Background: Panic disorder (PD) is a common, often unrecognized condition among patients presenting with chest pain to the emergency departments (ED). Nevertheless, psychological treatment is rarely initiated. We are unaware of studies that evaluated the efficacy of brief cognitive-behavioural therapy (CBT) for this population. Aim: Evaluate the efficacy of two brief CBT interventions in PD patients presenting to the ED with chest pain. Method: Fifty-eight PD patients were assigned to either a 1-session CBT-based panic management intervention (PMI) (n = 24), a 7-session CBT intervention (n = 19), or a usual-care control condition (n = 15). A structured diagnostic interview and self-reported questionnaires were administered at pre-test, post-test, 3- and 6-month follow-ups. Results: Statistical analysis showed significant reduction in PD severity following both interventions compared to usual care control condition, but with neither showing superiority compared to the other. Conclusions: CBT-based interventions as brief as a single session initiated within 2 weeks after an ED visit for chest pain appear to be effective for PD. Given the high prevalence of PD in emergency care settings, greater efforts should be made to implement these interventions in the ED and/or primary care setting.

Background: There has been considerable acknowledgement in treatment outcome research that, although the assessment of treatment integrity is essential in many respects, it requires great effort as well as resources and is therefore often neglected. Aims: In order to fill this gap, the Cognitive Therapy Competence Scale for Social Phobia (CTCS-SP) was developed, based on the Cognitive Therapy Scale, to measure therapist competence in delivering cognitive therapy for social phobia. The aim of the present study was to investigate interrater reliability, internal consistency and retest reliability of the scale. Method: Raters evaluated therapist competence from 161 videotaped sessions (98 patients) selected from 234 cognitive treatments within a multi-centre study. Results: Interrater-reliability was found to be high for the overall score (ICC = .81) and moderate for individual items (ICC = .62–.92). Internal consistency and retest reliability were also found to be high (Cronbach's alpha = .89; (ICCretest = .86). Conclusions: The results indicate that the CTCS-SP is highly reliable. As even individual items yield satisfactory reliability, the scale can be used in various fields of research, including the measurement of changes in skill acquisition and the impact of competence on outcome criteria.

Background: It was recently proposed that feelings of dirtiness and pollution can arise in the absence of physical contact with a contaminant. At present, there is limited data regarding the qualitative features of this construct of “mental contamination”, although it is hypothesized to be particularly relevant to Obsessive Compulsive Disorder (OCD), where compulsive washing in response to contamination fear is a common symptom presentation (Rachman, 2006). Aims and method: The aim of this research was to explore the qualitative features of mental contamination in 20 people with contamination-based OCD, using a semi-structured interview. Results: All participants reported times when they had felt dirty or contaminated in the absence of physical contact with a dirty or dangerous object. Mental contamination generated diffuse feelings of internal dirtiness not localized to the hands, which evoked urges to wash (100% participants), neutralize (80% participants) and avoid (85% participants). Conclusions: In support of the theory outlined by Rachman (2006), mental contamination was found to take a number of forms, be primarily associated with a human source, generate internal dirtiness and cause emotional distress and urge to wash. The clinical implications of these findings are discussed and ideas for future research are proposed.

Background: Previous research has shown that face to face cognitive behaviour therapy (CBT) is an effective treatment for chronic fatigue syndrome (CFS)/Myalgic Encephalomyelitis (ME). However, some patients are unable to travel to the hospital for a number of reasons. Aims: The aim of this study was to assess whether face to face CBT was more effective than telephone CBT (with face to face assessment and discharge appointment) for patients with CFS. Method: Patients aged 18–65 were recruited from consecutive referrals to the Chronic Fatigue Syndrome (CFS) Research and Treatment Unit at The South London and Maudsley NHS Trust in London. Participants were randomly allocated to either face to face CBT or telephone CBT by a departmental administrator. Blinding of participants and care givers was inappropriate for this trial. A parallel-groups randomised controlled trial was used to compare the two treatments. The primary outcomes were physical functioning and fatigue. Results: Significant improvements in the primary outcomes of physical functioning and fatigue occurred and were maintained to one year follow-up after discharge from treatment. Improvements in social adjustment and global outcome were noted and patient satisfaction was similar in both groups. Conclusions: Results from this study indicate that telephone CBT with two face to face appointments is a mild to moderately effective treatment for CFS and may be offered to patients where face to face treatment is not a viable option. Despite these encouraging conclusions, dropout was relatively high and therapists should be aware of this potential problem.

Background: The present study evaluated attentional bias in adolescents diagnosed with panic disorder. Although a large body of research exists in the area of attentional bias in adults, this feature of panic disorder is not well understood in adolescents. Method: Twenty-five adolescents, aged 12–17, with a panic disorder diagnosis were included in the study. An emotional Stroop task was utilized to assess whether: (1) adolescents with panic disorder exhibit an attentional bias to panic-relevant stimuli; (2) this bias diminishes after completing a course of CBT; and (3) a specific attentional bias towards disorder-relevant stimuli exists. Results: An attentional bias to panic-relevant stimuli was found at pre-treatment but was no longer present following an intensive CBT intervention. Contrary to some findings in the adult literature, no significant differences were found between panic-relevant versus other threatening stimuli. Conclusions: These results suggest that adolescents with panic disorder, similar to adults, do exhibit an attentional bias towards panic-relevant stimuli, and treatment seems to normalize this cognitive process.

