Medically unexplained symptoms (MUS) are not only common and distressing, but are also typically poorly managed in general medical settings. Those suffering from these problems tend to incur significantly higher health costs than the general population. There are many effective treatments for different MUS; these are almost entirely based on cognitive-behavioural approaches. However, the wide range of treatment protocols tend to be ‘syndrome specific’. As such, they do not generalise well in terms of training and application, making them expensive and difficult to disseminate, suggesting the desirability of developing a transdiagnostic approach. The general basis of such a CBT grounded transdiagnostic approach is considered, and the particular need to incorporate cognitive elements of both anxiety or health anxiety (threat) and depression (loss) is highlighted. Key empirically grounded and evidence-based processes (both specific and general) previously identified as underpinning the maintenance of MUS are delineated. The way in which these can be combined in a transdiagnostic model that accounts for most MUS presentations is presented and linked to a formulation-driven transdiagnostic treatment strategy, which is described. However, the need to take more syndrome-specific issues into account in treatment is identified, suggesting that the optimum treatment may be a hybrid transdiagnostic/specific approach with formulation, shared understanding, belief change strategies, and behavioural experiments at its heart. The generalisation of such approaches to psychological problems occurring in the context of ‘long-term conditions’ is identified as a further important development that is now within reach.

Background: It has been suggested that magical thinking is related to both obsessions and compulsions in obsessive-compulsive disorder (OCD). Recent studies have indicated the significant relationship between level of religiosity and beliefs about the importance and need to control unwanted thoughts in OCD. People also use diverse strategies to control their unwanted thoughts. Aims: The present study aimed to examine the interrelationships between magical thinking and worry and punishment as thought-control strategies in mediating the relationship between religiosity and obsessive-compulsive (OC) symptoms in a Turkish sample. Methods: The sample of the present study was comprised of 179 non-clinical, community-based participants who completed measures of OC symptoms (measured with the Obsessive Compulsive Inventory — Revised), magical thinking (measured with the Magical Ideation Scale), religiosity, and thought-control strategies (measured with the Thought Control Questionnaire). Results: Both worry and punishment as thought-control strategies and magical thinking mediated the links between religiosity and OC symptoms. Furthermore, the relationship between religiosity and OC symptoms was mediated by magical thinking through punishment and worry. Conclusions: Findings pointing out the mediating role of magical thinking through punishment and worry in the relationship between religiosity and OC symptoms are novel and need to be replicated in future studies.

Perfectionism is a risk and maintaining factor across psychopathology and has been proposed to be a transdiagnostic process. The aim of this study was to examine the reliability and validity of the Clinical Perfectionism Questionnaire (CPQ) in 32 adults (75% female, M age = 35.54 years, SD = 9.71) with a range of psychological disorders, presenting for treatment of clinical perfectionism. There was evidence that the CPQ was correlated with established measures of perfectionism and theoretically related constructs including self-criticism and dichotomous thinking. The CPQ was also able to predict treatment outcome. The internal consistency was not adequate in the current study; however, the sample size was small. Future studies should examine the psychometric properties of the CPQ in a larger sample of individuals with a range of psychological disorders.

As theories of bereavement have evolved, so too have evidence-based interventions to mitigate complications in post-loss adaptation. This article reviews one line of programmatic research grounded in a conceptualisation of grieving as an attempt to reaffirm or reconstruct a world of meaning challenged by loss. Anchored in therapeutic encounters with the bereaved, a meaning reconstruction approach to loss has grown over the past 15 years to generate an increasingly substantial research base, as well as to develop and refine a wide array of contributions to psychological assessment and therapy. By summarising the major models, measures and methods resulting from this collaborative work, it offers an introduction to meaning reconstruction for those unfamiliar with it, noting its contributions to date, its areas of future development, and its relevance for clinical practice.

Background: The present study explored the reliability, validity, and factor structure of a modified version of the Moral Disengagement Scale (MDS), which comprehensively assesses proneness to disengage from different forms of conduct specific to Australian adolescents. Methods: A sample of 452 students (M age = 12.79; SD = 1.93) completed the modified MDS and the Australian Self-Report Delinquency Scale. A multistep approach was used to evaluate the factor structure of the MDS. The sample was divided into exploratory (n = 221) and cross-validation samples (n = 231). Principal component analysis was conducted with the exploratory sample and multiple factor solutions compared to determine the optimal factor structure of the modified MDS. The final factor solution was confirmed in the cross-validation sample using confirmatory factor analysis. Internal consistency of the final scale and convergent validity with the delinquency questionnaire was also assessed. Results: Analyses resulted in a 22-item MDS for use in Australia, with four factors mapping onto the four conceptual categories of moral disengagement. The individual subscales demonstrated adequate to good internal consistency, and the total scale also demonstrated high internal consistency (α = 0.87). Convergent validity of the scale was established. Conclusions: The 22-item Australian MDS is a reliable and valid instrument for use within an Australian population.

