Background: The origins of childhood obesity invariably need to be looked at within a family context and several reviews have concluded in favour of parental involvement in the treatment of paediatric obesity. However, there is little consensus on the format, and next to weight outcomes behavioural outcomes also merit more attention when assessing program effectiveness. Method: In this pilot study, a total of 50 families with overweight children (aged 6–12) were randomly allocated to a parent-led intervention group (cognitive behavioural training) or to a waiting list control group (Study 1). Afterwards, the parents of the waitlist control group also followed the intervention. All children were included in a follow-up study and were compared with a reference group (Study 2). Results: The intervention group as well as the waitlist group (who had not yet received treatment) showed a decrease in adjusted BMI over a 6-month period, although the decrease was only significant for the intervention group (Study 1). All children showed a decrease of 7% in adjusted BMI from pre to one-year follow-up measurement (Study 2), while the reference group showed an increase in adjusted BMI over that period. Parents reported significant positive changes in children's eating behaviour and a significant positive increase in familial health principles. Conclusions: Weight and behavioural outcomes suggest potential for intervention effectiveness. Long-term follow-up is needed to reveal residual benefits of enhanced parenting skills on environmental lifestyle changes.

Background: Cognitive Behavioural Therapy (CBT) is not primarily conceptualized as operating via affective processes. However, there is growing recognition that emotional processing plays an important role during the course of therapy. Aims: The Emotional Processing Scale was developed as a clinical and research tool to measure emotional processing deficits and the process of emotional change during therapy. Method: Fifty-five patients receiving CBT were given measures of emotional functioning (Toronto Alexithymia Scale [TAS-20]; Emotional Processing Scale [EPS-38]) and psychological symptoms (Brief Symptom Inventory [BSI]) pre- and post-therapy. In addition, the EPS-38 was administered to a sample of 173 healthy individuals. Results: Initially, the patient group exhibited elevated emotional processing scores compared to the healthy group, but after therapy, these scores decreased and approached those of the healthy group. Conclusions: This suggests that therapy ostensibly designed to reduce psychiatric symptoms via cognitive processes may also facilitate emotional processing. The Emotional Processing Scale demonstrated sensitivity to changes in alexithymia and psychiatric symptom severity, and may provide a valid and reliable means of assessing change during therapy.

Background: Magical thinking has been proposed to have an aetiological role in obsessive compulsive disorder (OCD). Aims: To address the limitations of existing measures of magical thinking we developed and validated a new 24-item measure of magical thinking, the Illusory Beliefs Inventory (IBI). Method: The validation sample comprised a total of 1194 individuals across two samples recruited via an Internet based survey. Results: Factor analysis identified three subscales representing domains relevant to the construct of magical thinking: Magical Beliefs, Spirituality, and Internal State and Thought Action Fusion. The scale had excellent internal consistency and evidence of convergent and discriminant validity. Evidence of criterion-related concurrent validity confirmed that magical thinking is a cognitive domain associated with OCD and is largely relevant to neutralizing, obsessing and hoarding symptoms. Conclusions: It is important for future studies to extend the evidence of the psychometric properties of the IBI in new populations and to conduct longitudinal studies to examine the aetiological role of magical thinking.

Background: Social phobia frequently occurs as a comorbid condition, with high rates reported among people with psychosis. Little is known about the nature of social anxiety in this population or whether current psychological theories apply. Aims: This paper aims to develop and pilot a suitable measure to explore imagery experienced by participants with comorbid psychosis and social anxiety and to provide preliminary indications as to its nature. Method: A semi-structured interview exploring imagery was used with seven participants (adapted from Hackmann, Surawy and Clark, 1998) and the results were analysed using qualitative template analysis. Results: Initial indications from this sample suggest that some participants experience typical social anxiety images, as identified by Hackmann et al. (1998). However, some experience images that appear more threatening, and may be related to residual psychotic paranoia. Image perspective was also explored: typical social anxiety images tended to be seen from an observer perspective, while those that may have been more related to psychosis tended to be seen from a field perspective. Conclusions: This exploratory study has facilitated the careful adaptation and development of an imagery interview for use in this population and has suggested areas for further research and raised questions around clinical implications.

