Background: Randomized controlled trials have established that individual cognitive therapy based on the Clark and Wells (1995) model is an effective treatment for social anxiety disorder that is superior to a range of alternative psychological and pharmacological interventions. Normally the treatment involves up to 14 weekly face-to-face therapy sessions. Aim: To develop an internet based version of the treatment that requires less therapist time. Method: An internet-delivered version of cognitive therapy (iCT) for social anxiety disorder is described. The internet-version implements all key features of the face-to-face treatment; including video feedback, attention training, behavioural experiments, and memory focused techniques. Therapist support is via a built-in secure messaging system and by brief telephone calls. A cohort of 11 patients meeting DSM-IV criteria for social anxiety disorder worked through the programme and were assessed at pretreatment and posttreatment. Results: No patients dropped out. Improvements in social anxiety and related process variables were within the range of those observed in randomized controlled trials of face-to-face CT. Nine patients (82%) were classified as treatment responders and seven (64%) achieved remission status. Therapist time per patient was only 20% of that in face-to-face CT. Conclusions: iCT shows promise as a way of reducing therapist time without compromising efficacy. Further evaluation of iCT is ongoing.

Background: Many patients with non-cardiac chest pain or benign palpitations have poor prognosis in terms of symptom persistence, limitations in everyday activities, and reduced health-related quality of life (HRQOL). Aims: The aims of the study were to evaluate the changes and impact of illness perceptions during a three-session cognitive behavioural therapy (CBT) intervention for patients with non-cardiac chest pain or benign palpitations. Method: Patients with persistent complaints 6 months after a negative cardiac evaluation were invited to participate in a randomized controlled trial. Patients in the intervention group (n = 21) received three manualized sessions with CBT, including one physical activity exposure session; the control group (n = 19) received usual care from their general practitioner. Brief Illness Perception Questionnaire (BIPQ) was used to measure illness perceptions. Patients were assessed at start and end of the intervention and at 3- and 12-month follow-up. Results: The intervention and control group differed significantly on five of the eight items of BIPQ at least at one follow-up assessment. At end of treatment and at 3-month follow-up change in illness concern (Item 6 in BIPQ) mediated about 40% of the change in depression from baseline, and at 12-month follow-up about 50% of the change in depression was mediated by change in personal control (Item 3 in BIPQ). Conclusion: Illness perceptions measured with BIPQ may mediate the short and long term treatment effects of a three-session CBT-programme for patients with non-cardiac chest pain and benign palpitations.

Background: Previous studies have suggested that physical exercise can reduce symptoms for subjects suffering from panic disorder (PD). The efficacy of this intervention has so far not been compared to an established psychotherapy, such as cognitive behaviour therapy (CBT). Assessment of controlled long-term effects and the clinical significance of the treatment are also lacking. Aim: To compare physical exercise to CBT as treatment for PD, and assess controlled long-term and clinically significant effects. Method: PD-patients were randomized to either three weekly sessions of physical exercise (n = 17), or one weekly session of CBT (n = 19). Both treatments ran for 12 weeks, were manualized and administered in groups. Patients were assessed twice before the start of treatment, at post-treatment and at 6 and 12 months thereafter. Primary outcome-measures consisted of the Mobility Inventory (MI), the Agoraphobia Cognitions Questionnaire (ACQ) and the Body Sensations Questionnaire (BSQ). Results: A two-way repeated measures MANOVA of these measures demonstrated a significant effect of time, F(16, 544) = 7.28, p < .01, as well as a significant interaction effect, F(16, 544) = 1.71, p < .05, in favour of CBT. This finding was supported by the assessment of clinically significant changes of avoidant behaviour and of treatment-seeking one year later. Conclusion: Group CBT is more effective than group physical exercise as treatment of panic disorder, both immediately following treatment and at follow-up assessments.

Background: Association Splitting (AS) is a novel cognitive technique, which has shown some promise for the reduction of obsessive thoughts in patients with obsessive-compulsive disorder (OCD). Its effect on unwanted intrusive thoughts (UITs) in the general population is yet unknown. Method: Our experimental study tested the effect of AS in 49 participants who reported UITs as a regular problem. Participants were randomly allocated either to an AS versus waitlist control (WL) condition. The White Bear Suppression Inventory (WBSI) was used for measuring changes over time. Results: Significant group differences were found across time. Relative to WL, AS exerted a positive effect on the reduction of UITs yielding a large effect size. According to self-report AS exerted a positive effect 6 days after the participants had initiated the exercises. All subjects in the AS condition judged the technique as effective Conclusion: Results suggest that AS could be a suitable intervention to help people with a potential vulnerability to a clinical problem to control their UITs.

Background: There is a growing need for non-medical treatments for women experiencing problematic menopausal symptoms such as hot flushes and night sweats (HF/NS). A recent randomized control trial (RCT) (MENOS2) provides evidence of the effectiveness of Group CBT and Self-Help CBT for HF/NS. Aims: This study examines MENOS 2 participants’ experience of the CBT treatments. Method: Twenty women who had experienced CBT for HF/NS (10 Group CBT and 10 Self-Help CBT) were interviewed at the end of the trial to explore how they experienced the treatment and its effects. The interviews were analysed using interpretative phenomenological analysis. Results: Women experienced both treatment formats as positive and helpful, increasing their ability to cope and their sense of control over HF/NS. Four super-ordinate themes were identified: making sense of symptom change, new ways of coping and regaining control, acknowledging and challenging the menopause taboo, and social interaction and support versus individual learning. Conclusions: These qualitative results are consistent with those of the main trial in that women found both CBT formats helpful in reducing the impact of HF/NS. However, the results also suggest possible mechanisms of change and provide useful information on women's responses to the different treatment components and formats.

