Cognitive behavioural therapy (CBT) interventions are effective in reducing subjective stress. Nevertheless, the longitudinal links between mental health indicators are rarely studied in intervention research. Therefore, it is unknown how the intervention effects are sustained.

The current study investigated mechanisms explaining sustained intervention effects in a sample of medical nurses who receive a CBT-based internet-delivered stress recovery program.

A single-group longitudinal study design with three measurement points, pre-test, post-test, and 3-month follow-up, was used in the current study. The sample consisted of nurses and assistant nurses from Lithuania (n=111, age: M (SD) = 41.69 years (10.85)) who had participated in a 6-week CBT internet intervention targeting stress recovery. Data were collected as the randomised control trial, the treatment samples were combined, and the data were analysed using cross-lagged panel analysis with four variables representing the psychological well-being and symptoms of stress, anxiety, and depression.

The results revealed that decreased anxiety and increased psychological well-being at post-test predicted reduced stress levels at the 3-month follow-up. In addition, decreased anxiety at post-test predicted decreased depression at follow-up.

Decreased anxiety and increased well-being could explain the sustainability of reduced stress following a CBT-based internet intervention for nurses. The implications of this for research and practice are discussed.

Cognitive therapy for PTSD (CT-PTSD) is an efficacious treatment for children and adolescents with post-traumatic stress disorder (PTSD) following single incident trauma, but there is a lack of evidence relating to this approach for youth with PTSD following exposure to multiple traumatic experiences.

To assess the safety, acceptability and feasibility of CT-PTSD for youth following multiple trauma, and obtain a preliminary estimate of its pre–post effect size.

Nine children and adolescents (aged 8–17 years) with multiple-trauma PTSD were recruited to a case series of CT-PTSD. Participants completed a structured interview and mental health questionnaires at baseline, post-treatment and 6-month follow-up, and measures of treatment credibility, therapeutic alliance, and mechanisms proposed to underpin treatment response. A developmentally adjusted algorithm for diagnosing PTSD was used.

No safety concerns or adverse effects were recorded. Suicidal ideation reduced following treatment. No participants withdrew from treatment or from the study. CT-PTSD was rated as highly credible. Participants reported strong working alliances with their therapists. Data completion was good at post-treatment (n=8), but modest at 6-month follow-up (n=6). Only two participants met criteria for PTSD (developmentally adjusted algorithm) at post-treatment. A large within-subjects treatment effect was observed post-treatment and at follow up for PTSD severity (using self-report questionnaire measures; ds>1.65) and general functioning (CGAS; ds<1.23). Participants showed reduced anxiety and depression symptoms at post-treatment and follow-up (RCADS-C; ds>.57).

These findings suggest that CT-PTSD is a safe, acceptable and feasible treatment for children with multiple-trauma PTSD, which warrants further evaluation.

Distressing mental images are common in people with psychosis. The central role of metacognitive difficulties in psychosis suggests that metacognitive interventions with imagery properties could play a central role in managing distressing mental imagery. A brief imagery-based metacognitive intervention was developed to target the control mechanism of distressing mental images in psychosis.

A fixed baseline case series was designed to investigate whether the intervention was acceptable, feasible and effective.

Eight participants who met criteria for a schizophrenia spectrum diagnosis and experienced distressing future-oriented mental images took part in the case series, which consisted of three phases; baseline, intervention, and follow-up. Symptoms of anxiety, depression, persecutory delusions and schemas were assessed pre- and post-intervention, and qualitative feedback was collected at follow-up.

The metacognitive intervention was feasible, acceptable, and rated as highly satisfactory. One participant dropped out at the baseline phase. No adverse events were reported. Positive change scores with a decrease in symptoms were reported for anxiety, depression, persecutory delusions, and schemas. Tau-U analysis showed positive trends and high effect sizes on mental imagery characteristics at follow-up.

Our findings suggest that it is acceptable and feasible to engage people with psychosis in a brief imagery-based metacognitive intervention and that positive change can be achieved. Further studies are needed to replicate and clarify the findings of our study and develop the evidence base for this intervention.

