The aims of the present study were to investigate whether selective attention in borderline personality disorder (BPD) is content-specific and influenced by treatment. Comparisons were made between emotional Stroop interferences of stimulus types that were related and unrelated to hypothesized BPD schemas (1) of patients with BPD (n = 24) and nonpatient controls (n = 23), and (2) of BPD patients (n = 16) at start and end of an intensive, 3-year lasting treatment. Patients with BPD showed general hypervigilance, i.e. attentional biases for both schema related and unrelated emotional stimuli. Hypervigilance was completely reduced to normalized levels in recovered patients (n = 6), but not in non-recovered patients (n = 10) at the end of treatment. The findings support the possibility of structural change in BPD.

Low self-esteem is a common characteristic amongst populations with schizophrenia and co-morbid substance abuse (dual diagnosis) and has been linked to increased psychopathology, substance abuse and lower social functioning. The following study built upon the promising results of Hall and Tarrier (2003) and examined the feasibility and clinical utility of a cognitive behavioural intervention for low self-esteem within a population of dual diagnosis inpatients. A small sample of dual diagnosis inpatients (N = 23) were screened during a one-month wait list period to ensure stability in presentation of low self-esteem, psychopathology and substance abuse before commencing a brief eight-session intervention for low self-esteem. Results collected post intervention showed participants displayed significant increases in levels of self-esteem and corresponding significant decreases in depressive symptoms and psychopathology associated with schizophrenia. These improvements were maintained at 3-month follow-up. Outcomes were examined in terms of identifying and implementing beneficial treatments for dual diagnosis populations within everyday psychiatric settings, a population often considered one of the most challenging to treat.

Evaluations of computer-guided CBT (CCBT) suggest that this is a promising approach to closing the gap between the demand for, and the supply of, CBT. However, additional studies are required that are conducted by researchers independent of the programme developers, and include a wider range of participants. This independent study examined the viability of CCBT for panic and phobic anxiety in an unselected sample of referrals in remote and rural areas of Scotland. Outcome was assessed by a wide range of outcome measures, completed before and after treatment, and at 4-month follow-up. Participants experienced few difficulties in using the programme, and GPs and participants regarded CCBT as acceptable and useful. Major improvements were obtained, with several large effect sizes, which remained at follow-up. It was concluded that computer-guided CBT can play a useful part in delivering CBT services in rural areas; and that self-help CBT may be the only treatment option available to some sufferers.

Some studies of computerized cognitive behaviour therapy (CCBT) have found evidence of its effectiveness, yet a number have reported low uptake and/or completion rates. This study investigated attitudes towards CCBT for depression amongst 122 university students. The credibility of CCBT, expectancy-for-improvement and perceived likelihood of using it were all poor, although a minority (9.8%) stated a preference for CCBT over other interventions. When 20 of the original sample received a demonstration of a CCBT programme for depression, significant increases in credibility, expectancy-for-improvement and in perceived likelihood of using CCBT were found. Numbers stating a preference for CCBT increased to 30%. At both stages, most students stated a preference for CCBT to be accompanied by counselling. Qualitative analysis provided information about factors that might influence these attitudes. Implications for service delivery are discussed.

Training efforts for evidenced based treatments require evaluation, yet the value of practitioner self-reports of skills acquisition has been questioned. Thus, a key issue concerns how accurately practitioners assess their own clinical skills. In the current study, 23 community practitioners participated in training of Motivational Interviewing (MI), completed standardized patient (SP) interviews before and after training, and provided self-ratings of MI elements after each interview. Interview recordings were later coded independently. Results suggest training contributed to: 1) reasonable agreement between practitioner and independent ratings; and 2) more effective use of MI, despite a tendency for practitioners to underestimate training gains. This micro-analysis of training documents initial skill gains along with increased practitioner self-awareness. Further, it exemplifies how practitioner self-ratings and objective skill assessment methods may be used in tandem to more fully describe practitioner learning.

Sexual abuse in childhood is a pathogenetic factor for psychological disorders. The attention given to this phenomenon varies between therapists and therapeutic schools. The question is how often sexual abuse is recognized as a problem in cognitive behaviour therapy and how this is related to the present symptoms and therapeutic problems. 1223 case reports, written as application for reimbursement of routine cognitive behaviour therapy, were submitted to a content analysis in respect to childhood sexual abuse. Sexual abuse was mentioned in 10.3% of the cases; 59% of female and 50.0% of male victims were abused by relatives. Sexually abused patients showed significantly increased rates of inadequate care and negative life events during childhood. In comparison to controls, cases showed significantly increased rates of “eating disorders” (15 vs. 6; p<.05), “substance abuse/addiction” (16 vs. 6; p<.05), “suicide attempts” (15 vs. 3; p<.01), “strict refusal of sexual partners” (15 vs. 5; p<.05), “frequently changing partners” (21 vs. 3; p<.001), “problems in marriage/partnership” (95 vs. 77; p<.05) and “sexual problems” (51 vs. 24; p<.001). Childhood sexual abuse is a problem, frequently seen in behaviour therapy patients and therefore also warranting special attention in routine patient care. Sexual abuse is understood by cognitive behaviour therapists as an indicator for traumatizing conditions in general during childhood. It is associated with specific treatment problems and therapeutic needs in adulthood.

