Background: Common factors are important for the therapy outcome and also mediate the specific factors of therapy. As one of the common factors, client's expectations towards treatment have been understudied. Aims: The aim was to examine the pre-treatment expectations of outpatient substance abuse treatment clients (N = 327, 111 females, 216 males) and its impact on retention, effectiveness and satisfaction at 6-month follow-up. Method: Dependent variables included the clients’ attitudes towards the twelve-step principles and participation, medical treatment and therapists’ role. Results: An emphasis on the importance of medical treatment at baseline predicted dropping out. Similarly, it predicted a lower percent days abstinent (PDA6) at 6 months follow-up in comparison to those who did not consider medical treatment important for recovery. Percent days abstinent increased with a more positive attitude to mutual support. At follow-up, those who had assessed the therapist's role in recovery to be most important at the baseline were most satisfied with the treatment. Conclusions: The client's pre-treatment expectations have an impact on treatment retention and effectiveness. Further effort should be made to study how clients’ image of treatment could be improved and also how the commitment of the clients with multiple problems could be improved.

Background: Research has demonstrated the effectiveness of computerized cognitive behaviour therapy (cCBT) for depression and anxiety in adults, but there has been little work with children and adolescents. Aims: To describe the development of a cCBT intervention (Think, Feel, Do) for young people, and preliminary outcomes and feedback from a pilot randomized controlled trial. Method: Twenty participants aged 11 to 16 with depression or anxiety were randomized to receive cCBT immediately or after a delay. Standardized measures were used to assess self-reported anxiety, depression, self-esteem and cognitions, as well as parent rated strengths and difficulties. A feedback form was also completed to assess young people's views of the programme. Results: A total of 15 participants completed the pre and post assessments in the trial, and 17 provided feedback on the intervention. Paired samples t-tests demonstrated significant improvements on 3 subscales in the control condition, compared to 7 subscales in the cCBT condition. Feedback showed moderate to high satisfaction for participants. Conclusions: This study provides encouraging preliminary results for the effectiveness and acceptability of cCBT with this age group.

Background: It has been suggested that the perinatal period is a period of increased risk for the development and/or exacerbation of OCD and that postpartum OCD (ppOCD) presents a distinct clinical picture. This raises the possibility that ppOCD might be a distinct subtype of OCD. This review examines this contention. Method: A search using Ovid (Medline, PsycINFO and Embase), EBSCO, Cochrane Library, Web of Science (ISI), Pubmed databases and Google Scholar was carried out using the key words: “obsessive compulsive disorder” (and derivatives), “perinatal”, “pregnancy”, “postnatal”, “postpartum”, “mothers” (and derivatives), “anxiety disorders” and “subtypes.” These articles and their references were reviewed. Results: The majority of studies reviewed were retrospective, which makes it impossible to infer causality. Two prospective studies found a higher incidence of OCD in the postpartum period. These were carried out in Turkey and Brazil and, as such, may be limited in their applicability to other cultural groups. Conclusion: The concept of ppOCD as a specific subtype has not been robustly demonstrated. The evidence that OCD is more prevalent in the postpartum period is mixed. The evidence that OCD in the postpartum period presents a distinctive clinical picture with specific symptomatology and course is more compelling. In view of the impact of culture and religion on the expression of OCD, collaborative, international, prospective studies that take into account the methodological and definitional issues raised in this review are necessary to provide clarification.

Background: Guided internet-delivered CBT for anxiety disorders has received increasing empirical support, but little is known regarding the role of the therapist. Aims: This study addressed therapist factors in guided internet-delivered cognitive behavioural therapy for anxiety disorders. Method: Data from three controlled trials with a total N of 119 were analyzed with attention to differences between eight therapists. Results: No significant mean level differences between therapists appeared in the dataset. However, one significant intraclass correlation between participants was found, suggesting that the outcome on the Beck Anxiety Inventory might have been influenced by the impact of the individual therapists. Conclusion: The therapist can possibly have some influence on the outcome of guided internet-delivered CBT for anxiety disorders, but studies with more statistical power are needed to establish whether therapist effects are present in this modality of psychological treatment. The present study was underpowered to detect minor therapist effects.

Background: CBT case conceptualization is considered to be a key competency. Prior to the publication in 2009 of Kuyken, Padesky and Dudley's book, little has been documented concerning methods for training conceptualization skills and the conceptualization process is usually perceived as predominantly an intellectual process. In this paper, the Declarative-Procedural-Reflective model of therapist skill acquisition provides a route to understanding how different kinds of knowledge systems can be integrated to enhance therapist skill acquisition. Method: Sixteen recent graduates of a postgraduate diploma in cognitive behaviour therapy worked independently through a self-practice/self-reflection workbook designed to lead them through a series of CBT interventions commonly used to elicit the information required for a CBT conceptualization. Results: The participants’ self-reflections were thematically analyzed and uncovered the following inter-related themes: increased theoretical understanding of the CBT model, self-awareness, empathy, conceptualization of the therapeutic relationship, and adaptation of clinical interventions and practice. Conclusions: A tentative conclusion reached, based on the self-reflections of the participants, was that targeted self-practice/self-reflection enhanced case conceptualization skill by consolidating the Declarative, Procedural and Reflective systems important in therapist skill acquisition.

