Background: This study presents a new questionnaire to assess schema modes: the Schema Mode Inventory (SMI). Method: First, the construction of the short SMI (118 items) was described. Second, the psychometric properties of this short SMI were assessed. More specifically, its factor structure, internal reliability, inter-correlations between the subscales, test-retest reliability and monotonically increase of the modes were tested. This was done in a sample of N = 863 non-patients, Axis I and Axis II patients. Results: Results indicated a 14-factor structure of the short SMI, acceptable internal consistencies of the 14 subscales (Cronbach α's from .79 to .96), adequate test-retest reliability and moderate construct validity. Certain modes were predicted by a combination of the severity of Axis I and II disorders, while other modes were mainly predicted by Axis II pathology. Conclusions: The psychometric results indicate that the short SMI is a valuable measure that can be of use for mode assessment in SFT.

Background: The aim of the study was to evaluate the effectiveness of a recovery group intervention based on compassionate mind training, for individuals with psychosis. In particular, the objective was to improve depression, to develop compassion towards self, and to promote help seeking. Method: A within-subjects design was used. Participants were assessed at the start of group, mid-group (5 weeks), the end of the programme and at 6 week follow-up. Three group programmes were run over the course of a year. Nineteen participants commenced the intervention and 18 completed the programme. Results: Significant improvements were found on the Social Comparison Scale; the Beck Depression Inventory; Other As Shamer Scale; the Rosenberg Self-Esteem Inventory and the General Psychopathology Scale from the Positive and Negative Syndrome Scale. Conclusions: The results provide initial indications of the effectiveness of a group intervention based on the principles of compassionate focused therapy for this population. The findings of this study, alongside implications of further research are discussed.

The aim of this paper was to test the comparative effectiveness of three therapeutic modalities: a) individual stimulus control and exposure with response prevention; b) group cognitive restructuring; and c) a+b in the treatment of pathological gambling with slot machines. An additional waiting-list group was used to evaluate the spontaneous evolution of the non-treated gamblers. The sample consisted of 64 patients selected according to DSM-III-R criteria. A multigroup experimental design with repeated measures (pretreatment, posttreatment and 1, 3, 6 and 12-month follow-up) was used. Most treated patients gave up gambling as well as improved, albeit more slowly, in family/social and psychological functioning. The success rate was higher in the individual treatment compared both to group and combined treatment. There was also an improvement in gambling in the control group between the pretreatment and the 6–month follow-up and there was no difference between the combined treatment and control group. Individual stimulus control and exposure with response prevention appears to be a cost-effective therapy for pathological gambling. Implications of this study for clinical practice and future research in this field are discussed.

The motivational interviewing skills code (MISC) was used to review 86 audiotaped interactions between clinicians and patients participating in a smoking cessation intervention. Intraclass correlations (ICCs) were completed for two of the MISC elements: global evaluations and behavior counts. Results indicate 75% of the global ratings yielded ICCs in the good to excellent range, while only 44% of the behavior counts yielded this level of accuracy. Adherence scores were created to form overall ratings of clinician adherence to using motivational interviewing and 80% of these competence measures yielded ICCs in the good to excellent range. Specific recommendations regarding modifications for the MISC are suggested based on the data presented.

Outpatients from a V.A. outpatient substance abuse treatment program (N = 32) were assigned at random either to receive or not receive a brief motivational intervention in addition to standard outpatient treatment. The additional intervention consisted of two additional hours of assessment and a one-hour motivational interview. Control subjects received the same additional assessment, but with an attention-placebo interview in place of the motivational interview. Those assigned to receive the additional intervention demonstrated superior clinical outcome at three month follow-up on a composite variable composed of three individual variables: (1) total standard drinks, (2) peak blood alcohol level, and (3) percent days abstinent. These results were substantially corroborated by reports of significant others. By six month follow-up, the superiority of the treatment group was modest, and no longer significant. These findings support the utility of this approach for use with clinically severe alcohol populations on at least a time-limited basis.

