Background: Safety behaviours are ubiquitous across anxiety disorders and are associated with the aetiology, maintenance and exacerbation of anxiety. Cognitive behavioural models posit that beliefs about safety behaviours directly influence their use. Therefore, beliefs about safety behaviours may be an important component in decreasing safety behaviour use. Unfortunately, little empirical research has evaluated this theorized relationship.

Aims: The present study aimed to examine the predictive relationship between beliefs about safety behaviours and safety behaviour use while controlling for anxiety severity.

Method: Adults with clinically elevated levels of social anxiety (n = 145) and anxiety sensitivity (n = 109) completed an online survey that included established measures of safety behaviour use, quality of life, and anxiety severity. Participants also completed the Safety Behaviour Scale (SBS), a measure created for the current study which includes a transdiagnostic checklist of safety behaviours, as well as questions related to safety behaviour use and beliefs about safety behaviours.

Results: Within both the social anxiety and anxiety sensitivity groups, positive beliefs about safety behaviours predicted greater safety behaviour use, even when controlling for anxiety severity. Certain beliefs were particularly relevant in predicting safety behaviour use within each of the clinical analogue groups.

Conclusions: Findings suggest that efforts to decrease safety behaviour use during anxiety treatment may benefit from identifying and modifying positive beliefs about safety behaviours.

Background: Two ‘sibling’ disorders have been proposed for the fourthcoming 11th version of the International Classification of Diseases (ICD-11): post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). Examining psychological factors that may be associated with CPTSD, such as self-compassion, is an important first step in its treatment that can inform consideration of which problems are most salient and what interventions are most relevant. Aims: We set out to investigate the association between self-compassion and the two factors of CPTSD: the PTSD factor (re-experiencing, avoidance, sense of threat) and the Disturbances in Self-Organization (DSO) factor (affect dysregulation, negative self-concept and disturbances in relationships). We hypothesized that self-compassion subscales would be negatively associated with both PTSD and DSO symptom clusters. Method: A predominantly female, clinical sample (n = 106) completed self-report scales to measure traumatic life events, ICD-11 CPTSD and self-compassion. Results: Significant negative associations were found between the CPTSD DSO clusters of symptoms and self-compassion subscales, but not for the PTSD ones. Specifically it was also found that self-judgement and common humanity significantly predicted hypoactive affect dysregulation whereas self-judgement and isolation significantly predicted negative self-concept. Conclusions: Our results indicate that self-compassion may be a useful treatment target for ICD-11 CPTSD, particularly for symptoms of negative self-concept and affect dysregulation. Future research is required to investigate the efficacy and acceptability of interventions that have implicit foundations on compassion.

Background: Unwanted intrusive thoughts of intentionally harming one's infant (intrusive harm thoughts) are common distressing experiences among postpartum mothers and fathers. Aim: To understand infant crying as a stimulus for intrusive harm thoughts and associated emotional responses in prepartum and postpartum mothers and fathers in response to infant cry. Method: Following completion of self-report measures of negative mood and anger, prepartum (n = 48) and postpartum (n = 44) samples of mother and father pairs completed 10 minutes of listening to audio-recorded infant crying. Post-test questionnaires assessed harm thoughts, negative emotions, urges to comfort and flee, and thoughts of shaking as a soothing or coping strategy. Results: One quarter of prepartum and 44% of postpartum parents reported intrusive infant-related harm thoughts following crying. Mothers and fathers did not differ in the likelihood of reporting harm thoughts, nor in the number of thoughts reported. Women reported more internalizing emotions compared with men. Hostile emotions were stronger among postpartum parents, and parents reporting harm thoughts. All parents reported strong urges to comfort the infant. Urges to flee were stronger among parents who reported harm thoughts. The likelihood of using infant shaking as a soothing or coping strategy was minimally endorsed, albeit more strongly by fathers and parents who also reported harm thoughts. Conclusions: In response to crying, harm thoughts are common and are associated with hostile emotions, urges to flee, and increased thoughts of using infant shaking. Reassuringly, the number of participants considering infant shaking as a strategy for soothing or for coping with a crying infant was low.

Background: Although internet-delivered cognitive behaviour therapy (ICBT) yields large clinical outcomes when accompanied by therapeutic support, a portion of clients do not benefit from treatment. In ICBT, clients review treatment materials online typically on a weekly basis. A key component of therapist-assistance involves answering questions as clients review and work on assignments related to the treatment materials. Aims: The goal of this study was to enhance understanding of the nature of client questions posed during ICBT and examine potential associations between the number of questions asked and treatment outcomes in order to provide insight into how to improve ICBT for future users. Method: Content analysis was used to qualitatively analyse and identify questions that 80 clients asked their designated therapist over the course of an 8-week ICBT programme for anxiety and depression. Results: On average, clients sent six emails during the course of treatment, of which less than two questions were asked. Of the 137 questions posed by clients, 46.72% reflected questions designed to enhance understanding and apply the material and techniques reviewed in the programme. Additional questions were categorized as clarifying the therapeutic process (22.62%), addressing technical challenges (18.25%), and seeking assistance with problems outside the scope of ICBT (12.41%). Number of client questions asked was not significantly correlated with the number of lessons completed, symptom change, or perceptions of therapeutic alliance. Conclusions: Findings can inform future practitioners who deliver ICBT of what to expect with this treatment approach and also assist in the development of future ICBT programmes.

