This is going to be an interesting year for CBT. The National Institute of Clinical Excellence (NICE) unveils a series of treatment guidelines this year. These guidelines are intended to support good practice in clinical settings; implicitly, they also seek to discourage ineffective or bad practice. It is becoming evident that CBT is likely to be judged as a first line treatment (or the first line treatment) in a range of anxiety disorders, depression and eating disorders. Other issues which will be tackled include the lack of evidence for just about all other psychological treatment approaches, that CBT should be readily and rapidly available where it is needed and the need for quality control linked with (but not confined to) proper training and supervision of therapists. Early identification of clinical difficulties and a better research understanding of the extent and limitations of current psychological and pharmacological treatments are also likely to be advocated. These are all issues which greatly concern the Association and this journal, and as editor I look forward to receiving empirically based submissions addressing these topics.

The present study applied the Deese-Roediger-McDermott false memory paradigm to examine whether anxious and fearful individuals exhibit higher recall and recognition rates of never presented threat words than nonanxious individuals. In Study 1, 39 spider fearful individuals, 28 blood fearful individuals, and 41 nonfearful individuals learned four word lists associated with unpresented target words: “spider”, “blood”, “river”, and “music”. Regardless of whether participants completed only a recognition task or a recall task and then a recognition task, there were no differences as a function of group in the degree to which they falsely remembered unpresented target threat words. In Study 2, 48 socially anxious and 51 nonanxious individuals learned four lists associated with social/evaluative threat unpresented target words and four lists associated with neutral unpresented target words. Similar to the findings from Study 1, groups did not differ in the degree to which they falsely remembered target words. These findings add to an increasingly large literature suggesting that anxious individuals are not characterized by a memory bias toward threat.

The present study examined characteristics of autobiographical memories retrieved by individuals with social phobia (n=15) and nonanxious individuals (n=17). Participants were presented with social threat, positive, and neutral cue words and instructed to retrieve the first specific personal memory that came to mind. Memories were coded for retrieval latency, overgenerality (vs. specificity), and affective tone. Nonanxious individuals, rather than social phobic individuals, demonstrated a bias toward the retrieval of specific negative memories when cued by social threat words. Significant omnibus results were attenuated when self-reported depression was included as a covariate in analyses. These results suggest that memories cued by social threat words are particularly salient for nonanxious individuals but not for individuals with social phobia and that depressive symptoms must be accounted for in studies examining cognitive biases toward threat.

This edition has a special focus on cognitive and behavioural work with older people. Many of the papers have been written by national and international experts in their respective fields and demonstrate the variety and breadth of work undertaken within the specialty. Older people bring heterogeneity to the therapeutic context, with unrivalled opportunity for challenge, versatility and creativity. For example, during a single working day one could find oneself treating a centenarian with depression, a 60-year-old patient with early onset dementia, a person with pseudo-dementia whose anxiety mimics a Parkinson's presentation, a depressed person with chronic heart failure, and a depressed family carer. Alternatively, one could find oneself working with nursing home staff who are struggling to deal with a resident with challenging behaviour. Practitioners require knowledge and skills in neuropsychology, chronic disease management, standard 1:1 therapy, family and systems work. They must also be able to apply a wide ranging set of conceptual frameworks and associated interventions to people with varying degrees of cognitive impairment as well as undertake activities such as supervision, consultation and training of carers, staff and colleagues. Thus therapists working with older people are often acutely aware of the importance of extending treatment to the individual's supporting social context and the system within which treatment is offered.

Cognitive behaviour therapy (CBT) has proven efficacy as a treatment for depression in older people. An important debate amongst therapists working with older people is whether CBT needs to be adapted to ensure optimal treatment outcome and, if so, what adaptations are necessary. It is accepted that psychotherapy with older people can differ from psychotherapy with younger people in a number of important respects because of the higher likelihood of chronic conditions, changes in cognitive capacity, potential loss experiences and different cohort belief systems. As psychotherapists are often much less comfortable dealing with physical problems, they may become negatively biased in terms of outcome when patients present with co-morbid health issues. The impact of loss experiences in older people can also be overemphasized in their importance by inexperienced therapists and can result in lowered expectations for therapy outcome. Consequently, there is a need to develop a model that addresses age related issues within a coherent cognitive therapy framework suitable for older people. This paper describes a CBT model that is augmented with applied gerontological knowledge, taking account of cohort beliefs, intergenerational linkages, sociocultural context, health status/beliefs and role investments/transitions. Clinical examples are used throughout to illustrate clinical implications of the model.

