Background: The treatment of persisting psychotic symptoms with cognitive behavioural therapy (CBTp) is now established as an evidence-based treatment; however its availability remains limited. We piloted a novel CBTp skills-based group training program for carers. The aim was to reduce service users’ auditory hallucinations severity through carers’ use of basic CBTp methods in their regular interactions. Method: Eight carer-service user dyads and one carer-carer-service user triad participated. Carers attended the 10-week (25-hour) program, and completed measures of subjective burden and expressed emotion (EE) over a 30-week period that included a baseline phase prior to the training and implementation phase. Service users completed weekly interviews assessing voice symptomatology. Analyses were conducted for each dyad using time-series methods. Results: The training program was rated highly. Improvements in symptoms and carer burden ranged from none to clinically significant across different dyads. Carer implementation of strategies was related to reduced symptoms in one dyad; reductions in EE were related to symptom improvements in two dyads. Conclusions: There may be benefits in training carers in behavioural and cognitive management of persisting hallucinations. Possible mechanisms for improvements in voice symptomatology include reduction in carers’ EE, and carer implementation of strategies taught.

Background: Although behavioural activation therapy is effective for depression there is always room for improvement, and also the need to extend this treatment modality to anxiety disorders. Method: A search was conducted for an easy to apply and effective method of achieving these aims. Results: To both enhance the effectiveness of behavioural activation treatment for depression and facilitate its extension to anxiety disorders, it is proposed that the Behavioral Approach/Activation System (BAS) and Behavioral Inhibition System (BIS) be incorporated. BIS/BAS Scales are easy to administer and evaluate ensuring that there is minimal added complexity. Overall, BAS, BAS subscale (Drive, Reward Responsiveness, and Fun Seeking) and BIS scores provide valuable information pertaining to a person's approach and avoidance responses. This general information, plus that derived from specific scale items, can be used to guide more focused and effective behavioural activation strategies. Brief case examples are provided to demonstrate how the BIS/BAS Scales can be applied. Conclusion: BIS/BAS Scales offer an easy to apply and effective means of enhancing behavioural activation therapy for depression and extending this treatment modality to anxiety disorders.

Background: Online CBT training is in its infancy. The initial studies have varied program characteristics and trainee groups, but results appear promising. At this stage, there is a need to evaluate programs with different characteristics to determine which are useful, and which are not. Method: This paper reports a preliminary evaluation of an online CBT training package, OCTC Online, which is distinguished from other online programs by its particularly strong focus on video presentations by trainers, accompanying PowerPoint slides, and video demonstrations of key clinical techniques. Participants (N = 94) completed online rating scales and questionnaires assessing (a) their satisfaction with the training; (b) their self-rated knowledge and confidence about the topics discussed (pre- and post-training); and (c) a multiple choice questionnaire (MCQ) objective test of knowledge (also pre- and post-training). Results: Results showed that on average students were highly satisfied with the online training modules, their self-rated confidence increased significantly, and so did their scores on the MCQ. Conclusions: The study has significant limitations but nevertheless contributes to the growing body of evidence that online training may have a useful part to play in enhancing therapists’ knowledge of CBT theory and techniques, and their confidence in using the techniques.

Background: Cognitive bias modification (CBM) is a novel treatment for anxiety disorders that utilizes computerized tasks to train attention and interpretation biases away from threat. To date, attitudes toward and acceptability of CBM have not been systematically examined. Method: We conducted qualitative interviews with 10 anxious primary care patients to examine attitudes toward and initial impressions of CBM. Interviews explored general impressions, as well as reactions to the treatment rationale and two computer programs, one targeting attention bias and one targeting interpretation bias. Three clinical psychologists independently coded transcripts and collaboratively developed categories and themes guided by grounded theory. Results: A number of facilitators and barriers emerged related to engaging in treatment in general, computerized treatment, and CBM specifically. Participants stated that the written rationale for CBM seemed relevant and helpful. However, after interacting with the attention modification program, participants frequently expressed a lack of understanding about how the program would help with anxiety. Participants reported greater understanding and engagement with the interpretation modification program. Conclusions: Participants reported a number of positive characteristics of CBM, but it may need improvements regarding its treatment rationale and credibility. Future qualitative studies with individuals who complete a CBM treatment are warranted. Implications for future CBM development and dissemination are discussed.

