This issue sees the introduction of another journal section. I have been aware for some time of both the importance and strength of systematic reviews, meta-analyses and other published aspects of what has come to be termed “evidence based medicine” (EBM) and “evidence based mental health” (EBMH). At the same time, there is a co-existing uneasiness that something was missing, and that EBM promised more than it was able to deliver. There is a sense of scientific sterility that goes with this approach. It does not seem to be a complete formula for making sense of the existing literature, and it falls far short of what is needed for the scientific development of our ability to understand and treat psychological distress. This unease is increased by the way in which it appears that EBMH approaches provide definitive answers, an algorithm against which current science and clinical practice is to be weighed.

The current emphasis on Evidence Based Medicine (EBM) is both welcome as a bid to improve the empirical foundations of clinical practice and a cause for concern because it has the potential to distort the scientific approach that has underpinned the development of cognitive-behavioural approaches. It is suggested here that EBM needs to be seen in context; that is, as an approach that almost exclusively focuses on just one of the dimensions that have been and are crucial to the further development of Cognitive-Behavioural Treatments (CBT). EBM is particularly well suited to the development of Biological approaches to treatment, where treatments (and treatment development) are largely atheoretical. However, different considerations apply to CBT, where validated theory and linked research studies are key factors. It is suggested that relationship to evidence in CBT is best conceptualized in terms of Empirically Grounded Clinical Interventions. The parameters of such an approach are considered in relation to the Scientist Practitioner model that is prevalent in the field.

Recent research indicates the apparent paradox that social anxiety may be associated with both self-focused attention and selective attention to external social threat cues. A naturalistic paradigm was designed to explore both processes. High and low socially anxious individuals were asked to make a speech to a monitor displaying six people whom they believed to be watching them live. Two audience members exhibited only positive behaviours, two only neutral ones and two only negative behaviours. In contrast to the low social anxiety group who selectively discriminated positive audience members, the high social anxiety group selectively discriminated the negative individuals, yet they were no more accurate at discriminating the negative behaviours the audience members had performed and they reported more self-focused attention than the low social anxiety group. The effects remained while covarying for differences in dysphoria. The results indicate that socially anxious individuals base their judgements of being disapproved by others on limited processing of their social environment.

This study reports the factorial structure and psychometric properties of a Spanish version of the Padua Inventory (PI) in a sample of 863 undergraduate students, 55 patients with Obsessive-Compulsive Disorder (OCD), and 20 patients with other anxiety disorders (OAD). A Principal Components Analysis suggested a 4-factor structure, which was comparable but not identical to that found in other versions of the PI involving non-clinical samples. The PI sub-scales showed good internal consistency, test-retest reliability, as well as convergent and discriminant validity. The “Washing” sub-scale of the PI failed to separate OCD and OAD patients, although this may have been due to small sample sizes. It is suggested that a revised version of the PI should include symptoms that are not currently represented in the scale, such as hoarding obsessions and compulsions.

This paper describes a distinct clinical approach to the treatment of Posttraumatic Stress Disorder (PTSD). It is theoretically guided by recent cognitive models of PTSD and explicitly combines cognitive therapy techniques within exposure/reliving procedures. A clinically pertinent distinction is made between the cognitions and emotions experienced at the time of the trauma and, subsequently, in flashback experiences, and secondary negative appraisals. The term peritraumatic emotional “hotspot” is used to describe moments of peak distress during trauma. It is argued that a focus on cognitively restructuring these peritraumatic emotional hotspots within reliving can significantly improve the effectiveness of the treatment of PTSD and help explain some treatment failures with traditional prolonged exposure. An approach to the identification and treatment of these hotspots is detailed for a range of cognitions and emotions not limited to fear.

The objective of this study was to evaluate a multi-component behavioral intervention for child distress during repeated needle sticks. An AB single-subject experimental design with replication of procedures across five subjects was used to assess intervention effects on distress and procedure duration for five children (age 3–7 years). Playing preferred activities, signaled button pressing, and following directions were positively reinforced first during simulated then actual needle procedures. The results indicate that distress decreased substantially for three children, slightly for a fourth and was unchanged for one. Heart rate (HR) data obtained from one child provided preliminary evidence of counterconditioning. For three children with follow-up data, benefits were maintained after intervention transfer to caregivers. In conclusion, distraction and counter-conditioning appear to be compatible conceptualizations for designing interventions to reduce the distress of experienced children who undergo repeated invasive procedures. The independent and synergistic effects of behavioral interventions based on these two theories should be examined in future studies.

A consecutive series of six adolescents referred for obsessive compulsive disorder were treated using a cognitive behavioural approach that included procedures intended to: (1) reach a shared understanding of the psychological nature of the problem; (ii) normalize intrusive thoughts; (iii) help the patient to reappraise notions of responsibility; and (iv) help the patient re-evaluate the basis of their fears. The effects of treatment were measured using standardized questionnaires designed to elicit beliefs about responsibility, and symptoms of anxiety, depression, and obsessive compulsive disorder. During the course of treatment, appraisals of responsibility changed at the same time as changes in symptom levels. The results suggest a more cognitive approach to treatment can be helpful for this age group, and that cognitive change is associated with clinical improvement.

Based on a behavior-analytic interpretation of the skills acquisition process, a rationale is presented for augmenting a currently available cognitive-behavioral treatment (The Adolescent Coping With Depression course: CWD-A) with a newly developed therapy focusing on the interpersonal interactions and learning occurring in-session (Learning through In-Vivo Experience: LIVE). A description of the practice of LIVE is offered and the results from an initial feasibility study are presented. Using a single-subject methodology, two groups each consisting of 5 adolescents with significant symptoms of depression received the treatment. The intervention consisted of 16 2-hour group sessions occurring over an 8-week period. The first 1-hour of each meeting was taken directly from the CWD-A manual. The second hour was based on the LIVE manual. The adolescents who completed the treatment (n = 8) improved from pretreatment to posttreatment and those who discontinued treatment (n = 2) did not. Improvements were maintained at 3 months follow-up. The treatment produced strong group cohesion and both adolescents and their guardians rated the intervention positively. These results provide initial evidence of the efficacy of complementing CWD-A with LIVE.

A single case study is described of a cognitive behavioural approach with an elderly man with a delusional disorder of 6 years. Successful treatment, case conceptualization and engagement issues are reported. The delusion was that household electrical equipment was giving out dangerous rays and giving him cancer. Self-report measures and a cognitive challenge test evaluated results. Rapid and positive results were achieved. Recommendations for future research are made.

The aim of this study was to demonstrate the effectiveness of cognitive behavioural treatment (CBT) with a focus on academic skills and conduct problems and to increase parents' educational skills in managing aggressive and oppositional behaviour in a subsequent parent training (PMT). For this purpose 18 children with a diagnosis of ADHD combined type participated in the study. In an A-B study design the effects of a 12-week treatment phase (6 weeks CBT; 6 weeks PMT) were compared with a preceding 4-week baseline. Core symptoms of ADHD, conduct problems and individual problem behaviour were assessed by weekly administration of parent and teacher questionnaires. The results indicate a significant and generalized reduction of ADHD core symptoms, conduct problems and homework problems during CBT at home and at school. PMT resulted in a further amelioration of the cited symptoms. We conclude that CBT may be a promising component in the treatment of ADHD provided that aspects of generalization are considered during the treatment. PMT may be a useful adjunct in most cases as it is effective in situations where the ADHD child still has problems of self-guidance.