The present study examined attentional disruption in the presence of negative automatic thoughts specific to panic and social anxiety. Participants with panic disorder (n = 18), participants with social phobia (n = 19), and nonanxious participants (n = 19) completed a dichotic listening task in which they shadowed ambiguous passages heard in their dominant ear while ignoring lists of panic-related, social anxiety-related, or control automatic thoughts that were presented in their non-dominant ear. In addition, they completed a simultaneous simple reaction time task. Both patient groups made more shadowing distortions than the nonanxious group. Panic participants committed more shadowing omissions in trials in which they heard panic-related automatic thoughts as compared to trials in which they heard other automatic thoughts. Results suggest that both patient groups experienced some disruption on this demanding task but that only panic patients exhibited an anxiety-specific attentional bias.

Patient characteristics may partly explain individual differences in long-term maintenance of treatment gains in response to cognitive and behavioral therapies (CBT). This study evaluated the relative contribution of negative cognitive style, behavioral activation, and personality patterns, measured at the end of treatment among treatment responders, towards the risk of relapse of major depressive disorder over a 2-year prospective follow-up. The sample included depressed adults who were randomized and received an adequate dose of one of three forms of CBT, who then fully responded and completed a 2-year prospective follow-up (N = 93) (Jacobson et al., 1996; Gortner, Gollan, Dobson and Jacobson, 1998). Cox regression analyses revealed that for treatment responders, self-devaluative depressogenic cognitive style did not predict relapse during the 2-year follow-up. Separate cox regression analyses indicated that without considering the contribution of personality patterns, it was important to distinguish the level of behavioral activation (e.g. frequency of pleasant events) from its associated pleasure in predicting relapse. With the introduction of personality patterns; however, an integrated model revealed that only dependent personality pattern was associated with hazard of relapse during the 2-year prospective follow-up. Dependent personality pattern may increase relapse through behavioral passivity.

In the absence of good quality evidence for the effectiveness of specific aspects or formats of Cognitive Behavioural Therapy (CBT) supervision, it is necessary to consider what is recommended as good quality CBT supervision. This review of the literature aims to provide an overview of the recommended practice of CBT supervision by considering general principles and goals of CBT supervision; the format of individual supervision sessions; the course and stages of CBT supervision; attending to supervisees' cognitions and affects; the importance of the supervisory relationship as well as the recording and rating of therapy sessions. This could provide a framework for setting standards to aspire to and stimulate further research in this field. Conforming to such practice would be an important step toward quality assurance in CBT supervision.

This study investigated whether reasoning biases are specific to people with delusions and the role of emotional material on “jumping to conclusions”. Associations between reasoning and cognitive factors as well as other top-down factors such as metacognition were also explored. A comparative design was used to investigate group differences between people with persecutory delusions, people with panic disorder and non-patient controls. A probabilistic reasoning task involving three types of material was utilized to investigate the effect of emotional content on reasoning. Participants also completed questionnaire measures to explore whether hasty decision making was associated with measures of mood or cognitive processes. The results of the reasoning task showed that there was no main effect of group. However, all participants requested significantly less information on the two types of emotional material. None of the questionnaire measures were associated with performance on the reasoning task. Aspects of metacognition were found to be associated with ratings of delusions. This study suggested that between group differences in reasoning were small but that emotional content increases haste of decision making across all groups.

This study aimed to investigate factors associated with persistent Post-Traumatic Stress Disorder (PTSD) in people with Spinal Cord Injury (SCI). In the context of a cognitive model, it sought to determine how influential cognitive appraisals were in predicting persistent PTSD when compared to other known predictor variables in the literature such as injury severity. A sample of 50 inpatients receiving rehabilitation for SCI who were 3–24 months post-injury were interviewed using a series of standardized measures of PTSD symptoms and diagnosis, post-traumatic cognitive appraisals, social support, and injury severity. For PTSD symptoms, significant relationships were found for greater injury severity, lower satisfaction with social support and more negative cognitions. Negative cognitions were found to predict variance in PTSD symptoms over and above the non-cognitive variables, although gender and injury severity were also predictors. The only significant predictor of PTSD diagnosis was the cognitive sub-scale “negative cognitions about the self”. Cognitive appraisals were found to be important predictors of persisting PTSD in an SCI population. This supports the cognitive model of PTSD and the development of cognitive therapies for PTSD in this population.

Assessment and treatment of personality disorder (PD) is a key issue in UK mental health service provision (NIMH report, 2003), but there is limited information on individuals with personality disorder presenting to primary care mental health services. This study investigates the characteristics of PD in individuals receiving cognitive behaviour therapy (CBT) following GP referral and its relationship with therapist ratings of treatment process and outcome. One hundred and forty-eight participants completed the Millon Multiaxial Clinical Inventory (MCMI-III: Millon, Davis and Millon, 1997). Therapists completed a measure of therapy process and outcome (TPOQ) on 100 participants. Key therapy and process questions were answered for 60 participants who attended a minimum of five therapy sessions. MCMI-III indicated a rate of PD of 56.4%. Factor analysis of PD scales identified two factors: inward looking/emotionally distanced, and aggressive/acting out. For clinical syndromes (CLS), the factors were general psychopathology and substance abuse. TPOQ had two factors: therapeutic alliance and complexity in therapy. Regression analyses indicated that only those PDs contributing to the inward looking/emotionally distanced scale score were associated with therapeutic alliance problems. Conversely, complexity in therapy was only predicted by general psychopathology and not by personality disorder. This study identified high rates of personality disorder in primary care referrals to a clinical psychology service. It also indicated that relationships between the presence of personality disorder and therapist ratings of treatment difficulties were only associated with certain types of personality disorder. These findings are discussed in relation to service and therapy planning in mental health.