Low-intensity psychological interventions are effective for children and young people (CYP) with mental health difficulties and can help bridge the demand–capacity gap. Despite increasing awareness, training and use of low-intensity psychological interventions, it is not yet understood what is being implemented in clinical practice in the UK and the associated evidence base.

This paper presents two studies; first, a national survey (n=102) of practitioners to identify low-intensity psychological interventions currently delivered in practice and second, an exploration of the availability and the strength of empirical support (characterised as ‘gold’, ‘silver’ and ‘bronze’) of low-intensity CBT interventions for CYP.

The first study found a wide variety of interventions being used across different services; 101/102 respondents reported using routine outcome measures. The second study identified 44 different low-intensity interventions, 28 of which were rated as having gold empirical support. However, only 13 of the gold interventions were considered accessible for practitioners and only two were reported being used in routine practice.

These findings highlight that these interventions have been developed and empirically tested, but many are not easily accessible, highlighting the ‘research–practice’ gap in the provision of low-intensity interventions. There is a need for an increase in standardisation of care and accessibility of gold interventions. This paper hopes to begin the process of creating a hub of low-intensity interventions that are accessible and empirically supported to improve equity of access and outcomes of low-intensity psychological interventions for CYP.

Mental imagery plays a key role in the onset and maintenance of psychological disorders, and has become the target of psychological interventions for the treatment of several anxiety-related conditions. However, there are currently no transdiagnostic measures designed to assess the varied dimensions of mental imagery relevant to psychopathology.

To develop and validate a new measure assessing the experiences and appraisals of negative mental imagery.

The initial item pool was generated through a comprehensive literature review and interviews with subject-matter experts. An online community sample provided data for the exploratory (n=345) and confirmatory (n=325) factor analyses.

The new 16-item Negative Mental Imagery Questionnaire demonstrated four subscales (Intrusiveness, Controllability, Beliefs about Mental Imagery, and Realness). Reliability and validity were good to excellent for both the full- and sub-scales.

Appraisals of mental imagery captured by the new measure are consistent with previous research on mental imagery and psychopathology.

Several psychological models of bipolar disorder propose that certain types of appraisals can lead to increases in manic symptoms.

We tested whether the belief that being ‘high’ is a natural part of one’s personality and correlates with manic symptoms 4 months later when controlling for manic symptoms at baseline.

This was a prospective 4-month follow-up design using self-report measures. Forty people with a diagnosis of bipolar disorder completed a measure of manic symptoms, a measure of appraisals associated with bipolar disorder, and a single-item measure, ‘To what extent do you feel like being “high” is a natural part of your personality?’, at baseline and follow-up.

The single-item measure showed modest stability over time and construct validity in its correlation with a standardised measure of appraisals in bipolar disorder. As predicted, the single-item measure correlated with manic symptoms at follow-up when controlling for manic symptoms at baseline.

The belief that being ‘high’ is a natural part of one’s personality is a potential predictor of manic symptoms. Further research needs to study the potential mediating mechanisms such as activating behaviours, and control for indicators of the bipolar endophenotype.

Mainstream cognitive behavioural theory stipulates that clinically significant health anxiety persists over time at least partially due to negatively reinforced health-related behaviours, but there exists no broad and psychometrically valid measure of such behaviours.

To draft and evaluate a new self-report scale – the Health Anxiety Behavior Inventory (HABI) – for the measurement of negatively reinforced health anxiety behaviours.

We drafted the HABI from a pool of 20 candidate items administered in a clinical trial at screening, and before and after cognitive behaviour therapy (n=204). A psychometric evaluation focused on factor structure, internal consistency, convergent and discriminant validity, test–retest reliability, and sensitivity to change.

