Cognitive behaviour therapists working in the field over the last 10 years will have witnessed a shift to more schema focused forms of therapy. While these approaches have been introduced to treat people with personality disorders, they have also had a strong influence on the treatment given to people suffering from Axis I disorders. Indeed, it is my impression that many therapists are now of the opinion that they are not doing proper cognitive behaviour therapy (CBT) unless they have undertaken a detailed history of a patient's early childhood and, along the way, unearthed a couple of core beliefs. This paper outlines some of the pitfalls concerning the shift of emphasis towards schema focused techniques. While it is acknowledged that schema work is a development of “traditional” CBT, it is proposed that schema therapy is being employed without adequate assessment of its appropriateness, especially when used in primary care settings with people with no prior history of psychiatric problems. This paper provides some anecdotal details about therapists' difficulties in using schema techniques. These examples stress the need for good supervision, highlighting the responsibility of therapists to ensure that the patient receives the most appropriate form of therapy. This work recognizes the importance of schema focused approaches, but suggests that they are being used too pervasively, and too often by people with neither sufficient training, nor adequate grounding, in the empirically validated “traditional” CBT approaches.

Previous research has found an association between adult attachment style and symptoms of depression among university students and indicated that this relationship may be mediated by dysfunctional attitudes. The present study represents an initial step toward extending these findings to a clinical sample with more severe forms of depression. A sample of psychiatric outpatients diagnosed with major depressive disorder (n = 54) completed measures of adult attachment style, dysfunctional attitudes, and depression. An association was found between insecure attachment style and depression severity. This association was partially mediated by dysfunctional attitudes. These findings are consistent with cognitive-interpersonal models of depression that propose that adverse early experiences may contribute to vulnerability for depression through the establishment of dysfunctional attitudes.

Behavioural and Cognitive Psychotherapy is growing

There has been a steady increase in the flow of manuscripts to this journal, and I'm glad to say that the quality of submissions has commensurately improved. However, these trends have obviously created a problem, which is that there was simply not enough space for the range of excellent articles we have been receiving. The Association has therefore decided to increase the size of the journal by 25%. This should allow us to sustain a relatively short publication lag, and to maintain the mix of high quality clinical, theoretical and research material that has been the hallmark of the journal. Thanks to Cambridge University Press, particularly Janet Miles, for continued support and in making the transition to the larger size so straightforward. Of course, one of the reasons that we receive so many manuscripts is the fact that we are now one of the largest circulation journals in the field.

As ever, there are other changes in the journal. Nick Tarrier leaves us after a very long and distinguished period as assistant editor. Thanks to you Nick (but don't assume that this means that you won't get more manuscripts!) Within the editorial office during 2000 we have had additional assistance from Patrick McKnight, who has now moved on, and we would like to thank him for the excellent work he put in. Caroline Bradley has retired from the post of assistant editor; we are grateful to her for her work in this capacity. By way of consolation for our editorial losses, Hermine Graham and Elizabeth Kuipers have joined the editorial team as assistant editors. I'm looking forward to working with them over the coming years.

A cognitive approach to the understanding of psychotic symptoms that focuses on the interpretation of intrusions into awareness is outlined. It is argued that many positive psychotic symptoms (such as hallucinations and delusions) can be conceptualized as intrusions into awareness or culturally unacceptable interpretations of such intrusions, and that it is the interpretation of these intrusions that causes the associated distress and disability. It is also argued that the nature of these interpretations is affected by faulty self and social knowledge and that both the intrusions and their interpretations are maintained by mood, physiology, and cognitive and behavioural responses (including selective attention, safety behaviours and counterproductive control strategies). The literature is reviewed and found to be compatible with such a model and the clinical implications are discussed.

The literature on the use of cognitively based anger control packages of treatment for people with learning disabilities is reviewed. It is found that the experimental evidence for the effectiveness of such treatment is weak. There is, however, good evidence that two of the components of the package, relaxation and self-monitoring, can be effective in their own right, with relaxation being found to reduce anger and self-monitoring to reduce other challenging behaviours. The use of cognitive procedures with people who have learning disabilities is discussed.

