The journal has a sister! After a great deal of careful discussion and planning, the BABCP has launched The Cognitive Behavioural Therapist (tCBT). So why another journal? The idea is twofold. First, to provide members and subscribers access to more informal clinical and relatedmaterial of the type not presently covered in Behavioural and Cognitive Psychotherapy. Second, to allow constructive exchanges on the topics covered not only in the new ejournal but also this one. Taken together, these two functions should complement this journal in ways that the pressure on journal space and academic standing have not previously allowed.

The aims of the present study were to investigate whether selective attention in borderline personality disorder (BPD) is content-specific and influenced by treatment. Comparisons were made between emotional Stroop interferences of stimulus types that were related and unrelated to hypothesized BPD schemas (1) of patients with BPD (n = 24) and nonpatient controls (n = 23), and (2) of BPD patients (n = 16) at start and end of an intensive, 3-year lasting treatment. Patients with BPD showed general hypervigilance, i.e. attentional biases for both schema related and unrelated emotional stimuli. Hypervigilance was completely reduced to normalized levels in recovered patients (n = 6), but not in non-recovered patients (n = 10) at the end of treatment. The findings support the possibility of structural change in BPD.

Ehlers and Clark (2000) hypothesize that persistent PTSD is explained by a predominance of data-driven processing and a lack of conceptually-driven processing of the trauma. Data-driven/conceptually-driven processing is thought to relate to perceptual memory representations and memory fragmentation. The present study measured the result of data-driven/conceptually-driven processing in three ways: on utterance level by assessing 1) the ratio between perceptual and conceptual memory representations and 2) utterance disorganization, and 3) on narrative level by assessing the incoherence of the trauma narrative. Twenty-nine patients discharged from the Intensive Care Unit (ICU) were assessed within two weeks after ICU discharge and at 4 months follow-up. The present study tested whether perceptual memory representations, narrative disorganization and narrative incoherence immediately after ICU discharge are related to post-trauma symptomatology. If so, whether these variables are specific for PTSD as compared to depression. Data-driven/conceptually-driven processing was related to PTSD and Depression symptoms on utterance level. Although narrative incoherence did not predict PTSD symptoms, it was predictive of depression symptoms. The present study showed the viability of the data-driven/conceptually-driven conceptualization in explaining post-trauma symptomatology.

Kinderman (2005) presented a psychological model of mental disorder, based on a critique and reformulation of the biopsychosocial model. Kinderman suggested that disruption or dysfunction in psychological processes is a final common pathway in the development of mental disorder. These processes include, but are not limited to, cognitive processes. This ‘mediating psychological processes model’ proposes that biological and environmental factors, together with a person's personal experiences, lead to mental disorder through their conjoint effects on these psychological processes. The clinical implications of this model are discussed further here. It is proposed that formulations rather than diagnoses should predominate clinical planning, that these formulations should detail the hypothesised disruption to psychological processes or mechanisms, that psychological therapies should receive higher priority, and that medical, social and even psychological interventions are most likely to be clinically effective if they are designed on the basis of their likely beneficial impact on underlying psychological mechanisms.

This study examined the effects of anticipatory processing on a subsequent speech in high and low socially anxious participants. Forty participants (n = 20 in each group) gave two speeches, one after no anticipatory processing and one after 10-minutes of anticipatory processing. In anticipatory processing, high socially anxious participants were more anxious, and experienced more negative and unhelpful self-images than low socially anxious participants did. However, both groups rated memories of past speeches as having a somewhat helpful effect on their speech preparation. High socially anxious participants tended to use the observer perspective more in the anticipated speech, while, in the unanticipated speech, they might have been switching between observer and field perspectives. Low socially anxious participants tended to use the field perspective in both speeches. High and low socially anxious participants reported better speech performances after the anticipated, compared to after the unanticipated speech. Results suggest that anticipatory processing may have both positive and negative effects on socially anxious individuals' cognitive processing and performance before and during a speech.