Background: Social anxiety is a common problem among people who are recovering from psychosis. At present there is no evidence based psychological treatment targeting social anxiety in this population. Cognitive Bias Modification for Interpretation (CBM-I) has been shown to be effective in reducing social anxiety in people who do not have a history of psychosis. Aims: To assess the feasibility and acceptability of the CBM-I methodology for use in a clinical setting with people who are experiencing social anxiety following an episode of psychosis. Method: Eight participants with social anxiety were recruited from an early intervention service. A single session of computerized CBM-I was conducted, with mood and cognitive interpretation bias being assessed before and after the session. Results: All participants reported an improvement in mood immediately following the CBM-I session (n = 8). For those participants who had a negative interpretation bias, none became more negative following the CBM-I session, with three out of six participants showing a beneficial change. Conclusion: These results suggest that CBM-I is acceptable for use with people who are experiencing social anxiety following a psychotic episode. Further research looking at how CBM-I could be made more interactive and producing more applicable scenarios for use in a clinical setting is recommended.

Background: There is emerging evidence that mindfulness groups for people with distressing psychosis are safe and therapeutic. Aims: The present study aimed to investigate the feasibility of running and evaluating a mindfulness group on an inpatient ward for individuals with chronic and treatment resistant psychosis. Method: Eight participants attended a 6-week mindfulness group on a specialist tertiary inpatient ward. Results: This study demonstrated that mindfulness exercises were acceptable and well-tolerated by participants. Measuring outcome, systemic challenges and participant experience are discussed.

Background and Method: This naturalistic study was undertaken in routine settings and compared the clinical effectiveness, costs, treatment preference, attrition and patient satisfaction of Group and Individual CBT. Results: No significant differences were found in depressive and distress symptoms between group and individual CBT at post-treatment and follow-up. Individual CBT was 1.5 times more expensive to provide than Group CBT and the wider costs of other supports were similar between study arms suggesting a cost-effectiveness advantage for Group CBT. Patients preferred individual treatment at baseline but, despite this, there were no between-group differences in attrition or satisfaction. Conclusion: A larger RCT study is needed, but running CBT groups for depression could be considered more frequently by clinicians.

Background: Group CBT (G-CBT) for heterogeneous acute psychiatric inpatients (HAPIs), which allows patients to choose the group therapeutic target, might have clinical utility but is empirically untested. Aims: To test the feasibility, acceptability and patient-rated effectiveness of G-CBT for HAPIs in which patients' themselves choose the group therapeutic targets, within a previously rarely used sole-standalone session format. Method: Weekly G-CBT was run for two HAPI wards. The G-CBT was evaluated in terms of attendances/re-attendances, and patient feedback on 5-point scales of how strongly patients agreed/disagreed that the group was useful, enjoyable, worth re-attending, and had led to them learning something they could use to reduce their distress. Results: One hundred and thirty-seven separate patients attended a total of 291 times across 31 groups. Being female or having a diagnosis of bipolar disorder significantly predicted re-attendance. Sixty-three percent of patient feedback questionnaires were obtained from groups 10–31 and over 75% of respondents agreed positively with each of the evaluation dimensions. Conclusions: Practise-based evidence from this pilot study suggests that G-CBT for HAPIs, allowing patients to choose therapeutic targets in a sole-session format, is feasible, acceptable and patients find it effective. This supports more widespread deployment of this CBT treatment format. Future research might now test the format's clinical effectiveness with standardized and objective clinical outcome measures.

Background: Sleeping difficulties are an increasing problem for youths, but there is a lack of treatment research for this age group. Aim: The aim of this study was to investigate the effects of Cognitive Therapy for Insomnia (CT-I) on youths with primary insomnia; this treatment has never been tested on youths before. Method: The study was conducted according to an AB single-case experimental phase design, with pre-tests and post-tests. After 7–10 days of baseline assessment, three youths aged 16–18 (2 male) with primary insomnia participated in a 7-week long treatment. A sleep diary was used throughout the treatment. A follow-up assessment including one week with a sleep diary was conducted 3 months later. Visual inspection was used to analyze outcome. Results: Insomnia severity was greatly reduced for all participants after treatment. Daily measures showed that sleep onset latency was reduced for two participants but no change in total sleep time was confirmed. Daytime symptoms fluctuated for the participants. The insomnia-specific psychological processes were reduced to varying extents. These results were maintained at the follow-up measure. Conclusions: CT-I may be a promising treatment for youths with insomnia and the treatment should be tested further in randomized controlled studies.