The National Institute of Clinical Excellence (NICE) guidelines for anxiety (Panic and Generalized Anxiety Disorder) and depression were finally launched in December 2004, after much delay (see www.nice.org.uk). Given that these were such important documents, it might seem surprising that the launch went almost entirely unnoticed. Why was it surprising? Because the recommendations were ground breaking. CBT was identified as the first line treatment pretty much across the board, with huge resource implications. It is not the business of NICE to comment on resources (or the lack of these). However, it was noted in the anxiety guidelines that CBT should be available promptly from appropriately trained and supervised therapists. In many (if not most) areas, this strongly implies a huge change in emphasis in the delivery of psychological therapies. The (implicit) implications are staggering. With the honourable exception of Interpersonal Therapy in depression, other psychological therapies were not advocated – at all. In anxiety, combination treatment (medication and CBT) was not recommended as a first or second line treatment. Some medication (antipsychotic) was ruled out. Guided self-help (based on CBT principles) was “third choice”. So the explicit recommendation is that good quality, empirically grounded psychotherapies (CBT, CBT and IPT in depression) should be widely and promptly available, whereas therapies without an empirical basis were not recommended.

Welcome to this special issue of Behavioural and Cognitive Psychotherapy, a Festschrift to mark the retirement of Professor William Yule. The collection of papers here, covering reading problems, parenting and conduct disorder, the effects of war on civilian children, cognitive factors associated with trauma in children, social-cognitive approaches to post traumatic stress, and the assessment of PTSD in children, can only begin to skim the surface of his contribution to clinical child psychology in over 40 years of research, teaching, and – above all – clinical work. It is fitting that such a collection appears in this journal. Bill joined the BABP (later BABCP) as a founder member in 1972. Three years later, he and Ray Hodgson began to co-edit the new quarterly BABP Bulletin, the forerunner to Behavioural and Cognitive Psychotherapy. Bill retired as Editor of the Journal in 1984, having helped to develop what started out as a single sheet newsletter into a successful, respected, international scientific publication. He is also a former Chair of the Association, and was made an Honorary Fellow in 1984.

Previous research has associated the development of social phobia with parental rearing practices, learning influences such as conditioning, vicarious transmission and verbal acquisition, and the individual's own response to social situations. The present study aimed to further investigate these possible antecedents of social phobia. A Learning History Questionnaire (LHQ) was completed by patients with social phobia (n=55), patients with posttraumatic stress disorder (PTSD; n=30), and non-patient controls (n=30). The LHQ focused on events that occurred before the age of 14 (the median age of onset for social phobia). The results indicated the importance of parental rearing practices such as not actively encouraging participation in social situations and emotional coldness. Difficulties with peer group were highlighted as important contributors to conditioning experiences. Individual response factors, especially post-event rumination, are potentially associated with the development of social phobia. Four of the 12 significant variables were unique to the social phobia group when the results from the PTSD group were taken into account. Further research is required to clarify the extent to which the environmental factors assessed in this study specifically contribute to the development of social phobia or to the development of anxiety more generally.

Previous research with an on-line processing task found that individuals without social anxiety generate benign inferences when ambiguous social information is encountered, but people with high social anxiety or social phobia do not (Hirsch and Mathews, 1997, 2000). In the present study, we tested if it is possible to induce a benign (or less negative) inferential bias in people who report anxiety about interviews by requiring them to take the perspective of an interview confident person, rather than their own. High interview anxious volunteers were allocated to read descriptions of job interviews, either taking their own perspective in the described situation or that of a confident interviewee. At certain points during the text, a target letter string appeared and participants were asked to indicate whether it formed a word or a non-word (lexical decision). Some of the lexical decisions occurred in the context of ambiguous text that could be interpreted in both a threatening and a benign manner. In a baseline condition, decisions were made following text for which there was only one possible inference (either threat or benign). The results indicated that, compared to the self referent condition, participants who adopted the perspective of a confident other person showed enhanced inhibition of threat inferences.

