A five session cognitive behavioural treatment of an injection phobia is described, in which the patient’s dysfunctional attitudes about not being able to control events played a central role. The extreme negative meaning of the phobic situation was explored, and then the patient was asked to say when in her life she could first remember having those types of thoughts and emotions. This helped her to understand some of the origins of her fear, and then to transform the negative meaning into a more realistic positive one. The “Stress-In-Dynamic-Context” model of acquisition of phobias was used to understand factors other than simple pairing of stimuli that might have been involved in the triggering of her phobia.

By means of a single case study, the effects of redirecting attention above exposure only on fear of blushing, avoidance, and idiosyncratic dysfunctional beliefs were tested. A social phobic patient with fear of blushing as the predominant complaint received sessions of Task Concentration Training (TCT) and Exposure in Vivo (EXP) alternately, after a steady baseline had been established. The treatment consisted of 14 individual sessions. Assessments were held before and after baseline, after treatment, after 4 weeks follow-up, and after 1-year follow-up. Continuous measurements were held throughout the treatment in order to measure the differential effects of TCT and EXP on fear, avoidance and beliefs. TCT and EXP together, turned out to be an effective treatment for fear of blushing: large effects were observed on all three outcome measurements. When differential effects are closely looked at, EXP seemed more effective in decreasing fear of blushing. However, the patient appeared to have used TCT strategies as well during the EXP weeks, which may have contributed to the favourable effects of EXP.

The potential uses of the Internet to behavioural and cognitive psychotherapists and researchers are manifold. This article summarizes what the Internet is, how to connect to it, searching the Web, on-line publishing, discussion forums, chat-rooms, literature searching, transfer of documents and creating a web-site. It considers the potential of Internet technology in therapy and enhancing patient/therapist contact. A web page containing links to many of the sites referred to in this article as well as additional links and resources is accessible through the BABCP website (www.babcp.org.uk).

Chronic fatigue syndrome is a disabling condition characterized by persistent mental and physical fatigue. Its aetiology is controversial, and it has been attributed to both physical and psychological causes. Previous controlled trials with ambulatory patients have shown that a proportion of CFS patients respond to cognitive-behaviour therapy. In this paper, we report two case studies of patients who are wheelchair-bound, who have been treated by a pragmatic intervention designed to increase activity and challenge dysfunctional illness beliefs. The patients received 60 and 55 contacts with the therapist, some of which were face-to-face and some of which were by telephone. At the end of treatment, the patients experienced clinically significant reductions in fatigue, were not using wheelchairs, showed an increase in occupational and social functioning and were leading relatively independent existences.

Twenty participants self-referred from the general population as experiencing depersonalization were interviewed to determine the qualities of the experience and possible pathology. The participants and control group were also administered a battery of questionnaires measuring different aspects of psychopathology. There were no consistent diagnostic associations with depersonalization. In the majority of cases, onset was reported after a traumatic life event, or after sexual abuse or after giving birth. The most frequent experiences were related to derealization and participants did not score high on dissociation in general. The most common strategy to alleviate the problem was concentrating on a task. We distinguish between those clients who viewed the experience as a loss of or less than normal sensation, which we qualified as negative symptoms and others who evaluated the experience as an addition to their usual perceptions and sensations, which we qualified as positive symptoms.

A strategy involving urine-triggered alarm signals and prompts combined with positive reinforcement for appropriate urination was employed for promoting daytime urinary continence in a boy with severe intellectual disability. The strategy, which was applied only in the day centre the boy attended, seemed effective for promoting self-initiated toileting actions and for eliminating almost totally large urinary accidents. Some small urinary accidents (consisting of wetting small areas of the underpants) remained. Implications of the findings are discussed.

The efficacy of CBT for psychosis will be enhanced by a greater understanding of the mechanisms underlying symptoms. Therefore, an investigation is reported that examined a role for a neglected factor, anxiety, in the maintenance of delusional beliefs. It was hypothesized that processes responsible for chronic worry, as detailed by Wells’ (1994a) meta-cognitive model, contribute to delusional distress. Questionnaire measures of anxiety, chronic worry and of meta-worry and related processes were administered to individuals with persecutory delusions (N=15) and individuals with generalized anxiety disorder (GAD) (N=14). Evidence was found for the presence of dysfunctional meta-cognitive processes in the clinically anxious group, which adds to the growing support for the model of GAD. Moreover, it was found that many of the individuals with persecutory delusions had high levels of general worry, and the factors implicated in the meta-cognitive model of anxiety were also present in this group. The results indicated that delusional distress is not simply related to content but is associated with whether the individual experiences meta-worry concerning the control of delusion-relevant worries, that is, whether he or she worries about not being able to control thoughts about the belief. This is the first theoretical development of the important dimension of delusional distress.

The Nijmegen Motivation List 2 (NML2) is a new instrument to assess patient motivation for psychotherapy. A previous version of the instrument was associated with positive treatment outcome in cognitive-behaviour therapy in several studies but its psychometric properties were poor. The present study investigated the NML2’s factorial structure, psychometric properties, and predictive value for treatment outcome. The NML2 was completed by 133 outpatients. Three factors were found: preparedness, distress, and doubt. Internal consistencies and re-test reliabilities of the factors were reasonable. The NML2 total score and preparedness were associated with proximal treatment helpfulness and with treatment drop-out. Distress and doubt were not. These findings corroborate those found with the earlier NML version. Rather than assuming that the relationship between motivation factors and treatment outcome is mediated by the amount or quality of treatment or homework compliance, it is proposed that motivation for treatment is the first step in the patient’s change process itself.

