The quality control of therapy in routine clinical practice depends to a large degree on the ability of therapists to evaluate accurately their own performance in administering therapy. However, the literature in many fields casts doubt on the accuracy of people's self-evaluations. This study aimed to examine the accuracy of therapists' judgments about their own competence in cognitive therapy. Twenty-two therapists rated a tape of one of their cognitive therapy sessions from the middle of therapy using the Cognitive Therapy Scale (CTS) and provided information about their profession and their training in cognitive therapy. An independent expert rater, blind to all information about the therapist, also rated these tapes on the CTS. Therapists were coded as Competent or Less Competent on the basis of the observer-rated CTS score. Whilst there was a significant correlation between self-ratings and expert ratings of competence, therapists significantly over-rated their competence relative to the expert rater. Less competent therapists over-rated their own competence to a greater degree than therapists who met criteria for competence. The finding that therapists, especially less competent therapists, over-rate their competence in cognitive therapy has serious implications for ensuring effective practice of cognitive therapy in routine clinical situations.

This study tested the hypothesis that trauma memories are disjointed from other autobiographical material in posttraumatic stress disorder (PTSD). Assault survivors with (n = 25) and without PTSD (n = 49) completed an autobiographical memory retrieval task during script-driven imagery of (a) the assault and (b) an unrelated negative event. When listening to a taped imagery script of the worst moment of their assault, survivors with PTSD took longer to retrieve unrelated non-traumatic autobiographical information than those without PTSD, but not when listening to a taped script of the worst moment of another negative life event. The groups also did not differ in general retrieval latencies, neither at baseline nor after the imagery tasks. The findings are in line with suggestions that traumatic memories are less integrated with other autobiographical information in trauma survivors with PTSD than in those without PTSD.

Social phobia is a common and disabling condition for both children and adults. In recent years Clark and Wells' (1995) cognitive model of social phobia has given rise to an effective treatment protocol for the condition in adults (e.g. Clark et al., 2003, 2006). The current study investigates the applicability of this model to younger people. One hundred and seventy-one 11–14 year-old participants completed questionnaires measuring social anxiety, depression, and the variables hypothesized to maintain social phobia in Clark and Wells' (1995) cognitive model: negative social cognitions, safety behaviours, self-focused attention, and pre- and post-event processing. High socially anxious children scored significantly higher than low socially anxious children on all of the variables in Clark and Wells' model. Negative social cognitions, self-focused attention, safety behaviours, and pre- and post-event processing were all significant predictors of social anxiety, accounting for 48% of the variance in social anxiety. Furthermore, these variables showed specificity to social anxiety, predicting significantly more variance in social anxiety than in depression. Findings suggest that although Clark and Wells' (1995) model of social phobia was developed from research on adult populations, it may be equally applicable to younger people with social phobia.

This paper reviews recent theoretical, conceptual and practice developments in cognitive-behaviour therapy (CBT) for anxiety disorders. The empirical status of CBT for anxiety disorders is reviewed and recent advances in the field are outlined. Challenges for the future development of CBT for the anxiety disorders are examined in relation to the efficacy, effectiveness and cost-effectiveness of the approach. It is concluded that the major challenge currently facing CBT for anxiety disorders in the UK is how to meet the increased demand for provision whilst maintaining high levels of efficacy and effectiveness. It is suggested that the creation of an evidence base for the dissemination of CBT needs to become a priority for empirical investigation in order effectively to expand the provision of CBT for anxiety disorders.

Behavioural Activation is a contemporary contextual psychological treatment for depression. The outcome of a series of five treatment groups involving a total of 42 patients presenting to a psychotherapy department with self-reported depression is reported. Three of the treatment groups were delivered by two cognitive behavioural psychotherapists, two of the groups were delivered by a single cognitive behavioural psychotherapist and a trainee with no previous experience of the approach. The results suggest that group Behavioural Activation is an effective and tolerable treatment as indicated by BDI-II, CORE scores and the low drop-out rate. The methodological limitations of the findings are discussed.