Research has shown an important link between depression and rumination. This study set out to explore depression-focused rumination and anger-focused rumination in relation to shame and entrapment, and depression. 166 undergraduate students completed a battery of self-report questionnaires measuring current depression, rumination on depressive symptoms, rumination on anger, and the frequency of shame-focused and entrapment-focused thoughts. Both depression-focused and anger-focused rumination were related to depression, and to the frequency of shame and entrapment thoughts. In a mediational model, the link between depression-focused rumination and depression was partially mediated by feeling trapped by, and wanting to escape from, one's thoughts and feelings. Thus the link between rumination and depression is complex. Although rumination may contribute to depression by generating a spiral of negative thinking and negative feeling, feeling trapped and unable to control one's rumination, and being flight motivated, may add a further dimension to the depressogenic qualities of rumination.

A modified version of the probe detection task was used to investigate the time course of attentional biases for emotional words in high and low socially anxious individuals. Word pairs were presented at two exposure durations, 200 and 500 msec, in order to investigate the different components of attentional bias in anxiety (e.g., vigilance or avoidance of threat). There was evidence of an attentional bias favouring initial vigilance towards (social and physical) threat words and subsequent avoidance of the same stimuli in high social anxiety. In contrast, low socially anxious individuals did not exhibit an attentional preference. The interaction of social anxiety and exposure duration for threat words remained when controlling for general negative affect. Theoretical and clinical implications of the results are discussed.

We examined beliefs about depression in patients and their partners and explored the impact of beliefs on perceptions of marital functioning, level of distress and caregiving in partners, and clinical outcome of major depression. Fifteen patients meeting criteria for major depressive disorder and their co-habiting spouses were interviewed at baseline using the Reasons for Depression Questionnaire (Addis, Truax and Jacobson, 1995) and measures of symptom severity, distress, caregiver consequences and marital satisfaction. Outcome was assessed at 6 months. Identifying biological reasons for depression was significantly associated with patient severity of depression and with caregiver burden. Caregiver distress was significantly associated with endorsement of interpersonal reasons for depression. Concordance in reason giving between patients and partners was significantly associated with a good outcome. This is the first study to show that beliefs about depression held by patients and their partners may have an impact on the clinical outcome of major depression.

William Yule's many contributions to the field of reading disabilities over the last 40 years are reviewed and set in the context of recent research evidence. The value of regression methods in the measurement of reading performance remains valid, but spelling, as well as reading, difficulties need to be assessed in relation to the diagnosis of dyslexia. Although categorical approaches to diagnosis are needed for some purposes, it is likely that the genetic liability to dyslexia is dimensional. Overall, Yule's identification of the key features of specific reading retardation have been confirmed by subsequent research, but the concept of general reading backwardness as a diagnosis has proved less meaningful. The identification of the high rate of comorbidity between reading disability and emotional/behavioural disturbance, highlighted by Yule 35 years ago, has been amply confirmed but the causal mechanisms remain ill-understood.

The Motivational Interviewing Skill Code (MISC) is a coding system developed to measure adherence to motivational interviewing (MI). MI is an effective clinical style used in different treatment situations. Counsellors practising MI have to follow general principles and avoid certain traps. In the present study, the content of the MISC is compared with the general principles of MI and the traps to avoid in MI. Investigation of the content validity raises some questions. All general principles are represented but the traps to avoid in MI are not fully covered. The consequences of this under-representation are shown in transcripts of a selection of well-conducted MI training sessions. The reliability of the MISC was investigated by having five independent coders code 39 MI training sessions of different counsellors. The reliability of the MISC is reasonable. The five coders agreed to a large extent on the absolute ratings but the intraclass correlations were low. Although the MISC can be a useful research tool for process research of MI, it remains a labour-intensive instrument and for teaching and practice audit development of a more simple coding system is recommended.

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.

Alcohol use and anxiety disorder frequently co-occur. Despite this, no research has satisfactorily examined the effect of alcoholism treatment on anxiety states. The effect of Relapse Prevention (RP) treatment on alcohol dependence and co-morbid panic disorder in a single case was therefore examined. RP reduced alcohol intake and anxiety levels, and eliminated panic attacks, although carrying alcohol to prevent panic attack remained. Belief change was achieved when this behaviour was eliminated. Results are consistent with a “feed-forward” model of co-morbidity. The need for further research exploring RP and co-morbid anxiety disorder is emphasized, as is work examining alcohol-related safety-seeking behaviour.