Three influential theoretical models of OCD focus upon the cognitive factors of inflated responsibility (Salkovskis, 1985), thought-action fusion (Rachman, 1993) and meta-cognitive beliefs (Wells and Matthews, 1994). Little is known about the relevance of these models in adolescents or about the nature of any direct or mediating relationships between these variables and OCD symptoms. This was a cross-sectional correlational design with 223 non-clinical adolescents aged 13 to 16 years. All participants completed questionnaires measuring inflated responsibility, thought-action fusion, meta-cognitive beliefs and obsessive-compulsive symptoms. Inflated responsibility, thought-action fusion and meta-cognitive beliefs were significantly associated with higher levels of obsessive-compulsive symptoms. These variables accounted for 35% of the variance in obsessive-compulsive symptoms, with inflated responsibility and meta-cognitive beliefs both emerging as significant independent predictors. Inflated responsibility completely mediated the effect of thought-action fusion and partially mediated the effect of meta-cognitive beliefs. Support for the downward extension of cognitive models to understanding OCD in a younger population was shown. Findings suggest that inflated responsibility and meta-cognitive beliefs may be particularly important cognitive concepts in OCD. Methodological limitations must be borne in mind and future research is needed to replicate and extend findings in clinical samples.

Low self-esteem is a common characteristic amongst populations with schizophrenia and co-morbid substance abuse (dual diagnosis) and has been linked to increased psychopathology, substance abuse and lower social functioning. The following study built upon the promising results of Hall and Tarrier (2003) and examined the feasibility and clinical utility of a cognitive behavioural intervention for low self-esteem within a population of dual diagnosis inpatients. A small sample of dual diagnosis inpatients (N = 23) were screened during a one-month wait list period to ensure stability in presentation of low self-esteem, psychopathology and substance abuse before commencing a brief eight-session intervention for low self-esteem. Results collected post intervention showed participants displayed significant increases in levels of self-esteem and corresponding significant decreases in depressive symptoms and psychopathology associated with schizophrenia. These improvements were maintained at 3-month follow-up. Outcomes were examined in terms of identifying and implementing beneficial treatments for dual diagnosis populations within everyday psychiatric settings, a population often considered one of the most challenging to treat.

Definitions of treatment failure and the labelling of patients as non-responsive typically require treatments to have been offered and failed. For pharmacological treatments, treatment quality is relatively easy to define; this is much more difficult with psychological treatments. This study examined patient recollections of previous therapy for obsessive compulsive disorder (OCD). A Treatment History Questionnaire was administered to a sample of 57 apparently treatment refractory OCD patients from a specialist national OCD treatment unit and a national charity for OCD sufferers. On average, respondents reported an 8$\frac{1}{2}$ year wait between the obsessional symptoms interfering significantly with their lives and being diagnosed. Forty-three percent recalled having received either cognitive behaviour therapy (CBT) or behaviour therapy as the first treatment; 31% of the group did not know what type of therapy they had received. The components of therapy that respondents recalled were analysed and contrasted with minimal therapy criteria. These criteria appear not to have been met in most patients who understood that they had received “CBT”. The implications of this study for assessment of treatment integrity and the classification of patients as “treatment resistant” are discussed.

Panic disorder remains a major health problem associated with high levels of disability and medical care, compounded by difficulties accessing appropriate treatment. Despite significant advances in understanding and effective treatment with CBT, the scope for better recognition and early intervention to prevent panic disorder has been relatively neglected in the CBT literature. This pilot study utilized the prevalence of panic attacks presenting in emergency medical care to test deployment of CBT as a practical early intervention strategy for panic disorder in routine NHS conditions. Twenty-seven people attending two typical UK Accident & Emergency (A&E) Departments with recent onset panic attacks were given a single session of CBT-based intervention or assessment only, and followed-up over 3 months. Basic measures of panic symptoms showed an improving trend across the whole sample. The very limited experimental control did not permit firm conclusions about the role of the intervention but at follow-up nearly one-third reported persisting difficulties typical of panic disorder, which then improved with brief additional CBT. Implications are discussed in relation to the existing literature and regarding further research on panic disorder prevention.

A cognitive approach to understanding mood swings and bipolar disorders is provided, with the interpretation of changes in internal state as a central explanatory factor. The model explains how attempts at affect regulation are disturbed through the multiple and conflicting extreme personal meanings that are given to internal states. They prompt exaggerated efforts to enhance or exert control over internal states, which paradoxically provoke further internal state changes, thereby feeding into a vicious cycle that can maintain or exacerbate symptoms. Counterproductive attempts at control are classified as either ascent behaviours (increasing activation), or descent behaviours (decreasing activation). It is suggested that appraisals of extreme personal meaning are influenced by specific sets of beliefs about affect and its regulation, and about the self and relations with others, leading to an interaction that raises vulnerability to relapse. Pertinent literature is reviewed and found to be compatible with such a model. The clinical implications are discussed and compared to existing interventions.

