Aims: The purpose of this study was to investigate the cognitions of anxious school refusers. The cognitive constructs under investigation included negative cognition commonly linked to youth anxiety (i.e. negative automatic thoughts and cognitive errors) and positive automatic thoughts. Method: The cognition of school refusers (n = 50) and youth from a community sample (n = 181) was assessed with the Children's Automatic Thoughts Scale-Negative/Positive and the Children's Negative Cognitive Error Questionnaire-Revised. Results: When controlling for anxiety, school refusers were found to report more negative automatic thoughts concerning personal failure, fewer negative automatic thoughts concerning hostility, and fewer positive automatic thoughts. Negative automatic thoughts concerning personal failure and hostility, and the negative cognitive error of overgeneralizing were found to independently predict school refusal. Conclusions: The findings underscore the importance of further researching the role of cognition in the development, maintenance, and treatment of anxiety-based school refusal.

Background: Thirty-three Japanese children and adolescents diagnosed with an anxiety disorder participated in individual or group Cognitive Behaviour Therapy (CBT) that was modelled after evidence-based intervention programs developed in Western countries. Method: The treatment consisted of: (a) building rapport and education; (b) identifying emotions and recognizing cognitive self-talk; (c) challenging anxious self-talk; (d) developing an anxiety hierarchy and in vivo exposures; and (e) planning for future challenges. Results: Three months following treatment, 20 of the 33 children and adolescents (60.91%) no longer met criteria for their principal anxiety disorders and 16 (48.48%) were free from all anxiety disorders. Self-reported anxiety, depression, and cognitive errors also decreased significantly from pre- to post-treatment and these gains were maintained at 3-month follow-up. For the most part, similar outcomes were found in both the group and individual formats of CBT. Conclusions: This study provides preliminary support for the transportability of CBT in both an individual and group format to Japan.

Background: Parental overprotection may have a direct effect on worry through hindering children's exploration experiences and preventing the learning of action-oriented coping strategies (Cheron, Ehrenreich and Pincus, 2009; Nolen-Hoeksema, Wolfson, Mumme and Guskin, 1995) and an indirect effect through fostering the development of maladaptive metacognitions that are associated with the activation of worry and the escalation of anxiety (Wells, 2000). Aim: The aim was to investigate the relative contribution of recalled parental overprotection in childhood and metacognitions in predicting current levels of worry. Method: A community sample (n = 301) was administered four self-report instruments to assess parental overprotection, metacognitions, anxiety and worry. Results: Metacognitions were found to predict levels of worry independently of gender, anxiety and parental overprotection. They were also found to predict anxiety independently of gender, worry and parental overprotection. Conclusions: The combination of a family environment perceived to be characterized by overprotection and high levels of maladaptive metacognitions are a risk factor for the development of worry.

Background: Social network support for abstinence has been associated with improved treatment outcomes among samples of individuals with alcohol use disorders. As a result, research studies have focused on the inclusion of significant others (SOs) in the treatment process. Nonetheless, little is known about 1) the specific influence SOs may have on clients during treatment sessions or 2) whether SO within-session behaviors have any relationship to client post-treatment drinking. Method: In the current study, Motivational Enhancement Therapy sessions in which a SO was present were coded using a behavioral coding system designed to measure SO and client within-session language. Results: Relationships were observed between SO and client within-session language. Furthermore, some specific SO categories of language predicted post-treatment client drinking. Conclusions: This study is the first systematic evaluation of SO contributions in substance abuse treatment sessions. Future research examining SO language in the treatment of alcohol use disorders might allow clinicians to avoid contributions from SOs that are associated with poorer drinking outcomes.