Fear of negative evaluation (FNE) is a recognised diagnostic feature of Social Anxiety Disorder (SAD). Recently, the role of fear of positive evaluation (FPE) as a factor contributing to SAD has been a focus of research: there is evidence that FPE is associated with measures of social anxiety independent of measures of FNE and that measures of FPE may be sensitive to interventions for SAD. The present study examined the relationships between FPE, FNE and measures of social anxiety and depression in a sample assessed as suitable for group cognitive behaviour therapy (CBT) for social anxiety (n = 35), and the responsiveness of measures of FPE and FNE to standard group CBT for social anxiety in a subset of this group (n = 20). Measures of FNE and FPE were positively associated with each other and with measures of social interaction anxiety, general social anxiety concerns, and depression. However, the relationship between the FPE measure and measures of general social anxiety concerns and depression was not significant when FNE was statistically controlled. This is consistent with the view that FPE is specifically related to social interaction anxiety. In this sample, a measure of FPE was reduced in a sample receiving standard group CBT for social anxiety compared to a waitlisted group. The implications of these findings for the conceptualisation of SAD and for the delivery of interventions for those with SAD are considered.

Clinicians generally find individuals with personality disorders to be challenging to treat, especially compared to clients who have only a straightforward depression or anxiety disorder. In this article we will summarise research on the efficacy of cognitive behaviour therapy (CBT) for personality disorders. Then we will focus on the conceptualisation and treatment of CBT for personality disorders that is based on the work of Aaron Beck and colleagues; that is, it is predicated upon the cognitive model of psychopathology. Next, we will describe two other forms of treatment with cognitive behavioural roots: schema therapy and dialectical behaviour therapy. A final section will suggest future directions.

Recently, death anxiety, or dread of death, has been proposed as a key transdiagnostic process underlying the anxiety disorders, depressive disorders, somatic disorders, and trauma and stressor-related disorders. In fact, it has been argued that death anxiety underlies all psychopathology, and is more fundamental than perfectionism, a process which was previously considered the root of mental illness. However, there has been a paucity of research examining the relationship between death anxiety and the eating disorders, although these conditions have been found to be strongly related to perfectionism. The present study therefore aimed to examine whether death anxiety is related to disordered eating, and whether death anxiety is a better predictor of disordered eating than perfectionism. A sample of 164 participants (132 female), average age 33.55 years (SD = 15.45 years), completed an online survey comprising background questions (age, sex, diagnosed psychiatric disorder), the Eating Attitudes Test — 26 item version (EAT-26), the Almost Perfect Scale — Revised (APS-R), the Rosenberg Self-Esteem Scale (RSES), and the Death Anxiety Scale (DAS). The findings of a hierarchical multiple regression analysis with EAT-26 as the dependent variable, age entered at Step 1, the RSES and APS-R entered at Step 2, and the DAS entered at Step 3 showed that only death anxiety and self-esteem were independent predictors of disordered eating at Step 3. A simultaneous multiple regression analysis was subsequently run with age and the APS-R alone as predictors of EAT-26 scores. This analysis showed that perfectionism was only a predictor of disordered eating when death anxiety and self-esteem were not included in the regression model. Death anxiety and self-esteem both appear to be important transdiagnostic processes.

Clinical reasoning is one of the central components of psychological assessment. The identification of a client's psychological difficulties and the subsequent depiction of their onset, development, and interrelationships enables clinicians to plan treatment in a systematic and effective manner. In an article (Ward, Vertue, & Haig, 1999), we outlined the abductive theory of method (ATOM) and argued that it offered a useful framework for highlighting and integrating the major phases of psychological assessment. These phases involve detecting clinical phenomena, postulating psychological mechanisms, developing a case formulation, and evaluating a case formulation. In this article we present a revised version of the adaptation of ATOM and elaborate on the related clinical dimensions of assessment.

Social anxiety disorder (SAD) is characterised by an intense fear of social situations in which the individual believes they may be negatively evaluated (American Psychiatric Association, 2013). A number of cognitive models (Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997) have been proposed that provide frameworks for understanding the key cognitive processes involved in SAD. Negative rumination, which can be divided into pre- and post-event rumination, appears to be a key maintaining factor in the cycle of social anxiety. However, there are mixed findings regarding the cognitive predictors of post-event rumination and a lack of research regarding the consequences and predictors of pre-event rumination. Furthermore, there has been little empirical research investigating the effects of targeting negative rumination and state anxiety in social anxiety treatment. If the cognitive predictors of negative rumination can be determined then they can be targeted when designing interventions that aim to break the vicious cycle of social anxiety. The state of research investigating the cognitive determinants of state anxiety and negative rumination is reviewed and suggestions are made for continuing research.

