In recent years that has been an increasing interest in supervision within the UK's cognitive behaviour therapy (CBT) community. This is because the role of supervision has begun to be recognized in relation to the delivery of effective clinical services (Department of Health, 1998), and because of a clear recognition of the need to ensure that CBT practitioners are competent. Perhaps less well recognized in CBT are a number of interesting educational approaches to supervision, ones that may make supervision more successful. This paper summarizes some of these theories from a CBT perspective. Whilst the evidence base does not yet justify being too prescriptive, it is argued that some of these theories, such as Vygotsky's notion of the “Zone of Proximal Development”, provide helpful prompts for reflecting on CBT supervision. An integrative model is constructed from these theories, with illustrative examples and suggestions for future research.

Training efforts for evidenced based treatments require evaluation, yet the value of practitioner self-reports of skills acquisition has been questioned. Thus, a key issue concerns how accurately practitioners assess their own clinical skills. In the current study, 23 community practitioners participated in training of Motivational Interviewing (MI), completed standardized patient (SP) interviews before and after training, and provided self-ratings of MI elements after each interview. Interview recordings were later coded independently. Results suggest training contributed to: 1) reasonable agreement between practitioner and independent ratings; and 2) more effective use of MI, despite a tendency for practitioners to underestimate training gains. This micro-analysis of training documents initial skill gains along with increased practitioner self-awareness. Further, it exemplifies how practitioner self-ratings and objective skill assessment methods may be used in tandem to more fully describe practitioner learning.

One- and two-year cognitive therapy training programs are increasingly popular in the UK and overseas. Previous research has indicated that trainees show gains in competence, though this may at times be accompanied by self-doubt and stress. The present study sought specifically to gain the trainees' perspective: What happens to self-perception of competence (SPC) during cognitive therapy training – does it change over time? Do all elements of cognitive therapy skill show the same changes in SPC? Do individuals show different patterns of change? What environmental and internal factors influence changes in SPC? Twenty-four trainees on a one-year part-time training course completed a self-rated assessment of competence at six time points during the course. They also reported attributions about experiences that might have contributed to increases or decreases in SPC. Results demonstrated that SPC increases significantly over time, but there is considerable variation across different skills, and between individuals. A model developed from trainees' qualitative data indicated that the prime influences on SPC were new learning opportunities (acquiring knowledge, implementing knowledge, external evaluation, experiences with clients), self-reflection on performance, increased awareness of the standards required of a cognitive therapist, and emotional state, in particular emotionally salient memories and current stress. Practical implications of the findings for trainees, trainers and supervisors are discussed.

This paper describes the development of protocols with interpreters employed in an East London psychological trauma clinic. The service treats traumatized refugee people with cognitive methods, according to the National Institute for Clinical Excellence (NICE) Guidelines for PTSD. NICE states that language should not be a barrier to treatment, but provides no further guidance to achieve this. These protocols for interpreting CBT are designed to be explicit, consistent and ethical. A telephone poll from a recent UK-wide trauma survey, a focus group with local interpreters, and practitioner reflection were all used to develop and refine the protocols and their rationale, which are described, together with implications for future culturally sensitive practice and research.

The importance of self-esteem in the development and maintenance of psychotic experiences has been shown in previous research. However, there has been little research into the role this plays in individuals with psychosis and forensic histories. The current study investigated the effectiveness of a standardized group programme for improving self-esteem in individuals with psychosis living in high security settings. Fifteen participants were included in the group programme and measures were taken to record changes in self-esteem and symptomatology. The results demonstrated significant improvements in self-esteem over the course of the group intervention, with some effects maintained at 3-month follow-up. Improvements in depressed mood were also found. The results demonstrated the effectiveness of a group intervention for self-esteem in individuals with psychosis. The findings of this study, alongside implications for further research, are discussed.