Background: In recent years, cognitive behavioural group therapies (CBGT) have been increasingly deployed as a strategy to increase the efficiency and cost-effectiveness in treatment of common mental health problems. The vast majority of these therapies are disorder specific, but in the last few years there has been growing interest in transdiagnostic CBGT. Aims: The aim of this study was twofold: to evaluate the treatment effects of transdiagnostic CBGT on disorder specific symptoms and what (if any) differences would be observed in the treatment effects with regard to general as opposed to disorder specific symptoms measured pre- and post-treatment. Method: The participants were 233 adult patients diagnosed with depression and/or anxiety disorders. They underwent a 6-week transdiagnostic CBGT. To compare treatment effects on general and disorder specific symptoms, raw scores on all measures were converted to standardized scores. Results: Pre–post differences were significant and there was no evidence that treatment was differentially effective for general and disorder specific symptoms. Effect sizes ranged from medium to large. Conclusion: The 6-week transdiagnostic CBGT is feasible for a wide range of mood and anxiety disorders. The results indicate that low-intensity transdiagnostic group therapies may have similar effects on both general and disorder specific symptoms.

Background: Cognitive behavioural therapy (CBT) has relatively poor outcomes for youth with social anxiety, possibly because broad-based CBT is not tailored to their specific needs. Treatment of social anxiety in youth may need to pay more attention to negative social cognitions that are considered a key factor in social anxiety development and maintenance. Aims: The aim of the present study was to learn more about the role of performance quality in adolescents’ cognitions about their social performance and, in particular, the moderating role social anxiety plays in the relationship between performance quality and self-cognitions. Method: A community sample of 229 participants, aged 11 to 18 years, gave a speech and filled in questionnaires addressing social anxiety, depression, expected and self-evaluated performance, and post-event rumination. Independent observers rated the quality of the speech. The data were analysed using moderated mediation analysis. Results: Performance quality mediated the link between expected and self-evaluated performance in adolescents with low and medium levels of social anxiety. For adolescents with high levels of social anxiety, only a direct link between expected and self-evaluated performance was found. Their self-evaluation was not related to the quality of their performance. Performance quality also mediated the link between expected performance and rumination, but social anxiety did not moderate this mediation effect. Conclusions: Results suggest that a good performance does not help socially anxious adolescents to replace their negative self-evaluations with more realistic ones. Specific cognitive intervention strategies should be tailored to the needs of socially anxious adolescents who perform well.

Background: Although the ABC model proposed by cognitive behavioral theory has strong empirical support for a wide range of psychological problems, little is known about the role of irrational beliefs (IBs), a central concept of the ABC model, in the aetiology of paranoid thoughts, one of the most common psychotic symptoms. Aims: The present study aimed to investigate the impact of IBs on paranoid thoughts and people's perceptions of others. Method: Eighty-one non-clinical participants (m age = 21.21 years, SD = 2.72, range 18–33; 83.95% female) recruited for this study were randomly assigned to one of the two conditions: IBs or rational beliefs (RBs). In a role-play paradigm, subjects were asked to imagine holding a list of IBs or RBs, respectively, while being exposed to a neutral social context in a virtual reality environment. Results: In line with the ABC model, results indicate that IBs lead to significantly higher levels of state paranoid thoughts and more negative perceptions of others than RBs, even after controlling for participants’ baseline irrationality and trait paranoia [F (5,68) = 11.23, p < .001, Wilk's λ = .54, partial η2 = .45]. Conclusions: The findings of this paper suggest that IBs might play an aetiological role in the occurrence of paranoid thoughts. Practical and theoretical implications of these results are also considered.

Background: There is an emerging evidence base that mindfulness for psychosis is a safe and effective intervention. However, empirical data on the within-session effects of mindfulness meditation was hitherto lacking. Aims: The aim of the study was to assess the impact of taking part in a mindfulness for psychosis group, using a within-session self-report measure of general stress, and symptom-related distress. Method: Users of a secondary mental health service (n = 34), who experienced enduring psychotic symptoms, took part in an 8-week mindfulness for psychosis group in a community setting. Mindfulness meditations were limited to 10 minutes and included explicit reference to psychotic experience arising during the practice. Participants self-rated general stress, and symptom-related distress, before and after each group session using a visual analogue scale. Results: Average ratings of general stress and symptom-related distress decreased from pre- to post-session for all eight sessions, although not all differences were statistically significant. There was no increase in general stress, or symptom-related distress across any session. Conclusions: There was evidence of positive effects and no evidence of any harmful effects arising from people with psychotic symptoms taking part in a mindfulness for psychosis session.