The present study sought to explicate the time-course of posttraumatic stress (PTS)-related attentional bias to threat (ABT) by examining differences in attention bias variability (ABV; a measure which accounts for the temporal dynamics of ABT). A dot-probe task with four presentation durations was used to capture both subliminal and supraliminal stages of processing. Task stimuli consisted of neutral and threat images. Attentional control (AC) was examined as a moderator of the relationship between PTSD and ABV. At an experimental session, participants (PTSD = 11, trauma control = 18) completed questionnaires, a modified dot-probe task, and a stimulus-response task measuring AC. Individuals in the PTSD group exhibited greater ABV compared to trauma control participants. AC moderated this relationship, with participants with PTSD and poor AC exhibiting significantly greater ABV than trauma-exposed control participants with poor AC. These effects remained significant after accounting for traditionally calculated ABT scores and variability on trials for which only neutral stimuli were present, thus ensuring that the observed effects were specific to the presence of threat stimuli and not merely a function of general variability in response times. Findings implicate AC as a buffering mechanism against threat-related attentional dyscontrol among those with PTSD. Clinical implications will be discussed.

Specific deficits in decision-making have been demonstrated in patients with obsessive-compulsive disorder (OCD). The experience of anxious arousal in obsessive-compulsive (OC) patients has been posited to be responsible for disrupting the cognitive processes that lead to efficacious decision-making (Sachdev & Malhi, 2005). In spite of this, research has neglected to examine explicitly the effect of anxiety on the relationship between decision-making and OCD. The current study investigates whether decision-making differences on the Iowa Gambling Task (IGT) occur as a function of OC symptomatology in a non-clinical sample (n = 110). Participants were randomly allocated to either an anxiety condition (n = 58) or control condition (n = 52). Anxious arousal was induced in the anxiety condition via an experimental manipulation prior to commencing the IGT. Participants in the anxiety condition performed significantly worse than those in the control group on the IGT. However, OC symptomatology did not significantly predict IGT performance. The experience of anxiety did not significantly moderate the relationship between OC symptomatology and IGT performance. These findings indicate that decision-making differences do not occur as a function of OC symptomatology in a non-clinical sample; however, they do suggest that the experience of anxiety significantly impairs decision-making performance. The theoretical and practical applications of the findings are discussed.

Social anxiety disorder (SAD) is characterised by a marked and persistent fear of social or performance situations. Cognitive models suggest that self-focused cognitive processes play a crucial role in generating and maintaining social anxiety, and that self-focused cognition occurs prior to, during, and following social situations (Clark & Wells, 1995; Rapee & Heimberg, 1997). There is a substantial body of empirical evidence demonstrating that socially anxious individuals engage in self-focused cognition during and following a social or performance situation. A smaller but growing body literature suggests that a similar process occurs prior to such situations, and that these three processes are interdependent. Furthermore, the vast majority of research to date indicates that self-focused cognitive processes are detrimental, and that they generate and maintain social anxiety in a variety of ways. However, there remains considerable scope for research to further explicate the role of these processes in the maintenance of SAD, and to enhance interventions designed to ameliorate their negative effects.

The effectiveness of individually administered cognitive processing therapy (CPT) when compared with treatment as usual (TAU) in a community sexual assault centre was tested. Trauma survivors with acute stress disorder (ASD) following sexual assault were randomised to either CPT (n = 25) or TAU (n = 22), and assessed at pretreatment, posttreatment, and 3-, 6- and 12-month follow-up. Both groups demonstrated large reductions in PTSD and depression symptoms following treatment, and these gains were maintained over the course of follow-ups (Cohen's ds for PTSD symptom reductions ranging between 0.76 to 1.45). Although smaller and not always consistent, between-group effect sizes typically favoured CPT. Effect sizes (d) ranged between 0.13–0.50 for posttraumatic stress and 0.13–0.41 for depression over the course of follow-ups. Independent assessment of PTSD severity indicated more CPT participants reached good end-state functioning at 12-month follow-up (50%) than TAU (31%). Although both treatments were effective, there were some indications that CPT led to better outcomes relative to therapists delivering their usual therapy. The present study demonstrates that evidence-based, trauma-focused therapy such as CPT can be effective when delivered as an early intervention in a routine mental health setting.

Parents’ adjustment, co-parenting conflict, and parenting style are often intervention targets for parents following divorce. However, little is known about how these three aspects together relate to child outcomes. The aim of this study was to examine how parent adjustment (distress and anger), parenting conflict, and parenting style (laxness and over-reactivity) predict child internalising, externalising, and prosocial behaviours. Participants were a community sample of 109 divorced parents with a child aged 4–17 years. Results showed that increased parental distress and co-parent conflict predicted increased child emotional and behavioural problems; and increased lax parenting also predicted increased externalising behaviour problems. However, greater prosocial behaviour was predicted only by lower lax parenting. The results highlight the differential impact of parenting factors on child outcomes following divorce and have implications for the content and tailoring of interventions for divorced parents.