A new CBT based CD Rom (Williams, Taylor, Aubin, Harkin and Cottrell, 2002) was introduced as a way of offering a clinical psychology waiting-list initiative for patients with depression and depression with anxiety. This study evaluated the impact of this computerized cognitive behavioural therapy (CCBT) on consecutive referrals. Six hourly sessions of the interactive computer programme were offered to clients on the waiting list, to be completed by them with some support from a self-help support nurse. Seventy-eight consecutive referrals were offered an appointment for CCBT; 20 (26%) attended at least one session of CCBT and 14 (70% of starters) completed all six hour-long sessions. Beck Depression Inventory scores (BDI-II) fell from a mean of 28.15 (SD 11.41) to 20.00 (SD 10.41) (p = .000) over the 6-week intervention period using an intention to treat analysis. The discussion asks why only a quarter of patients on this psychology waiting list chose to use a CBT CD-Rom, but also notes that those who did use it had clinically and statistically significant reductions in their reported symptoms of depression.

In the UK, recent guidelines on the treatment of depression and anxiety recommend CBT-based self-help materials as one important component of services. However, despite being based on specific CBT techniques or “empirically grounded interventions”, early optimism has been dented by data from recent studies that have cast doubt on the effectiveness of the current generation of these materials. As a consequence, it may be necessary to consider that other factors may contribute to the overall magnitude of CBT effects. Indeed, it is logically inconsistent to argue that specific factors are pre-eminent in CBT whilst maintaining that delivery via therapists is more likely to be effective than self-help. The contribution of “common factors” that operate in personal therapeutic encounters, for example, therapist responsiveness and the patient-therapist alliance, may be one possible overlooked reason for the reduced ef-fectiveness of self-help materials. The development of the next generation of self-help materials, therefore, may benefit from the testing of materials that combine common and specific factors, including specific measurement of the strength of common factors and their relationship to clinical outcomes. We discuss a model of such common factors and suggest how they could be incorporated into the next generation of CBT based self-help materials.

Befriending (BF) has received attention as a beneficial part of mental health care. For example, when compared with cognitive-behavioural therapy (CBT) for schizophrenia, BF was found to be as effective as CBT in terms of initial symptom improvement (Sensky et al., 2000). Why was the BF apparently so effective? Was the BF really a discrete and powerful intervention? Or was it simply an unrecognized aspect of regular CBT? We addressed these questions by first observing BF's convergence with “social support” (a plausibly discrete treatment) and, second, by examining its divergence from CBT, drawing on archival data. For the convergence prediction we correlated the speech content of therapists' in 10 BF sessions from the Sensky et al. study with previously published social support data from stylists working with people with severe mental health problems in a psychiatric hospital (Milne and Netherwood, 1997). For the second prediction the same 10 BF sessions were compared with a sample of 10 CBT sessions, also from the Sensky et al. study. The results indicated that BF was indeed significantly correlated (converged) with social support (r=0.7; p<.05), and also that it did differ (diverged) significantly from CBT (p<.05). As a treatment fidelity check, therefore, these findings indicate tentatively that the two treatments in the Sensky et al. (2000) study were appropriately implemented. As an analysis of effective interventions for schizophrenia, it cautiously suggests that “social support” merits serious attention, and is perhaps no mere placebo.

Although there has been a long interest in the personality traits associated with obsessive-compulsive disorder (OCD), few studies have examined differences on normal, dimensional personality traits for individuals with OCD compared with other clinical disorders. The purpose of this study was to replicate and extend upon the work of Rector et al. (2002) who found unique associations between OCD and trait domains and facets of the five-factor model of personality (FFM) when compared with a clinical sample of depressed individuals. The current study compared individuals with a current diagnosis of OCD (n=21) with individuals with a current diagnosis of anxiety or depression but no OCD symptoms (n=39) on the Revised NEO Personality Inventory (NEO PI-R Form S). Of particular interest was whether individuals with OCD would differ from other clinically anxious/depressed individuals on the actions facet of the FFM, as this facet is known to be related to harm and risk avoidance, and previous research suggests specific relationships between these forms of avoidance and OCD. Individuals with OCD were found to have lower scores on the actions, competence and self-discipline facets. These results add further support to previous research that suggests unique associations between trait domains and facets of the FFM and OCD.

The purpose of this study was to examine whether counselor adherence to Motivational Interviewing (MI) principles was associated with more productive within-session client behavior in a smoking cessation trial for African American smokers. For these analyses 89 baseline counseling sessions of the trial were audiotaped and coded using the Motivational Interviewing Skill Code (MISC). Counselor adherence indicators included a global subjective rating of MI adherence and the frequency of MI-consistent and MI-inconsistent counselor behaviors described in the MISC. Indicators of productive client behaviors included global subjective ratings of within-session client functioning and counselor-client interaction, as well as the frequency of statements by the client favorable toward changing behavior (“change talk”) and resistant regarding changing behavior (“resist-change talk”). Results provided support for the principles of MI. Counselor adherence indexed by both the global subjective rating and MI-consistent behavior frequency was significantly positively associated with global ratings of within-session client functioning and counselor-client interaction, as well as more change talk.