There is active, current speculation about the relationship between trauma and psychosis. However, little is known about the information-processing mechanisms underlying the development of trauma-related intrusions in this area. Our account highlights the role of contextual integration, i.e. the need for experiential information to be effectively integrated into a temporal and spatial context in order to facilitate voluntary recall. Drawing on existing models of both posttraumatic stress disorder (PTSD) and psychosis (Brewin, 2001; Ehlers and Clark, 2000; Garety et al., 2001; Morrison, 2001), we propose a contextual integration account of trauma-related intrusions. It is argued that the strength of contextual integration, which occurs during encoding, influences the frequency and nature of subsequent intrusive experiences. Consequently, individual differences in schizotypal personality traits, which are known to be associated with levels of contextual integration, are also related to the phenomenology of trauma-related intrusions. Whilst intrusions can be seen to occur within a range of disorders, it is argued that contextual integration may be one key variable in understanding the relationship between an experienced trauma and any consequent psychiatric symptomatology. Implications for clinical interventions aimed at trauma-related psychosis are discussed, along with research aimed at developing the empirical basis for such interventions.

The aim of the study was to assess the effectiveness of cognitive group therapy compared to a waiting list in a sample of patients with heterogeneous non-psychotic disorders. Participants in this study were referred from either the psychiatric in- or outpatient clinic at the psychiatric university hospital in Trondheim, Norway. The patients were assessed with SCID I and SCID II, and randomized either to cognitive group therapy (n=15) or to a waiting list (n=17). Self-report assessments of symptoms and interpersonal difficulties were administered at the start of therapy, after termination of therapy (8 weeks), and at 6 months and 12 months follow-up. Thirty-two patients completed 8 weeks of therapy. Results showed that an 8-week program of CBGT performed better than the waiting list controls, on symptom relief at post-treatment for all patients. The effects of therapy were still upheld at 6 and 12 months follow-up. Cognitive therapy seems to be useful and effective in a group format in naturalistic clinical settings, with patients suffering from various forms of non-psychotic co-morbid psychiatric disorders.

This study reports the development of a self-report measure to assess metacognitive beliefs about paranoia in non-patients. We aimed to test the specific hypotheses that positive beliefs about paranoia would predict frequency of paranoia, and that negative beliefs about paranoia would predict distress associated with delusional ideation. Three-hundred and seventeen non-patient participants were asked to complete questionnaires assessing beliefs about paranoia, paranoia, dimensions of delusional ideation and trait anxiety. The results showed that four empirically distinct subscales were measured by the beliefs about paranoia scale (negative beliefs about paranoia, beliefs about paranoia as a survival strategy, general positive beliefs and normalising beliefs). The scales possessed acceptable internal consistency and were associated with the measures of paranoia, delusional ideation and anxiety. Consistent with predictions, it was found that beliefs about paranoia as a survival strategy were associated with frequency of paranoia, and negative beliefs were associated with distress associated with delusional ideation. These findings suggest that a metacognitive approach to the conceptualization of paranoia as a strategy for managing interpersonal threat may have some utility. The clinical implications of the findings are also discussed.

Given the large unmet need for services for anxiety, there is a need to develop larger-scale psychological interventions. Group interventions could help meet the need but the kind of Cognitive Behavioural Therapy (CBT) approach used merits investigation. The aim of the study was to compare the effectiveness and attendance of participants self-referring to three different CBT workshops: CBT, Cognitive Therapy (CT) only, and Behavioural (BT) only. Between 1998 and 2001 a series of day-long self-referral stress workshops were offered to members of the general public in South East London. A comparison was made of those attending the workshops immediately and those attending the workshops after a 3-month delay. Participants attending all three types of workshop reported reduced stress and anxiety compared with those in the wait-list control conditions. All three workshops were equally well attended. Results support previous findings showing the clinical effectiveness of large-scale stress workshops for the general public who suffer from high levels of anxiety. The specific kind of CBT approach did not make a marked difference either to attendance or outcome, although the CT groups invoked a greater degree of change on standardized measures than the BT or CBT groups.

