Deliberate self-harm (DSH) presents a significant health problem, especially as treatments have not been particularly successful in reducing repetition. Dialectical behaviour therapy (DBT; Linehan, 1993) is one approach that has reported some success in reducing self-harm rates in borderline personality disorder patients, who self-harm frequently, though it remains largely untested outside its original setting. The present study aimed to assess the effectiveness of DBT in self-harming women in an institutional setting in the United Kingdom where self-harm is common. Female patients at Rampton Hospital who were displaying self-harming behaviour and met criteria for borderline personality disorder (N = 10) participated in the full one-year treatment package of DBT. Patients were assessed on self-harm rates and on a number of psychological variables, pre-, during- and post-therapy, including a 6-month follow-up. There was a significant reduction in DSH during therapy, which was maintained at 6-month follow-up. This was paralleled by a reduction in dissociative experiences and an increase in survival and coping beliefs, alongside improvements in depression, suicide ideation, and impulsiveness. The findings are preliminary but the results suggest that DBT might provide an effective treatment for severe self-harm in institutional settings, and also highlight some of the psychological mechanisms that might mediate these improvements in self-harming behaviour.

This study reports an evaluation of a 10-day training course in cognitive behaviour therapy (CBT). The course comprised both formal CBT workshops and clinical case supervision, and was evaluated on measures of trainee satisfaction, trainee- and assessor-rated measures of CBT skill, and clinical outcomes for a subgroup of trainees' patients. The course was well received by trainees and their post-training therapy tapes were rated significantly higher on both trainee- and assessor-rated measures of CBT skills. In addition, trainees achieved significantly better outcomes with their patients after the training course than before, suggesting that the training impacted not only on their skills but also on their effectiveness in routine clinical practice. The limitations of the study and implications for future research in training are discussed.

Delivery of cognitive behavioural therapy (CBT) is limited by a scarcity of resource. In England and Wales, there are not enough practitioners appropriately trained in CBT to meet the needs of those who might benefit from treatment. In addition, there are reasons to believe that available therapists are inequitably distributed across the country. We investigated the distribution of British Association of Behavioural and Cognitive Psychotherapies (BABCP) members, accredited CBT practitioners, and BABCP members who are nurses or clinical psychologists in England and Wales by postal code. This analysis demonstrated a 20-fold discrepancy in availability of accredited CBT practitioners between the best and least well-served population deciles. Despite limitations, these findings are highly indicative of “postcode availability” of the best qualified CBT practitioners. We discuss possible strategies to remedy this inequity, which further challenges the ability of conventional methods of CBT delivery to meet public health requirements.

Background: Although rumination is a key process in the onset and maintenance of depressive symptoms and a powerful predictor of persistent posttraumatic stress disorder (PTSD), little is known about the differences and similarities of rumination in these conditions. Previous research has not always differentiated between rumination and intrusive images. Aims: We sought to systematically evaluate rumination and to gather more information about the content and associated emotions in three patient groups (PTSD, and depressed with and without trauma; n = 65). Furthermore, we examined the interaction between rumination and another predominant intrusive cognition, intrusive image. Method: A multi-method assessment for rumination, including a rumination questionnaire and a rumination log (kept for one week), was employed. Results: Rumination was found to be complex and composed of subcomponents that are similar across the diagnostic groups. Rumination rarely stopped intrusive images and it made the participants feel worse. There were, however, also important differences: in PTSD, rumination always or often triggered intrusive images and the traumatized individuals (PTSD and depressed with trauma) ruminated more than non-traumatized depressed patients. Conclusions: The results corroborate the assumption of rumination being a transdiagnostic process, with similarities but also with important differences across diagnostic groups. Moreover, the findings support recent research on the intricate relationship between different types of intrusive cognitions.

Background: Subjective Units of Distress Scale (SUDS) ratings are commonly used during exposure tasks in cognitive behavioral treatment (CBT) for anxiety. Aims: The present study examined patterns and predictors of SUDS in a sample of anxiety-disordered youth. Method: Youth (N = 99) aged 7 to 14 (M = 10.4, SD = 1.8) were treated with CBT for social phobia (SP), generalized anxiety disorder (GAD), and/or separation anxiety disorder (SAD). Analyses were conducted using hierarchical linear modeling. Results: Child's peak SUDS and magnitude of change in SUDS significantly increased between sessions. Higher child self-reported pretreatment total Multidimensional Anxiety Scale for Children (MASC) score predicted greater change in SUDS within the first exposure session. Primary GAD diagnosis predicted less increase in change in SUDS between sessions. Conclusions: Results suggest that higher pretreatment total MASC scores are associated with increased first exposure within-session habituation. Additionally, youth with a principal diagnosis of GAD experienced less between-session habituation, perhaps because they may have required more imaginal than in-vivo exposures.