A new model of therapist skill development is presented. Grounded in information processing theory, it provides a comprehensive framework that accounts for a range of phenomena encountered by trainers and trainees – for example, why different training methods are needed for different elements of therapist skill. The model features three principal systems: declarative, procedural and reflective (DPR). Reflection is identified as central to therapist skill development and, accordingly, a pivotal role is given to a reflective system, which enables therapists to reflect and build on their conceptual (declarative) knowledge and procedural skills. The DPR model incorporates a taxonomy of therapist skills, and explains why different skills develop in different ways at different rates. It highlights the centrality of therapists' perceptual skills, and of when-then rules, plans, procedures and skills (rules that determine when to implement what interventions with which patient under what conditions) in the development of therapist expertise. It makes a distinction between personal and professional selves (the self-schema vs. the self-as-therapist schema); and it identifies the role of the personal self in therapist skill development. While there are still many questions to be investigated, it is hoped that the model will stimulate researchers and provide guidance for trainers.

The present study was designed to test the hypothesis that blood fearful and nonfearful individuals would be differentiated by their pattern of recall of schematic and non-schematic prose material. Blood fearful (n=36) and nonfearful (n=40) individuals were presented with five prose passages describing harm or injury. Nine sentences in each passage described events representative of the schema content of most individuals, whereas six sentences in each passage described events that are not representative of typical schema content. Participants read passages that either described themselves experiencing the situations or described themselves witnessing others in the situations and completed a free recall task in both immediate (i.e. 2 minutes) and delayed (i.e. one week) recall conditions. Results did not replicate studies from the cognitive psychology literature on which this study was based. Instead, participants who read passages describing themselves in these situations recalled the gist of the material more accurately than participants who read passages in which they witnessed another individual in the situation. Blood fearful participants recalled the affective tone of neutral passages less accurately than nonfearful participants. Results suggest that activation of schema content has little influence on memory performance, although assessing the affective tone of recalled material detected subtle differences in memory performance between fearful and nonfearful groups.

The aim of this paper was to test the long-term contribution of cognitive-behavioural therapy to the treatment of mixed anxiety-depression disorder. Fifty-seven patients, selected according to DSM-IV diagnostic criteria, were assigned to: 1) cognitive-behavioural therapy; 2) combined therapy (drug and cognitive-behavioural therapy); or 3) a standard drug therapy control group. A multigroup experimental design with repeated measures of assessment (pretreatment, posttreatment, and 3-, 6- and 12 month follow-ups) was used. Most patients who were treated (71%) in experimental groups showed significant improvement at the 12-month follow-up, but there were no differences between the two therapeutic modes. No improvement was shown by the control-group participants at the 6-month follow-up. The results of the present trial do not support the beneficial effects of drug therapy by itself for this disorder. Finally, several topics that may contribute to future research in this field are discussed.

A specific type of social phobia – dictation phobia – was the main and unusual treatment problem in the cognitive-behavioural therapy for an 11-year-old schoolboy. For case formulation and treatment rationale, the social phobia model by Clark and Wells was used. The posttreatment assessment revealed clear positive treatment effects with respect to school grades, social anxiety and overall functioning. The model's applicability for children and adolescents is discussed.

This paper describes a project set up to treat four homeless men using cognitive behavioural therapy (CBT). The referral criteria were that individuals had alcohol and/or substance misuse problems, were roofless (i.e. sleeping rough) immediately before the intervention began and found it difficult or impossible to access hostel places in Southampton. Excessive alcohol use, violence (against self, others and property) and prison sentences were all features of their presentation. The project involved three levels of CBT intervention provided by the clinical psychologist: 1) training for the staff to enable them to work within this model; 2) continued supervision within model to ensure consistency and sustainability; 3) individual formulation (description of the problem within the CBT framework) and psychotherapy. The house itself was also run on a collaborative basis. A number of measures including mental health and social functioning constructs were used to evaluate the project, in addition to some qualitative data. All residents reduced incidents of theft, violence and alcohol consumption. Risk to self and others was also reduced for all residents. Perceived self-efficacy increased slightly for all residents, and staff perceived that they could be more effective, less hopeless, and therefore possibly less stressed as a result of training. More data will be gathered over time.

The aim of the current paper is to describe the tailoring of cognitive-behavioural treatment for a female client who developed posttraumatic stress disorder (PTSD) subsequent to awareness under anaesthetic during an emergency caesarean procedure. Treatment consisted of prolonged and in vivo exposure, and cognitive restructuring over eight sessions. Assessment was conducted prior to treatment, immediately after treatment, and at 6- and 24-month follow-up. Follow-up at 24 months demonstrated good outcome, with the client no longer meeting criteria for PTSD.

Behavioural and Cognitive Psychotherapy is an international multidisciplinary journal for the publication of original research, of an experimental or clinical nature, that contributes to the theory, practice and evaluation of behaviour therapy. As such, the scope of the journal is very broad and articles relevant to most areas of human behaviour and human experience, which would be of interest to members of the helping and teaching professions, will be considered for publication.