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.

Selective attention for bodily sensations is often found in patients with panic disorder. Whether this may be the result of fear was investigated in a group of normal subjects. Subjects were made to fear an acceleration in their heartbeats or an increase in their muscle tension by threatening them with an electric shock should this occur. When subjects were under threat of these shocks, attention for ECG and EMG feedback was measured. Although the task seemed sensitive to the manipulation, no evidence was found for selective attention for fear-relevant information. Several shortcomings of the task are discussed.

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.

Background: There has been little evaluation or development of nurse observation charts on psychiatric in-patient units since they were first introduced. Aim: We aimed to develop a new nursing chart that adds a functional and contextual assessment of the observed behaviour. We describe its initial evaluation in an in-patient setting. Method: A member of the staff coded a participant's behaviour as either an instance of an individual's daily life problem; or an improvement; or a non-clinically relevant behaviour. We evaluated the charts in 14 in-patients and compared the coding of the behaviour against that of one of the investigators. Results: After brief training the inter-rater agreement resulted in Kappa = 0.496 with p < .001. Removal of a rating of neutral behaviours resulted in a higher Kappa = 0.546 with p < .001. Conclusions: The inter-rater reliability was only moderate for the Functional Analytical Nurse Observation Charts. Frequent training and support from management and therapy staff is required to maintain a psychologically informed environment and observation in an in-patient setting. An area for further research is to explore the impact that a FANOC has on staff satisfaction and an individual's experience of care, and whether it can assist in determining mediators of change before an improvement in symptoms.

This paper reports an exacerabation of health fears in response to cognitive modification in a patient with Somatoform Disorder (NOS). The results of the intervention present interesting theoretical implications for the conceptualization of cognitive events in clinical disorders and those characteristics that may contribute to treatment failure.

This study compared the outcome of patients treated with behavioural psychotherapy by a nurse behavioural psychotherapist against the outcome of those treated by trainee psychiatrists under his supervision. The trainees were shown to produce improvement, but significantly less than the supervisor. It was shown that supervision of trainees was a cost effective use of the supervisor's time.

School phobia has been the subject of more concern, interest and study than any other childhood phobia. Perhaps this is not surprising in view of the suffering and upset that the condition has caused to children, parents and teachers.

This edition has a special focus on cognitive and behavioural work with older people. Many of the papers have been written by national and international experts in their respective fields and demonstrate the variety and breadth of work undertaken within the specialty. Older people bring heterogeneity to the therapeutic context, with unrivalled opportunity for challenge, versatility and creativity. For example, during a single working day one could find oneself treating a centenarian with depression, a 60-year-old patient with early onset dementia, a person with pseudo-dementia whose anxiety mimics a Parkinson's presentation, a depressed person with chronic heart failure, and a depressed family carer. Alternatively, one could find oneself working with nursing home staff who are struggling to deal with a resident with challenging behaviour. Practitioners require knowledge and skills in neuropsychology, chronic disease management, standard 1:1 therapy, family and systems work. They must also be able to apply a wide ranging set of conceptual frameworks and associated interventions to people with varying degrees of cognitive impairment as well as undertake activities such as supervision, consultation and training of carers, staff and colleagues. Thus therapists working with older people are often acutely aware of the importance of extending treatment to the individual's supporting social context and the system within which treatment is offered.

We report a subgroup analysis of 24 out of 42 subjects who were hospitalized for non-psychotic major depressive disorder and who agreed to participate in interviews at admission and 2 years afterwards (as reported previously by Domken, Scott, & Kelly, 1994; Bothwell & Scott, 1997). At 2 year follow-up, these 24 subjects were categorized according to established criteria into clients meeting criteria for full remission (FR; n=9) and those meeting criteria for partial remission (PR; n=15). The most striking findings were that, over time, PR subjects showed significant loss of self-esteem and showed greater divergence in self-ratings compared to observer ratings of their depressive symptoms, whilst the same ratings in the FR group changed in the opposite direction. We suggest that the persistence of depression in PR subjects may provide evidence to support Teasdale’s (1988) hypothesis that some individuals “get depressed about being depressed”. The research and clinical implications of the results are noted.

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.