Ehlers and Clark (2000) hypothesize that persistent PTSD is explained by a predominance of data-driven processing and a lack of conceptually-driven processing of the trauma. Data-driven/conceptually-driven processing is thought to relate to perceptual memory representations and memory fragmentation. The present study measured the result of data-driven/conceptually-driven processing in three ways: on utterance level by assessing 1) the ratio between perceptual and conceptual memory representations and 2) utterance disorganization, and 3) on narrative level by assessing the incoherence of the trauma narrative. Twenty-nine patients discharged from the Intensive Care Unit (ICU) were assessed within two weeks after ICU discharge and at 4 months follow-up. The present study tested whether perceptual memory representations, narrative disorganization and narrative incoherence immediately after ICU discharge are related to post-trauma symptomatology. If so, whether these variables are specific for PTSD as compared to depression. Data-driven/conceptually-driven processing was related to PTSD and Depression symptoms on utterance level. Although narrative incoherence did not predict PTSD symptoms, it was predictive of depression symptoms. The present study showed the viability of the data-driven/conceptually-driven conceptualization in explaining post-trauma symptomatology.

Definitions of treatment failure and the labelling of patients as non-responsive typically require treatments to have been offered and failed. For pharmacological treatments, treatment quality is relatively easy to define; this is much more difficult with psychological treatments. This study examined patient recollections of previous therapy for obsessive compulsive disorder (OCD). A Treatment History Questionnaire was administered to a sample of 57 apparently treatment refractory OCD patients from a specialist national OCD treatment unit and a national charity for OCD sufferers. On average, respondents reported an 8$\frac{1}{2}$ year wait between the obsessional symptoms interfering significantly with their lives and being diagnosed. Forty-three percent recalled having received either cognitive behaviour therapy (CBT) or behaviour therapy as the first treatment; 31% of the group did not know what type of therapy they had received. The components of therapy that respondents recalled were analysed and contrasted with minimal therapy criteria. These criteria appear not to have been met in most patients who understood that they had received “CBT”. The implications of this study for assessment of treatment integrity and the classification of patients as “treatment resistant” are discussed.

Negative thoughts about the self are a core component of Beck's cognitive triad of depression, and are seen by some as the central cognitive symptom of the disorder. The role of negative thoughts about the self in secondary depression associated with medical illness is less clear: thoughts relating to hopelessness and helplessness rather than guilt, self blame and failure may be more prominent. This study tested the hypothesis that the cognitive symptoms of depression in cancer patients would be less negatively self-referent than a psychiatric control group. Forty patients with cancer referred to a psychological medicine department were matched for age, sex and BDI score with 40 patients referred to a psychological therapies department for CBT. The cognitive-affective section of the BDI (items 1–14) was divided into a negative self-referent cognitions subscale (items 3, 5, 7, 8) and a mood-motivation subscale. These two subscales were then compared with the somatic-performance subscale (items 15–21). As a percentage of the total matched BDI score, the cancer patients had more somatic symptoms (42.7 v 34.8%), equivalent mood/motivation symptoms (44.5 v 45.6%) and less negative self-referent symptoms (12.8 v 19.5%). This difference may apply more to mild symptoms than moderate-severe symptoms. Some preliminary support for the hypothesis is therefore available.

There is controversy about the value of psychological interventions offered to refugee people through an interpreter, but little empirical evidence in this field. This study compared routine clinical outcomes of three groups of PTSD patients receiving CBT: refugees who required interpreters; refugees who did not require an interpreter; and English-speaking non-refugees. The aim of the study was to ascertain whether interpreted CBT is feasible. All three groups attended a similar number of sessions and showed significant improvements after treatment. Refugees receiving treatment with and without interpreting did not differ in treatment outcomes. The findings suggest that interpreters can be used with positive outcome in treating PTSD patients with CBT. This study supports NICE (2005) recommendations that CBT should be offered regardless of language need.

This paper describes the development of protocols with interpreters employed in an East London psychological trauma clinic. The service treats traumatized refugee people with cognitive methods, according to the National Institute for Clinical Excellence (NICE) Guidelines for PTSD. NICE states that language should not be a barrier to treatment, but provides no further guidance to achieve this. These protocols for interpreting CBT are designed to be explicit, consistent and ethical. A telephone poll from a recent UK-wide trauma survey, a focus group with local interpreters, and practitioner reflection were all used to develop and refine the protocols and their rationale, which are described, together with implications for future culturally sensitive practice and research.

Positive beliefs about the benefits of rumination have been shown to be a proximal factor determining rumination. This study investigated, in a sample of 29 currently depressed patients, whether positive beliefs about rumination parallel known gender differences in rumination and whether these beliefs differ between depressed individuals with and without a history of physical or sexual assault. Depressed women tended to report stronger positive beliefs in the benefits of rumination than men. However, this result was found to be due to differential effects of a history of assault: women with a history of assault showed significantly stronger positive beliefs than women without a history of assault while there were no significant differences in men. Experiences of assault may undermine women's beliefs in coping ability so that rumination is seen as a more compelling option.

