models, as they pertain to CBTgsh, may gain to be broadened both in their focus and methods of delivery.

Grazing, or the uncontrolled, repetitive eating of small amounts of food is being increasingly recognised as an important eating behaviour associated with obesity. In spite of the need for a better understanding of this eating behaviour for improved obesity treatment, currently there is no empirically validated self-report measure to assess grazing. Therefore, to contribute to a better understanding of this relatively understudied eating pattern, a new self-report questionnaire of grazing was developed in this study. Questionnaire items were designed to reflect previous empirical descriptions of grazing. A group of 248 university students completed the Grazing Questionnaire, other measures of eating-related behaviours and cognitions, and negative emotion. Sixty-two participants completed the Grazing Questionnaire a second time to calculate its temporal stability. Exploratory factor analysis revealed a clear two-factor solution for the questionnaire, reflecting repetitive eating behaviour and a perception of loss of control. Scores on the Grazing Questionnaire were positively associated with other measures of disordered eating, especially with binge eating. Initial psychometric properties of the new questionnaire are promising. Future research is now needed to examine the prevalence of this eating behaviour in more diverse populations, including those with binge eating disorder and obesity.

The current study examined the role of anxiety, negative affect, and trait experiential avoidance in choices between immediate and delayed aversive outcomes. Undergraduate students (N = 34) completed self-report measures and a laboratory-based delay-discounting task in which they made choices between electric shocks delivered immediately versus shocks delivered after various time delays. The hypotheses that higher levels of anxiety, greater negative affectivity, and greater tendency to engage in experiential avoidance would predict choices of an objectively worse delayed aversive stimulus over an immediate (but less severe) aversive stimulus were supported. These findings may have implications for interventions that target behavioural and experiential avoidance in anxiety.

Researchers have suggested that distrust in one's memory is both a cause and a consequence of repeated checking. We investigated whether reduced clarity and confidence occurs to an equal degree with repeated object use and repeated checking. In addition, whether decreased memory confidence persists after a delay in checking or use was examined. Participants (N = 113) either repeatedly checked or repeatedly used a virtual stove or a light bulb stimulus (the control stimulus). Significant declines in memory accuracy, confidence, vividness and detail were observed for the experimental compared to the control stimulus. No significant differences in these effects between the checking and exposure conditions were found. A significant increase in state anxiety across pre-, mid- and post-test was found for both conditions. These findings provide further support for the notion that repeated checking can be self-perpetuating due to its impact on memory processes. The findings also suggest that checking is not necessary for these effects to occur as repeated use without checking also results in significant declines in memory accuracy, confidence, vividness and detail. Theoretical and clinical implications are discussed.

Cognitive-Behaviour Therapy (CBT) is considered the number one non-pharmacological treatment for a number of mental and psychological disorders (Tolin, 2010; Stuhlmiller & Tolchard, 2009). While CBT with problem gamblers has shown promise, the quality of the research in this area is lacking. One area of concern is that across the many trials and reports using CBT with gamblers no single unified approach has been used and so comparison across studies is limited. Similarly, translation of the CBT research into clinical practice is almost entirely absent (Walker, 2005). This article will explore the concepts of CBT with problem gamblers and identify common elements across all reported approaches. A unified model of CBT with problem gamblers will be suggested and the direct clinical application of this model described from a state-wide gambling service in Australia (Flinders Approach) with 205 problem gamblers. The results indicate that the Flinders Approach is successful in treating gamblers considered to be at the severest end of the experience, with a 69% completion rate. Implications for future research in which this model may be tested against other therapies and pharmacological treatments will be discussed.

Benzodiazepines are widely prescribed to manage sleep disorders, anxiety and muscular tension. While providing short-term relief, continued use induces tolerance and withdrawal, and in older users, increases the risk of falls. However, long-term prescription remains common, and effective interventions are not widely available. This study developed a self-managed cognitive behaviour therapy package for cessation of benzodiazepine use delivered to participants via mail (M-CBT) and trialled its effectiveness as an adjunct to a general practitioner (GP)-managed dose reduction schedule. In the pilot trial, participants were randomly assigned to GP management with immediate or delayed M-CBT. Significant recruitment and engagement problems were experienced, and only three participants were allocated to each condition. After immediate M-CBT, two participants ceased use, while none receiving delayed treatment reduced daily intake by more than 50%. Across the sample, doses at 12 months remained significantly lower than baseline, and qualitative feedback from participants was positive. While M-CBT may have promise, improved engagement of GPs and participants is needed for this approach to substantially impact on community-wide benzodiazepine use.