Consistent with cognitive-behavioural formulations of Obsessive-Compulsive Disorder (OCD), recent research has supported the association between obsessive-compulsive phenomena, specific dysfunctional beliefs and negative affective states. However, such research has not been conducted across sufficiently different cultural contexts using the same measures in comparable samples. In the present study, university psychology students from Australia and Italy completed questionnaire measures of obsessive-compulsive phenomena, inflated responsibility, perfectionism, guilt, depression, and anxiety. Australian and Italian cultures can be seen to differ in a number of ways that could impact on the pattern of expected interrelations between these measures. Similarities in the factor structure and psychometric properties of the measures were apparent across the two cultural contexts, suggesting the appropriateness of cross-cultural comparisons in the pattern of intercorrelations. Significant interrelations were found between the measure of obsessive-compulsive phenomena, dysfunctional beliefs and negative affect in both cultural contexts. While there were some differences in the specific patterns of interrelations, these were few in number and, generally, could be explained by sociocultural factors or stereotypes, although the overall pattern of intercorrelations was stronger for the Australian cohort. The results suggest that cognitive-behavioural formulations of OCD can be generalized across these two different cultural contexts, although idiosyncratic cultural factors may need to be considered in developing cognitive-behavioural treatments.

Little is known about the weight, shape and eating concerns of mothers with young, overweight daughters. Even less is known about how these relate to their daughters' concerns. In a small pilot study (18 mother-daughter pairs in each group), general concerns and specific beliefs related to eating disorders were assessed, both in the mothers of overweight girls and in the mothers of average weight girls. These were then compared with their daughters' concerns. The findings indicated that mothers with overweight daughters (aged 11 and 12 years) scored more highly than the mothers of average weight girls on both general concerns and specific beliefs (i.e., underlying assumptions about weight, shape and eating and negative self-beliefs) related to eating disorders. While assumptions in mothers were highly correlated with daughters' concerns in the average weight group, no such relationship was found in the overweight group. The findings are briefly discussed and suggestions are made for further research.

People with sleep-onset insomnia commonly attribute their difficulty falling asleep to intrusive thoughts, worries, or “a racing mind”. Previous research has implicated strategies of thought control in the maintenance of symptoms in a number of psychological disorders. The purpose of the present study was to compare individuals diagnosed with insomnia (n = 30) and good sleepers (n = 29) for the strategies employed to manage cognitive activity during the pre-sleep period. Reappraisal, worry, and suppression were employed more by participants with insomnia than by good sleepers. Good sleepers employed social control, replacement, suppression, and reappraisal strategies most frequently, whereas the strategies most frequently employed by insomniacs were suppression and reappraisal. The results are discussed in terms of the role of strategies employed to manage pre-sleep cognitive activity in the maintenance and reversal of insomnia.

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.

This paper discusses the viability of an analogue research design for studying key processes in social phobia by comparing individuals who score high and low on the Fear of Negative Evaluation Scale (FNE: Watson & Friend, 1969). Research indicates remarkable consistency in the processes that distinguish patients with social phobia from controls and high FNE volunteers from low FNE volunteers. Unfortunately, all existing FNE norms are based on North American populations. The present paper presents British student norms and suggests possible cut-off points for defining groups for analogue research. Advantages of the analogue strategy include rapid piloting of new paradigms and the use of more complex experimental designs that require substantial sample sizes. Limitations of analogue research are also highlighted.

Primary school aged children with severe learning disabilities and behavioural problems were identified from those attending special needs schools in three adjacent Inner London boroughs. In two of the boroughs their parents/carers were randomly allocated to receive 5-7 group- or individually-based intervention sessions aimed at preventing or reducing their child's behaviour problems; teaching and support staff at their schools received a 2-day workshop with the same aims. Children in the third borough served as a “no treatment” control group. Follow-up assessments were carried out shortly after the interventions were completed and 6 months later. Individually-based intervention was superior to group-based intervention in acceptability, attendance, levels of participant satisfaction and the likelihood of reported behavioural improvement. Within the individual intervention group, behaviours that had been targeted for intervention were more likely to show improvements than those that were untargeted. However, in spite of these improvements, there were no significant differences between groups in the absolute frequency or severity of the child's behaviour problems at either post-intervention assessment, and reductions in levels of parental distress noted on completion of the interventions were no longer apparent 6 months later.