Background: Although the experience of stress and associated coping responses are thought to play a role in the onset of schizophrenia and other psychotic disorders, there is little empirical evidence to support such a relationship. The relatively recent development of validated and reliable criteria for identifying young people at “ultra” high-risk (UHR) of psychosis has enabled the process of illness onset to be studied more closely than was previously possible. Method: This longitudinal study compared the experiences of stress and coping between a UHR cohort (N = 143) and a healthy comparison group (HC group, N = 32). Results: The UHR group experienced significantly fewer life events over a 12-month period than the HC group, but there was no difference in the experience of minor events or “hassles”. However, the UHR group reported feeling significantly more distressed by events, felt they coped more poorly and utilized different coping strategies. Conclusions: The appraisals made about stressors differentiated the groups and was associated with differences in coping and distress levels. This suggests that treatment strategies focusing on stress management and enhancing coping skills might be important components of preventive interventions.

Background: Cognitive behavioural therapy (CBT) is increasingly being used to help children overcome emotional difficulties but its suitability is still a matter of debate. Aims: This study investigated young anxious children's ability to generate alternative interpretations for events, a skill thought to be important for the effectiveness of CBT. Method: A community sample of 60 children aged 6–7 years (30 high and 30 low in anxiety) was tested. IQ, developmental level and the ability to generate alternative interpretations for ambiguous social scenarios were assessed. Results: Both groups generated alternative interpretations. However, negative self-referent scenarios were more difficult to view from alternative perspectives than positive or other-referent scenarios. Correlation analyses suggested that verbal IQ was partially associated with this skill in both groups, while developmental level was most important in the high anxious group. A “personalizing” bias was found in the negative responses of both groups. Conclusions: It is concluded that young children, whether anxious or not, do possess the ability to complete one skill thought important in CBT. While difficulty with negative self-referent scenarios and personalizing seem to be normative in the sample, those most “at risk” who also have relatively lower developmental levels may find the task particularly difficult.

Background: There are already several existing studies that show the effectiveness of mindfulness-based approaches in varying types of disorders. Only a few studies, however, have analyzed the effectiveness of this intervention in psychosis, and without finding, up to now, significant differences from the control group. Aims: The aim of this study is two-fold: to replicate previous studies, and to focus on analyzing the feasibility and effectiveness of applying mindfulness in a group of people with psychosis. Method: Eighteen patients with psychosis were randomly assigned to experimental and control groups. The experimental group received eight 1-hour sessions of Mindfulness-Based Cognitive Therapy (MBCT), while the control group was relegated to a waiting list to receive MBCT therapy. Results: The experimental group scored significantly higher than the control group in their ability to respond mindfully to stressful internal events. Conclusions: Both the usefulness and effectiveness of implementing a mindfulness-based program have been replicated in a controlled manner in patients with psychosis.

Background: Cognitive behavioural therapy (CBT) can be helpful for many people who experience psychosis; however most research trials have been conducted with people also taking antipsychotic medication. There is little evidence to know whether CBT can help people who choose not to take this medication, despite this being a very frequent event. Developing effective alternatives to antipsychotics would offer service users real choice. Aims: To report a case study illustrating how brief CBT may be of value to a young person experiencing psychosis and not wishing to take antipsychotic medication. Method: We describe the progress of brief CBT for a young man reporting auditory and visual hallucinations in the form of a controlling and dominating invisible companion. We describe the formulation process and discuss the impact of key interventions such as normalising and detached mindfulness. Results: Seven sessions of CBT resulted in complete disappearance of the invisible companion. The reduction in frequency and duration followed reduction in conviction in key appraisals concerning uncontrollability and unacceptability. Conclusions: This case adds to the existing evidence base by suggesting that even short-term CBT might lead to valued outcomes for service users experiencing psychosis but not wishing to take antipsychotic medication.

Background: The treatment of persisting psychotic symptoms with cognitive behavioural therapy (CBTp) is now established as an evidence-based treatment; however its availability remains limited. We piloted a novel CBTp skills-based group training program for carers. The aim was to reduce service users’ auditory hallucinations severity through carers’ use of basic CBTp methods in their regular interactions. Method: Eight carer-service user dyads and one carer-carer-service user triad participated. Carers attended the 10-week (25-hour) program, and completed measures of subjective burden and expressed emotion (EE) over a 30-week period that included a baseline phase prior to the training and implementation phase. Service users completed weekly interviews assessing voice symptomatology. Analyses were conducted for each dyad using time-series methods. Results: The training program was rated highly. Improvements in symptoms and carer burden ranged from none to clinically significant across different dyads. Carer implementation of strategies was related to reduced symptoms in one dyad; reductions in EE were related to symptom improvements in two dyads. Conclusions: There may be benefits in training carers in behavioural and cognitive management of persisting hallucinations. Possible mechanisms for improvements in voice symptomatology include reduction in carers’ EE, and carer implementation of strategies taught.