Distinguishing substantively meaningful spillover effects from correlated residuals is of great importance in cross-sectional studies. Both forms of spatial dependence not only hold different implications for the choice of an unbiased estimator but also for the validity of inferences. To guide model specification, different empirical strategies involve the estimation of an unrestricted spatial Durbin model and subsequently use the Wald test to scrutinize the nonlinear restriction of common factors implied by pure error dependence. However, the Wald test’s sensitivity to algebraically equivalent formulations of the null hypothesis receives scant attention in the context of cross-sectional analyses. This article shows analytically that the noninvariance of the Wald test to such reparameterizations stems from the application of a Taylor series expansion to approximate the restriction’s sampling distribution. While asymptotically valid, Monte Carlo simulations reveal that alternative formulations of the common factor restriction frequently produce conflicting conclusions in finite samples. An empirical example illustrates the substantive implications of this problem. Consequently, researchers should either base inferences on bootstrap critical values for the Wald statistic or use the likelihood ratio test which is invariant to such reparameterizations when deciding on the model specification that adequately reflects the spatial process generating the data.

In this paper, rational emotive behaviour therapy (REBT) is presented as the most comprehensive cognitive behavioural therapy (CBT) to date, with over-arching influence on most of the other therapies that came after it. However, despite REBT’s comprehensiveness and the limitations inherent in other CBT approaches, REBT has its limitations. Limitations in REBT theory are explored and an argument is made in favour of rectifying these limitations by incorporating other approaches into REBT (namely cognitive therapy and compassion-focused therapy) to create a more complete integrative psychotherapy model. It is then argued that psychotherapy integration is the future of CBT mainly due to the fact that it reflects how most therapists practise, and due to its utilization of the common factors theory. Finally, the integrative model – which I call Assimilative Integrative Rational Emotive Behaviour Therapy – is presented and demonstrated using a clinical case example.

Many psychological therapies help clients to direct and sustain their awareness onto specific aspects of their problems to promote change. Yet, no theory-driven measure exists that can code moment-by-moment changes in awareness during a therapy session. It is known that awareness plays a crucial role in the process of change, but little is known about the underlying core processes. Perceptual Control Theory (PCT) offers a scientific explanation of psychological distress as loss of control and describes the role of awareness in processes responsible for restoring control by resolving any internal conflict. The Depth and Duration of Awareness Coding Scheme (D-DACS) was previously developed to capture the person’s current focus of awareness and its duration on the areas that from a PCT point of view are desirable in order to facilitate effective psychological change. The current research applies D-DACS to code three publicly available Method of Levels (MOL) therapy sessions delivered by an expert therapist and presents a visual representation of the client’s presumed attention in these sessions. The results showed that an average of 61.65% of the client’s attention was focused on the D-DACS areas, which is higher than the previous studies involving novel therapists. The produced visual representation of the clients’ presumed attention helps to examine the utility of this new coding scheme and further examine the validity of the underlying theory. Such work might help in examining effectiveness of therapy in meeting the underlying theoretical foundations of change. However, limitations and areas for improvement are also evident.

Policy and legislation requires clinicians and services to address diversity and equalities including disability. Currently, practice, training and research do not do this adequately. This paper outlines why adapted CBT is important and presents some evidence to increase accessibility for people who have cognitive impairments, learning disabilities and/or neurodevelopmental disorders. It demonstrates how CBT can be made accessible through clinical examples using traditional, adapted and personalized assessment and intervention materials. Implications and recommendations are identified.

Self-help therapies, such as bibliotherapy, are becoming increasingly more available to the general population as a treatment for psychological disorders, such as depression and anxiety. However, relatively few of these self-help books are properly evaluated to test their treatment efficacy. Two studies aimed to test a new self-help book to treat fears, phobias and anxiety in order to see if symptoms of anxiety and associated symptoms, such as functioning and coping, were improved compared to baseline scores and a waiting-list control group. Study 1 adopted a minimal guided approach (experimental group: n = 25; waiting-list control group: n = 29) whereas Study 2 adopted a non-guided approach (experimental group: n = 17; waiting-list control group: n = 16). In both studies, functioning and coping were improved and the current state of phobic symptoms was reduced. The main phobia improved only when adopting a guided approach and general psychological distress only reduced when adopting a non-guided approach. These studies provide preliminary support for a modest effect in a subclinical population. The results could have good implications for the treatment of anxiety and the use of self-help methods as an additional treatment aid or as a preventative treatment.