The attributions parents make about the problem behaviour of their children have been shown to be important determinants of their emotional and behavioural reactions to such behaviour. However, this relationship has not been studied in carers of children in residential settings. In this paper we apply Weiner's attributional model of helping to the self-predicted behaviour of 47 carers in residential children's homes in the U.K. Participants identified causes for four children's behaviours, made attributions about these behaviours on dimensions of internality, controllability, globality and stability, reported their emotional reactions to the behaviours on the dimensions of anger and sympathy and reported their likelihood of making extra effort to help in working with these behaviours. Results showed that attributions of controllability and globality, and the emotional response of sympathy were important in predicting reported likelihood of helping. The implications of these results for carer training are discussed.

Therapy process research has made surprisingly little headway during the past 25 years, which has been attributed to a range of methodological and conceptual problems. As a result, appeals have been made for fresh approaches to psychotherapy process research. Here we provide an experiential learning model as one promising way to crystallize conceptualizations of competence in therapy and to advance research. The model provides an integrative account of the moderators and mediators believed to explain the way that therapy achieves its outcomes. Its breadth takes it beyond the scope of its closest rival, the assimilation model. By way of illustration, the theoretical components of the experiential metaphor were operationalized and mapped onto an existing competence scale, the Cognitive Therapy Scale.

The existing scale for assessing competence in cognitive therapy (CTS) dates from 1988 and only the previous version of 1980 has been validated to any extent. A revised version, the CTS-R, was devised to improve on the CTS by: eliminating overlap between items, improving on the scaling system, and defining items more clearly. Kolb's well-known educational model was used as a guideline. In the new 14-item scale, three new items measure general therapeutic flair, the facilitation of emotional expression, and therapist's non-verbal behaviours (optional). We hypothesized that the CTS-R would prove more user friendly and demonstrate satisfactory reliability and validity. Twenty-one mental health professionals undergoing training in cognitive therapy provided 102 video-tapes of therapy with 34 patients, reflecting three stages of therapy. The tapes were rated by four expert raters, in a balanced design. The CTS-R showed high internal consistency and adequate average inter-rater reliability. Reliability for individual items varied widely among pairs of raters. Validity was demonstrated by improved ratings of competence for trainees who saw patients early and later during the course of training. Although raters found the CTS-R a more useful tool than the CTS and satisfactory reliability and validity were demonstrated, more refinement is needed in item definition. The study has led to modifications in the CTS-R, which are in the process of evaluation.

A considerable literature has developed over the past two decades that has investigated the utility of cognitive behavioural treatments for a variety of medical disorders, including rheumatoid arthritis. Research has consistently found that psychological variables affect the course of the illness and that cognitive behavioural approaches can improve psychological and physical function. However, the literature has focused almost exclusively on chronic illness. There is little literature that has investigated the role of cognitive behavioural therapy in facilitating the adjustment early in the disease course to diagnosis and subsequent illness. The diagnosis of any potentially chronic illness has enormous ramifications for a person's life and it is well documented that many people become depressed even early in the disease course. Theoretical accounts have been put forward that allow a model for understanding the process of adaptation and offer a foundation for the use of cognitive and behavioural strategies with a recently diagnosed group of patients. The present paper reports the use of a cognitive and behavioural intervention to facilitate coping and adjustment to illness.

Self-focused attention, also thought of a self-absorption, has been linked to a variety of affective states and clinical syndromes, including depression, panic disorder, social anxiety, schizophrenia, and alcoholism. Ingram (1990b) has suggested that self-focus may be a “nonspecific process” that is common across psychopathologies. Studies with nonclinical samples have supported this contention, and the current study assessed whether self-focus was common across various clinically diagnosed groups. A second issue, given this commonality, was to examine the factors across diagnostic conditions to which self-focus was related. One hundred and thirty-eight outpatients were included, and were divided into three groups based on primary diagnosis: “depression”, “panic”, and “other anxiety”. They were assessed with the ADIS-R/IV and completed measures assessing self-focus, affective states, global psychopathology, and problem-solving. Self-focus was common across groups, with minor valence variations. Severity of primary diagnosis predicted total self-focus, with level of depression and trait anxiety predicting negative self-focus. Correlational analyses suggested that self-focused attention is related to general measures of psychopathology and severity, and negatively related to problem-solving. The pattern with negative self-focus was even more pronounced, with significant relationships to all measures of psychopathology, clinician-rated severity, and a negative relationship with problem-solving. Results are discussed in terms of differences between “normal” and problematic self-focus, the causal direction in the relationship between self-focus and negative affect, and the link between self-focus and problem-solving.