Based on factor analysis, the HABI was completed as a 12-item instrument with a four-dimensional factor structure corresponding to the following scales: (i) bodily preoccupation and checking, (ii) information- and reassurance-seeking, (iii) prevention and planning, and (iv) overt avoidance. Factor inter-correlations were modest. The internal consistency (α=.73–.87) and 2-week test–retest reliability (r=.75–.90) of the scales was adequate. The bodily preoccupation and checking, and information- and reassurance-seeking scales were most strongly correlated with the cognitive and emotional components of health anxiety (r=0.41, 0.48), and to a lower extent correlated to depressive symptoms and disability. Change scores in all HABI scales correlated with improvement in the cognitive and emotional components of health anxiety during cognitive behaviour therapy.

The HABI appears to reliably measure negatively reinforced behaviours commonly seen in clinically significant health anxiety, and might be clinically useful in the treatment of health anxiety.

Parents of children with skin conditions can experience stress from the additional responsibilities of care. However, there is a lack of psychological interventions for families affected by a dermatological diagnosis.

To investigate (1) whether delivering the ‘Living in the Present’ mindfulness curriculum to parents of children with skin conditions reduced stress and increased both parental/child quality of life (QoL), and (2) determine intervention acceptability.

Ten parents of children with eczema, ectodermal dysplasia, ichthyosis, and alopecia took part in a mindfulness-based intervention. Using mixed methods, a single-group experimental case design (SCED) was conducted and supplemented by thematic analysis of exit interviews. Parents completed idiographic measures of parenting stress, standardised measures of QoL, stress, mindfulness, and took part in exit interviews. Children also completed QoL measures.

Tau-U analysis of idiographic measures revealed three parents showed some significant improvements in positive targets, and five parents showed some significant improvements in negative targets. Assessment of reliable change demonstrated that: one parent showed improvement in mindful parenting, three parents showed improvement in parenting stress, seven parents showed improvement in anxiety, three parents showed improvements in depression, six parents showed improvement in QoL, and four children showed improvement in QoL. However, two parents showed increased anxiety. Thematic analysis revealed positive changes to mood following mindfulness, although challenges were highlighted, including sustaining home practice.

Findings suggest this specific form of mindfulness intervention could be effective for parents of children with skin conditions; however, further robust studies are needed.

Future events can spring to mind unbidden in the form of involuntary mental images also known as ‘flashforwards’, which are deemed important for understanding and treating emotional distress. However, there has been little exploration of this form of imagery in youth, and even less so in those with high psychopathology vulnerabilities (e.g. due to developmental differences associated with neurodiversity or maltreatment).

We aimed to test whether flashforwards are heightened (e.g. more frequent and emotional) in autistic and maltreatment-exposed adolescents relative to typically developing adolescents. We also explored their associations with anxiety/depression symptoms.

A survey including measures of flashforward imagery and mental health was completed by a group of adolescents (n=87) aged 10–16 (and one of their caregivers) who met one of the following criteria: (i) had a diagnosis of autism spectrum disorder; (ii) a history of maltreatment; or (ii) no autism/maltreatment.

Flashforwards (i) were often of positive events and related to career, education and/or learning; with phenomenological properties (e.g. frequency and emotionality) that were (ii) not significantly different between groups; but nevertheless (iii) associated with symptoms of anxiety across groups (particularly for imagery emotionality), even after accounting for general trait (non-future) imagery vividness.

As a modifiable cognitive risk factor, flashforward imagery warrants further consideration for understanding and improving mental health in young people. This implication may extend to range of developmental backgrounds, including autism and maltreatment.

The relevance of family relationships in the outcome of various disorders has been highlighted from different domains. Specifically, empirical studies on the relationship between the outcome of schizophrenia and various affective dimensions of family relationships have allowed the identification of particularly relevant aspects: criticism, hostility, and over-protection.

The present study aims to adapt and validate an abbreviated Spanish version of the Influential Relationship Questionnaire (IRQ), an instrument that measures the patient’s own perception of the affective dimensions of family relationships.

Participants were 188 patients (63.8% male) of the Public Health Service in Andalusia (Spain) with a diagnosis of schizophrenia or a related disorder. One hundred and thirty-six participants provided data related to both father and mother, and 52 only related to mother or father, so the analyses were carried out with a total of 324 questionnaires. Simultaneously, in 130 participants, the Perceived Criticism Scale was applied, and in 50 cases, relatives were asked to complete the Family Attitudes Scale.

