Previous research has associated the development of social phobia with parental rearing practices, learning influences such as conditioning, vicarious transmission and verbal acquisition, and the individual's own response to social situations. The present study aimed to further investigate these possible antecedents of social phobia. A Learning History Questionnaire (LHQ) was completed by patients with social phobia (n=55), patients with posttraumatic stress disorder (PTSD; n=30), and non-patient controls (n=30). The LHQ focused on events that occurred before the age of 14 (the median age of onset for social phobia). The results indicated the importance of parental rearing practices such as not actively encouraging participation in social situations and emotional coldness. Difficulties with peer group were highlighted as important contributors to conditioning experiences. Individual response factors, especially post-event rumination, are potentially associated with the development of social phobia. Four of the 12 significant variables were unique to the social phobia group when the results from the PTSD group were taken into account. Further research is required to clarify the extent to which the environmental factors assessed in this study specifically contribute to the development of social phobia or to the development of anxiety more generally.

Research has shown an important link between depression and rumination. This study set out to explore depression-focused rumination and anger-focused rumination in relation to shame and entrapment, and depression. 166 undergraduate students completed a battery of self-report questionnaires measuring current depression, rumination on depressive symptoms, rumination on anger, and the frequency of shame-focused and entrapment-focused thoughts. Both depression-focused and anger-focused rumination were related to depression, and to the frequency of shame and entrapment thoughts. In a mediational model, the link between depression-focused rumination and depression was partially mediated by feeling trapped by, and wanting to escape from, one's thoughts and feelings. Thus the link between rumination and depression is complex. Although rumination may contribute to depression by generating a spiral of negative thinking and negative feeling, feeling trapped and unable to control one's rumination, and being flight motivated, may add a further dimension to the depressogenic qualities of rumination.

The Motivational Interviewing Skill Code (MISC) is a coding system developed to measure adherence to motivational interviewing (MI). MI is an effective clinical style used in different treatment situations. Counsellors practising MI have to follow general principles and avoid certain traps. In the present study, the content of the MISC is compared with the general principles of MI and the traps to avoid in MI. Investigation of the content validity raises some questions. All general principles are represented but the traps to avoid in MI are not fully covered. The consequences of this under-representation are shown in transcripts of a selection of well-conducted MI training sessions. The reliability of the MISC was investigated by having five independent coders code 39 MI training sessions of different counsellors. The reliability of the MISC is reasonable. The five coders agreed to a large extent on the absolute ratings but the intraclass correlations were low. Although the MISC can be a useful research tool for process research of MI, it remains a labour-intensive instrument and for teaching and practice audit development of a more simple coding system is recommended.

Given the large unmet need for services for anxiety, there is a need to develop larger-scale psychological interventions. Group interventions could help meet the need but the kind of Cognitive Behavioural Therapy (CBT) approach used merits investigation. The aim of the study was to compare the effectiveness and attendance of participants self-referring to three different CBT workshops: CBT, Cognitive Therapy (CT) only, and Behavioural (BT) only. Between 1998 and 2001 a series of day-long self-referral stress workshops were offered to members of the general public in South East London. A comparison was made of those attending the workshops immediately and those attending the workshops after a 3-month delay. Participants attending all three types of workshop reported reduced stress and anxiety compared with those in the wait-list control conditions. All three workshops were equally well attended. Results support previous findings showing the clinical effectiveness of large-scale stress workshops for the general public who suffer from high levels of anxiety. The specific kind of CBT approach did not make a marked difference either to attendance or outcome, although the CT groups invoked a greater degree of change on standardized measures than the BT or CBT groups.

The purpose of this paper is to report a pilot of Group Cognitive Behavioural Therapy (CBT) for Chronic Fatigue Syndrome (CFS). The cognitive behavioural approach to the management of CFS has been proven effective and group therapy is often seen as a cost effective approach where possible. Six patients with CFS who met the inclusion criteria were taken from a waiting list for CBT and entered the group. Treatment involved 10 sessions of one hour spread over 18 weeks. Using questionnaire analysis, measures of pre, post, and follow-up scores were used. Analysis, comparing medians with the Wilcoxin Signed Ranks Test reached statistical significance on the Fatigue Questionnaire and the Work and Social Adjustment Scale (p <.05) between pre and post-treatment levels. The authors conclude that these results may represent a useful approach to the management of CFS, but that a controlled trial is now required to establish this.

