Thirty-seven (37) couples experiencing child behavior problems and concurrent marital conflict were randomly assigned to one of two variants of a group parent training program, either Standard Group Triple P (SGTP; n=19) or Enhanced Group Triple P (EGTP; n=18). SGTP incorporated 8 sessions (4 group sessions and 4 telephone consultations) and taught parents to identify the causes of child behaviour problems, promote children's development, manage misbehavior and plan ahead to prevent child behavior problems in “high risk” parenting situations. Families in the EGTP condition received SGTP plus 2 additional group sessions of parent support training that taught partners to support one another to parent as a team. These additional sessions included information and active skills training in communication skills; giving and receiving constructive feedback; holding casual conversations; supporting each other when problems occur; holding problem solving discussions; and improving relationship happiness. There were significant improvements from pre- to post-intervention for both conditions, on measures of disruptive child behavior, dysfunctional parenting style, conflict over parenting, relationship satisfaction and communication. No differences, however, were found between the two conditions, with both the EGTP and the SGTP programs resulting in similar outcomes. In the main, initial treatment effects for both mothers and fathers were maintained at 3-month follow-up.

Experiential training and personal therapy have rich traditions in various therapies as strategies to enhance self-awareness and therapist skills. However, personal experiential work has not traditionally been part of cognitive therapy (CT) training. The purpose of the present study is to map the impact of personal experiential work on CT skills in a group of CT practitioners. Fourteen cognitive therapists undertook training courses utilizing a structured approach to self-practice of CT techniques, known as self-practice/self-reflection (SP/SR). Six therapists from one training group engaged in “co-therapy” sessions with a partner, while eight therapists from another training group practised CT techniques on their own. Both groups engaged in regular written reflections about their experience. Follow-up 1-5 months after the courses identified six areas of self-reported skill enhancement: Refinement of specific CT skills; Enriched communication of the conceptual framework of CT; Increased attention to the therapeutic relationship; Empathic attunement; Therapist self-reflection; and Therapeutic flexibility. The results suggested that SP/SR enhances the “professional artistry” of therapists, a finding consistent with literature suggesting that reflection is a key process in the development of therapist expertise. It is concluded that SP/SR represents a promising training strategy for cognitive therapists.

The extent to which cognitive behaviour therapy can be used with children is unclear. In meta analyses older children and teenagers seem to derive greater benefit than young children. This may be because the cognitive immaturity of young children means that they cannot manage the cognitive demands of cognitive behaviour therapy. This paper seeks to establish how well children aged 7-8 and aged 10-11 can complete a task requiring them to distinguish between thoughts and behaviours (based on Greenberger & Padesky, 1995). Half of the children were provided with a visual cue and half were not. The effects of age, the visual cue, and verbal IQ on performance were examined. Seventy-two children were randomized to the cue and no-cue condition and individually tested during school time. Both age groups performed well and there was a significant difference between older and younger children, with the older children performing better. Visual cues did not aid performance. Verbal IQ was significantly associated with performance in the younger but not the older children. The implications of these results for the delivery of cognitive behaviour therapy with children and future research are discussed.

The acceptability of behaviour management methods has become an important area of concern. However, most research has focused on behaviour support plans. This study evaluated the acceptability of a restrictive procedure used in dentistry: the hand over mouth technique. Two-hundred-and-eighteen members of the general public rated one of eight vignettes using the Treatment Evaluation Inventory. A 3-factor independent groups design evaluated the effects of child disability (average intelligence or moderate learning disability), intervention method (relaxation training and reinforcement or hand over mouth) and behavioural outcome (child became less distressed or child remained distressed). A significant main effect of treatment outcome was found, and effective treatments were rated as more acceptable than ineffective treatments. There was a marginal effect of treatment type, hand over mouth being rated as less acceptable than the use of reinforcement and relaxation. Where child behaviour problems are marked, the public's ratings of acceptability are largely influenced by the outcome of treatment.