Background: Perfectionism is implicated in a range of psychiatric disorders, impedes treatment and is associated with poorer treatment outcomes. Aims: The aim of this systematic review and meta-analysis was to summarize the existing evidence for psychological interventions targeting perfectionism in individuals with psychiatric disorders associated with perfectionism and/or elevated perfectionism. Method: Eight studies were identified and were analysed in meta-analyses. Meta-analyses were carried out for the Personal Standards and Concern over Mistakes subscales of the Frost Multi-Dimensional Perfectionism Scale (FMPS) and the Self Orientated Perfectionism and Socially Prescribed Perfectionism subscales of the Hewitt and Flett MPS (HMPS) in order to investigate change between pre and postintervention. Results: Large pooled effect sizes were found for the Personal Standards and Concern over Mistakes subscales of the FMPS and the Self Orientated Perfectionism subscale of the HMPS, whilst a medium sized effect was found for change in Socially Prescribed Perfectionism. Medium pooled effect sizes were also found for symptoms of anxiety and depression. Conclusions: There is some support that it is possible to significantly reduce perfectionism in individuals with clinical disorders associated with perfectionism and/or clinical levels of perfectionism. There is also some evidence that such interventions are associated with decreases in anxiety, depression, eating disorder and obsessive compulsive symptoms. Further research is needed in order to investigate the optimal dosage and format of such interventions as well as into specific disorders where there is a lack of evidence for their effectiveness.

This paper discusses the viability of an analogue research design for studying key processes in social phobia by comparing individuals who score high and low on the Fear of Negative Evaluation Scale (FNE: Watson & Friend, 1969). Research indicates remarkable consistency in the processes that distinguish patients with social phobia from controls and high FNE volunteers from low FNE volunteers. Unfortunately, all existing FNE norms are based on North American populations. The present paper presents British student norms and suggests possible cut-off points for defining groups for analogue research. Advantages of the analogue strategy include rapid piloting of new paradigms and the use of more complex experimental designs that require substantial sample sizes. Limitations of analogue research are also highlighted.

Recent publications have suggested that practising cognitive therapy (CT) techniques on oneself may be valuable in the development of cognitive therapists' clinical skills. The present study asks: Is this useful? If so, in what ways? We report a qualitative study of the experience of trainees undertaking a CT training course, which included an explicit self-practice (SP) and self-reflection (SR) component. Key features of the learning process were: (i) experiencing cognitive techniques from the client's perspective, and (ii) reflecting on this experience that led to (iii) a “deeper sense of knowing” of CT practices. The primary learning outcome was an enhancement of therapeutic understandings, which trainees reported to be both professionally and personally useful. Professionally, they reported deeper understanding of the therapist's role, the cognitive model and change processes. Personally, SP/SR led to greater understanding of themselves, and to the perception of CT as a useful tool for personal change. The data also suggested two other positive learning outcomes: an enhancement of therapist skills and therapist self-concept. We conclude that SP/SR may be a valuable component in CT training. Guidelines and recommendations for inclusion of SP/SR in training courses are discussed.

An experiment was conducted to investigate whether deliberate attempts to avoid a thought content have paradoxical effects. Twenty-four Ss received thought suppression instructions, 16 neutral instructions. Thought suppression resulted in an increased number of occurrences of the thought to be suppressed. The contribution of the results to the theory of obsessions is discussed.

Background and Aims: This pilot study tested the efficacy of a developmentally modified CBT for young children with Autism Spectrum Disorders (ASD) to teach emotion regulation strategies for reducing anger and anxiety, commonly noted problems in this population. Method: Eleven 5–7 year-old children participated in a CBT-group while parents participated in psychoeducation. Children were randomly assigned to an experimental or delayed-treatment control group. Results: From pre- to post-treatment, all children had less parent reported negativity/lability, better parent reported emotion regulation, and shorter outbursts, and also generated more coping strategies in response to vignettes. Parents also reported increases in their own confidence and their child's ability to deal with anger and anxiety. Conclusions: This study suggests that young children with high functioning ASD may benefit from CBT to improve regulation of anger and anxiety, and parent training may improve parental self-efficacy. Future studies are needed to make conclusions about its efficacy.