Mothers of children with behaviour problems have more negative attributions about their children than other mothers; they also report reacting differently to their children's misbehaviour. The present study explored whether maternal attributions were associated with actual maternal behaviour observed in the home. Fifty-seven mothers and their 3-year-old children were observed in the home carrying out a range of everyday tasks and behaviour was coded using Gardner's observational coding scheme. Mothers were interviewed about their attributions, using an adaptation of Walker's PAQ and level of behaviour problems was measured using the Child Behaviour Check List (CBCL). Mothers who thought the causes of the child's misbehaviour were more internal to the child had more conflict with their child, used more negative strategies and were more likely to use reactive strategies only, even when controlling for level of behaviour problem in the child. Mothers who thought the causes of the child's misbehaviour were more stable were more likely to use reactive strategies only and mothers who thought the causes of the child's misbehaviour were more global used fewer positive strategies. This study is part of the growing body of literature that suggests observed maternal behaviour is associated with maternal attributions.

Negative thoughts about the self are a core component of Beck's cognitive triad of depression, and are seen by some as the central cognitive symptom of the disorder. The role of negative thoughts about the self in secondary depression associated with medical illness is less clear: thoughts relating to hopelessness and helplessness rather than guilt, self blame and failure may be more prominent. This study tested the hypothesis that the cognitive symptoms of depression in cancer patients would be less negatively self-referent than a psychiatric control group. Forty patients with cancer referred to a psychological medicine department were matched for age, sex and BDI score with 40 patients referred to a psychological therapies department for CBT. The cognitive-affective section of the BDI (items 1–14) was divided into a negative self-referent cognitions subscale (items 3, 5, 7, 8) and a mood-motivation subscale. These two subscales were then compared with the somatic-performance subscale (items 15–21). As a percentage of the total matched BDI score, the cancer patients had more somatic symptoms (42.7 v 34.8%), equivalent mood/motivation symptoms (44.5 v 45.6%) and less negative self-referent symptoms (12.8 v 19.5%). This difference may apply more to mild symptoms than moderate-severe symptoms. Some preliminary support for the hypothesis is therefore available.

Motivational Interviewing is an evidence-based brief intervention for helping people change problematic health behaviors. The development of motivational interviewing was influenced, in part, by the social psychology literature, especially the concept of psychological reactance. This paper argues for expanding the influence of social psychological processes upon the practice of motivational interviewing by reviewing three relevant processes: defensive bias, message framing, and cognitive-affective ambivalence. Relevant research findings are reviewed and specific recommendations are offered for future research and enhancing the practice of motivational interviewing.

This study aims to explore help-seeking thresholds, beliefs and attitudes about depression and establish how these are affected by previous treatment for depression, the type of treatment received, and current depression. Participants were a cohort of 42 individuals previously diagnosed with Major Depressive Disorder (MDD) in two groups according to previous treatment for depression; 12 individuals previously diagnosed with a psychological disorder other than MDD; and 48 individuals from a community sample. Five self-report questionnaires measured thresholds for help-seeking, beliefs about depression, current depression and self-management skills. Between-group comparisons were made for help-seeking thresholds and beliefs about depression. Results showed lower thresholds for professional help-seeking in those who had previously received psychological treatment than in those treated with antidepressants only and non-clinical controls. Perceived stigma was negatively associated with help-seeking. Depressed mood was associated with delayed help-seeking and symptom recognition, even in those who had previously received treatment for depression. We conclude that relapse prevention interventions may educate patients about the effects of depression on help-seeking. Further research should clarify the extent to which help-seeking co-varies with depressed mood. More work is needed to reduce the stigma associated with depression.

Evaluations of computer-guided CBT (CCBT) suggest that this is a promising approach to closing the gap between the demand for, and the supply of, CBT. However, additional studies are required that are conducted by researchers independent of the programme developers, and include a wider range of participants. This independent study examined the viability of CCBT for panic and phobic anxiety in an unselected sample of referrals in remote and rural areas of Scotland. Outcome was assessed by a wide range of outcome measures, completed before and after treatment, and at 4-month follow-up. Participants experienced few difficulties in using the programme, and GPs and participants regarded CCBT as acceptable and useful. Major improvements were obtained, with several large effect sizes, which remained at follow-up. It was concluded that computer-guided CBT can play a useful part in delivering CBT services in rural areas; and that self-help CBT may be the only treatment option available to some sufferers.