The investigation of factors that may render an individual vulnerable to the development of suicide ideation may provide some light on the etiology of suicidal behavior and consequently contribute to the prevention of suicide. Based on this idea, an examination of the relationship between the underlying dimensions of the Dysfunctional Attitude Scale (DAS-A), the Automatic Thoughts Questionnaire (ATQ-30) and suicide ideation was conducted. The six DAS-A components and the two ATQ-30 components reported by Chioqueta and Stiles (2006a, 2006c) were among the variables employed in the present study. In a sample composed of 102 male military recruits, initially assessed at the Army School (Pretest) and re-tested 3 months later (Posttest), a series of multiple regression analyses were conducted. The results demonstrated that the two subscales of the ATQ-30 (Negative Self-Concept/Personal Maladjustment and Desire for Change/Negative Expectations), but none of the DAS-A subscales, predicted suicide ideation 3 months later. Thus, automatic thoughts reflecting ideas of negative self-concept, perceptions of personal maladjustment, thoughts of desire for change, and negative expectations seem to be more associated with suicide ideation than depressogenic beliefs.

Sexual abuse in childhood is a pathogenetic factor for psychological disorders. The attention given to this phenomenon varies between therapists and therapeutic schools. The question is how often sexual abuse is recognized as a problem in cognitive behaviour therapy and how this is related to the present symptoms and therapeutic problems. 1223 case reports, written as application for reimbursement of routine cognitive behaviour therapy, were submitted to a content analysis in respect to childhood sexual abuse. Sexual abuse was mentioned in 10.3% of the cases; 59% of female and 50.0% of male victims were abused by relatives. Sexually abused patients showed significantly increased rates of inadequate care and negative life events during childhood. In comparison to controls, cases showed significantly increased rates of “eating disorders” (15 vs. 6; p<.05), “substance abuse/addiction” (16 vs. 6; p<.05), “suicide attempts” (15 vs. 3; p<.01), “strict refusal of sexual partners” (15 vs. 5; p<.05), “frequently changing partners” (21 vs. 3; p<.001), “problems in marriage/partnership” (95 vs. 77; p<.05) and “sexual problems” (51 vs. 24; p<.001). Childhood sexual abuse is a problem, frequently seen in behaviour therapy patients and therefore also warranting special attention in routine patient care. Sexual abuse is understood by cognitive behaviour therapists as an indicator for traumatizing conditions in general during childhood. It is associated with specific treatment problems and therapeutic needs in adulthood.

This paper critically evaluates the empirical evidence of 36 studies regarding the comparative cost-effectiveness of group and individual cognitive behaviour therapy (CBT) as a whole, and also for specific mental disorders (e.g. depression, anxiety, substance abuse) or populations (e.g. children). Methods of calculating costs, as well as methods of comparing treatment outcomes were appraised and criticized. Overall, the evidence that group CBT is more cost-effective than individual CBT is mixed, with group CBT appearing to be more cost effective in treating depression and children, but less cost effective in treating drugs and alcohol dependence, anxiety and social phobias. In addition, methodological weaknesses in the studies assessed are noted. There is a need to improve cost calculation methodology, as well as more solid and a greater number of empirical cost-effectiveness studies before a firm conclusion can be reached that group CBT is more cost effective then individual CBT.

Positive beliefs about the benefits of rumination have been shown to be a proximal factor determining rumination. This study investigated, in a sample of 29 currently depressed patients, whether positive beliefs about rumination parallel known gender differences in rumination and whether these beliefs differ between depressed individuals with and without a history of physical or sexual assault. Depressed women tended to report stronger positive beliefs in the benefits of rumination than men. However, this result was found to be due to differential effects of a history of assault: women with a history of assault showed significantly stronger positive beliefs than women without a history of assault while there were no significant differences in men. Experiences of assault may undermine women's beliefs in coping ability so that rumination is seen as a more compelling option.

This paper reports on the development and running of an anger management service that has been provided in Southampton for the past decade. It discusses some of the challenges that the service has had to face, (including over-popularity with referrers and high attrition rates) and describes the model that is used. The paper also examines the outcome of one particular therapeutic group. The results of this evaluation show that those who drop out of the group have higher initial depression and poorer self-esteem compared to those who remain in the group. In addition, those who complete the anger management group show improvements in anger control and have improved self-esteem. The paper concludes with practice recommendations.