Principal component analysis allowed for the identification of four factors that explained 61.53% of the total variance (criticism, over-protection, restriction, and care). The values of Cronbach’s alpha coefficient, as well as the omega coefficient, showed high consistency. The temporal reliability for an interval of 3 months was high. The correlations between the IRQ dimensions and the other variables included in the study were significant and in the expected direction.

The results support the reliability and validity of the abbreviated version of the IRQ.

Imagery-focused therapies within cognitive behavioural therapy are growing in interest and use for people with delusions.

This review aimed to examine the outcomes of imagery-focused interventions in people with delusions.

PsycINFO, PubMed, MEDLINE, Web of Science, EMBASE and CINAHL were systematically searched for studies that included a clinical population with psychosis and delusions who experienced mental imagery. The review was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and quality appraisal of all included papers was completed using the Crowe Critical Appraisal Tool. Information from included texts was extracted and collated in Excel, which informed the narrative synthesis of results.

Of 2,736 studies identified, eight were eligible for inclusion and rated for quality with an average score of 70.63%. These studies largely supported their aims in reducing levels of distress and intrusiveness of imagery. Four of the eight studies used case series designs, two were randomised controlled trials, and two reported single case studies. It appears that interventions targeting mental imagery were acceptable and well tolerated within a population of people experiencing psychosis and delusions.

Some therapeutic improvement was reported, although the studies consisted of mainly small sample sizes. Clinical implications include that people with a diagnosis of psychosis can engage with imagery-focused therapeutic interventions with limited adverse events. Future research is needed to tackle existing weaknesses of design and explore the outcomes of imagery interventions within this population in larger samples, under more rigorous methodologies.

Perfectionism dimensions, including perfectionistic strivings and perfectionistic concerns, have a significant positive association with psychopathology. Clinical perfectionism is defined as when an individual’s self-esteem is excessively reliant on meeting high standards despite negative consequences. Numerous studies have found that higher perfectionistic concerns correlate with lower self-esteem; however, evidence for the association with perfectionistic strivings has been mixed.

The focus of this systematic review and meta-analysis was to inform theoretical understanding of the relationships between perfectionism dimensions and self-esteem in adults.

A systematic literature search was conducted in Medline, PsycINFO, PsychARTICLES, ProQuest Central, and Scopus on 31 May 2023.

There were 83 articles included, with 32,304 participants (Mage=∼24.66 years). There was a significant negative moderate pooled association between self-esteem and perfectionistic concerns, r=–.42, 95% CI [–0.47 to –0.38]. A significant negligible positive pooled association was found between self-esteem and perfectionistic strivings, r=.06, 95% CI [0.01 to 0.11]. Results indicate higher perfectionistic concerns is associated with lower self-esteem, providing indirect support for the cognitive-behavioural model of clinical perfectionism.

Future research should compare cognitive behaviour therapy for perfectionism to treatments for low self-esteem on outcomes of perfectionistic concerns and psychopathology.

Psychological interventions may assist in the management of bipolar disorder, but few studies have assessed the use of group therapy programs using telehealth.

The present study aimed to assess the feasibility and acceptability of a well-being group program for people living with bipolar disorder designed to be delivered via telehealth (Zoom platform) using a randomised controlled pilot design.

Participants were randomly assigned to either the 8-week well-being plan treatment condition or the wait-list control condition. They were administered a structured diagnostic instrument to confirm bipolar disorder diagnosis followed by a set of self-report questionnaires relating to mood, quality of life, personal recovery, and stigma.

A total of 32 participants (16 treatment; 16 control) were randomised with 12 participants completing the intervention, and 13 the control condition. The program appeared acceptable and feasible (75% retention rate) with a mean attendance being reported of 7.25 sessions attended out of a possible 8 sessions. Participants reported high levels of satisfaction overall with the intervention, with a mean score of 9.18 out of 10.