Background: Perseveration reflects the tendency to engage in a behavior even when it is no longer rewarding nor produces the expected consequences. Method: The current study explored whether (1) individuals endorsing a recent (past 2 years) history of nonclinical panic attacks would report greater levels of perseveration compared to individuals without such a history; (2) whether individuals endorsing higher levels of perseveration would evidence greater panic-relevant responding to a 4-minute 10% carbon dioxide-enriched air challenge. Results: Results indicated that individuals with, compared to without, a positive panic attack history endorsed significantly greater levels of perseveration. Additionally, greater pre-challenge levels of perseveration significantly predicted greater panic attack symptom severity as well as self-reported anxiety; these significant effects were evident above and beyond the variance accounted for by sex, trait-level negative affectivity, panic attack status, and distress tolerance as well as shared variance with the related constructs of persistence and perfectionism. Discussion: Together, the current findings provide initial, albeit preliminary, support for the utlity of investigating perseveration in relation to models of panic psychopathology specifically, and offer a further empirical context for perseveration-psychopathology relations in general.

Background: Self-esteem is an important factor in the development and maintenance of good psychological health. Low self-esteem can be a consequence of mental health disorders (such as depression, anxiety and panic) or it can be a vulnerability factor for the development of such problems. Aims and method: The current study reports pilot findings from a Cognitive Behavioural Therapy (CBT) group intervention for 37 adult women with low self-esteem, based on Fennell's Overcoming Low Self-Esteem Self-Help Course. Results: Findings suggest that the group is (statistically and clinically) effective at increasing levels of self-esteem and at reducing levels of depression and anxiety. Conclusions: Together, results suggest that the group provides an efficient and therapeutically beneficial service. However, since these findings are limited by the lack of control or follow-up data, they warrant further investigation.

Background: An appreciation of cognitive predictors of change in treatment outcome may help to better understand differential treatment outcomes. The aim of this study was to examine how rumination and mindfulness impact on treatment outcome in two group-based interventions for non-melancholic depression: Cognitive Behaviour Therapy (CBT) and Mindfulness-Based Cognitive Therapy (MBCT). Method: Sixty-nine participants were randomly allocated to either 8-weekly sessions of group CBT or MBCT. Complete data were obtained from 45 participants (CBT = 26, MBCT = 19). Outcome was assessed at completion of group treatments. Results: Depression scores improved for participants in both group interventions, with no significant differences between the two treatment conditions. There were no significant differences between the interventions at post-treatment on mindfulness or rumination scores. Rumination scores significantly decreased from pre- to post-treatment for both conditions. In the MBCT condition, post-treatment rumination scores were significantly associated with post-treatment mindfulness scores. Conclusions: Results suggest that decreases in rumination scores may be a common feature following both CBT and MBCT interventions. However, post-treatment rumination scores were associated with post-treatment mindfulness in the MBCT condition, suggesting a unique role for mindfulness in understanding treatment outcome for MBCT.

Background: Although behavioural activation therapy is effective for depression there is always room for improvement, and also the need to extend this treatment modality to anxiety disorders. Method: A search was conducted for an easy to apply and effective method of achieving these aims. Results: To both enhance the effectiveness of behavioural activation treatment for depression and facilitate its extension to anxiety disorders, it is proposed that the Behavioral Approach/Activation System (BAS) and Behavioral Inhibition System (BIS) be incorporated. BIS/BAS Scales are easy to administer and evaluate ensuring that there is minimal added complexity. Overall, BAS, BAS subscale (Drive, Reward Responsiveness, and Fun Seeking) and BIS scores provide valuable information pertaining to a person's approach and avoidance responses. This general information, plus that derived from specific scale items, can be used to guide more focused and effective behavioural activation strategies. Brief case examples are provided to demonstrate how the BIS/BAS Scales can be applied. Conclusion: BIS/BAS Scales offer an easy to apply and effective means of enhancing behavioural activation therapy for depression and extending this treatment modality to anxiety disorders.

Background: Chronic pain is a common condition among older adults. While cognitive behaviour therapy (CBT) has been tested in numerous studies on adults and children there are fewer studies on older persons. The objective of this study was to investigate the effects of a six-session CBT group treatment for older persons with chronic pain. As a secondary aim we investigated whether treatment credibility was associated with outcome. Method: We included 21 persons (mean age = 72.0 years) who were randomly allocated to either a waitlist condition or treatment consisting of applied relaxation, with the addition of problem solving, assertiveness, communication strategies, sleep management, and relapse prevention. Results: Few statistically significant effects were found on measures of pain, mood, anxiety, and quality of life; however, a significant treatment effect with a between group effect size of d = 1.0 was observed with respect to perceived ability to function despite the discomfort of pain. Conclusion: The study provides some preliminary support for the use of group-based CBT with a focus on applied relaxation for older adults with chronic pain.

Background: This paper looks at attrition in relation to deprivation and type of therapy – CBT or person-centred counselling. Method: Case notes of all those referred in a 4-month period (n = 497) were assessed for those who failed to opt-in; those who opted-in but failed to attend first appointment and those who attended first appointment but subsequently dropped-out. Results: Significant numbers failed to opt-in, attend first appointment or dropped out during therapy. There were no differences between CBT and PCT. Those from the most deprived areas were less likely to opt-in. Conclusions: We need to develop better approaches to attracting and maintaining contact with individuals complaining of common mental health problems.