Background: Grandparents have a significant role in providing regular child care to their grandchildren. As such, they are in a unique position to help with the prevention of child disruptive disorders. However, the child-care role grandparents provide can also negatively impact the grandparent-parent relationship. Aims: This case study examined the impact of a parenting program designed specifically for grandparents on a grandparent providing regular child care to her granddaughter. Method: A case study is presented of a 56-year-old grandmother providing between 31–40 hours of care per week to her granddaughter, who is at risk of developing an early onset child disruptive disorder. The grandparent was measured on outcomes of child behaviour; parenting style; parenting confidence; psychological wellbeing in terms of stress, depression, and anxiety; and relationship satisfaction with the parent. The parent was also measured on child behaviour outcomes and relationship satisfaction with the grandparent. Measures were given at baseline, post-intervention, and at 6-month follow-up. Results: The grandparent reported significant reductions in stress, anxiety and depression; improved relationship satisfaction with the parent; and decreased reliance on dysfunctional parenting practices. The parent also reported decreased child behaviour problems and increased relationship satisfaction with the grandparent. No findings were found for parenting confidence. Conclusion: This case study provides encouraging findings for a new parenting program designed specifically for grandparents, and it is recommended that future research evaluate its efficacy in a randomised controlled trial.

Children exposed to traumatic events either recently (Study 1) or in the past (Study 2) were administered the Autobiographical Memory Test (AMT). In Study 1 (N = 67), when asked to retrieve memories from the 24-hour period following their trauma, children with higher levels of acute stress disorder symptoms retrieved a greater number of specific memories on the AMT than either children with low acute stress levels or hospital control children; no difference between groups was observed when memories were retrieved from a period that predated their trauma. However, in Study 2 (N = 67) children with posttraumatic stress disorder retrieved fewer specific memories than non-PTSD controls. The two studies represent the first occasions that AMT performance has been examined in acutely traumatised children and in a sample of children stringently diagnosed with PTSD respectively. The findings underscore the need for further prospective research with clinical samples of children who have experienced trauma.

Objective: The effects of contingency management to induce physical activity levels were examined in seven non-obese physically inactive undergraduate students by providing monetary payments using a multiple baseline, changing-criterion procedure. Methods: Participants attended a baseline phase, a subsequent intervention phase consisting of three exercise sessions per week for 4 weeks, and a follow-up session 2 weeks post intervention. A total of $145 was available for attendance and exercise contingency payments. Results: Results indicate that all participants significantly increased exercise during intervention from inactivity at baseline to exercising three 30-minute sessions per week. Participants maintained some gains during follow-up. Limitations: The study employed a small and homogenous sample size and required participants to exercise in a lab setting thus limiting external validity. Conclusions: These findings suggest that incentive-based interventions are an effective and viable means for inducing exercise.

Deliberate self-harm (DSH), commonly defined as the intentional, direct and non-suicidal destruction of one's body, appears to be common across both clinical and non-clinical populations. A recently developed measure of functions of DSH, the Inventory of Statements About Self-Injury (ISAS), was examined to test its two-factor model within a sample of members of online social networks. The approach adopted was to fit data from the scale to the Rasch measurement model, which is increasingly used to develop and/or assess scales. Two hundred and one (n = 201) participants aged over 18 years of age, who had engaged in DSH in the last 12 months, were recruited from online social networks’ DSH peer support groups to complete an online survey. An exploratory factor analysis supported interpersonal and intrapersonal factors based on 13 function domains. Furthermore, both factors demonstrated satisfactory fit to the Rasch model. Some local dependency was detected, and when addressed, it impacted on the alpha coefficient level for intrapersonal factor. This study is the first independent psychometric investigation of ISAS, further supporting the scale authors’ psychometric evaluations. Additional validation across different DSH samples is recommended.

Although positive metacognitive beliefs have been found to be associated with symptoms of depression and generalised anxiety disorder, surprisingly few studies have focused on the degree to which positive metacognitive beliefs are associated to social phobia symptoms. In response to this limitation, the primary goal of the current study was the development and validation of the Positive Beliefs about Post-Event Processing Questionnaire (PB-PEPQ). It was anticipated that the PB-PEPQ would exhibit adequate psychometric properties. Based on a non-referred sample of 300 undergraduate students, the PB-PEPQ was found to be positively associated with measures of post-event processing and social anxiety symptoms. Further, support was found for the incremental validity of the PB-PEPQ, as the measure predicted variance in social phobia symptoms after controlling for other metacognitive variables, including positive beliefs about worry and positive beliefs about rumination. Overall, the findings may have implications for cognitive models of social phobia. Further, the current findings have possible treatment implications, as individuals with social phobia may benefit from interventions focused on the identification and modification of positive metacognitive beliefs.

Clinical perfectionism has been implicated as a transdiagnostic construct involved in the aetiology, maintenance, and course of a wide range of Axis I disorders. Typically characterised by the setting of unrealistically high standards for performance, perfectionism has been suggested to be associated with a number of negative psychological outcomes. Moreover, it has been suggested that the process in which perfectionists set and strive for their high performance standards, including the way in which they revaluate such standards, may be maintained by a number of maladaptive cognitive, affective, and behavioural constructs. However, how such factors may differ across adaptive and maladaptive dimensions of perfectionism remains unclear. This article reviews the adaptive and maladaptive conceptualisations of perfectionism and critically examines the empirical literature pertaining to the cognitive-behavioural model of clinical perfectionism. In addition, we also review outcomes of intervention studies that have focused on altering dysfunctional cognitions when treating clinical perfectionism. Clinical implications of these findings and directions for future research are also explored.

