Background: This study adds to the limited evidence concerning the benefits of Interpersonal Psychotherapy (IPT) with depressed adolescents. It evaluates the long-term effects of group versus individual delivery of this treatment approach. Aims: To conduct a small-scale examination of the long-term efficacy of group versus individual delivery of IPT for depressed adolescents. Method: Thirty-nine adolescents, aged 13–19 years, with a primary diagnosis of Major Depressive Disorder, were randomly assigned in blocks to either group or individual delivery of IPT. Standardized clinical interview and questionnaire assessments were conducted at pre- and posttreatment, and 12-month follow-up. Results: Intent-to-treat (ITT) analyses indicated significant improvements in depression, anxiety, youth-reported internalizing problems, and global functioning from pre- to posttreatment for those receiving IPT, with no significant differences in outcome between group and individual formats of delivery. Improvements were maintained at 12-month follow-up. Completer analyses also revealed significant and sustained improvements on these measures for those receiving IPT, with no differences in outcome between therapy formats for most measures. Individual IPT showed significantly greater improvements than group IPT in parent-reported internalizing problems for the completer but not the ITT analyses. Conclusions: Both individual and group formats of IPT offer promise in producing long-term benefits in the treatment of depression among adolescents.

Background: Little is known about the effect of case-formulation based cognitive behaviour therapy (CBT) for anxious children. Aim: The present study explores the feasibility of case-formulation driven CBT for anxious children. Parents were involved in treatment as either co-facilitators (involved only as the child's assistants, treatment being primarily directed at the child), or as co-clients (parents received therapy targeting theoretically established maintaining mechanisms; children received half of the sessions, parents the other half). Method: Feasibility of the case-formulation driven CBT was established by comparing the completion rate and the percentage of children free of anxiety after treatment, with manualized treatments reported in existing meta-analyses. Children aged 7–12 years and their parents participated (n = 54). Families were assessed at pre- and posttreatment and at 6-month follow-up. Results: All families completed treatment and the percentage of recovery in the case-formulation driven approach was comparable to results obtained in manualized treatments. Conclusion: The findings from this stage I study supports the notion that a case-formulation driven approach to CBT may be a feasible option when selecting treatment for anxious children; however, further studies must be conducted before firm conclusions can be drawn.

Background: Computer-assisted cognitive behavioral therapy (CCBT) programs for childhood anxiety are being developed, although research about factors that contribute to implementation of CCBT in community mental health centers (CMHC) is limited. Aim: The purpose of this mixed-methods study was to explore consumers’ and providers’ perceptions of utilizing a CCBT for childhood anxiety in CMHC in an effort to identify factors that may impact implementation of CCBT in CMHC. Method: Focus groups and interviews occurred with 7 parents, 6 children, 3 therapists, 3 project coordinators and 3 administrators who had participated in CCBT for childhood anxiety. Surveys of treatment satisfaction and treatment barriers were administered to consumers. Results: Results suggest that both consumers and providers were highly receptive to participation in and implementation of CCBT in CMHC. Implementation themes included positive receptiveness, factors related to therapists, treatment components, applicability of treatment, treatment content, initial implementation challenges, resources, dedicated staff, support, outreach, opportunities with the CMHC, payment, and treatment availability. Conclusion: As studies continue to demonstrate the effectiveness of CCBT for childhood anxiety, research needs to continue to examine factors that contribute to the successful implementation of such treatments in CMHC.

Background: Substantial epidemiological research has shown that psychotic experiences are more common in densely populated areas. Many patients with persecutory delusions find it difficult to enter busy social urban settings. The stress and anxiety caused by being outside lead many patients to remain in-doors. We therefore developed a brief CBT intervention, based upon a formulation of the way urban environments cause stress and anxiety, to help patients with paranoid thoughts to feel less distressed when outside in busy streets. Aims: The aim was to pilot the new intervention for feasibility and acceptability and gather preliminary outcome data. Method: Fifteen patients with persecutory delusions in the context of a schizophrenia diagnosis took part. All patients first went outside to test their reactions, received the intervention, and then went outside again. Results: The intervention was considered useful by the patients. There was evidence that going outside after the intervention led to less paranoid responses than the initial exposure, but this was only statistically significant for levels of distress. Conclusions: Initial evidence was obtained that a brief CBT module specifically focused on helping patients with paranoia go outside is feasible, acceptable, and may have clinical benefits. However, it could not be determined from this small feasibility study that any observed improvements were due to the CBT intervention. Challenges in this area and future work required are outlined.

Background: The phenomenological heterogeneity of auditory hallucinations (AHs) means individual models struggle to account for all aspects of the experience. One alternative is that distinct subtypes of AHs exist, with each requiring their own unique explanatory model and tailored cognitive behavioural intervention strategies. Aims: This exploratory study tested for the presence of one specific potential AH-subtype, hypervigilance hallucinations (HV-AHs). Method: Four specific aspects of the phenomenology of AHs (chosen on the basis of the predicted phenomenology of HV-AHs) were assessed using a semi-structured interview in 32 individual AHs taken from reports from 15 patients with psychosis. Results: Cluster analysis (at the level of the individual AH-experience) offered support for the existence of a distinct HV-AH subtype, characterized by hearing threatening, externally-located voices when attention was externally-focused. Other clusters identified all shared the contrasting properties of occurring in quiet contexts when patients’ attention was internally focused. Conclusions: The results offered tentative support for the existence of an HV-AH subcategorization and justifies future research in larger samples. Potential implications for models of AHs are also considered.

