Behavioural treatment of an adolescent girl with chronic stomach pain is described. The client was treated with a broad spectrum behavioural package including applied relaxation and coping skills. Results indicated considerable improvements in ratings of down-time, nausea, health, and mood. Moreover, she was nearly pain-free, and her activity and depression levels were substantially improved. The effects of treatment generalized to the natural environment and were sustained at a 9 month follow-up.

This study explored the relationships between individuals' ability to tolerate emotional distress to their tendency to worry excessively, the amount of imagery they experience during worrying, and the concreteness of their worrisome thought. A group of 119 university students completed a thought-listing task recording their most severe current worry, estimated the amount of imagery and verbal thought during this worry episode, and completed questionnaires assessing their worry proneness, negative effect, and ability to tolerate emotional distress. The concreteness of thought-listed worry episodes was rated by independent judges. Consistent with expectations, lower distress tolerance was associated with more worrying, even when levels of negative affect were statistically controlled for. Excessive worriers also reported lower levels of imagery, but imagery and distress tolerance were unrelated. The findings concerning concreteness were in the opposite direction to those expected: more excessive worrying and lower distress tolerance were associated with more concreteness of worrisome thought. The results are consistent with avoidance theory, but future research is needed to investigate the mechanisms by which low distress tolerance may contribute to excessive worrying.

This study aimed to examine the critical roles of exercising and body image satisfaction on social physique anxiety (SPA) among female university students. For this aim, 118 female university students, 58 of whom exercised regularly, participated in the study. The Social Physique Anxiety Scale, Eating Attitudes Test, and Liebowitz Social Anxiety Scale were administered to the participants; their dieting habits were also investigated. Results revealed that approximately half of the participants used at least one unhealthy weight control method in the past 6 months. An analysis of covariance indicated that, after controlling for the effects of abnormal eating behavior, participants who were dissatisfied with their body image and did not participate in a regular exercise activity experienced higher social physique anxiety. However, such a tendency was not found for social anxiety. Thus, these characteristics seem to be specific to social physique anxiety. It was concluded that individuals who have negative view of their appearance were more prone to experience SPA, and they might be avoiding exercise for self presentational purposes. Findings were discussed in the light of literature.

Parents of children with anxiety disorders (n = 45) and parents of nonclinical children (n = 33) were interviewed regarding the rearing of two children in their family. The purpose of the study was to determine whether overprotective parenting, according to parent report, occurs specifically in the context of relationships with the anxiety-disordered child or whether parents also perceive themselves to be overprotective of the anxious child's sibling. Self-reports of overprotection by parents of anxious children were also compared to self-reports of overprotection by parents of nonclinical children. Mothers in the clinical group were more likely to report that they were more protective of the anxious child than they were to report being either more protective of the sibling or equally protective of both children. Both mothers and fathers in the clinical group were no more likely than nonclinical parents to perceive themselves as being more protective overall than other parents.

Support for the efficacy of cognitive—behavioural therapy (CBT) for anxious youth has accumulated. Significant treatment effects are observed and maintained over the long term for the majority of children receiving individual, family or group-based treatments. Nevertheless, all children do not improve. In fact, there is evidence to suggest that a significant percentage of children continue to experience anxiety following treatment and will seek additional treatment for their anxiety. This article will review the substantial evidence for CBT, the current information available on predictors of outcome and mechanisms of change. The article will also discuss the need for adequately powered randomised clinical trials that continue to refine and evaluate treatments for anxious children in an effort to improve outcomes for those children whose needs are not being met by our current treatments.

In a retrospective recall study, mothers of 102 clinically anxious children (7–16 years) and 76 nonclinical comparison children completed questionnaires describing several aspects of their child's early life. There were no differences between the groups on several aspects of development such as age of walking, talking and toilet training. However, mothers of anxious children reported a significantly greater number of birth complications, difficulties in the first year, early fears, and general settling difficulties. There were few differences found between anxiety disorders except that children with social phobia were more likely to be first born and tended to spend less time in day care, while children with separation anxiety disorder experienced more stressful life events. The results are described as preliminary evidence for the possible role of several factors in the development of anxiety that now require more detailed investigation.