The development in science and practice of cognitive therapy for psychological disorders has benefited from coherent models that specify the key cognitions that can be targeted in therapy. A scale is required to identify the cognitions that characterize bipolar affective disorder and that may influence the development of mania or hypomania. In this pilot study, 104 items were generated within five theory-driven categories: Self-activation, Response style, Other-positive, Other-negative, and Self-catastrophic. The mean score for all items, and for each category of items, was significantly elevated in a group of individuals with a diagnosis of bipolar disorder (n = 22) relative to a group of non-clinical controls (n = 22). An exploratory analysis revealed the items that were significantly elevated in the bipolar group. Theoretical and clinical implications, limitations and plans for future research are discussed.

We describe the first application of Danger Ideation Reduction Therapy (DIRT) in the UK. It is a novel approach developed in Australia, for treatment resistant obsessive compulsive disorder with contamination fears. The DIRT program was administered to an inpatient at Springfield Hospital, South London, with severe, treatment resistant obsessive compulsive disorder. Treatment consisted of weekly one hour therapy sessions for 14 weeks. A reduction in symptom severity measured on all scales undertaken was seen by the end of treatment. The Padua Inventory had shown an 85% reduction; Activity checklist an 86% reduction; Y-BOCS an overall 41% reduction and a 33% reduction on the Beck Depression Inventory. The DIRT approach has demonstrated an impressive and consistent improvement, maintained to 6 months post-treatment. More studies are needed to evaluate this treatment further.

The central aim of this study was to assess the effectiveness of object-affect fusion informed cognitive-behavioural therapy, with a patient presenting with compulsive hoarding. The methodology employed an A/B single case experimental design. Experimental measures illustrated an increased ability to be able to discard objects and an increased sense of associated ease of discard during treatment, with clinically significant change across a variety of robust psychometric measures in the pre-post data. The study illustrates the utility of single-case approaches in the evaluation of innovative clinical approaches and also the potential for utilizing the object-affect fusion concept in the treatment of compulsive hoarding.

In 1986, I suffered a psychotic breakdown. With support from the staff at Fulbourn Hospital, I was able to overcome my illness. My mental health had been blighted by fearful dark delusion and associated alarm for 15 years. As I recovered, I developed my own interpretation of psychosis and have constructed a personal theory that attempts to give form and structure to a nebulous and very disturbing state of mind. My theory is of the existence of an active and directive rogue psychotic mindset; hereafter referred to as the RPM. I would define this mindset as being a body of nonsensical thoughts, ideas, beliefs, suppositions and assumptions that occupy a volume in the mind. This body of cognitions is given credence by being tentatively linked to the factual world. It is active in the sense that one is influenced by its rogue contents. As such it is directive and can drive not only one's thoughts, but also one's behaviour. Other normal mindsets co-exist cerebrally with the RPM. Such mindsets serve to tip the balance and normalize behaviour. During and after psychotic breakdown; in the absence of clinical psychology knowledge, my RPM developed as I struggled and tried to explain the unusual experience of going psychotic.

Cognitive behaviour therapy (CBT) treatments have been developed and validated with respect to specific diagnoses. In routine clinical practice diagnostic accuracy is poor, making for poorly targeted treatment. The problems posed by lack of diagnostic rigour, including non-detection of co-morbidity, are rarely the subject of supervision sessions and treatment failures may be inappropriately attributed to other factors such as lack of therapeutic skill or an unmotivated client. It is argued that a false dichotomy exists between diagnosis and case formulation fuelled by professional territorial disputes. We suggest that diagnosis acts as a lens, focusing attention on the range of cognitions salient to a case formulation and also highlights psychosocial and environmental factors that may affect treatment outcome. It is recommended that practitioners enhance their effectiveness by using structured interviews routinely as a part of their ongoing assessment of clients.

The aim of the current study was to examine how belief in the validity of hallucinations relates to the association between hallucination frequency and associated distress. In a sample of inpatients with psychotic symptoms, results demonstrated that hallucination believability predicted later distress after controlling for symptom frequency. In addition, results were consistent with the hypothesis that hallucination believability mediated the frequency- distress link. Recent randomized controlled trials have supported the efficacy of cognitive behavior therapy for schizophrenia and related psychotic disorders. Further evidence suggests that cognitive behavioral approaches that incorporate mindfulness and acceptance-based strategies may be effective in reducing the believability of positive symptoms. Future trials incorporating longitudinal designs and more detailed assessments of these variables are needed.

This short case series aimed to explore whether and how an intervention with a cognitive component changed parental attributions about child behaviour and parents' reports of their own behaviour. The results suggest change in parental attributions, coded using the Leeds Attributional Coding System (LACS), was associated with Problem score changes on the Eyberg Child Behaviour Inventory (ECBI). Changes in parents' reports of their own behaviour were associated with Intensity score changes on the ECBI. However, the changes were in both positive and negative directions. The results call for more understanding of the mechanisms involved in change in parental attributions.