Cognitive theorists propose that each anxiety disorder is associated with a specific tendency to overestimate the danger inherent in particular situations or internal states. Studies comparing anxious patients with non-patient controls have shown that several anxiety disorders are associated with elevated subjective estimates of the likelihood (probability) and cost of negative events. The present study focuses on social phobia and extends previous findings by: a) including a control group of equally anxious patients with another anxiety disorder and b) investigating the effects of successful cognitive and drug treatments on patients' probability and cost estimates. In line with cognitive theory, the results indicate that social phobia is associated with a specific elevation in subjective estimates of both the probability and cost of potentially negative social events. Reductions in overestimation occurred in successful cognitive and drug treatment and were closely related to the degree of symptomatic improvement in both treatments. Contrary to previous findings, there was no evidence that reductions in cost were more important than reductions in probability.

Several authors have suggested that threat schemata of high worriers may differ from those of less worried individuals with regards to the manner with which information is structured in the Long Term Memory (LTM) or the content of the information stored in the LTM. The present study tested this hypothesis using the catastrophizing interview technique (c.f., Vasey & Borkovec, 1992). Results revealed that high worriers evaluated the likelihood of the occurrence of feared consequences generated for each worry as more likely to actually happen than low worriers did. Second, the ultimate outcome generated in the catastrophizing sequence for a given worry was more severe for high worriers. Finally, high worriers generated ultimate outcomes that were more similar in content, presumably reflecting tightly organized threat schemata. It is argued that activation of these threat schemata in the LTM contributes to the maintenance of worry and anxiety in anxious individuals.

The question of which cut-off point would be more appropriate in the selection of sub-clinical obsessive-compulsive (OC) samples is an important methodological issue that has not been formally addressed, hence prompting the current study. Three groups of sub-clinical OC subjects, scoring 1, 1.5, and 2 standard deviations (SD) above the mean on the Padua Inventory, and a matched non-OC control group, were compared on various clinical and personality measures. As expected, the three sub-clinical groups had higher scores than the non-OC group on measures of OC symptoms (including obsessional slowness), depression, anxiety, and on personality measures of neuroticism, psychoticism, and obsessional traits. However, no significant differences were observed between the three sub-clinical groups on most measures, although the 2 SD group had higher scores on neuroticism and obsessional personality traits. It is concluded that a wide range of selection criteria can yield similar results that are interpretable within the current theoretical models of Obsessive-Compulsive Disorder (OCD). It is suggested that subjects with a diagnosis of OCD should be carefully excluded from sub-clinical studies. [A Spanish abstract follows the references.]

The aim of the study was to examine whether there are specific cognitive personality traits that are related to specific cluster C personality disorders as suggested by Beck's cognitive model. The study included 135 psychiatric outpatients and 41 healthy controls. The subjects were diagnosed according to DSM-III-R axis I and axis II. The cognitive dimensions of sociotropy, autonomy and dysfunctional attitudes were assessed. The results indicated some cognitive specificity, especially when the effects of a lifetime depressive disorder were statistically controlled for. Dependent personality disorder was significantly associated with higher scores on all sociotropic subscales and dysfunctional attitudes. Avoidant personality disorder was significantly associated with the sociotropic subscales “concern about disapproval” and “pleasing others” as well as dysfunctional attitudes, while obsessive-compulsive personality disorder was associated with only higher scores on the sociotropic subscale “concern about disapproval”.

The present study examined the dysfunctional attitudes and the personality styles of 40 psychiatric outpatients with obsessive-compulsive disorder (OCD) and compared them to 33 outpatients with major depressive disorder (MDD) and 41 healthy controls (HC). Scores on Beck's Depression Inventory (BDI), Dysfunctional Attitude Scale (DAS), and Sociotropy-Autonomy Scale (SAS) were obtained for the three groups. Based on previous research it was predicted that higher levels of sociotropy subscales S 1 (concern about disapproval), and S 2 (attachment/separation concerns) would be specifically related to the diagnosis of OCD after controlling for differences in demographic variables and other psychiatric diagnoses. These hypotheses were confirmed. Significantly lower scores on subscale A 3 (solitary pursuits) was also found specifically related to OCD diagnoses. Higher scores on DAS and lower scores on autonomy subscale A 1 (independent achievement) were found to be particularly related to MDD. Implications of these findings for a cognitive model of the development of OCD are discussed.