Cognitive variables hypothesised to be mediating obsessive—compulsive behaviour include an overestimation of the probability and consequences of danger, a sense of overinflated personal responsibility for harm to oneself or others, a belief in the overimportance of thoughts, a lack of confidence in memory, an intolerance of uncertainty and a need to control thoughts. In the present study, the relationship between these variables and improvement in OCD symptoms was examined. Fourteen obsessive—compulsives with checking concerns completed a 12-session treatment program of exposure and response prevention (ERP). Before and after treatment, subjects completed the Maudsley Obsessional-Compulsive Inventory (MOCI) and a self-rating of severity (SER), and each week they completed the Yale-Brown Obsessive Compulsive Scale (YBOCS) and answered seven questions that were used to rate their beliefs in the six cognitive domains outlined above. Changes in perception of danger, intolerance of uncertainty and need to control thoughts all correlated significantly with improvement in symptoms. Moreover, significant changes in these variables occurred immediately prior to or concurrent with major symptom improvement, supporting the possibility that they are mediators of the disorder. Changes in ratings of responsibility, overimportance of thoughts and confidence in memory were not related to improvements in compulsive checking on any scale and, in the case of responsibility, ratings actually increased (i.e., worsened) in the week prior to major improvement in symptoms. For most subjects, major reductions in responsibility ratings only took place after symptom reduction. The implications of these findings for the role of these variables in mediating obsessive—compulsive checking are discussed.

This randomised, clinical trial tested whether The Emotional Freedom Technique (EFT) reduced food cravings. This study involved 96 overweight or obese adults who were allocated to the EFT treatment or 4-week waitlist condition. Degree of food craving, perceived power of food, restraint capabilities and psychological symptoms were assessed pre- and post- a 4-week treatment program (mixed method ANOVA comparative analysis), and at 6-month follow-up (repeated measure ANOVA with group data collapsed). EFT was associated with a significantly greater improvement in food cravings, the subjective power of food and craving restraint than waitlist from pre- to immediately post-test (p < .05). Across collapsed groups, an improvement in food cravings and the subjective power of food after active EFT treatment was maintained at 6 months, and a delayed effect was seen for craving restraint. Although there was a significant reduction in measures of psychological distress immediately after treatment (p < .05), there was no between-group difference. These findings are consistent with the hypothesis that EFT can have an immediate effect on reducing food cravings and can result in maintaining reduced cravings over time.

Secure attachment is characterised by a secure base script regarding the attachment figure as a source for support. Having such a cognitive script should affect the stability of state attachment. Specifically, incongruent attachment-related information should get assimilated to this secure base script, leading to state attachment scores that hardly fluctuate. For children without a script, state attachment should vary depending on the quality of attachment-related interactions. Two diary studies were carried out in 9- to 13-year-old children. Results suggested that with assimilation: (1) securely attached children fluctuated less in their daily attachment-related appraisals; (2) fluctuations were related to conflicts with mother; (3) this relation was stronger for less securely attached children. Consequently, these studies further support the secure base script hypothesis and provide insight into the interplay of trait and state components of attachment-related appraisals.

While dialectical behaviour therapy (DBT) appears efficacious in reducing suicidal and self-harming behaviour, it is unclear whether DBT reduces emotion regulation (ER) difficulties, a purported mechanism of change of treatment. This review aims to investigate and evaluate the current evidence to understand the effectiveness of DBT in improving ER difficulties. A qualitative synthesis of studies investigating the effectiveness of DBT on self-reported ER difficulties as measured by the Difficulties in Emotion Regulation Scale (DERS) was performed, identifying eligible studies using PsycINFO, PubMed, MEDLINE and EMBASE databases. Fourteen studies were identified. Current evidence indicates that DBT does not show consistent benefits relative to existing psychological treatments in improving ER difficulties. The literature is compromised by significant methodological limitations increasing risk of bias across study outcomes. Furthermore, high variability across DBT programs and a lack of investigation regarding adherence and participant engagement within interventions was observed. Further research is needed in order to conclude regarding the effectiveness of DBT in improving ER difficulties. Consistent use of active treatment conditions, greater standardisation of DBT-based interventions, in addition to further examination of participant engagement level in DBT-based interventions in the long term may assist understanding as to whether DBT improves ER difficulties.