The concept of safety (seeking) behaviours has been very important in cognitive behavioural models of anxiety disorders. Morrison (1998) considered how a similar process may be involved in the development and maintenance of auditory hallucinations; however there has been no research that specifically explores safety behaviours in people who hear voices. The S-REF model (Wells and Matthews, 1994) proposed that compensatory beliefs mediate the choice of coping mechanism. The aim of this study was to explore whether people who hear voices have interpretations about the experience of hearing voices and if this interpretation threatens their physiological or psychological wellbeing, do they engage in safety behaviours to prevent this feared outcome. The study also considered whether the choice of behaviour was cognitively mediated. Twelve participants who had heard voices in the previous 2 weeks completed the study; 11 participants reported catastrophic interpretations and 12 reported using safety behaviours. The theoretical and clinical implications are discussed.

There is uncertainty about the role of avoidance behaviours in recovery from loss. Some authors have noted that avoidance exacerbates grief, whereas others have claimed that avoidance, at some times during the grieving process, can foster recovery. In the current study, it was hypothesized that avoidance behaviours are particularly detrimental when mourners have threatening misinterpretations about the consequences of confronting the loss, but less detrimental when mourners do not have such misinterpretations. To test this hypothesis, 400 mourners completed questionnaires tapping threatening misinterpretations, avoidance, and complicated grief (CG) and depression. In support of the prediction, situational avoidance, ruminative avoidance, and efforts to maintain ties with the deceased were only linked with depression in those who strongly endorsed misinterpretations. In addition, misinterpretations magnified the associations of ruminative avoidance and efforts to continue ties, with CG. Findings suggest that avoidance interacts with threatening misinterpretations in affecting particular emotional problems after loss.

Relationships between trauma symptoms and delusional ideation were explored in a forensic sample. A between-subjects design compared low and high trauma scoring patients on measures of delusional ideation and paranoia. A within-subjects design examined associations between trauma-related cognitions, delusional ideation and paranoia. Thirty-four participants were recruited from a number of secure units. Participants' “worst trauma” was identified using a self-report analogue scale. Self-report measures of trauma symptoms, trauma-related beliefs, delusions and paranoia were completed. Thirteen patients scored above the cut-off on the trauma measure, indicating a high rate of trauma symptoms. The most frequently cited worst traumas were committing an offence and the experience of psychosis. Correlational analyses revealed positive associations between traumatization and intensity of delusional ideation and paranoia. Trauma-related negative cognitions about the self were positively associated with level of delusional ideation, associated distress, and preoccupation. Negative cognitions about the world were associated with paranoia. Findings provide some evidence for associations between traumatization and delusional ideation and paranoia in this population. Future research should aim to replicate and extend the study, using a larger sample size and diagnostic measures of post-traumatic stress disorder (PTSD).

The past decade has seen considerable growth in the evidence base of cognitive behavioural therapy for psychosis. Consistent reports of moderate effect sizes have led to such interventions being recommended as part of routine clinical practice. Most of this evidence is based on a generic form of CBT for psychosis applied to a heterogeneous group. An increase in the effectiveness of cognitive behavioural interventions may require new protocols. Such therapeutic developments should be based on the theoretical understanding of the psychological processes associated with specific forms of psychotic presentation. The current evidence base of CBT for psychosis is reviewed, and barriers that have held back the development of this research are discussed.

We report the results of a randomized controlled trial that compared the efficacy of an internet-based self-help treatment for paediatric headache including chat communication (cognitive-behavioural treatment, CBT) with an internet-based psychoeducation intervention (EDU). In the CBT group, significant pre- to post-treatment decreases were found for headache frequency and pain catastrophizing, but not for headache intensity or duration. In the EDU group none of the variables (frequency, intensity, duration, pain catastrophizing) showed improvement. No significant between group differences were found for headache variables and pain catastrophizing at post-treatment. The patients reported high satisfaction with the internet-based training and a good patient-trainer-alliance. Results were maintained at 6-month follow-up. Due to the small sample size, no general conclusions can be drawn regarding the efficacy of the internet-based training regarding the outcome variables, but the training was well accepted by patients. Further research is necessary to evaluate the therapeutic potential of such interventions.

