A number of developments make the formal specification of competences in CBT both timely and relevant, in particular the Improving Access to Psychological Therapies (IAPT) programme, the increasing focus on process and therapist variables in determining outcome, and the increasing diversity of CBT. This paper outlines the development of an evidence-based methodology for determining both a model and a framework for CBT competences, and considers issues related to the implementation of the framework.

Evidence indicates that workshop training, personalized feedback, and individual consultation can increase competence in motivational interviewing (MI) among highly motivated and skilled substance abuse counselors. Little is known, however, about the translational value of these training strategies for counselors with fewer counseling skills and less stated motivation to learn MI. This study presents evidence from a randomized, controlled trial of 129 behavioral health providers assigned to receive workshop training and enrichments to learn MI. A diverse group of Air Force behavioral health providers working in substance abuse treatment programs were trained in MI and subsequently observed in clinical sessions at 4, 8 and 12 months after training. Results indicate that training was effective in increasing the skill level of these clinicians; however, these gains had decreased by the 4-month follow-up point. Training enrichments in the form of personalized feedback and consultation phone calls did not have an expected, additive effect on clinician skill level. The results of this study lend support to the hypothesis that a greater investment of resources and incentives may be necessary to achieve gains in MI skills for counselors with relatively lower baseline skills than those commonly participating in research studies.

This paper reports the psychometric properties of a CBT for psychosis adherence scale, the Revised Cognitive Therapy for Psychosis Adherence Scale (R-CTPAS). The scale's factor structure, inter-rater reliability and concurrent validity were analysed in a sample of 67 audiotaped sessions of CBT for psychosis. The concurrent validity of the scale was examined through comparison with the Cognitive Therapy Scale (CTS, Young and Beck, 1980). Principal components analysis of the trial data suggested three factors: “engagement/assessment work”, “relapse prevention work” and “formulation/schema work”. Satisfactory levels of inter-rater reliability were established between rater dyads. Moderate correlations with the CTS provided an indication of concurrent validity. The R-CTPAS is concluded to be a reliable and useful instrument that can assess adherence to CBT for psychosis using the Fowler, Garety and Kuipers (1995) therapy model.

Cognitive-behavioral models of obsessive compulsive disorder (OCD) assert that negative appraisals of obsessional thoughts lead to distress over the thoughts and drive ameliorative actions such as thought suppression and compulsions. These responses in turn play a role in the persistence of the disorder. However, past research has not examined (a) what factors lead individuals to suppress obsessional thoughts; (b) whether certain predictors and consequences relate to suppression uniquely or can be explained by general factors such as negative mood and neuroticism; or (c) individuals' natural active suppression of obsessions. The current study addresses these limitations by examining the roles of natural suppression and distress over thought intrusions in the thought-appraisal/OC symptoms relationship while controlling for general factors. Ninety-one nonclinical participants completed a variety of measures assessing theoretically relevant constructs. After their obsessional thought was primed, they recorded their thoughts for 6 minutes and then rated their suppression effort. Four hours later, longer-term outcomes were assessed. Path analyses supported most components of cognitive-behavioral models.

Mindfulness training was evaluated as a new treatment for attention and impulsivity problems in adolescents with a variety of different externalizing disorders: attention deficit-hyperactivity disorder, oppositional-defiant and/or conduct disorder, and autism spectrum disorder if characterized by externalizing problem behaviour. It was argued that the large overlap between these three disorders may be partially explained by common underlying attention and behaviour control deficits. Fourteen clinically referred adolescents suffering from externalizing disorders followed mindfulness training in a group format. Parallel, their parents received mindful parenting training. Adolescents and their parents were measured before and after waitlist, after 8-week training, and at 8-week follow-up. No improvement occurred during waitlist on most variables. After mindfulness training, children self-reported substantial improvement on personal goals, internalizing and externalizing complaints, attention problems, happiness, and mindful awareness, and performed better on a sustained attention test. Likewise, parents reported improvement on children's goals, externalizing and attention problems, self-control, attunement to others and withdrawal. In addition, parents improved on their own goals. Improvement was maintained 8 weeks after the training. Consistent with mindfulness theory, increased child awareness after training predicted longer-term improvement in parent-rated child symptoms. Concomitant parent and child mindfulness training appears to be a promising approach for clinic-referred adolescents with attention and impulsivity problems.

The present study explored whether and how self-injurers attempt to resist urges to harm themselves. Participants were 39 young adults with a history of skin cutting and other non-suicidal self-injurious behaviors. A structured interview assessed the prevalence and perceived helpfulness of 48 methods for resisting self-injurious urges. Ninety percent of participants indicated that they had made efforts to resist urges to self-injure. These individuals had used an average of 16 different methods, and reported that they were successful in resisting the urges most of the time. “Keeping busy” and “Being around friends” were the most common methods used to resist self-injurious urges. However, “Doing sports or exercise” and “Removing the means/instruments typically used to self-harm from the home” were rated as being the most helpful for resisting self-injurious urges. Findings have implications for enhancing treatment and guiding future research.

This study tested the hypothesis that trauma memories are disjointed from other autobiographical material in posttraumatic stress disorder (PTSD). Assault survivors with (n = 25) and without PTSD (n = 49) completed an autobiographical memory retrieval task during script-driven imagery of (a) the assault and (b) an unrelated negative event. When listening to a taped imagery script of the worst moment of their assault, survivors with PTSD took longer to retrieve unrelated non-traumatic autobiographical information than those without PTSD, but not when listening to a taped script of the worst moment of another negative life event. The groups also did not differ in general retrieval latencies, neither at baseline nor after the imagery tasks. The findings are in line with suggestions that traumatic memories are less integrated with other autobiographical information in trauma survivors with PTSD than in those without PTSD.

Behavioural Activation is a contemporary contextual psychological treatment for depression. The outcome of a series of five treatment groups involving a total of 42 patients presenting to a psychotherapy department with self-reported depression is reported. Three of the treatment groups were delivered by two cognitive behavioural psychotherapists, two of the groups were delivered by a single cognitive behavioural psychotherapist and a trainee with no previous experience of the approach. The results suggest that group Behavioural Activation is an effective and tolerable treatment as indicated by BDI-II, CORE scores and the low drop-out rate. The methodological limitations of the findings are discussed.

We report the results of a randomized controlled trial that compared the efficacy of an internet-based self-help treatment for paediatric headache including chat communication (cognitive-behavioural treatment, CBT) with an internet-based psychoeducation intervention (EDU). In the CBT group, significant pre- to post-treatment decreases were found for headache frequency and pain catastrophizing, but not for headache intensity or duration. In the EDU group none of the variables (frequency, intensity, duration, pain catastrophizing) showed improvement. No significant between group differences were found for headache variables and pain catastrophizing at post-treatment. The patients reported high satisfaction with the internet-based training and a good patient-trainer-alliance. Results were maintained at 6-month follow-up. Due to the small sample size, no general conclusions can be drawn regarding the efficacy of the internet-based training regarding the outcome variables, but the training was well accepted by patients. Further research is necessary to evaluate the therapeutic potential of such interventions.