Background: In the UK, bibliotherapy schemes have become a widespread source of support for people with common mental health disorders such as depression. However, the current evidence suggests that bibliotherapy schemes that are offered without guidance are not effective. It may be possible to improve the effectiveness of self-help books by incorporating into them some of the “common factors” that operate in personal therapeutic encounters, for example therapist responsiveness. Aim: The aim was to test whether and to what extent authors have incorporated common factors into self-help books. Method: A model of how common factors might be incorporated into CBT-based self-help books was developed and a sample of three books were examined against the model criteria. Results: The sampled self-help books were found to have common factors to a greater or lesser extent, but some types of common factors were more prevalent than others. Factors addressing the development and maintenance of the therapeutic alliance were less often apparent. Conclusions: Self-help books have the potential to provide a valuable service to people with depression, but further work is necessary to develop them. It is suggested that future generations of self-help books should pay explicit attention to the use of common factors, in particular developing and investigating how factors such as flexibility, responsiveness and alliance-rupture repair can be woven into the text.

Method of Levels (MOL) is a form of cognitive therapy based on Perceptual Control Theory (PCT). This paper presents the initial steps towards four methods of establishing the validity of MOL. First, the session was rated by two independent experts for its adherence to MOL using a newly developed 6-item scale based on the Cognitive Therapy Rating Scale. Second, each therapist utterance within a session of MOL was coded and categorized in terms of the therapist's goal to test for adherence to the two specified goals of MOL. Third, a macroanalysis of a MOL session utilizing interpretative phenomenological analysis hypothesized the control hierarchies involved in a client's presenting problem and their zones of conflict. Fourth, a microanalysis of a brief interchange between the therapist and client explored its adherence to PCT. These methods of establishing validity are introduced and explored for later use in larger scale studies. The limitations of the present study and suggestions for future research are discussed.

This editorial introduces the special issue of The Cognitive Behaviour Therapist on Control Theory and CBT. The various routes through which Perceptual Control Theory (PCT) can inform CBT are explained and a range of theory, research and practice articles are introduced. Each focuses on encouraging and validating a Control Theory perspective to the clinical practice of cognitive behavioural therapies.

This article considers the pros and cons of using Method of Levels (MOL), a therapy based on Perceptual Control Theory (PCT). Five concerns about PCT are that it is an early theory, is not well known, originates from outside psychology, implies that established theories are inaccurate and has a mechanistic approach. Five positive features are that it explains how ‘control’ works, takes a phenomenological perspective, is grounded in biology, integrates many disciplines and has an evidence base. Five features of MOL can raise caution: it is not well known, emphasizes intrinsic change, requires the therapist to let go of control, concentrate intensively and use alternative evaluations of outcome. There are major advantages: it is a simple process to learn; theory-practice links are clear, it is ‘ultra cognitive therapy’ – focused on the present moment, client-centred and enables shifting in perspective, promotes service empowerment, and has an evidence base. This article will help therapists make an informed choice about using MOL.

In the UK, recent guidelines on the treatment of depression and anxiety recommend CBT-based self-help materials as one important component of services. However, despite being based on specific CBT techniques or “empirically grounded interventions”, early optimism has been dented by data from recent studies that have cast doubt on the effectiveness of the current generation of these materials. As a consequence, it may be necessary to consider that other factors may contribute to the overall magnitude of CBT effects. Indeed, it is logically inconsistent to argue that specific factors are pre-eminent in CBT whilst maintaining that delivery via therapists is more likely to be effective than self-help. The contribution of “common factors” that operate in personal therapeutic encounters, for example, therapist responsiveness and the patient-therapist alliance, may be one possible overlooked reason for the reduced ef-fectiveness of self-help materials. The development of the next generation of self-help materials, therefore, may benefit from the testing of materials that combine common and specific factors, including specific measurement of the strength of common factors and their relationship to clinical outcomes. We discuss a model of such common factors and suggest how they could be incorporated into the next generation of CBT based self-help materials.