Background: Cognitive therapy is an effective treatment for social anxiety disorder but little is known about the mechanisms by which the treatment achieves its effects. Aims: This study investigated the potential role of self-focused attention and social phobia related negative automatic thoughts as mediators of clinical improvement. Method: Twenty-nine patients with social phobia received individual cognitive therapy (ICT) in a randomized controlled trial. Weekly process and outcome measures were analysed using multilevel mediation models. Results: Change from self-focused to externally focused attention mediated improvements in social anxiety one week later. In contrast, change in frequency of, or belief in, negative social phobia related negative automatic thoughts did not predict social anxiety one week later. Conclusions: Change in self-focused attention mediate therapeutic improvement in ICT. Therapists should therefore target self-focused attention.

Background: Mental contamination is a psychological sense of contamination that involves an internal, emotional feeling of dirtiness that may be evoked by unwanted thoughts and images, such as sexual assaults. Aims: This study aimed to investigate which types of unwanted sexual experiences evoke the strongest mental contamination, and to test the hypothesis that cognitive appraisals of an unwanted sexual experience predict indices of mental contamination (i.e. feeling of dirtiness, urge to wash, internal negative emotions, and external negative emotions). Method: 148 female participants were asked to recall their most distressing unwanted sexual experiences. Indices of mental contamination and cognitive appraisals of the experience were then assessed. Results: Our findings indicated that individuals recalling experiences related to rape felt more intense feelings of dirtiness than individuals recalling other types of unwanted sexual experience, such as verbal sexual assault, visual sexual assault, and forcible touching/frottage. In addition, hierarchical regression analyses demonstrated that a cognitive appraisal of perceived violation predicted all of the indices of mental contamination after controlling anxiety, depression, and fear of contact contamination. Conclusions: The present study demonstrated that an individual is at greatest risk of mental contamination if she has experienced rape/attempted rape, and if she makes a cognitive appraisal of violation regarding the incident.

Background: Environmental factors have been associated with psychosis but there is little qualitative research looking at how the ongoing interaction between individual and environment maintains psychotic symptoms. Aims: The current study investigates how people with persecutory delusions interpret events in a virtual neutral social environment using qualitative methodology. Method: 20 participants with persecutory delusions and 20 controls entered a virtual underground train containing neutral characters. Under these circumstances, people with persecutory delusions reported similar levels of paranoia as non-clinical participants. The transcripts of a post-virtual reality interview of the first 10 participants in each group were analysed. Results: Thematic analyses of interviews focusing on the decision making process associated with attributing intentions of computer-generated characters revealed 11 themes grouped in 3 main categories (evidence in favour of paranoid appraisals, evidence against paranoid appraisals, other behaviour). Conclusions: People with current persecutory delusions are able to use a range of similar strategies to healthy volunteers when making judgements about potential threat in a neutral environment that does not elicit anxiety, but they are less likely than controls to engage in active hypothesis-testing and instead favour experiencing “affect” as evidence of persecutory intention.

Background: Current clinical models emphasize certain cognitive processes in the maintenance of distressing paranoia. While a number of these processes have been examined in detail, the role of strategic cognition and self-focused attention remain under-researched. Aims: This study examined the deployment of cognitive strategies and self-focused attention in people with non-clinical paranoia. Method: An experimental design was used to examine the impact of a threat activation task on these processes, in participants with high and low non-clinical paranoia. Twenty-eight people were recruited to each group, and completed measures of anxiety, paranoid cognition, strategic cognition and self-focused attention. Results: The threat activation task was effective in increasing anxiety in people with high and low non-clinical paranoia. The high paranoia group experienced more paranoid cognitions following threat activation. This group also reported greater use of thought suppression, punishment and worry, and less use of social control strategies when under threat. No differences were found between the groups on measures of self-focused attention. Conclusions: This study shows that the threat activation task increased anxiety in people with high non-clinical paranoia, leading to increased paranoid thinking. The use of strategic cognition following threat activation varied dependent on level of non-clinical paranoia. If these differences are replicated in clinical groups, the strategies may be implicated in the maintenance of distressing psychosis, and may therefore be a valuable target for therapeutic intervention.

Background: Despite the prevalence of co-morbid anxiety and depression in older adults, evaluation of suitable clinical models is rare. Aims: This study tested the acceptability and effectiveness of a transdiagnostic approach to treating co-morbid anxiety and depression in an older adults in a routine clinical setting. Method: In an A/B single case experimental design, a patient completed five daily ideographic measures of anxiety and depression across baseline and treatment and the HADS at five time points over time, including 3-month follow-up. The 8-session treatment was transdiagnostic CBT informed by the Unified Protocol. Results: All sessions were attended. Significant baseline-treatment improvements were found for daily structure, mood, confidence and worry, with large associated effect sizes. The HADS showed that the patient met recovery criteria by the end of treatment, with some evidence of anxious relapse at follow-up. Conclusion: Transdiagnostic CBT offers promise as a treatment approach to mixed anxiety and depression in older adults. The model needs to be further tested using more rigorous and suitably powered methodologies.