The study investigated if the degree of personality pathology among people with clinical levels of social anxiety disorder was similar to those with personality disorders more generally, if the degree of avoidant personality pathology was correlated positively with Neuroticism and negatively with Extraversion and facets of Agreeableness (particularly Trust), and finally if scores on the relevant personality dimensions improve from pre- to post-treatment. Changes in Neuroticism, Extraversion, and Agreeableness were examined following group treatment for social anxiety disorder. The current study employed a within-subjects repeated-measures design (N = 25) to investigate whether these traits can be changed by group treatment for social anxiety disorder. A measure of personality disorder pathology was found to correlate positively with Neuroticism and negatively with Agreeableness in the absence of significant relationships with other Five-Factor Model traits. Treatment was associated with significant reductions in Neuroticism and there was significant improvement of the Trust facet of Agreeableness. These results are discussed in terms of the way that group treatment for Social Anxiety Disorder may be enhanced.

The present study investigated the role of experiential avoidance in posttraumatic stress disorder (PTSD) following war-related stress. Eighty-four civilian war survivors were assigned to one of three PTSD groups — current PTSD, recovered PTSD and non-PTSD. Groups were subsequently compared in regard to experiential avoidance. Results indicated significantly higher rates of experiential avoidance and psychological distress in the current PTSD group as compared with the recovered PTSD and non-PTSD groups. The recovered PTSD and non-PTSD groups did not significantly differ.

Recent cognitive models of trauma response predict that negative trauma appraisals are central to the development of psychopathological stress reactions. Fifty-nine civilian survivors of motor vehicle accidents (MVA; n = 24) and nonsexual assaults (n = 35) were assessed within 4 weeks of their traumatic event for acute stress disorder (ASD), prior traumatic events and prior mental health contact, and were administered the Anxiety Sensitivity Index and the Posttraumatic Cognitions Inventory. Participants who were diagnosed with ASD displayed more maladaptive appraisals about their functioning following their trauma and reported higher levels of concern regarding anxiety symptoms than those who were not diagnosed with ASD. Negative beliefs were strongly associated with acute stress severity. These findings are discussed in the context of cognitive mechanisms that may influence maladaptive adjustment following trauma.

The assessment of sexual offenders consists of the systematic collection of clinically relevant information in order to detect clinical problems and to provide clear treatment targets. A key but neglected issue in the area of sexual offending concerns the role of individual case formulations in the determination of offenders' treatment needs. In this paper, we investigate the relative strengths and weaknesses of manual-based treatment (MBT) and formulation-based treatment (FBT) for sex offenders. On the one hand, FBT has the advantages of greater flexibility and a more individualistic focus, and arguably is better equipped to deal with more complex clinical presentations. On the other hand, MBT has the advantages of standardisation and less reliance on clinicians' (flawed) judgement, and may be a more efficient use of scarce resources. We conclude that clinicians should initially provide manual-based treatment rather than that based on individualised case formulations. However, we also suggest that there are at least four situations where FBT represents a valuable strategy, namely when confronted with particularly complex or unusual cases, when standardised treatment has failed, or when there are significant threats to the therapeutic relationship. Finally, we briefly discuss some possibilities for research, and caution that our mixed model is only proposed as a temporary solution and that ultimately any model concerning treatment selection needs to be empirically based and conceptually defensible.

Substance abuse in schizophrenia is a significant management problem for both clients and treatment agencies, impacting on psychotic symptoms, medication adherence, and participation in training and employment. However, there is little published work on the treatment of drug abuse in this population. This paper describes a cognitive-behavioural intervention for alcohol and cannabis abuse which integrates substance abuse treatment with other aspects of psychosis management.

