This paper describes the first trial of danger ideation reduction therapy (DIRT) in an adolescent patient with severe, treatment resistant obsessive-compulsive disorder (OCD). This case study also represents the first published data on DIRT for any individual outside the Anxiety Disorders Clinic at the University of Sydney, where the treatment package was originally developed. KP was a 16-year-old girl with a 4-year history of obsessive-compulsive disorder. She was primarily concerned with contamination and presented with associated washing and avoidance behaviour. KP met Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association [APA], 1994) criteria for OCD, oppositional defiant disorder and major depressive disorder. She had also had previous diagnoses of attention-deficit/hyperactivity disorder and motor tics. KP had received considerable treatment for OCD prior to the current trial, including 12 months of outpatient treatment at the local community health centre, a 4-week inpatient admission to a private hospital in Sydney and a 16 week inpatient admission to Rivendell Adolescent Unit in Sydney. All previous treatments involved a combination of pharmacotherapy (clomipramine [up to 125mg[, sertraline [up to the 200mg], fluvoxamine [up to 200 mg], risperidone [up to 2.5 mg] and chlorpromazine [25-50 mg prn]), and attempts to administer exposure-based treatment. KP had failed to benefit from all previous treatment attempts. However, following 16 sessions of DIRT, KP experienced substantial improvement, approximating symptom-free status on all measures. Importantly, these improvements were maintained at 12-month follow-up. The DIRT package was also effective in reducing depression and anxiety scores on self-report measures over the follow-up period. There were no substantial differences between posttreatment and 12-month follow-up scores on any of the measures given.

This study investigated the effectiveness of posted feedback as a litter control strategy in a university cafeteria. Patronage and litter rates were monitored daily throughout the second term of the academic year. Posted feedback was effective in reducing litter rates relative to baseline. Reductions in litter rates were maintained following intervention and continued to be evident 2 weeks after the completion of the study. Results support previous findings that posted feedback is a simple and effective method of litter control.

A great deal is at stake for children who are sexually abused; not only in the here-and-now, but also the possibility of long-term blight in their future relationships and mental health. This puts a heavy responsibility on the professionals who are required to investigate, and further assess for treatment or other interventions, cases where sexual maltreatment is confirmed or suspected. The multidimensional, multicomponent elements that make up an assessment (in particular, the ASPIRE process) are described here in terms of their practical and theoretical implications. The difficulties of finding reliable and valid methods (be they interviews or psychometric instruments) for this onerous task are discussed.

Behavioural parent training as a treatment approach for conduct disordered children and their families has been a remarkably successful endeavour. However, both clinical experience and research findings have shown that some families can be considerably more difficult to treat than others. Families in which there is significant marital disharmony, maternal depression, low income, and lack of support networks, often drop out from treatment and fail to generalize or maintain treatment gains. This paper explores some of the potential ecological obstacles to programming generalization and maintenance effects in parent training. It also reviews a range of clinical strategies that can be employed to facilitate generalization effects in families. It is argued that if generalization enhancement strategies are to be effective they need to be derived from a fine grained functional analysis of each parent's ecological environment and individually tailored to that setting.

Forty parents of children aged between 1 and 8 years were recruited by means of an exhaustive telephone survey of a defined suburban area in regional Queensland. Following recruitment, parents were mailed a family survey comprising measures of parenting and child behaviour problems. The sample represents almost 50% of parents of young children in the defined area. Forty-four per cent of parents in the sample reported numbers of child behaviours as problems that exceeded recommended clinical cut-off scores based on data reported in other studies. Thirty per cent of parents reported problems occurring at an intensity that exceeded clinical cut-off scores. Fathers who completed the questionnaires reported significantly more problems than mothers, although the ratio of mothers to fathers in the sample was 3:1. However, there was no difference between the reported behaviours of boys or girls. Parent characteristics that were highly correlated with reported child behaviour problems were overreactivity; stress, anxiety, and depression; and parental satisfaction with their parenting style. Family and other demographic variables appeared to play less significant roles. The results are discussed in the context of the challenge of delivering effective early-intervention parenting programs to large numbers of parents.

There is a well established relationship between marital discord and individual psychopathology in family members. This paper reviews evidence relating to patterns of marital interaction related to the co-occurrence of marital discord and three common psychological disorders: depression, alcohol abuse, and childhood conduct disorders. The effects of behavioural marital therapy (BMT) on dysfunctional marital interaction in such cases, and the impact of BMT on individuals' psychological disorders, are evaluated. It is concluded that BMT is often a useful component of treatment in each disorder reviewed. Further it is argued that it is important routinely to assess the relationship context in which these disorders occur. Finally, some of the difficulties and limitations of the application of BMT in cases where the presenting problem is an individual psychopathology are considered.