The present paper aimed (1) to review the literature to examine the effectiveness of CBT as treatment for PDA and (2) to evaluate whether the efficacy of CBT treatments is related to the change to cognitive processes that are postulated to be important in the cognitive models of PDA. A literature review of CBT studies in the area of PDA was conducted using both descriptive and quantitative (meta-analysis) procedures. In all, 35 studies published between 1969 and 1996 were included. The results show that CBT is an effective treatment for PDA. However, the contribution of cognitive processes to this disorder and the role that they play in the successful outcome of CBT remain unclear and in need of further empirical investigation. At present, CBT treatment provides limited support to validate the cognitive models of PDA.

Nagy Bishay was born in 1936 in Cairo, Egypt, the eldest son of a lawyer. He decided to pursue a medical career and after his medical training in Cairo, he joined the army as a general practitioner and soon pursued his interest in psychological medicine and gained its diploma. He practised psychiatry in 1965 in different military hospitals, was particularly interested in military psychiatry during the 1967 war, and wrote his MD thesis on the study of hysterical fits among young adult males under the stress of military service.

He came to England in 1975, seeking to further his experience and training and in pursuit of improving his therapeutic skills. He trained as a senior registrar in psychiatry in the West Midlands Regional Health Authority and took up his post as consultant psychiatrist at the North Manchester General Hospital in 1980. He had an initial interest in psychoanalysis and group analytic psychotherapy, then was introduced to cognitive therapy in 1982, a tool he continued to develop and use with passion for the remainder of his years.

Psychiatrists, who are still performing the executive roles in many areas of mental health, make up 6.5% (N=184) of the British Association for Behavioural and Cognitive Psychotherapies (BABCP) membership. Considering that there are currently 4577 practising psychiatrists in the U.K. (Consultants, Senior Registrars, Specialist Registrars, Associate Specialists and Staff grades), the above figure is put into perspective. The equivalent figure for clinical psychologists is 40.9% (N=1162) of BABCP membership, taken from a national total of 3734 qualified professionals. Viewed in this context, the present review examines the profile of cognitive therapy (CT) in British psychiatry during the last three decades. As a measure of this, it was decided to survey the number of articles on cognitive therapy appearing in two key psychiatric journals widely circulated in Britain: The British Journal of Psychiatry and Current Opinion in Psychiatry.

Training in cognitive therapy includes a grounding in relevant empirical research, and the development of a range of clinical skills. It is recognized that this training will need to be continually updated in line with new developments. Several postgraduate training courses in cognitive therapy or cognitive behaviour therapy exist in the United Kingdom. Such courses are expensive in terms of both direct and indirect costs. A postal survey was employed to investigate the effects of the one-year post-qualification course in cognitive therapy at the Newcastle Cognitive Therapy Centre on trainees who had attended the course. The questionnaire examined trainees’ views about the course, of their current clinical skills in cognitive therapy and their use of cognitive therapy since leaving the course. Finally, continuing professional development, on-going supervision and further training in cognitive therapy were examined.

This single case study describes the successful application of pelvic floor exercise to the treatment of childhood encopresis. A 10-year-old boy with lifelong incontinence of faeces and anal sphincter hypotonia practised daily pelvic floor contractions by interrupting his urine flow mid-stream, the rationale for the regime being strengthening of the sphincter muscle and improvement of its voluntary operation. Benefits to bowel control were immediate and complete cleanliness was achieved in 9 weeks. Being non-intrusive, the exercise procedure may be more acceptable to some patients with anal sphincter flaccidity than balloon biofeedback. The likely mechanism underlying the method is simultaneous contraction of the anorectal sphincter when the bladder sphincter is tensed.

Where a behaviour has been maintained on a variable schedule of reinforcement theoretically it should be possible to reduce resistance to extinction by first putting the behaviour onto a continuous schedule of reinforcement. This approach has been employed in animal research but rarely with human participants, and where it has, with little success. This study describes the use of the approach to overcome some minor problems in the behaviour of young children, the problems being sufficiently troublesome for the parents to consult their GP. All the families who used the approach were successful in remediating the behaviour. Some reasons for this success, in contrast with the disappointing outcomes of some of the earlier research, are discussed. Although the study lacks formal controls it is suggested that the approach could be usefully applied to other common childhood behaviours that have been subjected to variable reinforcement.

Memory aid groups have often been used as a method for teaching mnemonic strategies to older adults in early stages of dementia. This study describes the use of CBT to address unhelpful memory-related beliefs in three older men with mild/moderate dementia and associated low mood or anxiety. The members were able to participate and engage in the sessions, and changes in behaviour, cognition and affect were monitored over the course of a 7 week group intervention. Recommendations are made for further research.

Empirical evidence for the efficacy of Cognitive Therapy (CT) treatments for older adults, when compared with other psychotherapies, is inconclusive (Davies & Collerton, 1997). The current authors suggest that one reason for the equivocal findings lies in the failure to adapt the cognitive rationale sufficiently to cater for the different presentation of depression in older people; particularly for those experiencing first-episode late onset-depression. It is argued that existing models tend to focus on the negative aspects of self-appraisal, and fail to fully conceptualize the functional role of positive beliefs (i.e. functional beliefs that have maintained the self-esteem over many years). The work presents an alternative conceptualization of depression for older people, along with implications for therapy. This framework does not represent a brand new approach, but emphasizes specific aspects of existing psychological conceptualizations.