Imagery appears to be associated with higher levels of anxiety than does worry. Borkovec has argued that worry could be a way of avoiding distressing imagery and the associated affect. Thus worry could suppress emotional activation, interfere with emotional processing, and contribute to the maintenance of anxiety. This hypothesis suggests that short and long-term effects of worrying after experiencing a distressing stimulus should differ from the effects of engaging in imagery. In the short term, imagery should maintain anxiety while worry should not do so, or should do so less. In the longer term, worry should be a less successful way of reducing anxiety associated with the stimulus than imagery, and should be followed by a greater number of intrusive cognitions (indicating the relative failure of emotional processing). These predictions were tested by asking subjects to worry, engage in imagery or “settle down” after watching a distressing video. The results were broadly consistent with the hypothesis. Other interpretations are also considered.

Historically people with intellectual disabilities have not been offered or received cognitive behavioural interventions that have been shown to be effective for mental health and emotional problems experienced by those without such disabilities. This is despite many people with intellectual disabilities having life experiences that potentially result in them having an increased risk to such problems. This paper discusses whether such therapeutic disdain is justified based on the evidence that is available and emerging concerning the application of cognitive behavioural interventions for this population. Issues concerning access to services, the ability of people with intellectual disabilities to engage in and benefit from the cognitive components of CBT, and the effect of cognitive abilities and IQ level on treatment effectiveness are explored in relation to this question.

Background: Internet-delivered cognitive behaviour therapy (iCBT) has been found to be an effective way to disseminate psychological treatment, and support given by a therapist seems to be important in order to achieve good outcomes. Little is known about what the therapists actually do when they provide support in iCBT and whether their behaviour influences treatment outcome. Aims: This study addressed the content of therapist e-mails in guided iCBT for generalized anxiety disorder. Method: We examined 490 e-mails from three therapists providing support to 44 patients who participated in a controlled trial on iCBT for generalized anxiety disorder. Results: Through content analysis of the written correspondence, eight distinguishable therapist behaviours were derived: deadline flexibility, task reinforcement, alliance bolstering, task prompting, psychoeducation, self-disclosure, self-efficacy shaping, and empathetic utterances. We found that task reinforcement, task prompting, self-efficacy shaping and empathetic utterances correlated with module completion. Deadline flexibility was negatively associated with outcome and task reinforcement positively correlated with changes on the Penn State Worry Questionnaire. Conclusions: Different types of therapist behaviours can be identified in iCBT, and though many of these behaviours are correlated to each other, different behaviours have an impact on change in symptoms and module completion.

Safety-seeking behaviours are seen as playing a key role in the maintenance of various anxiety disorders. This article examines their role in panic disorder and social phobia and suggests that, whilst there are clear theoretical differences between safety-seeking behaviours and adaptive coping strategies, the difficult issue in clinical practice is being able to distinguish between the two. It builds on previous work by Salkovskis and colleagues and provides a detailed discussion of the problems in distinguishing between safety-seeking behaviours (direct avoidance, escape and subtle avoidance) and adaptive coping strategies in clinical practice. The suggestion is made that topology can only be a guide to categorizing the two types of responses and they can only be fully distinguished by taking into account the intention of the individual and their perceived function to that individual in the specific context. It is suggested that further analysis of the use of safety-seeking behaviours aimed at avoiding a variety of outcomes at differing levels of catastrophe may provide useful information that would clarify our understanding of the role of such behaviours in maintaining anxiety disorders.

Although low self-esteem is common in clinical populations, a cognitive conceptualization of the problem and an integrated treatment programme deriving from that conceptualization are as yet lacking. The paper proposes a cognitive model for low self-esteem, deriving from Beck's model of emotional disorder. It outlines a treatment programme which integrates ideas and methods from cognitive therapy for depression, anxiety and more recent work on schemas or core beliefs. The model and treatment are illustrated with an extended case example.

Background: Mediation studies test the mechanisms by which interventions produce clinical outcomes. Consistent positive mediation results have previously been evidenced (Hayes et al., 2006) for the putative processes that compromise the psychological flexibility model of acceptance and commitment therapy (ACT). Aims: The present review aimed to update and extend the ACT mediation evidence base by reviewing mediation studies published since the review of Hayes et al. (2006). Method: ACT mediation studies published between 2006 and 2015 were systematically collated, synthesized and quality assessed. Results: Twelve studies met inclusion criteria and findings were synthesized by (a) the putative processes under investigation, and (b) the outcomes on which processes were tested for mediation. Mediation results were found to be generally consistent with the psychological flexibility model of ACT. However, studies were limited in methodological quality and were overly focused on a small number of putative processes. Conclusions: Further research is required that addresses the identified methodological limitations and also examines currently under-researched putative processes.