Clients undergo change as a function of engaging in a therapeutic experience. To date, little research into the residual effects of therapy have been completed using client-centred therapy. Some therapies provide didactic experiences to gain and practise skills and understandings so they can be recalled after the conclusion of therapy. Other therapies preclude such interventions and instead emphasise the insights of the client and the transformative therapeutic alliance to facilitate change. This research is an investigation of the possibility that client-centred therapy provides clients with experiences to allow insight into, and understanding of processes to optimally facilitate change through therapy. The aims of the research were to establish: whether factors known to enhance change in therapy increased for clients from the beginning to the end of therapy; whether the clinical group (n = 28; intervention) scores differed from a nonclinical group at both time points (n = 22; control); and establish whether gender differences were present. Analyses showed that nonclinical respondents’ scores at Times 1 and 2 were consistently higher on all factors compared with clinical respondents. The findings indicated that scores did not vary significantly between Time 1 and 2 for either the clinical or the nonclinical groups of respondents. The state/trait-like characteristics of the factors are discussed in reference to their application in therapeutic and applied settings.

Cognitive-behavioural (CB) therapy for internalising disorders in youth is discussed from both a procedural and empirical standpoint. A theoretical overview of CB treatment is provided, and the unique difficulties faced in the identification and treatment of internalising disorders are considered. With reference to specific internalising disorders (i.e., anxiety and depression), the present paper considers the differential application of CB strategies and the efficacy of treatment procedures. Issues relevant to CB treatment, including (a) flexibility in application, (b) developmental considerations, (c) treatment methodology, and (d) transportability, are discussed.

There is evidence that the school-based program FRIENDS for Life is effective in preventing childhood anxiety and depression. Effectiveness is, however, not the only prerequisite for successful implementation. Participants’ evaluation of a prevention program may provide suggestions about how to fine-tune it to fit the needs of the target population. This study investigated children's and parents’ evaluations of the Dutch version of FRIENDS for Life. Forty-four participants of FRIENDS for Life (9–13 years) participated in online focus groups and 38 parents were interviewed in 2011–2012. Questions concerned the general opinion about the program, its perceived effectiveness and group atmosphere, and suggestions for program improvement. Most children (95.5%) and parents (65.8%) evaluated the program positively, and the majority (61.4% and 76.3%) thought that it had been useful in changing the child's behaviour. Children and parents expressed complementary views about the behaviours the child had learned. Some children (38.6%) expressed negative opinions about the program. Parents’ attendance at parent meetings was low (31.6–36.8%). Considered together with the growing evidence of the effectiveness of FRIENDS for Life, we concluded that it can be successfully implemented as an indicated prevention program in primary schools for children who show symptoms of anxiety or depression. Efforts could be made to increase parents’ involvement in the program.

High-functioning children with autism spectrum disorders display social skill deficits that can have a debilitating impact on their daily lives. The Secret Agent Society (SAS) program has been shown to be effective in improving the social skills of these children when delivered in a group setting. This pilot study evaluated whether individually delivered SAS would yield similar outcomes. Three participants were recruited for the 9-week intervention. Measures of social competence were administered at four points: pretest 1, pretest 2, post-intervention, and 6-week follow-up. Participants showed significant improvement in half of the measures assessing social competence. On a third of these measures, two participants demonstrated improvements to within the range of their typically developing peers. Follow-up results suggested that improvements were maintained at 6 weeks’ post-intervention. Limitations of this study and directions for future research are discussed.

This study aims to determine the effects of the Parents Plus Children's Programme (PPCP) on children's symptoms of attention deficit and hyperactivity disorder (ADHD) and on family functionality and parenting stress. The children in the study were aged 6–11 years, and they had been diagnosed with ADHD and had residual symptoms despite effective dosage and timing of their medication. Forty-six couples, who with their children met the eligibility criteria, were enrolled and randomly allocated to the PPCP or the control group. The intervention involved a 9-week, 2 h a week, parenting group exercise. Those in the PPCP group improved significantly more over time on Conners’ Parent Rating Scale-Revised, Family Assessment Device, and Parent Stress Index than those in the control condition. The trial is the first clinical study involving the parents of children with ADHD that addresses residual symptoms and functional impairments that remain despite the administration of the maximum effective dose of pharmacological treatment.

The relative power of Positive and Negative Punishment as predictors of anxiety and depression was investigated within the gender-specific population of Prostate Cancer patients. As well as being a more powerful predictor of total test scores, Positive Punishment was also a stronger predictor of the presence of clinical levels of anxiety and depression. Examination of the particular Positive Punishment events that were significantly associated with clinical anxiety and depression showed considerable overlap, supporting the concept of a combined anxiety-depression disorder. Suggestions for behavioural interventions with this patient group are made.

The mental health correlates of male aggression or violence against an intimate partner (IPV) are examined using exploratory cluster analysis for 81 men who self-reported risk factors for IPV perpetration on a computer-based health risk assessment. Men disclosing IPV perpetration could be meaningfully subdivided into two different clusters: a high pathology/high violence cluster, and lower pathology/low violence cluster. These groups appear to perpetrate intimate partner violence in differing psychoemotional contexts and could be robustly identified using multiple distinct analytic methods. If men who self-disclose IPV in a health care setting can be meaningfully subdivided based on mental health symptoms and level of violence, it lends support for potential new targeted approaches to preventing partner violence perpetration by both women and men.