The present study aimed to investigate the common fears and their origins among children and adolescents from different age, gender, and socioeconomic levels (SES). The sample was comprised of 642 females (48.8%) and 673 males (51.2%) with a total of 1,315 participants aged between 8 and 18 (M = 13.15; SD = 3.18). The Fear interview was utilised to examine the common fears and the role of conditioning, modelling and negative information in the development of children's fears. The result showed that the most common fear in Turkey was ‘God’, followed by ‘losing my friends’ and ‘going to Hell’. In addition, the findings revealed that Turkish students are more likely to learn fears by modelling rather than negative information transmission and conditioning. The results also indicated that negative information transmission had a more intensifying effect on the children and adolescents’ existing fear rather than modelling and conditioning. Furthermore, multinomial logistic regression was conducted to examine the effects of age, gender and SES on the origins of fear. Results showed that age and gender were significant predictors of origins of fear.

Background: This study examined reasons parents endorsed/provided for not completing homework tasks during their participation in a group-based behavioural parent training (BPT) intervention. Method: Eighty single mothers anonymously completed a questionnaire at the end of each of eight BPT sessions to ascertain reasons for not completing assigned homework. Results: Data suggests that there are varied reasons for poor HW completion that are related to various aspects of the homework process, but most notably the implementation phase of homework. Conclusions: Therapists should utilise various strategies to support homework completion, with special attention focused on methods for ‘in-vivo’ support for parents.

Fourteen ‘treatment resistant’ problem gamblers received 9 weeks of Dialectical Behavior Therapy (DBT) at specialist problem gambling services delivered in Melbourne, Australia. This study is the first to investigate the effectiveness of a brief DBT treatment for problem gambling, with a focus on measuring change in the four DBT process skills (mindfulness, distress tolerance, emotion dysregulation, and negative relationships). Although there were no statistically significant improvements in measures of gambling behaviour, 83% of participants were abstinent or reduced their gambling expenditure pre- to post-treatment. Participants also reported statistically and clinically significant improvements in psychological distress, mindfulness, and distress tolerance. Moreover, there were no increases in alcohol or substance use. These results are discussed in the context of focusing on a single DBT process skill, and the benefits of using group-based approaches.

Feeding problems that can lead to associated nutritionally related medical conditions and often cause stress and difficulties for parents are prevalent in children with autism. It is therefore important to target these problem behaviours through effective interventions. The present study was designed to trial a procedure comprised of escape extinction combined with positive reinforcement with the aim to reduce food refusals and increase eating in a child with autism. It was predicted that the intervention package would significantly reduce food refusals and increase eating and that any increase in food acceptance would be maintained and generalised to other behaviours related to feeding on termination of the intervention. The research design was a multiple baseline across settings. The results confirmed our predictions. It was concluded that the treatment package was effective at increasing food acceptance.

Background: Worry exposure is a cognitive–behaviour therapy (CBT) technique frequently used to treat GAD, yet there are only a few studies on its effectiveness. Aim: To compare two worry exposure protocols developed for GAD to make a preliminary determination about the most effective way in which to present the feared stimuli to participants. Method: Nine university students suffering from GAD were administered four 1-hour treatment sessions. Exposure was conducted by either directly imagining (DI) or via audio-recording/playback (AR) exposure to their feared event. General worry and intolerance of uncertainty (IOU) were the primary dependent variables. Results: All participants in the DI and half of the AR condition reported subclinical GAD at post-treatment, with results being maintained at 3-month follow-up and the treatment responders also reported decreased depression, anxiety and stress. Conclusions: The DI protocol was more effective than the AR methodology in this sample, and may be an appropriate standard for worry exposure research and clinical practice.

Objectives: Interpersonal difficulties have been implicated in both anxiety and depression. However, much less is known about whether interpersonal difficulties may account for, in part, the high level of comorbidity between mood and anxiety symptoms. This study examined whether various interpersonal difficulties, assessed with the Inventory of Interpersonal Problems, Short Circumplex (IIP-SC), were underlying mechanisms in the relationship between anxiety and depression symptoms in a high-risk sample of late adolescents with clinical levels of anxiety. Methods: 144 late adolescents with clinical levels of anxiety (mean age = 18.63 years; SD = 0.92) reported on their trait anxiety, worry, anxiety and depressive symptoms, and interpersonal problems. Results: Consistent with hypotheses, the IIP-SC overly nurturant subscale partially accounted for the relationship between anxiety and depression. The IIP-SC non-assertive and social avoidant subscales did not significantly account for the anxiety-depression relationship. Conclusions: Findings suggest that interpersonal behaviours characterised by excessive attempts to please and accommodate others may ultimately contribute to our understanding of the anxiety-depression association. We discuss the implications of our findings and how they may be applied to evidence-based assessment and treatment of anxiety problems.