This paper reviews empirical research on cognitive factors associated with the experience of trauma and with the development of posttraumatic stress, Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) in children and adolescents. The review covers three main areas: cognitive experimental and neuropsychological studies; large scale studies on representative samples; and, randomized clinical trial data examining cognitive-behaviour therapy (CBT) interventions. Overall, the conclusions are that progress in all three areas lags far behind that in adult work and that, perhaps, the studies to date raise more questions than they provide answers provided by the studies to date. The paper concludes with detailed empirical recommendations for future research in the three chosen domains.

Research into the operant determinants of self-injurious behaviour (SIB) in people with learning difficulties has largely concentrated on the reinforcing effects that the behaviour of others may exert on the occurrence of SIB. In this single case study, the effects of SIB of differential severity on the behaviour of others are considered. The results of continuous, direct natural observations show social contact to be more likely to follow long bursts of SIB than short bursts and to be presented intermittently during and following long bursts of SIB. The implications of this finding for the functional analysis of SIB and the long term maintenance and development of severe SIB are discussed and related to the establishing operations and contingencies which govern the behaviour of the participants in the interaction.

Health-related fear is a normal and common response in the face of the global pandemic of COVID-19. Children and young people are frequently being exposed to messages about the threat to health, including from the media and authorities. Whilst for most, their anxiety will be proportionate to the threat, for some, existing pre-occupation with physical symptoms and illness will become more problematic. There is a growing body of evidence that health anxiety may occur in childhood, however much of the literature is taken from research using adult samples. This practitioner review aims to give an overview of the assessment and treatment of health-related worries in children and young people in the context of the COVID-19 pandemic. This review is based on the limited existing evidence in this population and the more substantial evidence base for treating health anxiety in adults. We consider the adaptations needed to ensure such interventions are developmentally appropriate.

Background: Many people hear voices but do not access psychiatric services and their experiences are largely unknown, not least because of the difficulty in contacting such people. This study investigates the beliefs held about voices, distress experienced, and provides a topographical account of the experience of hearing voices in a sample of individuals who hear voices in a non-psychiatric population. Method: A quantitative questionnaire internet-based study with a within-subjects and between-subjects design was used. The internet was used to make contact with people who hear voices. One hundred and eighty-four participants in the general population who heard voices completed measures online assessing anxiety, depression, and beliefs about their dominant voice. Results: Participants reported a broad range of experiences associated with hearing voices, some in keeping with the previous research on clinical populations. Conclusion: The use of the internet to recruit and research non-clinical samples of people who hear voices is supported. This study provides details regarding demographic information and the experience of voice hearing from a fairly large sample of people who hear voices in a non-psychiatric population. It lends support to the idea that voice hearing occurs on a continuum, with evidence that many people hear voices in the general population and are not distressed by the experience.

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.

Background: Cognitive-behavioural therapy (CBT) has proven to be effective for anxiety-based school refusal, but it is still unknown how CBT for school refusal works, or through which mechanisms. Aims: Innovative statistical approaches for analyzing small uncontrolled samples were used to investigate the role of self-efficacy in mediating CBT outcomes for anxiety-based school refusal. Method: Participants were 19 adolescents (12 to 17 years) who completed a manual-based cognitive-behavioural treatment. Primary outcomes (school attendance; school-related fear; anxiety) and secondary outcomes (depression; internalizing problems) were assessed at post-treatment and 2-month follow-up. Results: Post-treatment increases in school attendance and decreases in fear about attending school the next day were found to be mediated by self-efficacy. Mediating effects were not observed at 2-month follow-up. Conclusions: These findings provide partial support for the role of self-efficacy in mediating the outcome of CBT for school refusal. They contribute to a small body of literature suggesting that cognitive change enhances CBT outcomes for young people with internalizing problems. Regarding methodology, the product of coefficient test appears to be a valuable way to study mediation in outcome studies involving small samples.

The aim of this paper was to determine the features of pathological gamblers who dropped out of the treatment or relapsed within a one year follow-up period. The sample consisted of 69 patients selected according to DSM-IV criteria. Results indicated that the only difference between the patients who dropped out of treatment and the ones who completed was the level of state-anxiety. The former were more anxious than the latter. Predictive variables for the therapeutic failure were the dissatisfaction with the treatment, the high level of alcohol consumption, and the neuroticism as a personality variable. Implications of the study for clinical practice and future research in this field are commented upon.