Background: Nonattendance rates remain high for first therapy appointments, despite initiatives to increase access to psychological therapy. The reasons for nonattendance are poorly understood and studies of demographic and clinical predictors have produced conflicting findings. Aims: We aimed to pilot a method for investigating psychological factors associated with first appointment attendance in a primary care mental health service. Method: Questionnaires were completed by individuals at the point of referral to CBT with a low-intensity service in one general practice (n = 67), including a measure of beliefs, goals and attitudes towards therapy, as well as anxiety and depression scales. Subsequent attendance at the first appointment was used as an outcome. Results: Preliminary results showed that attendance was not associated with age or gender, severity of distress, or overall ratings for positive or negative attitudes towards therapy; although distress itself was associated with increased endorsement of negative attitudes. However, one specific psychological item, “Talking to a therapist will help me understand better how my mind works” had a significant association with subsequent attendance. Conclusions: The psychological factor that was associated with increased attendance may reflect the concept of psychological mindedness; however, this requires replication in a larger study. A full-scale study was deemed to be warranted based on this prospective design.

Background: There is a developing literature into Anger Management interventions for people with intellectual disability. While initial reports suggest that these interventions are effective there are few evaluations examining what aspects of the therapeutic process contribute to effectiveness. Method: Individuals with an intellectual disability and anger control difficulties who were referred to community psychology services were allocated to either experienced clinical psychologists or a less experienced assistant psychologist who followed the same intervention framework. Results: Significant reductions in self-reported anger intensity were reported; however, the group who were treated by more experienced therapists reported more change and more individuals reported clinically significant change. Conclusions: While effective change was reported by both groups, these results suggest that clinical experience and training may be an important variable in determining the magnitude of change. This has implications for the design of intellectual disability mental health services.

Background: Growing evidence supports the association between early memories of shame and lack of safeness and current shame and depression. Nevertheless, it is unclear whether shame serves as a mediator between such early memories and depressive symptoms. Aims: This study aimed at testing whether the impact of shame traumatic memory, centrality of shame memory, early memories of warmth and safeness (predictors), on depressive symptoms (outcome) would be mediated by current external and internal shame. Method: Student participants (N = 178) recalled an early shame experience and completed self-report instruments measuring centrality and traumatic characteristics of the shame memory, early memories of warmth and safeness, external and internal shame and depressive symptoms. Results: Path analysis’ results revealed that internal shame fully mediated the relationship between shame traumatic memory, centrality of shame memory, and early memories of warmth and safeness, and depression. However, current feelings of external shame, highly linked to internal shame, did not significantly predict depression. Conclusion: These findings shed light on the role of internalizing early shame and lack of safeness memories into a sense of self as globally self-condemning in the vulnerability to experience depressive symptoms.

Background: Distressing visual hallucinations (VH) are frequently present in schizophrenia. Despite their prevalence, limited research exists regarding effective clinical interventions. Cognitive models of VH state that distress results from threat appraisals of the hallucination. Method: This individual case study describes the use of a graded exposure approach following the discovery of phobic anxiety associated with visual hallucinatory content. Treatment involved 20 sessions of individual cognitive behaviour therapy (CBT), of which 12 sessions focused on graded exposure. Results: A reduction in frequency of visions and associated distress was reported and these changes were maintained at a 3-month follow-up. Conclusions: The findings are consistent with the cognitive model of VH. Through exposure to the hallucinatory content, the client re-appraised her VH as non-threatening, and her fear of them reduced. This reduction in anxiety led to a decrease in the occurrence of the VH.

Background: Studies have shown that the intolerance of uncertainty may play a key role in the aetiology and maintenance of worry and generalized anxiety disorder. Aims: This study investigated the psychometric properties of the Chinese version of Intolerance of Uncertainty Scale (IUS), which had already been validated in French and English versions. Method: In a large college student sample (N = 940), the factor analysis and regression analyses were performed on the IUS. Results: The IUS had excellent internal consistency (α = 0.90) and good test-retest reliability (r = 0.75) over a 5-week period. Factor analysis showed that the IUS had a four-factor solution. Finally, the regression analysis demonstrated that IU contributed significantly to worry, after controlling for demographic variables and levels of anxiety and depression. Conclusions: The Chinese version of the IUS was a sound scale for assessing IU and the intolerance of uncertainty was an important influencing factor on worry.

Background: New technologies have slowly become a part of psychologists’ therapeutic office. However, many therapists still have doubts about the possibility of creating a good therapeutic relationship with patients in the presence of technology. Aims: This study evaluates the development of the therapeutic alliance in individuals with small animal phobia disorder who were treated with Augmented Reality Exposure Therapy or In Vivo Exposure Therapy. Method: Twenty-two participants received an intensive session of cognitive behavioural therapy in either a technology-mediated therapeutic context or in a traditional therapeutic context. Results: The results show no significant difference for the therapeutic alliance between two conditions. Conclusions: The results seem to show that technologies such as Augmented Reality do not represent a danger to negatively influence the therapeutic alliance.