Background: Chronic pain is a common condition among older adults. While cognitive behaviour therapy (CBT) has been tested in numerous studies on adults and children there are fewer studies on older persons. The objective of this study was to investigate the effects of a six-session CBT group treatment for older persons with chronic pain. As a secondary aim we investigated whether treatment credibility was associated with outcome. Method: We included 21 persons (mean age = 72.0 years) who were randomly allocated to either a waitlist condition or treatment consisting of applied relaxation, with the addition of problem solving, assertiveness, communication strategies, sleep management, and relapse prevention. Results: Few statistically significant effects were found on measures of pain, mood, anxiety, and quality of life; however, a significant treatment effect with a between group effect size of d = 1.0 was observed with respect to perceived ability to function despite the discomfort of pain. Conclusion: The study provides some preliminary support for the use of group-based CBT with a focus on applied relaxation for older adults with chronic pain.

Background: Generating alternative interpretations is a widely used technique in cognitively-oriented treatments for psychosis, including social cognitive treatments. However, research on judgment and decision-making suggests that this technique may backfire among individuals with cognitive deficits. Aims: Mary/Eddie/Bill (MEB) was developed as an alternative approach to help improve Theory of Mind, attributional bias and Jumping to Conclusions in psychosis. An initial pilot trial was conducted to evaluate the tolerability and potential efficacy of MEB. Method: Twenty-four outpatients with psychotic disorders participated in an uncontrolled trial. Social cognition, social functioning, and participant feedback were assessed. Results: Treatment completers exhibited statistically significant improvements in Theory of Mind, social cognitive overconfidence and self-reported social engagement, and reported positive experiences with MEB. No improvements were observed in attributional bias. Conclusions: Given that there are risks associated with the use of traditional generating-alternatives techniques, the current findings support ongoing development of MEB and similar approaches.

Background: This paper looks at attrition in relation to deprivation and type of therapy – CBT or person-centred counselling. Method: Case notes of all those referred in a 4-month period (n = 497) were assessed for those who failed to opt-in; those who opted-in but failed to attend first appointment and those who attended first appointment but subsequently dropped-out. Results: Significant numbers failed to opt-in, attend first appointment or dropped out during therapy. There were no differences between CBT and PCT. Those from the most deprived areas were less likely to opt-in. Conclusions: We need to develop better approaches to attracting and maintaining contact with individuals complaining of common mental health problems.

Background: Increasingly, clinical psychologists and CBT trained clinicians work with and within teams. The cognitive model enables us to formulate the processes maintaining distress, and work with people to effect change. The model tends to be used to understand individuals’ difficulties, but may be effective in making sense of problems within teams. Aims: This study aimed to (i) explore the value of the cognitive model in formulating key staff-service user relationships; and (ii) determine whether such an approach would yield useful team based interventions. Method: The cognitive interpersonal model was used to develop an idiosyncratic conceptualization of key staff-service user interactions in an in-patient setting. This then informed management team planning aimed at improving provision for service users, and staff experience. Additionally, frequency of challenging behaviours and levels of staff burnout were assessed before and after service changes, as preliminary outcome data. Results: The team formulation was effective in (i) making sense of interactions contributing to the maintenance of service users’ challenging behaviours and staff burnout, and (ii) deriving systemic interventions likely to effect change. This was then used to guide service development planning. In support of a CBT approach to understanding and intervening with teams, preliminary data indicate that staff burnout and incidents of challenging behaviours reduced over time. Conclusion: The cognitive interpersonal model can be used to formulate relationships within teams and guide systemic change. This is likely to have a beneficial impact for both service users and staff.