Self-help interventions in mental health are increasingly seen as one way of overcoming problems with access to psychological therapy, but there is insufficient evidence of effectiveness in routine care settings. This paper investigates the process and outcome of a non-guided self-help manual for anxiety and depression compared to a waiting list control in a primary care setting. Patients with mild to moderate mental health problems were recruited from routine GP referrals to the local Primary Care Mental Health Team. Thirty patients were randomly assigned to either non-guided self-help or a waiting list control group. Patients completed outcome measures at baseline, 6 weeks and 12 weeks. Intention to treat analysis found no significant differences between the two groups on measures of anxiety or depression at 12 weeks. Between 40% to 50% of patients in both groups were no longer clinical cases at the end of the trial. However, there was a high level of satisfaction with the self-help manual. Within the limitations of the small sample size, the study does not support the hypothesis that non-guided self-help is superior to waiting list control in the treatment of anxiety and/or depression in primary care.

Harvey (2002) developed a model of insomnia that has advanced the understanding of cognitive processes involved in the maintenance of this problem. Despite the high co-morbidity of insomnia with mental health problems, such as anxiety, the relevance of the cognitive processes specified in the model to people with insomnia as well as other mental health problems is yet to be established. This was the subject of investigation in the present study. A between-subjects design was used to compare people with insomnia and co-morbid anxiety (insomnia plus anxiety) with people with insomnia only (insomnia only), and with good sleepers on measures of mental arousal prior to sleep, thought control strategies employed, and unhelpful beliefs about sleep. Results showed that participants with insomnia plus anxiety were comparable to participants with insomnia only, and significantly different from good sleepers on all measures. The research suggests that the cognitive processes thought to maintain insomnia in people without other co-morbid mental health problems may also maintain insomnia in people with co-morbid anxiety disorders.

Injectable medications are commonplace but injection phobia can have a detri-mental impact on the utilization of health care by patients with subsequent adverse clinical outcomes. This systematic review aimed to identify the various psychological treatments for injection phobia and to assess their effectiveness. A systematic literature search was conducted using Cochrane, PsycINFO, EMBASE, MEDLINE, and AMED databases. Studies with five or more cases that investigated psychological treatment outcomes were selected and assessed in terms of methodological quality, type of intervention and outcomes. Eighty-four publications were identified by the search. Only three studies fulfilled the selection criteria and all used cognitive-behavioural techniques, including exposure to the feared object through a traditional graded hierarchy. Methodology differed but all had optimistic outcomes. Psychological treatments for injection fear or phobia exist, but the overall quality of evidence for treatment effectiveness is poor and outcome measures need consensus and further development.

The study's objective was to assess the impact on clinical functioning of group based mindfulness training alongside standard psychiatric care for people with current, subjectively distressing psychosis. Data are presented from the first 10 people to complete one of four Mindfulness Groups, each lasting six sessions. People were taught mindfulness of the breath, and encouraged to let unpleasant experiences come into awareness, to observe and note them, and let them go without judgment, clinging or struggle. There was a significant pre-post drop in scores on the CORE (z=−2.655, p=.008). Secondary data indicated improvement in mindfulness skills, and the subjective importance of mindfulness to the group process (N=11). The results are encouraging and warrant further controlled outcome and process research.

A behavioural approach was utilized in the assessment and treatment of severe self-injurious behaviour (SIB) in a woman with Smith-Magenis Syndrome (SMS). The results showed a marked reduction in the frequency of SIB following the introduction of functional assessment driven behavioural interventions (differential reinforcement of other behaviour, self-monitoring and social reinforcement, and extinction). There were also considerable reduc-tions in the frequencies of aggressive behaviour towards others, the use of rapid tranquilization and the use of control and restraint. The results of this study suggest environmental factors may play a significant role in maintaining some self-injurious behaviour shown by people with Smith Magenis Syndrome. The results are discussed in relation to emerging models of SIB in SMS.

A cognitive-behavioural analysis of clinical perfectionism has recently been proposed. The aim of this study was to explore the phenomenology of clinical perfectionism and its putative maintaining mechanisms. Of the 21 participants, 15 were judged to have the core psychopathology of clinical perfectionism. The data obtained were largely consistent with the model. In particular, self-imposed dysfunctional standards, continual striving and adverse consequences appeared to be highly salient features of those people who had the core psychopathology of clinical perfectionism but not of those without. A number of other possible maintaining factors not originally described in the model were also identified.

Behavioural and Cognitive Psychotherapy is an international multidisciplinary journal for the publication of original research, of an experimental or clinical nature, that contributes to the theory, practice and evaluation of behaviour therapy. As such, the scope of the journal is very broad and articles relevant to most areas of human behaviour and human experience, which would be of interest to members of the helping and teaching professions, will be considered for publication.