Self-efficacy is a potentially useful concept when applied to Social Anxiety Disorder (SAD). The aims of the current study were to examine the psychometric properties of the Self-Efficacy for Social Situations Scale (SESS; Gaudiano and Herbert, 2003) and to investigate the relationship between self-efficacy and anxiety in an adolescent sample with generalized SAD. Results replicated those found in a previous adult SAD sample. The SESS showed high internal consistency and good construct and criterion-related validity. The SESS also predicted subjective anxiety and perceived performance in social role play tests after controlling for social anxiety severity. Furthermore, self-efficacy more clearly predicted self-ratings in contrast to observer ratings of performance in social role play tests. Finally, changes in social self-efficacy were strongly associated with changes in social anxiety symptoms following treatment, even after controlling for changes in fear of negative evaluation. Treatment implications for adolescent SAD are discussed.

Research suggests that there is low inter-rater reliability between therapists when asked to formulate the same case and that there may be discrepancies in what is considered an essential part of a formulation. The present study aimed to explore the diversity of therapists' viewpoints regarding the purpose and essential features of a cognitive-behavioural therapy (CBT) case formulation of depression. A Q-sort methodology was used in order to render these beliefs operational. Seven experienced CBT therapists participated in the construction of 86 statements, capturing concepts considered relevant to a CBT formulation of depression. This Q-sort was then administered to 23 therapists, who rated these statements in terms of their importance using a Q-sort procedure. Three factors emerged, suggesting three dominant opinions as to the importance of features of a formulation. A “state” CBT factor, focusing on the “here and now”, accounted for most variance; followed by a second factor emphasizing “function and process” and a third factor emphasizing “trait” components. Whilst there was some agreement between what was considered to be least important in a formulation, the emergence of three distinct viewpoints suggests a lack of complete consensus amongst the therapists.

The development of a brief psychological intervention aimed at clinicians without high levels of bipolar disorder expertise was described, and the manual based therapy was evaluated for feasibility with 13 bipolar diagnosed clients. Outcome was assessed using inventories related to central concerns with the bipolar population including suicide risk (Beck Hopelessness Scale), perceived control over mood and other internal states (Perceived Control of Internal States Scale) and satisfaction with treatment (Client Satisfaction Questionnaire). Data from Visual Analogue Scales and research interviews were used to complement the main results. Significant improvements were observed on all measures and it is concluded that the evaluated treatment can have important effects on central aspects of the bipolar experience and that it can be a useful adjunct to pharmacological therapies. Implications for clinical practice and service provision are discussed.

Although empathy has been shown to play an important role in therapeutic outcomes for cognitive-behaviour therapy (CBT) as for other therapies, there has been remarkably little discussion or research on empathy in the CBT literature. This paper seeks to make the implicit explicit: to conceptualize the nature and function of therapeutic empathy within CBT. It proposes a model of therapeutic empathy with four key elements: Empathic attunement, Empathic attitude/stance, Empathic communication, and Empathy knowledge. The model points to the importance of the “person of the therapist” and self-reflection in the development of therapeutic empathy; and describes how the specific contribution of CBT knowledge and skills can help therapists understand clients' moment-to-moment experiences and, if used sensitively, can enhance the empathic process. The paper indicates how therapists may use different modes of empathic processing to process experience under different circumstances, and how empathy fulfils a variety of functions within CBT. This conceptualization has considerable implications for therapists, trainers, supervisors and researchers including: more accurate identification and targeted strategies to address therapeutic empathy problems; recognition of the value of personal experiential work and self-reflection in empathy training; increased understanding of the functions of empathy; and development of finer-grained clinical and research measures.

Childhood onset conduct problems present some of the most significant challenges to mental health and public services today. Parent management training is among the most effective treatments for conduct problems, and yet a significant proportion of families do not benefit from this approach. This may be because key elements of parenting, such as parental cognitions, are not directly addressed in such interventions. This study investigated the role of mothers' interpersonal schemas in the maintenance of conduct problems and their relationship to parenting behaviour. It examined whether mothers of 7 to 11-year-old boys with conduct problems would have more negative child-related interpersonal schemas (Hill and Safran, 1994), and related negative parenting behaviours, observed during two parent-child interaction tasks, than mothers in a comparison group. The findings showed that there was a significant difference between the two groups in both maternal Negativity and Warmth and child-related interpersonal schemas. However, no relationship was found between parenting behaviour and child-related interpersonal schemas. The results suggest that targeting maternal cognitions in addition to negativity and warmth may enhance interventions for childhood onset conduct problems. However, more research needs to be done to ascertain which kinds of cognitions relate most closely to parenting behaviour in stressful situations.