The motivational interviewing skills code (MISC) was used to review 86 audiotaped interactions between clinicians and patients participating in a smoking cessation intervention. Intraclass correlations (ICCs) were completed for two of the MISC elements: global evaluations and behavior counts. Results indicate 75% of the global ratings yielded ICCs in the good to excellent range, while only 44% of the behavior counts yielded this level of accuracy. Adherence scores were created to form overall ratings of clinician adherence to using motivational interviewing and 80% of these competence measures yielded ICCs in the good to excellent range. Specific recommendations regarding modifications for the MISC are suggested based on the data presented.

Delivery of cognitive behavioural therapy (CBT) is limited by a scarcity of resource. In England and Wales, there are not enough practitioners appropriately trained in CBT to meet the needs of those who might benefit from treatment. In addition, there are reasons to believe that available therapists are inequitably distributed across the country. We investigated the distribution of British Association of Behavioural and Cognitive Psychotherapies (BABCP) members, accredited CBT practitioners, and BABCP members who are nurses or clinical psychologists in England and Wales by postal code. This analysis demonstrated a 20-fold discrepancy in availability of accredited CBT practitioners between the best and least well-served population deciles. Despite limitations, these findings are highly indicative of “postcode availability” of the best qualified CBT practitioners. We discuss possible strategies to remedy this inequity, which further challenges the ability of conventional methods of CBT delivery to meet public health requirements.

The importance of clinical supervision is increasingly recognized, as is the need to demonstrate that the work we do in the NHS is effective. However, observational analyses of supervision or evidence bearing out the effectiveness of supervision are rare and narrow in focus. To contribute to the evidence base, the present N=1 content and outcome evaluation describes and then assesses the effectiveness of cognitive behaviour therapy supervision, in terms of its observed impacts on a supervisee and her patient. The supervisee was a trainee therapist participating in a diploma course in cognitive therapy. The study utilized a qualitative and quantitative content analysis methodology, based on the intensive coding of a series of 10 longitudinal, video-recorded supervision sessions, linked to the subsequent 10 therapy sessions. Based on this method, 14 supervisory themes were extracted, which served to describe the change methods employed in the supervision. The predicted transfer (generalization) of those themes from supervision to therapy was observed to occur to a surprisingly marked extent, indicating that the supervision was effective. Implications are drawn for developing supervision and related research.

The assessment and treatment of an unsuaul pre-sleep ritual are described. The patient had unusual ideas about the probability and consequences of self-harming behaviour in sleep, and averted such behaviour through a ritual with possibly dangerous consequences. The origin and maintaining factors of the ritual are described; a cognitive-behavioural approach was used to treat the ritual, with successful results.

Psychological measures have little sensitivity in the prediction of postnatal depression. We report the development of a questionnaire of beliefs about pregnancy and motherhood. Information from a literature review, staff working with women with postnatal depression and interviews with recently ill patients was used to develop a questionnaire called the PRBQ. The PRBQ was piloted on 42 pregnant women and achieved a Cronbach alpha of 0.85. Scores significantly correlated with scores on the Dysfunctional Attitude Scale (DAS), Beck Depression Inventory (BDI) and the Cognitive Adaptation to Stressful Events questionnaire (CASE), measuring adaptation to pregnancy. DAS and CASE scores did not correlate. The PRBQ and the CASE differentiated between those with (n = 5) and those without moderate depression. The PRBQ has been validated against established psychological measures. It may be a helpful tool contributing to the identification of women specifically at risk of postnatal depression. Further basic research is required.

The present study illustrates the use of brief functional analysis probe conditions to verify the results of a descriptive assessment. An initial descriptive assessment of the disruptive behaviour of an 8-year-old student with severe developmental disabilities showed that levels of disruptive behaviour (screaming and throwing equipment) were higher in some lessons than others and suggested that the behaviour might be maintained by escape from task demands. An intervention in which work demands were alternated with 5-minute periods of free activity reduced levels of screaming to under 50%, and of throwing to under 25%, of baseline levels. Brief experimental variations of demand level in some lessons confirmed that levels of disruption were generally higher under high demand conditions. We conclude that brief probes provide a method by which experimental analyses can be conducted in the client's natural environment, reducing the problem of non-occurrence of the target behaviour that can pose problems for analogue assessments and facilitating ongoing assessment during initial intervention. We note also, however, that the consequent reduction in control over establishing operations may reduce the precision of the analysis and that ethical considerations limit the range of behaviours for which the method is appropriate.