The National Institute for Clinical Excellence recently published their guidelines on the treatment of depression in children and young people. This article critically reviews these guidelines in terms of their likely impact on BABCP members and the services in which they work. The evidence base that underpins the guideline is very sparse. There is particularly limited information on which to base guidance to therapists working with younger children. The use that has been made of this evidence is discussed, and some controversial interpretations are criticized. Implications for services and therapists are outlined. In particular, attention is drawn to the pressing need for very substantial additional training if the guidelines are to be implemented correctly. Some suggestions for deployment of staff with differing levels of knowledge and expertise in CBT are offered. Finally, challenges for the field as a whole are discussed. In particular, a great deal more research is needed into the effectiveness of psychological therapies versus wait list and versus each other and medications, and into the levels of training required to provide competent CBT to children and adolescents.

A survey of individuals was conducted on self-diagnosed vomit phobics compared to panic disorder and non-clinical controls. Vomit phobics were overwhelmingly female and had had symptoms for over 25 years. They were significantly more likely to fear themselves vomiting (in public and private situations) than fear others vomiting. The vomit phobics interpreted sensations of nausea as impending vomit and had a wide range of safety seeking and avoidance behaviours that were maintaining their fear. Although the vomit phobics reported feeling nauseous more often, there was no difference in their frequency of vomiting compared to the control group. The clinical implications of the study for therapy are discussed.

Obsessive-compulsive disorder (OCD) is associated with an inflated sense of responsibility to prevent harm. Increasingly, it has been recognized that inflated responsibility is a complex phenomenon. The purpose of this study was to examine how interpersonal aspects of responsibility are related to symptoms of OCD. Three new valid and reliable scales assessing beliefs about other people's responsibility, comparative beliefs about responsibility, beliefs about the allocation of responsibility, and beliefs about how others allocate responsibility were used to evaluate interpersonal influences on responsibility. Whereas personal beliefs about responsibility were related to all OCD symptom types, it appears that beliefs about other people's responsibility were related to only a subgroup of symptom types. Furthermore, the belief that one is more responsible than others predicts OC symptoms beyond commonly assessed personal beliefs about responsibility. Finally, individuals with OC symptoms tend to allocate more responsibility to themselves than others, compared to individuals without OC symptoms, despite the fact that individuals with OC symptoms believe that others tend to allocate responsibility equitably. Results are discussed in terms of cognitive models of OCD.

Improving the long-term psychological health of the population is an ambitious but consistent goal in the National Service Framework for Mental Health (MHNSF). Large-scale self-referral psycho-educational Stress workshops, run in one geographical area for members of the general public, had been shown to be effective and to reach those who had not consulted their GPs about their stress problems. A key aim of this study was to explore whether this workshop format, which may help achieve the MHNSF goal, can be generalizable to other areas of differing deprivation. We compared outcome and levels of take-up of Stress workshops run in three geographical areas, differing in degrees of deprivation, as well as characteristics of self-referrers, including baseline scores, sociodemographic details and treatment-seeking patterns. In all three areas, experimental group participants showed less anxiety, stress and distress at 3-month follow-up compared to waiting list control group participants, with no geographical differences in effectiveness. No differences in initial stress and anxiety scores were found. GP consultation rates varied between 50–72%, with the highest consultation rates in the most deprived area. Surprisingly, enquiries about workshops correlated negatively with area deprivation indices. Some sociodemographic differences were found. A certain amount of self-selection for these workshops seems to have occurred; this may be a function of help-seeking for psychological help in deprived areas being different to that in less deprived areas. Nevertheless, large-scale Stress workshops have been found to be equally effective for those who self-referred in areas differing in deprivation, reaching people with stress problems who may not have consulted their GPs. While they did not reach all groups of people, they may have the potential to help improve the psychological health of the population.

In cognitive-behavioural therapy with children, young people and families, formulation-based practice ensures that interventions are based on underlying causative and maintaining processes. Importantly, however, developmental, attachment, family, systemic and other perspectives must be incorporated into therapy. This paper describes a template for systemic cognitive-behavioural formulation that facilitates incorporation of the necessary range of perspectives including processes more traditionally expressed through other psychotherapeutic modes of working. Case formulation based on this template is sufficiently comprehensive, yet simple enough to derive collaboratively and leads to a distinct clinical process for working with individuals, families and wider support systems. This generic formulation process is appropriate for use across the range of presentations encountered in child and adolescent mental health practice and provides a structure for therapist training. It requires formal evaluation and has implications for future research.