Preliminary evidence suggests that delivery of the group program online is feasible and acceptable for participants living with bipolar disorder. As the program was designed to prevent relapse over time, further research is needed to determine if the program may be helpful in improving symptom outcomes over a longer follow-up period.

Obsessive-compulsive disorder (OCD) symptoms are hypothesized to be driven by two core motivations: harm avoidance and incompleteness. While cognitive-behavioural therapy (CBT) is an effective treatment for OCD, many posit that OCD presentations characterized by high incompleteness may be harder to treat. The relationship between the core motivations and treatment outcomes remains to be further explored.

To investigate if harm avoidance and incompleteness decrease across group CBT and to examine the relationship between treatment outcomes and both baseline and changes in harm avoidance and incompleteness throughout treatment.

A naturalistic sample of 65 adult out-patients with OCD completed self-report questionnaires measuring OCD symptom severity and the core motivations before, during, and after 12 weeks of group CBT for OCD.

Harm avoidance and incompleteness scores significantly decreased from pre- to post-treatment. Pre-treatment harm avoidance and incompleteness levels did not predict post-treatment symptom severity, but changes in the core motivations throughout treatment were significant predictors of treatment outcome. Specifically, reductions in harm avoidance across treatment and reductions in incompleteness early in treatment, were associated with better treatment outcomes.

Participants who completed group CBT for OCD experienced modest reductions in the core motivations thought to maintain OCD symptoms and these changes predicted better outcomes. However, pre-treatment levels of harm avoidance and incompleteness do not appear to moderate treatment outcome.

Social anxiety and paranoia are connected by a shared suspicion framework. Based on cognitive-behavioural approaches, there is evidence for treating social anxiety and psychosis. However, mechanisms underlying the relationship between social anxiety and paranoia remain unclear.

To investigate mediators between social anxiety and paranoia in schizophrenia such as negative social appraisals (i.e. stigma or shame; Hypothesis 1), and safety behaviours (i.e. anxious avoidance or in situ safety behaviours; Hypothesis 2).

A cross-sectional study was conducted among Asian out-patients with schizophrenia (January–April 2020). Data on social anxiety, paranoia, depression, shame, stigma, anxious avoidance, and in situ behaviours were collected. Associations between social anxiety and paranoia were investigated using linear regressions. Mediation analysis via 10,000 bias-corrected bootstrap samples with 95% confidence intervals (CI) was used to test the indirect effects (ab) of mediators.

Participants (n=113, 59.3% male) with a mean age of 44.2 years were recruited. A linear relationship between social anxiety and paranoia was found. In multiple mediation analyses (co-varying for depression), stigma and shame (Hypothesis 1) did not show any significant indirect effects with ab=.004 (95%CI=–.013, .031) and –.003 (–.023, .017), respectively, whereas in situ behaviours (Hypothesis 2) showed a significant effect with ab=.110 (.038, .201) through the social anxiety–paranoia relationship.

Social anxiety and paranoia are positively correlated. In situ safety behaviours fully mediated the social anxiety and paranoia relationship. Targeted interventions focusing on safety behaviours could help reduce paranoia in psychosis. Symptom severity should be measured to help characterise the participants’ characteristics.

Symptom accommodation is suggested to maintain anxiety pathology and interfere with treatment effectiveness for anxiety and related disorders. However, little is known about symptom accommodation in generalized anxiety disorder (GAD).

This study investigated the associations between romantic partner symptom accommodation, GAD symptoms, intolerance of uncertainty (IU), relationship satisfaction, and cognitive behavioural therapy (CBT) outcomes from the perspective of the person with GAD.

One hundred and twelve people with GAD participated in group CBT and completed measures at pre- and post-treatment.

All participants endorsed that their partner engaged in symptom accommodation to some extent, and the most commonly endorsed type was providing reassurance. Greater self-reported partner symptom accommodation was associated with greater GAD symptoms, chronic worry severity, IU, and relationship satisfaction at baseline. Partner symptom accommodation was found to significantly decrease over treatment; however, less improvement in symptom accommodation from pre- to post-treatment was associated with worse treatment outcomes.