Exposure to a traumatic event may lead a person to experience posttraumatic stress. But there are wide individual differences in the severity and chronicity of reactions. Some people remain affected for considerable periods of time, but others are able to adjust relatively quickly, and some even go on to report experiencing positive personal changes as a result of experience of trauma. The psychosocial framework proposes that individual variation in response to trauma is attributable to the interaction between various personality and social psychological factors. This is a practical framework for formulation and for developing interventions with people who have problems adjusting to traumatic life experiences. In this paper we provide a retrospective account of the building of the psychosocial framework, and using case examples illustrate its use in formulation and developing intervention with individuals with varying difficulties. We also aim to look beyond this work in the past to subsequent developments and to future directions, in particular the new and emerging field of growth through adversity.

A total of 1695 Norwegian adolescents answered a questionnaire concerning how they perceived and reacted to the threat of war during the 1999 Kosovo war and the 2003 Iraq war. Based on previous research and clinical experience the following hypotheses were formed: a) The Kosovo war, being in closer proximity to Norway, will result in more reactions than the Iraq war; b) There will be more communication between adolescents and adults following the Iraq war than following the Kosovo war, due to education by psychologists via the media in the intervening period; c) Girls will evidence more reactions than boys, in line with previous work; d) Adolescents who score above cut-off on the Impact of Event Scale will report less communication with friends and parents, in line with psychosocial theories of posttraumatic stress and previous empirical findings. The first three hypotheses were generally supported, but findings regarding hypothesis (d) were mixed. It is believed that a more open communicative climate has developed in families and schools following increased attention by professionals and media to the coverage of wars and disasters in the media. Mild reactions to the two wars suggest adolescent resilience. Professionals can play an important role in disseminating information on how such events can be handled by parents, professionals and society at large.

It has now been established in several randomized controlled trials that specialist cognitive-behavioural therapy (CBT) is an effective treatment for severe and persistent health anxiety (diagnostically, “Hypochondriasis”). It has not yet been established whether or not such results will generalize from academic research centres to routine clinical settings. The present study was designed to address the issue of generalization by evaluating the outcome of a consecutive series of patients meeting diagnostic criteria for hypochondriasis, treated using CBT in a non-academic clinic in Copenhagen, Denmark. The delivery of the treatment was adapted to fit with the practice of the clinic, so that the later components of therapy were delivered in a group therapy setting. Therapists participated in a brief training course, which was subsequently supplemented by expert clinical and peer supervision. Patients received the same amount of treatment used in previous clinical trials. Results indicate that the degree of improvement obtained in this study was significant and compared well with those obtained in the previous trials. These results support the use of dissemination of new treatments using a specialist training model.

The purpose of this paper is to report a pilot of Group Cognitive Behavioural Therapy (CBT) for Chronic Fatigue Syndrome (CFS). The cognitive behavioural approach to the management of CFS has been proven effective and group therapy is often seen as a cost effective approach where possible. Six patients with CFS who met the inclusion criteria were taken from a waiting list for CBT and entered the group. Treatment involved 10 sessions of one hour spread over 18 weeks. Using questionnaire analysis, measures of pre, post, and follow-up scores were used. Analysis, comparing medians with the Wilcoxin Signed Ranks Test reached statistical significance on the Fatigue Questionnaire and the Work and Social Adjustment Scale (p <.05) between pre and post-treatment levels. The authors conclude that these results may represent a useful approach to the management of CFS, but that a controlled trial is now required to establish this.

The transfer of knowledge occurs most effectively through the stories – the narratives – that we tell others and ourselves about our experiences. Cognitive behaviour therapists may incorporate stories, metaphors and analogies within their daily practice, when assessing suitability for treatment, challenging unhelpful styles of thinking, and addressing maintaining behaviours. The collaborative development of stories can enhance rapport, enable clients to gain a new perspective upon their problems, increase personal impact and clarity of meaning, and reinforce clients' motivation to effect therapeutic change. This paper discusses the use of the story, anecdote, metaphor, analogy, and quotation within cognitive behaviour therapy (CBT). The contribution of other psychotherapies to these forms of therapeutic communication is outlined. Practical examples of stories and analogies that illustrate the main principles of CBT and its application to the treatment of common mental disorders are described. The benefits and limitations of employing individualized analogies and stories within the therapy session are highlighted.