The Cognitive Behavioural Therapy Group Program at Central Coast Mental Health Specialty Clinics includes treatments for generalised anxiety disorder, panic disorder and depression. This study provides empirical validation for hypotheses developed in clinical controlled studies; that is, that cognitive-behaviour therapy provided benefits in the treatment of anxiety and depression in a service setting. This would be reflected in decreases in the symptoms of anxiety and depression and increased self-esteem. Participants (N = 139) were referred to Specialty Clinics, Central Coast Mental Health Services for treatment for depression and/or anxiety in CBT groups. They were tested on the BDI, STAI and the SERS at three time points, prior to entering the group, at termination of the group and at 3-month follow-up. Depression and anxiety symptoms decreased and self-esteem increased between pre- and post-group and the trends continued to 3-month follow-up.

This study presents the results of preliminary findings on the continuing effect of cognitive-behavioural treatment groups (CBT) for Chinese people in Hong Kong with depression at 6-month follow-up. Data from 18 of the 48 CBT group participants was analysed using repeated-measures ANOVAs. The same questionnaire was administered to the participants at the pretest, posttest, and 6-month follow-up test. The findings reveal that participants continued to maintain significantly fewer symptoms of depression and dysfunctional rules, and significantly more adaptive coping skills and positive emotions when their follow-up test scores were compared to their pretest and posttest scores. Effect size statistics showed mostly medium differences in all of the above outcome measures between the pretest and posttest, and between the pretest and follow-up test (Cohen's d = 0.51–.77). A statistical approach to clinical significance revealed that in the follow-up test, over 60% of the participants could be considered clinically recovered or clinically remitted. Lastly, the results of hierarchical multiple regression analyses provided some evidence of a linkage between cognition and depression among the participants at posttest and follow-up. This study appears to support the continuing effect of CBT groups for Chinese people in Hong Kong with depression at a 6-month follow-up.

Health promotion involves the modification of behaviours which constitute risks to health, through such activities as intensive interventions with individuals, community health campaigns, and legislative and social change. Major target behaviours for health promotion include cigarette smoking, eating habits, exercising, and the management of stress. This paper outlines the range of approaches to behaviour change in health promotion, and considers the stages involved in the behaviour-change process. Theoretical frameworks for dealing with health-related behaviour change are suggested. In considering the relationship between behavioural research and health promotion activities, the process of development from basic research to programmes and policies is outlined, and the importance of maintaining conceptual and methodological rigour when working in field settings is stressed. We also argue that there is a need to take into account some relevant local contextual factors in the development and application of a behavioural approach to health promotion.

Behavioural momentum refers to the tendency for reinforced behaviour to persist when conditions are altered. Research on persistence with pigeons as subjects has suggested that response rate under steady-state conditions and its persistence when conditions are altered are independent aspects of behaviour, with response rate determined by response-reinforcer contingencies and persistence determined by stimulus-reinforcer contingencies. These results have been replicated with humans in a natural setting, and may therefore be relevant to clinical practice. The following prescriptions are suggested by the research results: (a) To eliminate undesirable behaviour, it is not sufficient to reinforce alternative behaviour in the same setting because this may actually enhance persistence of the undesired response; change to a new setting may also be necessary; (b) to establish desirable behaviour, the behaviour should be reinforced frequently, and to make it persistent, both the therapeutic and natural environments should be highly correlated with reinforcement.

Research from specialised hospital feeding programmes in the United States has shown effectiveness of a variety of treatments for packing (not swallowing food or liquid in the mouth) to increase swallowing and consumption. One potential component used in clinical practice has not been evaluated in the literature to our knowledge. This component is move-on and involves moving on to the next bite presentation rather than waiting for swallowing (i.e., clean mouth). A 5-year-old female with autism spectrum disorder and avoidant/restrictive food intake disorder participated in a home setting in Australia. We used a withdrawal/reversal single-case experimental design for a move-on component added to a treatment package. With move-on added, latency to clean mouth decreased and consumption increased to 100%. After the treatment evaluation, additional procedures (interspersal, redistribution) were needed in full plate and portion meals. Food variety was increased to 116 regular texture foods across all food groups. All (100%) of admission goals were met. Parents were trained to high procedural integrity, and the protocol was generalised to the community. Gains maintained to 1-month follow-up.