Research suggests that there is low inter-rater reliability between therapists when asked to formulate the same case and that there may be discrepancies in what is considered an essential part of a formulation. The present study aimed to explore the diversity of therapists' viewpoints regarding the purpose and essential features of a cognitive-behavioural therapy (CBT) case formulation of depression. A Q-sort methodology was used in order to render these beliefs operational. Seven experienced CBT therapists participated in the construction of 86 statements, capturing concepts considered relevant to a CBT formulation of depression. This Q-sort was then administered to 23 therapists, who rated these statements in terms of their importance using a Q-sort procedure. Three factors emerged, suggesting three dominant opinions as to the importance of features of a formulation. A “state” CBT factor, focusing on the “here and now”, accounted for most variance; followed by a second factor emphasizing “function and process” and a third factor emphasizing “trait” components. Whilst there was some agreement between what was considered to be least important in a formulation, the emergence of three distinct viewpoints suggests a lack of complete consensus amongst the therapists.

The current study investigated the relationship between session impact and outcome in group psychoeducative CBT, conducted in a routine clinical setting. Participants completed a range of outcome measures at screening, start of the group, termination of the group and at the 3-month follow-up of the six-session intervention. At the end of each psychoeducative session, participants completed a group-specific version of the Session Impact Scale. No single psychoeducative session was seen to generate greater impacts than any other session of the six. Clients who experienced a clinically significant reduction in symptoms during the group perceived greater interpersonal impacts in the group. Results suggest that interpersonal aspects such as normalization may be the active ingredient of change in such service delivery settings. The results are discussed in terms of the potential powerful role of non-specific factors in such large groups and directions for further research examining the impact-outcome relationship in group-based CBT.

The Cognitive Therapy Scale is a well-established tool for assessing skills in delivering cognitive therapy, but has been subject to criticism. It has recently been updated by two groups, producing the Revised version or CTS-R (Blackburn, James, Milne and Reichelt, 2000) and a version designed for therapy of psychosis, the CTS-Psy (Haddock et al., 2001). The present study made a direct comparison of these scales to evaluate their inter-rater reliability, the extent to which they measure the same therapist qualities, and their utility for assessment of skills in trainee therapists working with different client-types. Twenty-six trainees submitted tapes of therapy with clients suffering either personality disorder or psychosis. Each tape was rated by two independent assessors on each of the two scales. Results suggest the scales are both fairly easy to use and produce highly similar estimates of student competence. Client diagnosis has no significant influence on the scores obtained by the therapist. However, inter-rater reliability is relatively low. It is concluded that safeguards are needed where these scales are used as a training outcome measure.

Generally, the suppression of unwanted thoughts is found to be ineffective. Moreover, in the longer run, suppression attempts may backfire in that they produce a delayed increase in unwanted thoughts (i.e. a rebound effect). This ineffectiveness and paradox have been observed in various studies, and with various targets, such as neutral thoughts, obsessive intrusions, worries, addictive urges, and phobia-related cognitions. The present study sought to explore the effect of suppression of a different intrusion, namely a hallucination. Healthy undergraduates were exposed to a laboratory procedure that was to provoke hallucinations. Half of the participants were additionally given instructions to suppress the hallucinations. Results indicated that suppression was somewhat effective in the short run, but ineffective in the long run. However, no rebound effect was observed.

This was a cognitive-behavioural therapy (CBT) group for formulation and treatment of low self-esteem, with emphasis on the use of creative approaches (stories, metaphors and experiential exercises) to enhance memory and learning. Evaluation of outcome for 72 clients attending these groups indicates that this is a successful intervention in terms of self-esteem, anxiety and depression. Qualitative feedback has been very positive and there has been a steady and increasing demand in terms of referrals.

Low self-esteem is an underlying component of depression and psychological therapy may first need to address deeply entrenched negative self-evaluations in order to challenge and reduce the rigidity of core beliefs (Fennell, 1997). Hall and Tarrier (2003) developed an effective brief intervention aimed at reducing low self-esteem in patients with psychosis. Subsequent anecdotal evidence suggested that this intervention may also provide positive results in an older adult population with depression. In this case study, the intervention was implemented with a 79-year-old woman who was experiencing anxiety symptoms and depression with suicidal thoughts. Following implementation of the self-esteem intervention, significant improvements were obtained. This paper offers preliminary evidence that this novel intervention can be used successfully with older age clients and provides a positive and engaging therapy for depression.

This case example demonstrates the role of massed exposure in optimizing treatment outcome in panic disorder with agoraphobia. Treatment of a 28-year-old male patient in a clinical routine setting is described. Full remission was achieved after an 8 day period of intensive treatment and proved to be stable at follow-up (6 months). More systematic research including controlled studies comparing massed and spaced exposure is suggested.