The current study investigated the relationship between session impact and outcome in group psychoeducative CBT, conducted in a routine clinical setting. Participants completed a range of outcome measures at screening, start of the group, termination of the group and at the 3-month follow-up of the six-session intervention. At the end of each psychoeducative session, participants completed a group-specific version of the Session Impact Scale. No single psychoeducative session was seen to generate greater impacts than any other session of the six. Clients who experienced a clinically significant reduction in symptoms during the group perceived greater interpersonal impacts in the group. Results suggest that interpersonal aspects such as normalization may be the active ingredient of change in such service delivery settings. The results are discussed in terms of the potential powerful role of non-specific factors in such large groups and directions for further research examining the impact-outcome relationship in group-based CBT.

Service user satisfaction with Cognitive Behavioural Therapy (CBT) for psychosis was examined with the Satisfaction with Therapy Questionnaire (STQ; Beck, Wright, Newman and Liese, 1993). Sixty-five service-users completed the STQ at the end of therapy, and 40 3-month post therapy. Overall, the majority of service-users were satisfied with therapy. Satisfaction was unaffected by service-user demographics or service issues, and remained stable over the 3-month follow-up. Belief in the extent to which CBT skills/knowledge had been gained predicted overall satisfaction at the end of therapy, while there was a near-significant effect for belief about the usefulness of homework(s) to predict overall satisfaction at 3-month follow-up. These results suggest that (i) CBT for psychosis is an acceptable intervention to service-users, regardless of their demographic characteristics or service issues; (ii) the specific aspects of CBT, not the non-specific attributes of therapy, predict overall satisfaction; (iii) homework setting may be important in ensuring ongoing satisfaction post-therapy.

We assessed the use of a microswitch cluster (i.e. a combination of two micro-switches) plus contingent stimulation for promoting adaptive responding and reducing aberrant behaviour in a woman with profound developmental disabilities. The woman was initially taught an adaptive hand response that activated a pressure microswitch and produced preferred stimuli. Subsequently, her hand response led to preferred stimuli only if it occurred free from face hiding (i.e. aberrant behaviour detected through a mercury microswitch). The study also included a 3-month post-intervention and generalization check, and a social validation assessment. Data showed that the woman increased her adaptive responding, learned to perform this responding largely free from aberrant behaviour, and maintained and generalized the new performance across settings. Forty-five psychology students provided positive social validation of the woman's new performance and the use of microswitch-cluster technology.

A brief treatment for panic disorder with agoraphobia (PDA) supported by self-help materials may be an alternative choice to standard CBT: this type of program may also help to overcome some of the cost-benefit limitations of standard cognitive behavioural therapy. The aim of this study was to test the efficacy of a brief cognitive behaviour therapy (7 weeks) for PDA, with and without partner involvement, along with a self-study manual. A total of 77 participants meeting DSM-IV criteria of PDA were assigned to one of three treatment conditions: 1) a 14-session standard CBT (n = 26); 2) a 7-session brief cognitive behaviour therapy along with a self-study manual (n = 26); and 3) a 7-session brief cognitive behaviour therapy involving a partner along with a self-study manual (n = 25). Results show a statistically and clinically significant improvement on all outcome measures in the three treatment conditions. Gains were maintained up to 6 months. Both brief CBT conditions were as effective as the standard cognitive behavioural treatment. These results suggest that a brief program, supported by self-help materials, that shortens the time during which the patient suffers from this problem may be a good option for the treatment of panic disorder.

Parenting styles and the parent-child bond are associated with anxiety in children. Despite this association, little is known about the mechanism through which parenting has its effect. One possibility is that parenting interacts with other known pathways to fear. Two experiments are reported that look at the interaction between parenting styles and parent-child relationships and the verbal information pathway to fear. In Experiment 1, a punitive maternal parenting style was found to interact with the effect of threat information about a novel animal in 6–9-year-old children. Maternal warmth, neglect, overprotection and accurate monitoring were not found to have a significant effect. Experiment 2 showed that children reporting a greater number of negative interactions with their fathers had greater increases in fear beliefs about novel animals after both threat and no information. The quality of mother-child relationships did not significantly interact with the verbal information pathway. These experiments offer preliminary evidence that parenting practices influence how children react to negative information, which offers some insight into the potential causes of the association between parenting and anxiety in children.