Background: It has been suggested that the perinatal period is a period of increased risk for the development and/or exacerbation of OCD and that postpartum OCD (ppOCD) presents a distinct clinical picture. This raises the possibility that ppOCD might be a distinct subtype of OCD. This review examines this contention. Method: A search using Ovid (Medline, PsycINFO and Embase), EBSCO, Cochrane Library, Web of Science (ISI), Pubmed databases and Google Scholar was carried out using the key words: “obsessive compulsive disorder” (and derivatives), “perinatal”, “pregnancy”, “postnatal”, “postpartum”, “mothers” (and derivatives), “anxiety disorders” and “subtypes.” These articles and their references were reviewed. Results: The majority of studies reviewed were retrospective, which makes it impossible to infer causality. Two prospective studies found a higher incidence of OCD in the postpartum period. These were carried out in Turkey and Brazil and, as such, may be limited in their applicability to other cultural groups. Conclusion: The concept of ppOCD as a specific subtype has not been robustly demonstrated. The evidence that OCD is more prevalent in the postpartum period is mixed. The evidence that OCD in the postpartum period presents a distinctive clinical picture with specific symptomatology and course is more compelling. In view of the impact of culture and religion on the expression of OCD, collaborative, international, prospective studies that take into account the methodological and definitional issues raised in this review are necessary to provide clarification.

Background: High rates of trauma and post-traumatic stress disorder (PTSD) are reported in people who hear voices (auditory hallucinations). A recent meta-analysis of trauma interventions in psychosis showed only small improvements in PSTD symptoms and voices. Imagery Rescripting (ImRs) may be a therapy that is more effective in this population because it generalizes over memories, which is ideal in this population with typically repeated traumas.

Aims: The primary aims of this study were to investigate whether ImR reduces (1) PTSD symptoms, and (2) voice frequency and distress in voice hearers.

Method: We used a single arm open trial study, case-series design. Twelve voice hearers with previous traumas that were thematically related to their voices participated. Brief weekly assessments (administered in sessions 1–8, post-intervention, and at 3-month follow-up) and longer measures (administered pre-, mid- and post-intervention) were administered. Mixed regression analysis was used to analyse the results.

Results: There was one treatment drop-out. Results of the weekly measure showed significant linear reductions over time in all three primary variables – voice distress, voice frequency, and trauma intrusions – all with large effect sizes. These effects were maintained (and continued to improve for trauma intrusions) at 3-month follow-up. On the full assessment tools, all measures showed improvement over time, with five outcomes showing significant time effects: trauma, voice frequency, voice distress, voice malevolence and stress.

Conclusions: The findings of the current study suggest that ImRs for PTSD symptoms is generally well tolerated and can be therapeutically beneficial among individuals who hear voices.

The aim of the study was to see whether there were lasting effects of a behaviourally-based group parenting programme when delivered in a real life, regular clinical practice setting. Follow-up was one year after the end of a controlled trial that involved four local child and adolescent mental health services in London and Southern England. The participants were fifty-nine children aged 3–8 years referred with antisocial behaviour, whose parents received the Webster-Stratton Incredible Years basic videotape group programme. Those in the waiting list control group were not followed up as some went on to receive the same intervention. Measures included the semi-structured parent interview (PACS) and questionnaire (SDQ) about child behaviour. At follow-up, the original improvement in the intervention group was found to have persisted, with no loss of treatment effectiveness (effect size compared to pre-treatment score 0.91 standard deviations, compared to post treatment score −0.06 SD). The proportion of children in the clinical range before treatment was 68%, at follow-up 37%. Children with the most severe initial problems changed the most; risk factors such as low income, being a lone parent, or being in an ethnic minority did not reduce treatment effectiveness. Parenting groups can reduce serious child antisocial behaviour effectively in the longer term. This is an important ongoing benefit for the children and their families. If this trajectory continues to be maintained in the future, then the poor long-term prognosis, which includes criminality and social exclusion, is likely to be improved.

Background: Preliminary research has indicated that general facets of metacognition are associated with problem gambling. In the present study we aimed to investigate whether specific facets of metacognition play a role in explaining gambling initiation and perseveration in individuals presenting with gambling disorder. Aim: To investigate: (1) the presence of metacognitive beliefs about gambling; (2) the goal of gambling, and its start and stop signals; and (3) the perceived impact of gambling on self-consciousness. Method: Ten individuals with a diagnosis of gambling disorder were assessed using metacognitive profiling, a semi-structured interview. Results: Findings indicated that all participants endorsed both positive and negative metacognitive beliefs about gambling. The primary goal of gambling was to relieve economic hardship and improve cognitive-emotional state. All participants reported that they did not know when this goal was achieved. Start signals for gambling included the ideas and feelings that gambling could solve problems and sensations that it might be the right time to win. The stop signal for gambling, for all participants, was running out of money. All participants also reported a perceived reduction in self-consciousness during a gambling episode. Conclusions: These findings provide preliminary evidence that specific facets of metacognition play a role in gambling disorder.