Four randomized controlled trials have shown out-patient cognitive behaviour therapy reduces fatigue and disability in people suffering from chronic fatigue syndrome (CFS). However, some patients referred to Kings College Hospital, London are unable to attend regular appointments. We therefore developed a self-help treatment manual using cognitive-behavioural principles for patients to use at home with telephone contact with a therapist. Nine consecutive patients with a diagnosis of CFS who were unable to attend regular out-patient appointments used this self-help treatment approach at home. The therapist (MB) carried out a face-to-face assessment at the hospital. Subsequently, patients had fortnightly telephone appointments to discuss their progress, plan and discuss their homework and any problems. Outcome was evaluated using measures of functional impairment, fatigue, mood and general health before and after treatment and at 3 and 6-month follow-up. Eight patients completed treatment. Functional impairment, fatigue and general health improved at discharge and gains were maintained at 6-month follow-up. Self-treatment at home guided by a manual with fortnightly telephone sessions was helpful in the treatment of patients with chronic fatigue syndrome. A randomized controlled trial is underway to compare telephone cognitive behaviour therapy with out-patient cognitive behaviour therapy. Patients with other conditions such as chronic pain who are unable to travel for regular appointments may benefit from a home-based treatment package involving therapist contact by phone.

In the present climate of limited resources and long waiting lists, it is not surprising that there is more emphasis on making sure that psychological treatments are not only clinically sound but also cost-effective. One solution to this is to provide time-limited, focused interventions such as cognitive therapy. Another obvious solution is to deliver treatment in groups rather than individually. However, what evidence is there that therapy can be delivered as effectively in groups as individually? This review will look at which different formats have been tried, what the advantages and disadvantages of those formats might be, which client groups have been targeted for cognitive- behavioural group therapy (CBGT), and whether a group format in general offers any advantages over individual CBT. Outcome studies and their implications for the use of CBGT are considered. Results suggest that, in most client groups, there is little difference in efficacy between group and individual CBT, although there is some evidence that results for some types of patient can be disappointing in CBGT. It may be that the best compromise in terms of cost- effectiveness between quality of therapy and quantity of patients treated is offered by large-scale psychoeducational didactic group therapy.

In a near miss experience, a person learns anxiety despite the fact that the feared outcome does not actually occur. Theories based on S-R links or direct encoding of emotional memories do not provide a good model of near miss learning because they fail to account for informational variables. An alternative cognitive model is outlined, based on expectancy of an inferred negative outcome. The model is applied to posttraumatic stress disorder, in which the critical feared outcome is often death, and panic disorder, in which a near miss inference may protect expectancies of harm from disconfirmation. Unlike direct emotional encoding models, the inferential/expectancy model provides multiple cognitive targets for treatment. Near miss learning may be usefully distinguished from other pathways to anxiety, and warrants further experimental investigation.

It is hypothesized that there might be two subtypes of dysphoria. Comparison of the characteristic deficits of attributional styles and social skills of adolescent dysphorics differentiated them into two subtypes. This suggested that matched treatments of the two subtypes of dysphoria might be more effective than non-matched treatments. As is predicted by the hopelessness theory of depression (Alloy, Abramson, Metalsky, & Hartlage, 1988), dysphorics characterized by the depressogenic attributional style and adequate social skills reported significantly greater numbers of negative life-events than dysphorics characterized by social-skill deficits and healthy attributional style. Treatments matched to dysphoria subtypes were more effective than non-matched treatments. The authors suggest that similar tests of dysphorics over several years might indicate that some dysphoric states intensify and that matched treatments would abort potentially severe depressions.