Understanding the underlying mechanisms of recovery from insomnia is an important goal for improving existing treatments. In a randomised controlled trial, 57 participants with insomnia disorder were given either cognitive therapy (CT) or mindfulness-based therapy (MBT) following 4 sessions of CBT. Each participant was assessed on process measures related to CT and MBT. MBT resulted in improvement on mindfulness process measures and the size of the improvement was significantly greater than achieved in the CT condition. Interestingly, CT and MBT both resulted in significant improvement on the cognitive process measures. Treatment outcome on the primary outcome measure (Insomnia Severity Index) was not predicted by type of treatment but was predicted by posttreatment scores on the cognitive process measures. The results suggest that changes in cognitive processes are especially important in treating insomnia, and that there are different therapeutic modalities through which this can be achieved.

The depressive-realism effect refers to a phenomenon in which depressed individuals are more realistic at assessing the relationship between two events than non-depressed individuals. Recent evidence suggests that the depressive realism hypothesis is weaker than first thought. Thus, we sought evidence for depressive-realism under conditions that we hypothesised would maximise the effect. We tested a clinically depressed sample of participants who were administered a rumination induction. Twenty-eight clinically depressed and 39 non-depressed participants were randomly allocated to either a rumination condition (focused on the causes, consequences, and meaning of their mood) or a distraction condition (focused on external objects/events such as a classroom). Participants then completed a contingency task in which there was no relationship between their responses and an outcome, and they were asked to make a judgment of how much control they had over an outcome. Both groups and conditions did not differ in their judgments of control; participants in all conditions showed a non-normative judgment of control. The depressive-realism effect was not observed in this study, even when depressed participants were encouraged to ruminate. Rather, the present study clearly demonstrates the robustness of the illusion of control.

Body-focused repetitive behaviours (BFRBs), such as hair-pulling, skin-picking, and nail-biting, are non-functional habits associated with difficulties in emotion regulation. Although several models have been developed to explain the difficulties experienced by people suffering from BFRBs, a number of cognitive and emotional processes have yet to be explored. This study sought to investigate the psychological characteristics involved in the development and maintenance of BFRB symptoms. In particular, we aimed to evaluate the relationship of self-criticism, shame, and maladaptive cognitive emotion strategies with symptoms and examine if the relationship between perfectionism and symptoms was mediated by self-criticism and shame. Seventy-six participants from a community sample completed a number of self-report measures. Findings from our multivariate linear regression model supported that shame and maladaptive cognitive emotion regulation strategies significantly predicted BFRB symptoms. Results of our mediational analyses revealed that shame significantly mediated the relationship between perfectionism and BFRB symptoms. Interventions that target shame may be beneficial for treating these conditions. Future studies should replicate these findings with clinical populations and other BFRB subtypes.

The aim of the study was to compare the psychophysiological pattern associated with obsessive–compulsive disorder (OCD) in clinical patients (n = 13) and checking behaviours in a nonclinical population (n = 13) to evaluate the validity of the anxiety reduction hypothesis. A second objective was to examine the psychophysiological pattern associated with prevention of ritualistic behaviour in the OCD group and of checking behaviour in the control group. A guided imagery methodology was utilised in order to examine the progression of the behaviours over time. Various psychophysiological measures were incorporated to account for the response to personalised imagery presented in four distinct stages. The stages included setting the scene, approach, incident, and consequence. Both the psychophysiological and the subjective response to the ritual/checking and response-prevention/no-checking scripts were higher than to the neutral script for both groups. A trend towards significantly higher heart rate response to the response-prevention/no-checking than to the ritual/checking script was also observed. Higher levels of depersonalisation and anxiety in the OCD group were observed following prevention of the ritual. The patterns of response indicated obsessive–compulsive behaviour may act to prevent the level of anxiety experienced by an individual from escalating, rather than to reduce it from an already elevated level.

Background: Worry exposure is a cognitive–behaviour therapy (CBT) technique frequently used to treat GAD, yet there are only a few studies on its effectiveness. Aim: To compare two worry exposure protocols developed for GAD to make a preliminary determination about the most effective way in which to present the feared stimuli to participants. Method: Nine university students suffering from GAD were administered four 1-hour treatment sessions. Exposure was conducted by either directly imagining (DI) or via audio-recording/playback (AR) exposure to their feared event. General worry and intolerance of uncertainty (IOU) were the primary dependent variables. Results: All participants in the DI and half of the AR condition reported subclinical GAD at post-treatment, with results being maintained at 3-month follow-up and the treatment responders also reported decreased depression, anxiety and stress. Conclusions: The DI protocol was more effective than the AR methodology in this sample, and may be an appropriate standard for worry exposure research and clinical practice.