Testing a variant of Wegner's (1989) “thought suppression” paradigm, we had subjects identify a personally-relevant negative thought that had been troubling them recently. Subjects were then randomly assigned either to a negative target thought group or to a neutral target thought (“white bear”) group, and randomly assigned either to an initial suppression condition (followed by a free expression period) or an initial free expression condition (followed by a suppression period). The results revealed that subjects in the neutral thought group experienced a decline in thoughts about white bears throughout the course of the experiment, whereas subjects asked first to suppress a personally relevant negative thought experienced nearly a three-fold increase in its frequency of occurrence when later given permission to express it. These findings suggest that negatively valent thoughts may respond differently than neutral thoughts following attempts to suppress them.

Relationships between obsessive-compulsive symptoms and several cognitive constructs that are theoretically related to such symptoms were investigated among university students. A total of 211 subjects filled in a measure of the frequency of intrusive thoughts based on Clark and de Silva (1985), Salkovskis' Responsibility Attitudes Scale (RAS) (Salkovskis et al., 2000), the Thought-Action Fusion Scale (TAF) (Shafran, Thordarson, & Rachman, 1996), Wegner and Zanakos' (1994) White Bear Suppression Inventory (WBSI), and the Maudsley Obsessive-Compulsive Inventory (MOCI) (Hodgson & Rachman, 1977). The main hypothesis addressed was that in accordance with Salkovskis' model (1996) responsibility and thought suppression serve as mediators between intrusive thoughts and obsessive-compulsive symptoms as measured with the MOCI. The results were consistent with the model.

Background: Post-traumatic stress disorder (PTSD) is a common and debilitating consequence of natural disaster in children and adolescents. Accumulating data show that cognitive behavioural therapy (CBT) is an effective treatment for PTSD. However, application of CBT in a large-scale disaster in a setting with limited resources, such as when the tsunami hit several Asian countries in 2004, poses a major problem. Aims: This randomized controlled trial aimed to test for the efficacy of the modified version of CBT for children and adolescents with PSTD. Method: Thirty-six children (aged 10–15 years) who had been diagnosed with PSTD 4 years after the tsunami were randomly allocated to either CBT or wait list. CBT was delivered in 3-day, 2-hour-daily, group format followed by 1-month posttreatment self-monitoring and daily homework. Results: Compared to the wait list, participants who received CBT demonstrated significantly greater improvement in symptoms of PTSD at 1-month follow-up, although no significant improvement was observed when the measures were done immediately posttreatment. Conclusions: Brief, group CBT is an effective treatment for PTSD in children and adolescents when delivered in conjunction with posttreatment self-monitoring and daily homework.

Aims: This study aimed to assess the validity of two models which integrate the cognitive (satisfaction with life) and affective (symptoms of anxiety and depression) aspects of subjective well-being within the framework of rational emotive behaviour therapy (REBT) theory; specifically REBT's theory of psychopathology and theory of psychological health. Method: 397 Irish and Northern Irish undergraduate students completed measures of rational/irrational beliefs, satisfaction with life, and anxiety/depression symptoms. Structural equation modelling techniques were used in order to test our hypothesis within a cross-sectional design. Results: REBT's theory of psychopathology (χ2 = 373.78, d.f. = 163, p < .001; comparative fit index (CFI) = .92; Tucker Lewis index (TLI) = .91; root mean square error of approximation (RMSEA) = .06 (95% CI = .05 to .07); standardized root mean square residual (SRMR) = .07) and psychological health (χ2 = 371.89, d.f. = 181, p < .001; CFI = .93; TLI = .92; RMSEA = .05 (95% CI = .04 to .06); SRMR = .06) provided acceptable fit of the data. Moreover, the psychopathology model explained 34% of variance in levels of anxiety/depression, while the psychological health model explained 33% of variance. Conclusions: This study provides important findings linking the fields of clinical and positive psychology within a comprehensible framework for both researchers and clinicians. Findings are discussed in relation to the possibility of more effective interventions, incorporating and targeting not only negative outcomes, but also positive concepts within the same model.