Treatment non-adherence is a common problem in mental health services but little is known about non-adherence to psychological therapy for psychosis. The main aim of the present study was to investigate the role of patients' recovery style and the therapeutic alliance in provoking or forestalling patient drop-out from cognitive behaviour therapy (CBT) for psychosis. Ratings were made by two independent observers on 29 recordings of sessions from a controlled trial of CBT for psychosis. Sessions of 10 patients who dropped out of treatment prematurely were matched with sessions of 10 patients who stayed in. Another nine sessions were selected at random from the middle and late stages of treatment so that the sample was representative of all sessions in the trial. Patients who dropped out of treatment, compared with those who stayed in, were less engaged in treatment, showed less agreement with their therapists, and had a sealing-over recovery style before they dropped out but did not differ in their therapeutic bonds. The results suggest that the premature termination of the drop-outs was not provoked by the therapists but was due to the patients' lack of curiosity about their psychotic episodes and minimization of the impact of their illness.

This study investigated whether anxiety in patients who have had a myocardial infarction is maintained through similar processes to those proposed in the cognitive models of panic disorder (Clark, 1986) and health anxiety (Warwick and Salkovskis, 1990). Anxious (n = 22) and non-anxious (n = 29) patients, who all had an MI 3–12 months before testing, participated. The groups were compared on self-report measures of risk perception, bodily vigilance, illness perceptions the type of causal attributions (somatic, normalizing and psychological) generated for congruent and incongruent types of anxiety-related bodily sensations (cardiac, respiratory, gastro-intestinal and cognitive dyscontrol). Anxious, compared to non-anxious, MI participants perceived themselves to be at higher risk of a further MI, had higher levels of bodily vigilance and more negative emotional and cognitive representations of their MI. Anxious participants generated significantly more somatic attributions and fewer normalizing attributions, than non-anxious participants for cardiac sensations. There was also a trend for anxious participants to generate this pattern of attributions for respiratory items. The study provides evidence that the models of health anxiety (Warwick and Salkovskis, 1990) and panic disorder (Clark, 1986) are useful in understanding persistent anxiety following an MI.

Schemata (and other cognitions) were investigated in depressed adolescent girls and their mothers and were compared to those in a control group. Links between adolescent and maternal cognitions were also examined. There were 14 girls and mothers in the clinical group and 15 in the control group. The depressed adolescents had higher total scores on a measure of schemata than the control adolescents, and higher scores on several of its sub-scales. They also scored more highly on two other measures of cognition (dysfunctional attitudes and negative automatic thoughts). The mothers of the depressed adolescents were more depressed than mothers of control adolescents. However, the two groups of mothers did not differ on the measures of cognition, including schemata. Depression and schemata in adolescents were related to these variables in their mothers but only in the depressed group. Possible explanations for the findings, including the nature of the link between mood and cognition in the groups studied, are considered. Implications for cognitive theory and therapy in depressed adolescents are briefly discussed.

The aim of this study was to validate the Body Checking Questionnaire (BCQ) in an eating disorder population, using students in psychology as control. Five hundred and seventy-three females (422 controls and 151 eating disorders patients, mean age 24.1 ± 5.9 years) completed the BCQ and measures of eating disorders psychopathology. Confirmatory factor analysis confirmed that the BCQ measures the global construct of body checking with three correlated subfactors. The BCQ has good test-retest reliability (0.90), and the subfactors had good internal consistency (0.90, 0.92, and 0.84). The BCQ correlates with other body image and eating disorders measures, indicating that the BCQ measure has good concurrent validity. Finally, the BCQ reliably distinguishes eating disorders patients from controls, as well as “dieters” from “non-dieters.” The study provides support for factor structure, validity and reliability of the BCQ on eating disorders population and supports the use of this questionnaire in cross-national studies.

Interpretation and judgmental biases for threat-relevant stimuli are thought to play a role in anxiety disorders. To investigate whether social anxiety is associated with interpretation and judgmental biases for unambiguous external social events, individuals high and low in social anxiety (N = 36 per group) were presented with unambiguous scenarios depicting positive and mildly negative social events. Interpretations were assessed by participants' answers to open-ended questions and by their ratings for experimenter-provided, alternative explanations. In addition, for each event, participants indicated the probability that the event would happen to them and estimated their own emotional reaction to it. Compared to low socially anxious group, individuals high in social anxiety were more likely to interpret positive social events in a negative way and to catastrophize in response to unambiguous, mildly negative social events. Also, they estimated the emotional cost of negative social events as higher and the probabilities of positive social events as lower.