Elevated anxiety sensitivity and the tendency to catastrophically misinterpret ambiguous bodily sensations has been demonstrated in people who experience nonclinical levels of panic (Richards, Austin, & Alvarenga, 2001), and anxiety sensitivity has been shown to be associated with insecure attachment in adolescents and young adults (Weems, Berman, Silverman, & Saavedra, 2001). This study investigated the relationship between attachment style, anxiety sensitivity and catastrophic misinterpretation among 11 nonclinical panickers and 58 nonanxious controls aged 18 to 19 years. Participants completed the Brief Bodily Sensations Interpretation Questionnaire (BBSIQ), Anxiety Sensitivity Index (ASI) and an attachment questionnaire. The hypothesis that insecurely attached individuals would demonstrate greater catastrophic misinterpretation and higher anxiety sensitivity than securely attached individuals was not supported; however, nonclinical panickers gave more anxiety-related interpretations of ambiguous internal stimuli than nonanxious controls. Results do not support the notion that attachment style is related to anxiety sensitivity or catastrophic misinterpretation (regardless of panic experience). Results do, however, support the notion that anxiety-related misinterpretation of ambiguous somatic sensations precedes the onset of panic disorder.

Attention-deficit/hyperactivity disorder (ADHD) is the most recent diagnostic label used to describe a behavioural condition of which the essential features are developmentally inappropriate levels of inattention, impulsivity and overactivity. ADHD has attracted both controversy and attention from the professional and scientific community. However, little is known regarding the explanatory models (implicit theories) of health professionals or of their beliefs regarding the treatment of this condition, specifically the impact of diagnostic labelling on their decisions concerning treatment. This study manipulated the presence versus absence of the diagnostic label ‘ADHD’ in a vignette study describing the symptoms of this condition. The vignette was presented to professionals in the educational, mental health and allied health fields. After reading the vignette, participants were required to complete a questionnaire examining implicit beliefs concerning ADHD. The results confirmed that the presence of the diagnostic label (ADHD) changed the causal explanations by professional groups. However, the presence of the diagnostic label did not significantly change the beliefs about the optimal treatment strategy for this condition.

Eating disorders (EDs) are one of the most severe and complex mental health problems facing researchers and clinicians today. The effective prevention and treatment of these conditions is therefore of paramount importance. However, at present our treatments fall short: generally demonstrating only poor to moderate efficacy, and often completely ineffective for severe or chronic cases. A possible reason for this is that the current theories underlying these treatments are flawed. In this paper, we review and evaluate several prominent theoretical explanations associated with current frontline and promising treatments for ED. In doing so, we identify fundamental problems within the construction of current ED explanations and their implications for treatment. In response to these findings, we propose several strategies for the construction of future ED explanations which we believe have the power to ameliorate these problems and potentially help to develop more efficacious treatment downstream.

Social anxiety disorder (SAD) is a common mental health condition that is characterised by a persistent fear of social or performance situations. Despite effective treatments being available, many individuals with SAD do not seek treatment or delay treatment seeking for many years. The aim of the present study was to examine treatment barriers, treatment histories, and cognitive behavioural therapy (CBT) delivery preferences in a sample of women with clinically relevant SAD symptoms. Ninety-nine women (Mage = 34.90, SD = 11.28) completed the online questionnaires and were included in the study. Participants were recruited from advertisements on community noticeboards and posts on social media. The results demonstrated that less than 5% of those who received psychological treatment in the past were likely to have received best-practice CBT. The most commonly cited barriers to accessing treatment for women with SAD related to direct costs (63%) and indirect costs (e.g., transport/childcare) (28%). The most preferred treatment delivery method overall was individual face-to-face treatment (70%). The study demonstrates a need to provide a variety of treatment options in order to enhance access to empirically supported treatment for women with SAD.

Attention Bias Modification (ABM) targets attention bias (AB) towards threat, which is common in youth with anxiety disorders. Previous clinical trials showed inconsistent results regarding the efficacy of ABM, and few studies have examined the effect of online ABM and its augmented effect with cognitive behavioural therapy (CBT). The aim of the current study was to examine the efficacy of online ABM combined with CBT for children and adolescents with anxiety disorders in a randomised, double-blind, placebo-controlled trial. Children (aged 8–16 years) completed nine online sessions of ABM (n = 28) or online sessions of the Attention Control Condition (ACC; n = 27) over a period of 3 weeks (modified dot-probe task with anxiety disorder-congruent stimuli), followed by CBT. Primary outcomes were clinician-reported anxiety disorder status. Secondary outcomes were patient-reported anxiety and depression symptoms and AB. Results showed a continuous decrease across time in primary and secondary outcomes (ps < .001). However, no differences across time between the ABM and ACC group were found (ps > .50). Baseline AB and age did not moderate treatment effects. Online ABM combined with CBT does not show different efficacy compared with online ACC with CBT for children and adolescents with anxiety disorders.