Treatment of compulsive hoarding has rarely been described in the literature, apart from standard treatments for obsessive compulsive disorder of which hoarding is thought to be a subset. This paper presents preliminary findings from seven patients treated with cognitive and behavioral interventions derived from Frost and Hartl's (1996) theoretical model of hoarding. Six clients attended 15 group treatment sessions over 20 weeks plus individual home treatment sessions and one client received 20 weekly-sessions of individual treatment only. After 20 weeks, treatment resulted in noticeable improvement in several hoarding symptoms for five of the seven patients, especially reduction in excessive acquisition of possessions, although problems with clutter persisted. Three of four clients who continued in treatment for approximately 1 year showed substantial further improvement, although none felt entirely recovered. Findings are discussed in light of the model of hoarding and possible modifications to treatment to enhance motivation and benefits.

A single case study of a schema-focused cognitive therapy approach to treatment of a young woman with long-term interpersonal relationship problems and affective instability is described. There have been few accounts of this type of therapy that have incorporated outcome measures. Measures of mood and of schema have been taken throughout treatment and results would appear to offer some support for schema-focused cognitive therapy.

Motivational interviewing is a client-centered, directive therapeutic style for initiating and facilitating change. Introduced through this journal two decades ago, it has been supported in a series of clinical trials as effective in enhancing behavior change through relatively brief intervention. The author explores parallels between this therapeutic style and the nonviolent “join-up” method of Monty Roberts for training and rehabilitating horses. Both methods emphasize a collaborative rather than adversarial working relationship, seek to enhance intrinsic motivation, and produce positive change in a briefer period of time than traditionally thought to be possible. Both respect the other's autonomy and choice, and move with rather than against resistance. Both seem to enhance the speed and amount of change that follow from behavioral methods.

This paper describes an intervention with a man who has Prader-Willi Syndrome (PWS) and mild learning disabilities in a residential setting. PWS is a chromosomal disorder that is characterized by a wide range of behavioural characteristics including overeating and challenging behaviour. The intervention was based on a range of principles derived from a motivational interviewing approach, which were embedded in a broader behavioural framework that was designed to assist in weight reduction and reduce challenging behaviour. Records of weight and challenging behaviour kept over time suggest that the approach had relatively little impact on overall weight. However, levels of challenging behaviour were reduced quickly and have been maintained at a stable and lower level. Weight has also been maintained at a reasonably constant level without confrontation with staff or excessive restrictions on the individual concerned. Relationships between the individual and staff in the home also improved over the course of the intervention.

This case describes the cognitive-behavioural treatment of a 40-year-old woman with a 22-year history of infrequent fainting episodes. It highlights three features: 1) the potential importance of undiagnosed medical conditions in people presenting for anxiety disorders; 2) a somewhat unusual comorbid diagnosis of Agoraphobia Without History of Panic and Panic Disorder with Agoraphobia; and 3) the importance of modifying attitudes about performance and responsibility to reduce the chance of relapse.

Psychological formulations are central to cognitive behavioural approaches. The use of such formulations presents a number of difficulties when working with clients with psychotic problems. Despite this, sophisticated psychological formulations can be collaboratively developed with psychotic clients. This paper presents one method of developing such formulations through an evolutionary process. Early in the therapeutic process, simple formulations involving straightforward theoretical models are presented, which are systematically elaborated as therapy proceeds. This involves developing, collaboratively with clients, successive layers of formulation. Each of these layers builds on and incorporates the previous one, yet involves an incremental increase in complexity, depth and informational content. The evolutionary process is illustrated with a case example.