Background: In the past decade, a great deal of research has examined the efficacy and mechanisms of attentional bias modification (ABM), a computerized cognitive training intervention for anxiety and other disorders. However, little research has examined how anxious patients perceive ABM, and it is unclear to what extent perceptions of ABM influence outcome. Aims: To examine patient perceptions of ABM across two studies, using a mixed methods approach. Method: In the first study, participants completed a traditional ABM program and received a hand-out with minimal information about the purpose of the task. In the second study, participants completed an adaptive ABM program and were provided with more extensive rationale and instructions for changing attentional biases. Results: A number of themes emerged from qualitative data related to perceived symptom changes and mechanisms of action, acceptability, early perceptions of the program, barriers/facilitators to engagement, and responses to adaptive features. Moreover, quantitative data suggested that patients’ perceptions of the program predicted symptom reduction as well as change in attentional bias. Conclusions: Our quantitative data suggest that it may be possible to quickly and inexpensively identify some patients who may benefit from current ABM programs, although our qualitative data suggest that ABM needs major modifications before it will be an acceptable and credible treatment more broadly. Although the current study was limited by sample size and design features of the parent trials from which these data originated, our findings may be useful for guiding hypotheses in future studies examining patient perceptions towards ABM.

Background: Exposure is an effective intervention in the treatment of pathological anxiety, but it is insufficiently disseminated. Therapists’ negative attitudes towards exposure might be of relevance when considering factors contributing to the non-application of this intervention. Aims: In order to be able to measure concerns in German-speaking therapist populations, the study aimed at validating a German version of the Therapist Beliefs about Exposure Scale.Method: The scale was translated into the German language and validated in a sample of 330 German licensed cognitive behavioural therapists. Results: In the present sample, the mean total score was significantly lower than in the original study including US-American therapists. Confirmatory factor analysis did not confirm the proposed one-factor model, while the exploratory factor analysis indicated that more than one factor is necessary to explain the structure of negative attitudes towards exposure. The internal consistency was high. Higher scores (more negative beliefs) were significantly correlated with older age, holding a master's degree (vs PhD), not being specialized in the treatment of anxiety disorders and with less experience with performance of exposure gained during clinical training. Negative beliefs about exposure were further associated with the self-reported average number of sessions spent on exposure in current treatment of post-traumatic stress disorder and panic disorder, and with negative attitudes towards application of exposure sessions presented in case vignettes. Conclusions: The German adaptation provides the opportunity of measuring concerns regarding application of exposure in German-speaking therapist populations. However, the presented data reveal suggestions for further scale development.

Background: Insomnia has become a major public health concern. Aims: The study examined the efficacy of a web-based unguided self-help programme with automated feedback. The programme was based on cognitive behaviour therapy for insomnia (CBT-I). The investigation particularly focused on factors that contribute to the maintenance of insomnia and tested whether treatment effects were stable over a period of 12 months. Method: Fifty-six participants were randomly assigned either to web-based CBT-I or to the waiting-list control group. Included measures assessed insomnia severity, sleep-related cognitions, safety behaviours, depression, anxiety and somatization. In the intervention group, a sleep diary was used to assess sleep continuity parameters, sleep quality and daytime performance. Results: Large between- and within-group effect sizes (d = 1.79, d = 1.59) for insomnia severity were found. The treatment group effect remained stable over the period of 12 months. Further, sleep-related cognitions, safety behaviours, depression and somatization significantly decreased in the treatment group compared with the control group. On all sleep diary parameters, medium to large effects were revealed within the treatment group. Anxiety did not decrease significantly from pre- to post-assessment. For all measures except somatization and anxiety significant within-group effects were found at 12-month follow-up assessment indicating long-lasting effects. Conclusions: This study adds evidence to the literature on unguided online interventions for insomnia, and indicates that online CBT-I can have substantial long-term effects on relevant sleep-related outcome parameters. Moreover, the results indicate that sleep-related cognitions and safety behaviour can be successfully altered with an unguided CBT-I intervention.