Background: A theoretical and empirical base for CBT training and supervision has started to emerge. Increasingly sophisticated maps of CBT therapist competencies have recently been developed, and there is evidence that CBT training and supervision can produce enhancement of CBT skills. However, the evidence base suggesting which specific training techniques are most effective for the development of CBT competencies is lacking. Aims: This paper addresses the question: What training or supervision methods are perceived by experienced therapists to be most effective for training CBT competencies? Method: 120 experienced CBT therapists rated which training or supervision methods in their experience had been most effective in enhancing different types of therapy-relevant knowledge or skills. Results: In line with the main prediction, it was found that different training methods were perceived to be differentially effective. For instance, reading, lectures/talks and modelling were perceived to be most useful for the acquisition of declarative knowledge, while enactive learning strategies (role-play, self-experiential work), together with modelling and reflective practice, were perceived to be most effective in enhancing procedural skills. Self-experiential work and reflective practice were seen as particularly helpful in improving reflective capability and interpersonal skills. Conclusions: The study provides a framework for thinking about the acquisition and refinement of therapist skills that may help trainers, supervisors and clinicians target their learning objectives with the most effective training strategies.

This study investigated the effectiveness of an Internet-based intervention for people with panic disorder. Twenty-two participants met criteria for panic disorder and were randomly assigned to either the treatment or a self-monitoring control condition. The study took place over 3 weeks and consisted of one week of self-monitoring prior to the intervention group accessing the program for one week, followed by one week of post-intervention assessment. Participants were assessed on measures pertaining to panic, negative affect, body vigilance, anxiety sensitivity and self-efficacy in managing panic. The treatment condition was associated with significant reductions in all variables except anxiety sensitivity and depressive affect. This type of intervention for people with fearful panic attacks holds promise as an efficacious and economical method for treating spontaneous panic.

Background: Mindfulness-Based Cognitive Therapy (MBCT) is a promising approach to help people who suffer recurrent depression prevent depressive relapse. However, little is known about how MBCT works. Moreover, participants' subjective experiences of MBCT as a relapse prevention treatment remain largely unstudied. Aim: This study examines participants' representations of their experience of MBCT and its value as a relapse-prevention program for recurrent depression. Method: Twenty people who had participated in MBCT classes for recurrent depression within a primary care setting were interviewed 12 months after treatment. The focus of the interview was on participants' reflections on what they found helpful, meaningful and difficult about MBCT as a relapse prevention program. Thematic analysis was used to identify the key patterns and elements in participants' accounts. Results and conclusions: Four overarching themes were extracted: control, acceptance, relationships and struggle. The theoretical, clinical and research implications are discussed.

Background: Studies of cognitive behaviour therapy (CBT) for schizophrenia demonstrate that African-Caribbean and Black African patients have higher dropout rates and poor outcomes from treatment. Aim: The main aim of the study was to produce a culturally sensitive adaption of an existing CBT manual for therapists working with patients with psychosis from specified ethinic minority communities (African-Caribbean, Black-African/Black British, and South Asian Muslims). This will be based on gaining meaningful understanding of the way members (lay and service users) of these minority communities typically view psychosis, its origin and management including their cultural influences, values and attitudes. Method: This two-centre (Hampshire and West London) qualitative study consisted of individual semi-structured interviews with patients with schizophrenia (n = 15); focus groups with lay members from selected ethnic communities (n = 52); focus groups or semi-structured interviews with CBT therapists (n = 22); and mental health practitioners who work with patients from the ethnic communities (n = 25). Data were analyzed thematically using evolving themes and content analysis. NVivo 8 was used to manage and explore data. Results: There was consensus from the respondent groups that CBT would be an acceptable treatment if culturally adapted. This would incorporate culturally-based patient health beliefs, attributions concerning psychosis, attention to help seeking pathways, and technical adjustments. Conclusion: While individualization of therapy is generally accepted as a principle, in practice therapists require an understanding of patient-related factors that are culturally bound and influence the way the patient perceives or responds to therapy. The findings of this study have practical implications for therapists and mental health practitioners using CBT with people with psychosis from BME communities.