Childhood onset conduct problems present some of the most significant challenges to mental health and public services today. Parent management training is among the most effective treatments for conduct problems, and yet a significant proportion of families do not benefit from this approach. This may be because key elements of parenting, such as parental cognitions, are not directly addressed in such interventions. This study investigated the role of mothers' interpersonal schemas in the maintenance of conduct problems and their relationship to parenting behaviour. It examined whether mothers of 7 to 11-year-old boys with conduct problems would have more negative child-related interpersonal schemas (Hill and Safran, 1994), and related negative parenting behaviours, observed during two parent-child interaction tasks, than mothers in a comparison group. The findings showed that there was a significant difference between the two groups in both maternal Negativity and Warmth and child-related interpersonal schemas. However, no relationship was found between parenting behaviour and child-related interpersonal schemas. The results suggest that targeting maternal cognitions in addition to negativity and warmth may enhance interventions for childhood onset conduct problems. However, more research needs to be done to ascertain which kinds of cognitions relate most closely to parenting behaviour in stressful situations.

Parenting styles and the parent-child bond are associated with anxiety in children. Despite this association, little is known about the mechanism through which parenting has its effect. One possibility is that parenting interacts with other known pathways to fear. Two experiments are reported that look at the interaction between parenting styles and parent-child relationships and the verbal information pathway to fear. In Experiment 1, a punitive maternal parenting style was found to interact with the effect of threat information about a novel animal in 6–9-year-old children. Maternal warmth, neglect, overprotection and accurate monitoring were not found to have a significant effect. Experiment 2 showed that children reporting a greater number of negative interactions with their fathers had greater increases in fear beliefs about novel animals after both threat and no information. The quality of mother-child relationships did not significantly interact with the verbal information pathway. These experiments offer preliminary evidence that parenting practices influence how children react to negative information, which offers some insight into the potential causes of the association between parenting and anxiety in children.

We examined a non-specific or relationship variable as well as a specific or technical variable (i.e. homework compliance) and their prediction of cognitive behavioral treatment (CBT) outcome for children with anxiety disorders. Therapist ratings of the therapeutic relationship (TR), but not homework compliance (HC) predicted CBT outcome at posttreatment (n = 138) and at 1-year follow-up (n = 121) for anxious children (aged 9 to 13 years). Findings from this study suggest the therapeutic relationship is a hardy non-specific factor in CBT of anxious children. Implications for the treatment of children with anxiety disorders using CBT and recommendations for research are offered.

There is now considerable evidence that anxiety disorders aggregate in families. Whilst genetic heritability plays a part, environmental factors are another factor explaining this aggregation. However, little is known about the cognitive mechanisms involved. This study examined maternal attentional focus as a possible mechanism in a community sample of mothers of young infants, using an ambiguous scenarios paradigm. In particular, we examined whether more anxious mothers were more likely to interpret everyday scenarios concerning their young children as more threatening and whether this affected their predictions of their own reactions to the situations. Anxiety scores were associated with a greater likelihood of anxious interpretation in first-time mothers but not in the whole sample. Mothers who scored higher on state and trait anxiety were found to perceive ambiguous scenarios involving infants as more threatening than mothers scoring lower on anxiety and were more likely to indicate that they would seek external reassurance. These relationships were stronger when data were only analysed for the sub-group of first-time mothers. This suggests that anxious interpretations by the mother may ultimately influence the child's assessment of and response to threat. However, direct observational research is needed to examine this issue.

The National Institute for Clinical Excellence has recommended cognitive behaviour therapy (CBT) for a number of common child and adolescent mental health disorders. The aim of this study was to clarify the practice of CBT within specialist child and adolescent mental health services in the United Kingdom. A survey was distributed to specialist child mental health workers through national organizations and professional bodies. Approximately 10% of specialist CAMHS professionals replied (n = 540). One in five reported CBT to be their dominant therapeutic approach, whilst 40% rarely used CBT. Specialist post-qualification training had been undertaken by 21.0% of respondents, with over two-thirds identifying training needs in the core skills of CBT. This survey suggests that the capacity of specialist CAMHS to meet the requirements of NICE in terms of the availability of CBT skills is doubtful. There is a need to develop CBT training and supervision infra-structures.

An exploration of trainees' abilities to identify question types, their function and the process of questioning was carried out with 25 trainees who were studying for either a Diploma in Cognitive Therapy or a Doctorate in Clinical Psychology. The results showed that trainees were best at determining the functions of questions, but were poor overall at identifying the different elements of questioning. This study highlights the absence of terminology for breaking down therapeutic dialogue into its component parts. It is concluded that research is needed to explore ways in which the components of questioning can be better articulated and conceptualized so as to aid our ability to reflect on questions in a meaningful way.