This paper reviews the role and indications for pharmacotherapy of children with school refusal. The psychopharmacological treatment of school refusal is based mainly on evidence of the effectiveness of certain drugs in the treatment of adult disorders. There is some evidence that tricyclic antidepressants and benzobiazepines may be specifically useful in the treatment of school refusal, but further research is warranted. Potentially serious side effects mean that drugs are best confined to cases where psychological treatments have not been effective or where drugs are used briefly as an adjunct to a broader psychological treatment plan. Drugs may also have a role in the specific treatment of comorbid conditions associated with school refusal. Any use of drugs should involve regular reviews to monitor response, compliance, and side effects.

Despite a well-documented record of notable success in the treatment of neuroses, behaviour therapy is little taught in academic departments. A major reason for this appears to be the existence of an unending stream of misinformation about it. This paper describes the essential features of modern behaviour therapy of the neuroses, and the range of its therapeutic effects. It outlines some major sources of misinformation and their stifling effect on the academic spread of behaviour therapy.

This research aimed to examine the effects of moving (videos) versus static (pictures) images on habituation and progression in a hierarchy during online symbolic exposure (OSE) for spider fear. Participants were 351 people with high spider fear who logged on to an OSE website (www.feardrop.com) for self-help purposes. The inclusion of moving images in the exposure hierarchy increased adherence rates relative to static images, particularly among those with lower relative to higher spider fear. Those who viewed moving images at Stage 2 showed higher Subjective Units of Distress Scale (SUDS) ratings overall, but a similar pattern of habituation relative to those who viewed static images. In addition, 71% of participants completed at least one stage of the OSE program, representing an improvement from 30% adherence in previous research that used an earlier version of the program. These findings support the development of tailored exposure hierarchies to maximise adherence and treatment benefit for individual participants.

Repetitive negative thinking (RNT) has been confirmed as a transdiagnostic phenomenon, but most measures of RNT are contaminated with diagnosis-specific content. The first aim of this study was to examine the structure of an anticipatory version of the Repetitive Thinking Questionnaire (RTQ-Ant) as a trans-emotional measure of anticipatory RNT. The original RTQ was completed with reference to a past stressor, whereas the RTQ-Ant instructs respondents to link their responses to a future stressor. The second aim was to test if the associations between a range of emotions (anxiety, depression, shame, anger, general distress) and the original post-stressor version of the RTQ would be replicated. Undergraduates (N = 175, 61% women) completed the RTQ-Ant, along with measures of various emotions, with reference to upcoming university exams. Principal axis factor analysis yielded many similarities between the original post-event RTQ and the RTQ-Ant, and some differences. The RTQ-Ant was comprised of two subscales: the RNT subscale measures engagement in repetitive thinking, negative thoughts about oneself, and ‘why’ questions; and the Isolated Contemplation (IC) subscale included items referring to isolating oneself and reflecting on negative thoughts, feelings, loneliness, and listening to sad music. RNT was more strongly related to negative emotions than IC. The RTQ-Ant appears to be a reliable measure of anticipatory RNT that is associated with a broad array of emotions.

Thought–action fusion (TAF) refers to the belief that thoughts and actions are linked. While ‘Moral’ TAF refers to the belief that unacceptable thoughts are morally equivalent to overt actions, ‘Likelihood’ TAF is the belief that certain thoughts can increase the probability of some events (related to self or others) to occur. The objective of this study was to compare the schizophrenic patients with nonclinical controls in terms of TAF Likelihood and TAF Moral after controlling for the effects of obsessive compulsive and depressive symptoms, magical ideation and schizotypy. The sample was composed of patients hospitalised for schizophrenia (n = 45) and nonclinical control subjects (n = 41). Thought–Action Fusion Scale, Maudsley Obsessive–Compulsive Inventory, Magical Ideation Scale, Schizotypal Personality Characteristics Subscale and Beck Depression Inventory were administered. Results revealed that after controlling the effects of obsessive–compulsive and depressive symptoms, magical ideation and schizotypy, patients still had higher scores on TAF Likelihood Others but not on Self. Patients also had a tendency to get higher scores on TAF Moral. It is concluded that the study shows the presence of TAF Likelihood Others in schizophrenia even after controlling for the effects of magical ideation, depressive and OCD symptoms and schizotypal characteristics.