Background: This study adds to the body of evidence regarding the theoretical underpinnings of interpersonal psychotherapy and the mechanisms through which it impacts upon depression in adolescents. Aims: The aims were to determine whether the interpersonal constructs proposed to underpin interpersonal psychotherapy do indeed change in response to this therapy and whether such changes are associated with changes in depression in young people. Method: Thirty-nine adolescents, aged 13–19 years, with a primary diagnosis of major depressive disorder, were randomly assigned in blocks to group or individual treatment. Assessments were conducted at pre and posttreatment, and 12-month follow-up. Results: The results supported the hypotheses, with significant improvements in social skills, social functioning, and the quality of parent-adolescent relationships, and an increase in secure attachment style and decrease in insecure attachment style being evident following treatment. Benefits were maintained at 12-month follow-up. Adolescents who showed greater reductions in depressive symptoms over this period tended to also show greater improvement in parent reported social skills, quality of the parent-adolescent relationship, and attachment style from pretreatment to 12-month follow-up. Conclusions: The findings are consistent with the proposed underpinnings of interpersonal psychotherapy. Adolescents showed significant improvements in interpersonal functioning and changes in attachment style following treatment, and changes in social skills, parent-adolescent conflict and attachment style were associated with reductions in depression. As such, the results add to the body of knowledge regarding the construct validity of interpersonal psychotherapy as an intervention for depression in young people. Clinical implications and directions for future research are discussed.

Background: Sleep disturbance is increasingly recognized as a major problem for patients with schizophrenia but it is rarely the direct focus of treatment. The main recommended treatment for insomnia is cognitive behavioural therapy, which we have been evaluating for patients with current delusions and hallucinations in the context of non-affective psychosis. Aims: In this article we describe the lessons we have learned about clinical presentations of sleep problems in schizophrenia and the adaptations to intervention that we recommend for patients with current delusions and hallucinations. Method: Twelve factors that may particularly contribute to sleep problems in schizophrenia are identified. These include delusions and hallucinations interfering with sleep, attempts to use sleep as an escape from voices, circadian rhythm disruption, insufficient daytime activity, and fear of the bed, based upon past adverse experiences. Specific adaptations for psychological treatment related to each factor are described. Conclusions: Our experience is that patients want help to improve their sleep; sleep problems in schizophrenia should be treated with evidence-based interventions, and that the interventions may have the added benefit of lessening the psychotic experiences. A treatment technique hierarchy is proposed for ease of translation to clinical practice.

Background: Cognitive remediation (CR) is a psychological therapy, effective in improving cognitive performance and functioning in people with schizophrenia. As the therapy becomes more widely implemented within mental health services its longevity and uptake is likely to depend on its feasibility and acceptability to service users and clinicians. Aims: To assess the feasibility and acceptability of a new strategy-based computerized CR programme (CIRCuiTS) for people with psychosis. Method: Four studies were conducted using mixed methods. Perceptions of attractiveness, comprehensibility, acceptability and usability were assessed using self-report questionnaires in 34 non-clinical participants (study 1), and five people with a schizophrenia diagnosis and three experienced CR therapists (studies 2 and 3). The ease with which pre-specified therapy programmes could be assembled was also assessed by three therapists (Study 2). Finally, the satisfaction of 20 service users with a diagnosis of schizophrenia regarding their experience of using CIRCuiTS in the context of a course of the CR therapy was assessed in a qualitative interview study (study 4). Results: Ratings of perceived attractiveness, comprehensibility, acceptability and usability consistently exceeded pre-set high targets by non-clinical, clinical and therapist participants. Qualitative analysis of satisfaction with CIRCuiTS showed that receiving the therapy was generally seen to be a positive experience, leading to perceptions that cognitive functioning had improved and attempts to incorporate new strategy use into daily activities. Conclusions: CIRCuiTS demonstrates high acceptability and ease of use for both service users with a schizophrenia diagnosis and clinicians.

Background: Social cognition difficulties in schizophrenia are seen as a barrier to recovery. Intervention tackling problems in this domain have the potential to facilitate functioning and recovery. Social Cognition and Interaction Training (SCIT) is a manual-based psychological therapy designed to improve social functioning in schizophrenia. Aims: The aim of this study is to evaluate the feasibility and acceptability of a modified version of SCIT for inpatient forensic wards. The potential benefits of the intervention were also assessed. Method: This study is a randomized single blind controlled design, with participants randomized to receive SCIT (N = 21) or treatment as usual (TAU; N = 15). SCIT consisted of 8-week therapy sessions twice per week. Participants were assessed at week 0 and one week after the intervention on measures of social cognition. Feasibility was assessed through group attendance and attrition. Participant acceptability and outcome was evaluated through post-group satisfaction and achievement of social goals. Results: The intervention was well received by all participants and the majority reported their confidence improved. The SCIT group showed a significant improvement in facial affect recognition compared to TAU. Almost all participants agreed they had achieved their social goal as a result of the intervention. Conclusions: It is feasible to deliver SCIT in a forensic ward setting; however, some adaptation to the protocol may need to be considered in order to accommodate for the reduced social contact within forensic wards. Practice of social cognition skills in real life may be necessary to achieve benefits to theory of mind and attributional style.