In 1990, 13 regionally based Behaviour Intervention Support Teams (BISTs) were established in Victoria to assist agencies providing support to persons with an intellectual disability who exhibited challenging behaviour. A primary function of the BISTs was to conduct intensive interventions for clients with severe challenging behaviours. The outcomes of the interventions conducted by eight of these teams were monitored over the period from 1991 to 1993. During this time, a total of 134 such interventions were completed by the teams. Many outcome measures were used for each intervention. These included direct observational measures of the challenging behaviours, measures of skill acquisition by the clients, and satisfaction with the results by caregivers. It was concluded that the interventions resulted in a high rate of success (approximately 75%). Additionally, it was concluded that the use of regionally based specialist teams was an effective way of treating severe challenging behaviours that had previously proven difficult to manage.

Individuals with obsessive-compulsive disorder (OCD) experience a significant deterioration in quality of life (Fontenelle et al., 2010; Kugler et al., 2013) and marked functional impairment (Markarian et al., 2010). Despite this, a large proportion of these individuals do not seek any type of help (Goodwin, Koenen, Hellman, Guardino, & Struening, 2002; Mayerovitch et al., 2003). The current study investigated the barriers to seeking OCD treatment using an online survey that was completed by 86 participants living in Australia who identified as having OCD. Results showed that the three main barriers to seeking OCD treatment were: (a) preference for handling problems alone; (b) cost of treatment; and (c) lack of knowledge about available mental health treatment. Individuals who reported receiving an OCD diagnosis (n = 57) demonstrated more severe symptoms, poorer quality of life and higher symptom intrusiveness than those who had not received a diagnosis (n = 29). Furthermore, significant associations were found between religious affiliation and barriers to treatment where greater religious attendance was correlated with a higher likelihood of identifying cultural factors as a barrier to OCD treatment. Additionally, higher levels of religious attendance were associated with a greater understanding of where to go for OCD treatment, not wanting to handle problems alone, and recognising that symptoms are a problem. This article considers approaches to overcoming barriers to accessing effective evidence-based treatment for people with OCD symptoms, and highlights future directions for research.

This study evaluated a behavioural treatment package for simple phobias in children using a multiple baseline design across subjects. The participants were three adolescents presenting with a principal DSM-III-R diagnosis of Simple Phobia. One participant also met the criteria for Separation Anxiety Disorder. Results showed marked improvement (at posttreatment and 3 months follow-up) of the anxiety for all three adolescents, both at overt-behavioural and cognitive levels with no negative effects on family and dyadic adjustment. Theoretical considerations and prognoses are discussed.

One aim of this study was to describe attitudes, beliefs, and behaviours concerned with testicular and breast self-examination (TSE, BSE); the second was to test the efficacy of the Ajzen and Fishbein theory of reasoned action in predicting self-examination behaviour. Participants comprised 116 male adults with a mean age of 27.9, and 141 female adults with a mean age of 30.0 years. The sample was relatively well-educated, with over half having engaged in some tertiary studies. They completed a questionnaire assessing self-examination behaviours, intentions, beliefs, attitudes, and perceived norms. Results indicated low rates of self-examination for both TSE and BSE. Barriers to self-examination included embarrassment, perceived unpleasantness and difficulty, concern about reliability, and worries about what the tests might reveal. Respondents perceived only moderate levels of support from salient others for engaging in the self-examinations. The theory of reasoned action was strongly supported by the study, with intentions to perform self-examination being predicted by attitudes and subjective norms, and intentions in turn predicting self-examination behaviours.

In this study, the relationship between adolescent leisure and gambling was explored. Three different models of time usage were compared as potential predictors of gambling behaviour and problem gambling among 769 adolescents (15 to 18 years old) from five secondary schools in Melbourne. More leisure time, particularly unstructured leisure, predicted more frequent gambling behaviour for girls and boys. Specific activity factors provided the best time usage-based prediction of gambling behaviour. More time socialising and being involved in organised sport predicted more gambling for boys, possibly because of the access these activities provide to gambling venues. For boys, lower levels of so-called masculine pursuits (activities with other male peers) were associated with problem gambling, as were “cognitive pursuits” such as board games and collecting hobbies. For girls, more time in studious activity mitigated against gambling frequency. Lower levels of typically “feminine” adolescent pursuits predicted problem gambling. By far the major predictor of problem gambling for both sexes was gambling frequency. The role of leisure in problem gambling was discussed in terms of the role played by peer socialising, which may increase risk through access to gambling venues yet simultaneously increase protection through a sense of belongingness.