Specific deficits in decision-making have been demonstrated in patients with obsessive-compulsive disorder (OCD). The experience of anxious arousal in obsessive-compulsive (OC) patients has been posited to be responsible for disrupting the cognitive processes that lead to efficacious decision-making (Sachdev & Malhi, 2005). In spite of this, research has neglected to examine explicitly the effect of anxiety on the relationship between decision-making and OCD. The current study investigates whether decision-making differences on the Iowa Gambling Task (IGT) occur as a function of OC symptomatology in a non-clinical sample (n = 110). Participants were randomly allocated to either an anxiety condition (n = 58) or control condition (n = 52). Anxious arousal was induced in the anxiety condition via an experimental manipulation prior to commencing the IGT. Participants in the anxiety condition performed significantly worse than those in the control group on the IGT. However, OC symptomatology did not significantly predict IGT performance. The experience of anxiety did not significantly moderate the relationship between OC symptomatology and IGT performance. These findings indicate that decision-making differences do not occur as a function of OC symptomatology in a non-clinical sample; however, they do suggest that the experience of anxiety significantly impairs decision-making performance. The theoretical and practical applications of the findings are discussed.

The aim of the study was to survey a group of clinicians who identify themselves as experienced in treating social anxiety disorder using cognitive behavioural treatment (CBT) with regard to the characteristics of clients which they think, based on their experience, are predictive of poor or good CBT outcome. Fifty-four practising clinicians responded to an email inviting participation in a research study of clinicians’ opinions about client characteristics that may be important in CBT outcome for social anxiety. Participants completed open-ended questions about, and made ratings of the importance of, client characteristics that they believed impact upon the outcome of CBT for social anxiety disorder. Motivation for seeking treatment, comorbidity, and intellect or reasoning ability were nominated most frequently by clinicians as having an effect on CBT outcome. Acceptance of the CBT rationale/model, ability to take responsibility for change, motivation/reason for seeking treatment, and ability to develop an alliance were all rated by participants as being important in contributing to CBT outcome. The results provide direction for future empirical research on client characteristics as predictors of CBT outcome.

An extension of the Home Situations Questionnaire is described (HSQ-M), and normative data for an Australian clinical sample are reported. Reports were obtained from both female (339) and male (143) informants on 403 children aged between 3 and 12 (287 boys, 116 girls) from nine centres in Sydney. Clinicians from these centres predicted the likely findings on the HSQ-M, and their expectations were not wholly supported by the data. Boys were reported to have more problem situations than girls by fathers but not by mothers, and boys were reported as having greater situation severity than girls by mothers but not by fathers. While these differences were statistically significant, they were not clinically significant. Contrary to expectations, fathers reported similar levels of home situation difficulty to mothers. The data provide useful information for targeting situations that would meet the need of parents in parenting groups, and for supplementing the assessment tools used by clinicians working with families.

Despite its inclusion as a basic component of the cognitive-behavioural treatment for panic disorder, the effects of the provision of information about panic anxiety have not been separately assessed. This study compared information-giving with self-monitoring of panic alone, on panic-related variables and negative affect for 40 people with panic disorder. In comparison to self-monitoring alone, information-giving together with self-monitoring was associated with reductions in anticipatory fear of panic and negative affect, but not panic frequency. These results suggest that provision of information about panic anxiety is an important component of the cognitive-behavioural approach to panic disorder in reducing anxious and depressive affect. The other cognitive-behavioural components of this intervention are required to impact upon specific panic parameters.

Following on from the American Psychological Association's (1993) findings regarding empirically validated treatments, a British task force (Roth & Fonagy, 1996) arrived at similar conclusions. Both publications strongly endorsed the superior efficacy of cognitive-behaviour therapy (CBT) over placebos, waiting list controls and other psychological treatments. These findings, although not new, are becoming increasingly important as new ways of funding health care become more likely. With these probable changes in health system funding, organisations such as the Australian Association for Cognitive and Behaviour Therapy will almost certainly be asked to provide evidence supporting the efficacy of certain interventions for certain problems, but also to decide who can implement such treatments. This article attempts to present the well known findings within the current framework, and poses an important question: Who can ethically and competently practice CBT?

Driving-while-disqualified (DWD) offenders represent a significant proportion of the driving offender population, and contribute to a significant drain on governmental and societal resources. The reoffence or relapse process of recidivist DWD offending has been somewhat neglected in the past, and this paper represents a first attempt at developing an empirically generated model of this phenomenon. In this study, we undertook a grounded theory analysis of offence chain information obtained from 28 male recidivist DWD offenders. The grounded theory analysis resulted in the development of a 15-stage model of the relapse process of recidivist DWD offenders. The model identifies and describes the sequence of psychological, behavioural, and environmental factors, including mediating variables that contribute to DWD reoffending. The model was then applied to 14 new offence chains to examine its level of saturation, content validity, and inter-rater reliability. The results suggest that the model has provisional validity and adequate inter-rater reliability, and achieved a high level of saturation. The strengths and value of the model are discussed, as are its clinical and research implications.