There is controversy about the value of psychological interventions offered to refugee people through an interpreter, but little empirical evidence in this field. This study compared routine clinical outcomes of three groups of PTSD patients receiving CBT: refugees who required interpreters; refugees who did not require an interpreter; and English-speaking non-refugees. The aim of the study was to ascertain whether interpreted CBT is feasible. All three groups attended a similar number of sessions and showed significant improvements after treatment. Refugees receiving treatment with and without interpreting did not differ in treatment outcomes. The findings suggest that interpreters can be used with positive outcome in treating PTSD patients with CBT. This study supports NICE (2005) recommendations that CBT should be offered regardless of language need.

As a result of its expanding evidence base from randomized controlled trials, cognitive therapy is becoming increasingly widely practised in the treatment of many mental health problems. However, little is known about the extent to which it is carried out competently in practice, nor about what characteristics of therapists may be associated with competence. In therapists claiming to practice cognitive therapy, this study examined the relationship of a number of therapist factors, including training, profession, experience, supervision and accreditation, to competence. Therapists (n = 24) taped a mid-treatment cognitive therapy session. An independent rater, blind to information about the therapist, assessed the competence shown by the therapist during this session using the Cognitive Therapy Scale (CTS). Five randomly selected tapes were rated by a second rater and the inter-rater correlations were high. Although all therapists had received some cognitive therapy training during basic professional qualification, therapists with formal post-qualification training in cognitive therapy showed significantly higher levels of competence than those without. Psychologists were rated as more competent than therapists from other professions on one of the CTS subscales (Interpersonal Effectiveness). Number of years of experience, frequency of supervision, and accreditation were unrelated to ratings of competence. A number of accredited cognitive therapists scored well below a widely used criterion of competence.

Some studies of computerized cognitive behaviour therapy (CCBT) have found evidence of its effectiveness, yet a number have reported low uptake and/or completion rates. This study investigated attitudes towards CCBT for depression amongst 122 university students. The credibility of CCBT, expectancy-for-improvement and perceived likelihood of using it were all poor, although a minority (9.8%) stated a preference for CCBT over other interventions. When 20 of the original sample received a demonstration of a CCBT programme for depression, significant increases in credibility, expectancy-for-improvement and in perceived likelihood of using CCBT were found. Numbers stating a preference for CCBT increased to 30%. At both stages, most students stated a preference for CCBT to be accompanied by counselling. Qualitative analysis provided information about factors that might influence these attitudes. Implications for service delivery are discussed.

Impairment in mental control is a primary complaint of many sufferers of obsessive-compulsive disorder (OCD). Most OCD sufferers work very hard to rid themselves of their obsessions, to little avail. Although active resistance is a defining feature of obsessions, it is typically not assessed in measures of OCD severity and little is known about the frequency of attempts at thought control or its impact on functioning while control strategies are engaged. In the present study, 37 individuals diagnosed with OCD kept a diary of their suppression attempts over a 3-day period, recording the circumstances under which the attempt at suppression occurred, the suppression strategy used, its outcome, and its impact on concentration, mood, peace of mind, and ability to proceed with planned activities. Results indicated that individuals with OCD engage in frequent, strenuous, time-consuming and ultimately unsuccessful attempts to control thoughts. Suppression was used as a means of avoiding the hassles associated with experiencing an obsession and with performing a compulsive ritual. Consistent with other research, suppression was also used as a means of neutralizing harm potentiated by the obsession. These findings suggest that thought suppression efforts and their impact may contribute significantly to the severity of impairment associated with OCD, and that it might be useful for clinical and research purposes to evaluate suppression as a severity indicator.

Numerous research studies have found evidence of psychotic-like experiences in the general population which are unrelated to psychopathology. Recent cognitive models of psychosis have considered these findings and have taken a normalizing approach to psychosis. It is suggested that hallucinations and delusions are essentially “normal” but are interpreted and responded to in an unhelpful way by individuals who come into contact with services. A web-based cross-sectional survey was conducted in which 544 students completed measures of predisposition to psychotic phenomena, appraisals of hallucinations and delusions, the use of safety behaviours and thought control strategies and a measure of general health. Positive appraisals of psychotic-like phenomena were found to be associated with the frequency of such phenomena but no more so than negative beliefs. Negative appraisals were more strongly associated with distress than positive appraisals but when the frequency of psychotic-like phenomena was controlled for negative appraisals made only a small contribution to distress. Avoidant safety behaviours and punishment-based thought control strategies were found to be associated with both distress and the frequency of psychotic-like phenomena. These findings provide some support for recent cognitive conceptualizations of psychosis, but essentially they emphasize the multi-faceted nature of vulnerability to psychosis.