Background: The cognitive-behavioural model of perinatal OCD suggests the role of increased sense of responsibility during the perinatal period in the development and maintenance of obsessive-compulsive symptoms. However, the idiosyncratic nature of responsibility attitudes and interpretations of intrusions is not fully understood. Aims: To investigate how responsibility interpretations regarding intrusions vary across the perinatal period and how this relates to obsessive-compulsive symptomatology. Method: 94 women (26 antenatal, 35 postpartum and 33 non-childbearing controls) completed measures of responsibility attitudes and interpretations regarding specific intrusions (either general or baby-related), as well as obsessive-compulsive symptomatology, anxiety and depression. Results: Postpartum ratings of responsibility interpretations regarding baby-related intrusions were significantly higher than: i) postpartum ratings of responsibility interpretations regarding non-baby intrusions; and ii) control group responsibility interpretations. The groups were not significantly different regarding general responsibility ratings. Ratings of baby-related responsibility interpretations predicted variance in obsessive-compulsive symptomatology. Conclusion: The postpartum group showed significant differences in responsibility interpretations regarding baby-related intrusions. These responsibility interpretations were shown to predict obsessive-compulsive symptomatology.

Background: There is little data to inform the treatment of severe obsessive compulsive disorder (OCD) in an inpatient or residential setting. Aims: This paper aimed to: a) describe treatment outcomes at a residential unit over 11 years; b) investigate whether treatment was successful for a subset of severe treatment refractory residents; c) compare an intensive treatment programme to a “standard” treatment programme; and d) find predictors of self or early discharge from the unit. Method: We compared treatment outcomes for (i) a minimum 12-week treatment (hereafter “standard”) programme versus a 2-week intensive programme and (ii) for severe treatment refractory cases on the standard programme. We identified 472 residents with OCD admitted to the Anxiety Disorders Residential Unit at the Bethlem Royal Hospital between 2001 and 2012. Outcomes were measured with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Obsessive Compulsive Inventory (OCI), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) obtained throughout treatment and up to one year after discharge. Results: Although residents had very severe OCD on admission, sequential assessment with the Y-BOCS, OCI, BAI and BDI demonstrated that scores on all outcome measures significantly decreased from pre to posttreatment and were generally maintained at follow-up. There was no significant difference between those on the standard or the 2-week intensive programme. Sixty-nine per cent of residents with OCD made significant improvements, with at least a 25% reduction on the Y-BOCS. There were predictors of self or early discharge but none for outcome on the Y-BOCS. Conclusions: The data support the principle of stepped care for severe OCD.

Background: Worry about physical health is broadly referred to as health anxiety and can range from mild concern to severe or persistent anxiety such as that found in DSM-IV hypochondriasis. While much is known about anxiety regarding physical health, little is known about anxiety regarding mental health. However, recent conceptualizations of health anxiety propose that individuals can experience severe and problematic worry about mental health in similar ways to how people experience extreme worry about physical health. Aims: Given the paucity of research in this area, the aim of the current study was to explore anxiety regarding mental health through validation of the Mental Health Anxiety Inventory (MHAI), a modified version of the Short Health Anxiety Inventory. Method: The MHAI, and measures of state anxiety (Depression, Anxiety and Stress Scales-21), trait worry (Penn State Worry Questionnaire), and health anxiety (Short Health Anxiety Inventory) were administered to 104 adult volunteers from the general community. Results: The MHAI demonstrated high internal consistency, acceptable test-retest reliability, and good construct validity when correlated with other measures of anxiety. Results also indicated that participants worried about their mental health and physical health equally, and that almost 9% of participants reported levels of mental health anxiety that were potentially problematic. Conclusion: Preliminary results suggest that a small proportion of adults in the community may experience high levels of mental health anxiety requiring treatment, and that the MHAI, if validated further, could be a useful tool for assessing this form of anxiety.

Background: There is concern that diagnostic labels for psychiatric disorders may invoke damaging stigma, stereotypes and misunderstanding. Aims: This study investigated clinicians’ reactions to diagnostic labelling by examining their positive and negative reactions to the label borderline personality disorder (BPD). Method: Mental health professionals (n = 265) viewed a videotape of a patient suffering from panic disorder and agoraphobia undergoing assessment. Prior to viewing the videotape, participants were randomly allocated to one of three conditions and were given the following information about the patient: (a) general background information; (b) additional descriptive information about behaviour corresponding to BPD; and (c) additional descriptive information about behaviour corresponding to BPD, but explicitly adding BPD as a possible comorbid diagnostic label. All participants were then asked to note things they had seen in the videotape that made them feel optimistic or pessimistic about treatment outcome. Results: Participants in the group that were explicitly informed that the patient had a BPD diagnostic label reported significantly fewer reasons to be optimistic than the other two groups. Conclusions: Diagnostic labels may negatively impact on clinicians’ judgments and perceptions of individuals and therefore clinicians should think carefully about whether, and how, they use diagnoses and efforts should be made to destigmatize diagnostic terms.

Background: Although mental illness anxiety is described in the literature, there is very little information on which to draw when treating individuals who present with fears and worries about mental health. In fact, we identified no previous case descriptions focused on this form of anxiety and treated from a cognitive behavioral perspective. Aims: The current case study aims to advance the understanding of the clinical picture of mental illness anxiety, and facilitate the understanding of how cognitive behavioral techniques for health anxiety can be effectively adapted and implemented for such a case. Method: A case study approach was adopted in which a baseline condition and repeated assessments were conducted during an 8-week treatment and 2-month follow-up period. In the current case study, we discuss the assessment, conceptualization, and cognitive behavioral treatment of a 24-year old woman who presented with mental illness anxiety. Several common health anxiety assessment tools and cognitive behavioural techniques were adapted for her particular clinical presentation. Results: Consistent with research evidence for health anxiety, significant improvements in health anxiety and anxiety sensitivity were seen after eight sessions of therapy and maintained at 2-month follow-up. Conclusions: The results provide preliminary evidence that cognitive behavioral techniques for health anxiety can be effectively and efficiently adapted for mental illness anxiety. However, the lack of available research pertaining to mental illness anxiety contributes to challenges in conceptualization, assessment and treatment.

Thank you very much to all those reviewers who participated in the peer-review process for Behavioural and Cognitive Psychotherapy during 2015.