Background: Neuroticism is associated with inflated somatic symptom reporting. Worry and rumination are a cognitive concomitant of neuroticism and potentially mediate the neuroticism–somatic complaint relationship. Aims: The present study examined the degree to which worry and rumination mediated the relationship between neuroticism and somatic complaints. Method: A sample of 170 volunteers, recruited via convenience sampling, took part. Participants completed a series of self-report measures: the Eysenck Personality Questionnaire Revised-Short Form, Penn State Worry Questionnaire, the Ruminative Response Scale and the Somatic Symptom Scale-8. Results: Analysis revealed significant positive correlations between neuroticism, rumination and worry. Neuroticism, rumination and worry also correlated positively with somatic complaints. Using structural equation modelling, a mediational model indicated that rumination fully mediated the relationship between neuroticism and somatic complaints. Conclusions: Findings are consistent with the symptom perception hypothesis and have implications for healthcare in terms of managing individuals who present with multiple somatic complaints. Future research would benefit from adopting a longitudinal approach to test how rumination interacts with neuroticism and somatic complaints over time.

Background: Transdiagnostic psychotherapies are designed to apply the same underlying treatment principles across a set of psychiatric disorders, without significant tailoring to specific diagnoses. Several transdiagnostic psychotherapy protocols have been developed recently, each of which has its own strengths and weaknesses. One promising treatment is Transdiagnostic Behaviour Therapy (TBT), in that it is one of the few transdiagnostic treatments to date shown to be effective in patients with depressive and anxiety disorders. However, TBT has only been investigated via individual psychotherapy. Aims: The present study investigated the effectiveness of a group protocol for TBT, compared with disorder-specific group psychotherapies, in a naturalistic setting. Method: 109 participants with various diagnoses of affective disorders completed either group TBT (n = 37) or a disorder-specific group psychotherapy (n = 72). Measures included assessments of psychiatric symptomatology and transdiagnostic impairment at baseline and post-treatment. Results: Overall, participants in the TBT group demonstrated significant improvements across all measures. When compared with disorder-specific groups, no statistical differences were observed between groups across symptoms; however, participants in the TBT group demonstrated roughly twice the treatment effect sizes in transdiagnostic impairment compared with participants in the disorder-specific groups. In addition, when participants from the most well-represented diagnosis and disorder-specific treatment (social anxiety disorder) were investigated separately, participants in the TBT group demonstrated significantly larger improvements in comorbid depressive symptoms than participants in the disorder-specific treatment. Conclusions: Pending replication and additional comparison studies, group TBT may provide an effective group treatment option for patients with affective disorders.

Background: There is strong evidence to suggest that anxiety is associated with paranoia in clinical and non-clinical samples. However, no research to date has directly manipulated anxiety to investigate if state-anxiety has a causal role in state-paranoia in clinical populations. Aims: To investigate whether an anxious-mood induction leads to greater paranoia than a neutral-mood induction in people experiencing psychosis and paranoia and, if so, whether this is predicted by anxiety over and above other variables. Method: 22 participants with a psychosis-spectrum diagnosis took part in a two condition cross-over experimental design. Participants underwent a neutral-mood and an anxious-mood induction with levels of state-anxiety, state-affect and state-paranoia being measured before and after each condition. Results: State-paranoia was significantly higher after the anxious condition compared with the neutral condition. State-anxiety and negative-affect were significant predictors of levels of state-paranoia after the anxious condition. When both predictors were included in a regression model, only negative-affect was a significant predictor of state-paranoia after the anxious condition. There were a number of methodological limitations. Conclusions: State-anxiety and negative-affect may both be involved in the maintenance of paranoia in clinical populations, as predicted by cognitive models. Negative-affect may be the strongest predictor of state-paranoia in clinical populations. Reasons for this are discussed, as well as the implications. Interventions that seek to reduce negative state-affect may be beneficial in managing state-paranoia. Further research is warranted to explore the suggested clinical and theoretical implications of these findings.

Background: Previous research suggests benefits of targeting beliefs about the unacceptability of emotions in treatment for irritable bowel syndrome (IBS). Aims: The current study developed and tested an intervention focusing on beliefs and behaviours around emotional expression. Method: Four participants with IBS attended five group sessions using cognitive behavioural techniques focusing on beliefs about the unacceptability of expressing emotions. Bi-weekly questionnaires were completed and a group interview was conducted. This study used an AB design with four participants. Results: Averages indicate that participants showed decreases in beliefs about unacceptability of emotions and emotional suppression during the intervention, although this was not reflected in any of the individual trends in Beliefs about Emotions Scale scores and was significant in only one individual case for Courtauld Emotional Control Scale scores. Affective distress and quality of life improved during follow-up, with only one participant not improving with regard to distress. Qualitative data suggest that participants felt that the intervention was beneficial, referencing the value in sharing their emotions. Conclusions: This study suggests the potential for beliefs about emotions and emotional suppression to be addressed in cognitive behavioural interventions in IBS. That beliefs and behaviours improved before outcomes suggests they may be important processes to investigate in treatment for IBS.