Background: Though motivational interviewing (MI) has demonstrated efficacy in a range of behaviour change settings, effectiveness will require successful integration into everyday practice. This study examines implementers’ views on delivering MI within an exercise referral scheme and consistency of consultations with MI before and after a 2-day workshop. Method: Semi-structured interviews were conducted with 27 exercise professionals and 10 area coordinators delivering the Welsh National Exercise Referral Scheme (NERS), and the MI trainer. Eleven professionals provided consultation recordings before and 6-months after training, coded for fidelity using the Behaviour Change Counselling Index. Results: The workshop was well received by most, triggering increased recognition of potential motivational roles of consultations. However, some cited difficulties combining MI with structured data gathering activities, whilst a minority rejected MI, seeing current practice as effective, or MI as unnecessary because patients were ready to change. Although limited aggregate improvement in practice was observed, substantial improvements were observed in some individuals. Comments on the need for further practice or training were widespread. Conclusions: Efforts to implement MI should ensure that training and structures to provide monitoring and feedback are in place and that activities incorporated within consultations are compatible with MI delivery.

Background: While considerable attention has been focused in recent years on evidence-based practice, less attention has been placed on clinical social workers’ choice to use ineffective or harmful interventions, referred to in the present paper as Novel Unsupported Therapies (NUSTs). Method: The present study surveyed 400 Licensed Clinical Social Workers (LCSWs) across the United States in order to determine the extent of their usage of NUSTs, as well as their usage of conventional therapies that lacked support and empirically supported therapies (ESTs). Reasons for selecting interventions were also assessed. Results: While the vast majority (97.5%) reported using some form of EST, 75% of our sample also reported using at least one NUST. Logistic regression analysis revealed that NUST usage was related to female gender and trauma specialization. A split plot ANOVA revealed that respondents rated positive clinical experience higher than published research as a reason for selecting an intervention. LCSWs with a CBT theoretical orientation rated research evidence more highly than those of other theoretical orientations. However, even within the group of LCSWs with a CBT orientation, clinical experience was rated more highly than research evidence. Conclusions: Implications for practice are discussed.

Background: The Improving Access to Psychological Therapies (IAPT) initiative has depended on the training of a new NHS mental health workforce. At step 3 of the stepped care model, capacity building has required the recruitment of a wide range of mental health professionals into high intensity therapists training posts. This shift naturally entails role transition on the part of trainees into delivering cognitive behavioural psychotherapy (CBP), but no previous research has examined the experience of such transitions. Aim: To describe the lived experience of transition from mental health nurse to IAPT high intensity therapist and to identify possible factors which moderate effective role conversions. Method: Six qualified high intensity therapists were interviewed using a semi-structured interview and the subsequent interviews transcribed. Thematic content analysis (TCA) was used to analyze personal accounts of role transition. All participants had previously been mental health nurses and attended the same IAPT high intensity therapist (HIT) training programme. Results: Six key themes were apparent from the TCA. Three interconnected themes concerning supervision (style, impact of approach and historical context) and three additional themes of the challenge of learning a new clinical approach, high need for support, and forming a new psychotherapist identity. Conclusions: Findings suggest supervision is the most important factor in supporting complex psychotherapy role transitions. Clinical supervisors may need to incorporate dedicated time on role and identity shift during CBP training to ensure effective assimilation and transition. Methodological short-comings are identified and discussed.

Background: Visual hallucinations (VH) are a common experience and can be distressing and disabling, particularly for people suffering from psychotic illness. However, not everyone with visual hallucinations reports the experience to be distressing. Models of VH propose that appraisals of VH as a threat to wellbeing and the use of safety seeking behaviours help maintain the distress. Aims: This study investigated whether people with distressing VH report threat appraisals and use safety behaviours. Method: The study utilized a single group descriptive design, in which 15 participants with psychosis and VH were asked questions in order to assess the content, distress, appraisals, and behaviours associated with visual hallucinations. Results: People who found visual hallucinations distressing (n = 13) held negative appraisals about those hallucinations and specifically saw them as a threat to their physical or psychological wellbeing. They also engaged in safety seeking behaviours that were logically related to the appraisal and served to maintain the distress. Conclusions: People with distressing VH regard them as a threat to their wellbeing and use safety seeking behaviours as a result of this perceived threat. These key processes are potential targets for treatments that will alleviate the distress associated with VH.