Cognitive models of obsessive compulsive disorder (OCD) have been influential in understanding and treating the disorder in adults. Cognitive models may also be applicable to children and adolescents and would have important implications for treatment. The aim of this systematic review was to evaluate research that examined the applicability of the cognitive model of OCD to children and adolescents. Inclusion criteria were set broadly but most studies identified included data regarding responsibility appraisals, thought-action fusion or meta-cognitive models of OCD in children or adolescents. Eleven studies were identified in a systematic literature search. Seven studies were with non clinical samples, and 10 studies were cross-sectional. Only one study did not support cognitive models of OCD in children and adolescents and this was with a clinical sample and was the only experimental study. Overall, the results strongly supported the applicability of cognitive models of OCD to children and young people. There were, however, clear gaps in the literature. Future research should include experimental studies, clinical groups, and should test which of the different models provide more explanatory power.

Self help approaches are increasingly being used in healthcare settings through over 100 book prescription schemes in the UK. The use of Cognitive Behavioural Therapy (CBT) self-help materials for depression is advocated as part of stepped care service models. This study assesses how the reading ages of the most recommended self-help books for depression compare to British literacy levels. A cross sectional survey was carried out. The most recommended self-help books for depression were identified; seven CBT based self-help books were included in this study as well as a widely used booklet for depression. Readability scores and reading ages were calculated for a randomly generated selection representing 15% of each selected book using the Readability Studio® software to generate a wide range of key readability and comprehension scores. The reading ages of the selected books were between 12.6 and 15.4. Reading ease varied amongst the texts, and their complexity (percentage of unfamiliar words, range: 14.8% – 22.6%). A significant proportion of the UK population would struggle to use some of the current CBT-based self-help books recommended. For some patient groups, non text based self-help materials as well as shorter and more easily read written materials may be more appropriate. To our knowledge, this is the first study to address this question. Publication of the reading ages of the recommended books within the book prescription schemes may allow for a more accurate match between the book and the reader.

According to the cognitive model, an inflated sense of responsibility is an important cognitive mediator both in the development and maintenance of obsessive-compulsive disorder (OCD). Empirical findings assign differential roles to responsibility in different kinds of obsessive-compulsive (OC) symptoms. However, findings that suggested a different function for responsibility revealed the need for an operational definition of responsibility and its multi-factorial structure. Few studies have examined the role of responsibility in OC symptoms in adolescents. The present study therefore aimed to explore responsibility concerns and to evaluate the relationship between responsibility dimensions and obsessive-compulsive symptom subgroups in two samples of adolescents and university students in a developing non-Western country. The findings suggested that the Responsibility Attitude Scale had a bifactorial structure, responsibility being based on self-dangerousness and prevention. Adolescents reported more responsibility in prevention and self-dangerousness than university students. The results appear to contribute to the symptom differentiation of OC behaviour by highlighting the importance of both dimensions of responsibility for checking symptoms, responsibility based on danger prevention for cleaning and, finally, responsibility based on self-dangerousness for obsessive thinking. Replication with clinical samples and different methodologies are encouraged.

Procrastination can have deleterious effects on well-being. Despite this, little is known about cognitive-attentional processes involved in procrastination. In this study, 12 individuals self-reporting problematic procrastination were assessed using a semi-structured interview to investigate: (1) whether they held positive and/or negative metacognitive beliefs about procrastination; (2) what was their main goal in procrastinating, and how they knew if they had achieved their goal; (3) how they directed their focus of attention when procrastinating; and (4) what they perceived the advantages and disadvantages of these attentional strategies to be. Results indicated that participants endorsed both positive and negative metacognitive beliefs about procrastination, and that the goal of procrastination was to regulate cognition and negative affect. Participants reported that they either did not know how to determine if they had achieved their goal or that an improvement in mood would signal the goal was achieved. Participants also reported that the principal object of their attentional focus when procrastinating was their emotional state. All participants were able to identify disadvantages to their attentional strategies, whilst nine participants described perceived advantages. The implications of the findings are discussed.