This study is the first to show that partner symptom accommodation is prevalent in adults with GAD and to elucidate the presentation and frequency of behaviours. The findings provide preliminary evidence that targeting partner symptom accommodation in treatment may improve CBT outcomes.

Cognitive models of mental contamination (i.e. feelings of internal dirtiness without contact with a contaminant) propose that these feelings arise when individuals misappraise a violation. However, an operational definition of ‘violation’ and identification of specific violation misappraisals is limited.

This study’s aim was to elaborate on cognitive models using qualitative data from those with lived experience to fill these gaps.

Twenty participants with a diagnosis of obsessive-compulsive disorder and/or a trauma history took part in a semi-structured interview about violation. Grounded theory was used to analyse interview transcripts.

Three categories emerged, each with several themes – qualities of violation, violation-related appraisals, and violation-related behaviours. Different violation-related appraisals were associated with different emotions and urges. Specific self-focused appraisal sub-themes (i.e. permanence of consequences; self-worth; responsibility, self-blame and regret) were most closely related to emotions tied to mental contamination. These findings support and expand upon existing cognitive models of mental contamination, identifying key violation-related appraisals and differentiating between mental contamination-related appraisals and those related to other emotional sequelae. Future quantitative and experimental research can evaluate the potential of these appraisals as intervention targets.

Sexuality and gender minoritised (SGM) adolescents are at increased risk of self-injury and suicide, and experience barriers to accessing mental health support. Dialectical behaviour therapy (DBT) is an effective treatment for self-injury and emotion dysregulation in adolescent populations, but few studies have published outcomes of DBT for SGM young people.

This study aimed to investigate treatment outcomes and completion for SGM adolescents and their cisgender and heterosexual peers, in the National & Specialist CAMHS, DBT service (UK).

Treatment completion, and opting out before and during treatment were examined for sexual and gender identity groups, as well as changes by the end of treatment in emotion dysregulation, self-injury, in-patient bed-days, emergency department attendances, and borderline personality disorder, depression and anxiety symptoms.

SGM adolescents were over-represented in this service, even after considering their increased risk for self-injury. No statistically significant differences were found for treatment completion between the sexual orientation and gender identity groups, although there were patterns indicating possible lower treatment uptake and completion that warrant further investigation. Clinical outcomes for treatment-completers showed improvement by the end of DBT for each group, with few exceptions.

These results are from relatively small subsamples, and it was not possible to separate by sex assigned at birth. Findings should be treated tentatively and as early indications of effect sizes to inform future studies. This study suggests that DBT could be a useful treatment for SGM adolescents in a highly specialist treatment setting.

It is unclear whether treatment for an anxiety disorder improves sleep. This study examined baseline sleep characteristics of adolescents with an anxiety disorder, comparing weekdays and weekends, and whether there were significant improvements in sleep following cognitive behaviour therapy (CBT).

To improve our understanding of sleep problems in adolescents with an anxiety disorder and examine whether CBT for the treatment of the anxiety disorder improves sleep.

Data was gathered from 179 participants with an anxiety disorder (11–17 years old) who had previously engaged with the out-patient child and adolescent mental health service. Baseline self-report measures of anxiety and depression symptoms, sleep patterns and experiences of insomnia were examined. Of this group, 135 participants had baseline data. A subset (n=73) had outcome data, which was used to examine changes in sleep following CBT.

At baseline, adolescents reported significantly less total sleep and more night-time waking on weekdays than weekends. Following treatment for their anxiety disorder, adolescents’ weekday sleep patterns significantly improved for sleep onset latency and total sleep time, whereas weekend sleep patterns only showed improvements for sleep onset latency. No significant improvements were reported for symptoms of insomnia.

The study relied upon subjective measurement of sleep and there was no control group; however, the findings provide promising results that CBT for adolescent anxiety disorders can improve some sleep problems. Further research is needed to understand discrepancies between subjective and objective sleep, and to explore avenues for the delivery of support for sleep problems.