Obsessive-compulsive symptoms (OCS) have been observed in a substantial proportion of patients with schizophrenia. Although several studies have investigated the comorbidity associated with OCS in schizophrenia, few case studies are available regarding cognitive behavioural therapy (CBT) for the treatment of OCS of patients within this group. This paper describes a case report in which OCS emerged gradually after the remission of positive symptoms of schizophrenia. The CBT involved psycho education and case formulation, cognitive restructuring, exposure and response prevention (EPR), and behavioural experiments. Improvement in the compulsive behaviours led to a greater insight regarding the relationship between OCS and past experience of positive symptoms (e.g. hallucinations). The cognitive characteristics of the patient were discussed in light of current cognitive models of OCD.

Parenting styles are associated with anxiety in children. Part of this association can be explained by how parenting interacts with known pathways to anxiety. Although parenting interacts with the verbal threat information pathway to create anxiogenic cognitions in children, it is not known whether parenting styles mediate the physiological component of the anxiety emotion. An experiment is reported in which 6–10-year-old children (N = 54) completed parenting styles, and anxiety beliefs questionnaires. They were then given threat, positive or no verbal information about three novel animals before being asked to place their hands in boxes they believed these animals inhabited. Their average heart rate during the approach was recorded. The results suggest that a neglectful maternal parenting style mediates the effect that verbal threat information has on physiological responses. However, a punitive maternal parenting style, maternal warmth, overprotection, and accurate monitoring were not found to have a significant effect. Paternal parenting styles were not found to have any significant effect. This experiment adds to the existing evidence demonstrating that parenting practices can mediate components of acquired anxiety emotions.

The eating disorders provide one of the strongest indications for cognitive behaviour therapy (CBT). This bold claim arises from two sources: first, the fact that eating disorders are essentially cognitive disorders and second, the demonstrated effectiveness of CBT in the treatment of bulimia nervosa, which has led to the widespread acceptance that CBT is the treatment of choice. In this paper the cognitive behavioural approach to the understanding and treatment of eating disorders will be described. A brief summary of the evidence for this account and of the data supporting the efficacy and effectiveness of this form of treatment will be provided. Challenges for the future development and dissemination of the treatment will be identified.

Clinical supervision is of growing importance professionally, but instruments to measure its effectiveness are scarce. Based on the observational instrument Teachers' PETS, two complementary levels of outcome measurement were used to analyse supervisory effectiveness, namely momentary time sampling (i.e. a micro-analysis of frequencies) and the more molar “change episodes”. Ten audio-taped sessions of routine (baseline; N = 5) and CBT supervision (N = 5; i.e. the intervention phase) were coded with both measures, to assess their relative sensitivity to this manipulation. Improved supervisee learning was detected during the intervention phase by both measures. However, a retrospective comparison between the data within these change episodes and the accompanying non-episode data indicated that the micro level of analysis provided a more sensitive measure of supervisory effectiveness. Technical and conceptual issues arise.

Five variables were investigated with regard to their possible predictive value for cognitive behavioural treatment (CBT) outcome in a large sample of panic disorder (PD) patients. The variables were initial symptom severity, comorbid anxiety or depressive disorders, comorbid cluster C personality disorders, and initial motivation for treatment. A total number of 161 PD patients received a standardized CBT of 15 sessions. Assessments of predictive variables took place prior to treatment. Outcome measures were assessed at pre- and posttreatment. The patients had significantly improved after the treatment. None of the variables, separately or together, affected CBT outcome, save initial severity of panic disorder symptoms, which was positively associated with posttreatment symptom severity. Since research efforts failed to produce consistent predictors for CBT treatment outcome in panic disorder thus far, the usefulness of future outcome prediction research in panic disorder by pre-treatment demographic, disorder-related, psychological, or socio-psychological variables is put into question.