A 4-year follow-up compared the long-term effects of two treatments for severely conduct disorder children referred to a Child and Adolescent Mental Health Service (CAMHS). Forty-two families received either the standard CAMHS treatment or a more intensive intervention. The intensive treatment involved a unit-based component for parents to practise new child management strategies. At the 6-month follow-up the intensive treatment group showed significant improvements on all measures of child behaviour and maternal mental health and improvements remained significant at the 4-year follow-up. By contrast, initial improvements for the standard treatment group, which were significant on only two measures, were not significant at the 4-year follow-up. The results suggest that the intensive treatment was advantageous in bringing about long-term improvements for these families. They also add to the growing evidence that interventions involving the rehearsal of child management strategies have better outcomes than those using more didactic methods of parent training.

Thirty-five outpatients (25 women, 10 men) with a DSM-III-R principal diagnosis of OCD accepted exposure treatment at a psychiatric outpatient clinic. They were randomly assigned to one of two individual treatments for a 6-week exposure therapy treatment based on a treatment manual or to a 6-week waiting list condition. The 12 patients assigned to the waiting list were subsequently randomly assigned to one of the active treatments. Both treatment groups received in vivo or imaginal exposure in each of the 10 twice-weekly treatment sessions held after two assessment sessions. One group (n=16) received cognitive therapy interventions for comorbidity problems or to alter beliefs underlying patients' OCD. The other group (n=19) received relaxation training as an attention placebo control. Both groups received relapse prevention follow-up contacts. Twenty-seven patients completed intensive treatment. Both treatments overall showed satisfactory levels of clinical improvement and large effect sizes. ANCOVAS for treatment completers showed non-significantly lower levels of OCD symptoms, depression and state anxiety in the treatment condition that did not include cognitive interventions. The patients receiving additional cognitive therapy showed significantly lesser dropout than those in the other treatment condition, but there were no significant differences in the intention-to-treat analyses.

Although cognitive behavior therapy (CBT) has been shown to be generally effective in the treatment of social anxiety disorder (SAD), not all individuals respond to treatment, and among those who do respond the degree of improvement is sometimes far from optimal. Little research has examined the impact of variations in the format of treatment delivery in this area. Participants were randomly assigned to either a standard, 12-session CBT program for generalized SAD in which treatment was delivered in successive weekly sessions (standard treatment) or a similar program in which the 12 sessions were delivered over 18 weeks (extended treatment). Intent-to-treat analyses revealed that the standard treatment program resulted in superior outcome in terms of self-rated symptom and impairment levels, categorical ratings of responder status, and lower dropout rates. Analyses of treatment completers only revealed comparable gains between the two conditions by post-treatment. However, the standard treatment condition revealed a more rapid improvement in magnitude initially. These findings suggest no benefit from extending the course of CBT treatment over a greater length of time, and suggest that such extension may in fact substantially increase the likelihood of premature termination.

The current study explored whether, consistent with Wegner's (1994) theory of ironic process of mental control, instructions to suppress rape-related thoughts would lead to paradoxical increases in the accessibility and distress associated with these thoughts. In order to minimize experimental artifacts, instructions and assessments were designed to be unobtrusive. Although no effects of suppression instructions on rape-related distress emerged, directed suppression was associated with a concurrent increase in heart rate. In addition, directed suppression led to a medium-sized effect of increased accessibility, although this effect was nonsignificant due to small sample size. Finally, individual differences in the tendency to suppress thoughts were associated with increased accessibility in the suppression condition, suggesting that thought control strategies may be particularly problematic when they are chronically employed.

Homework assignments are an essential part of cognitive-behavioural therapy, and are included in the majority of therapy manuals and frequently used in therapeutic practice. Despite this, little is known about problems with homework completion or possible influences on homework compliance. The aim of the present practitioner survey was to provide data on problems related to homework use and compliance. Furthermore, the relationships between different variables and homework compliance were examined. Data were collected by asking 77 cognitive-behavioural therapists to recall two individual patients. Therapists described homework tasks assigned to these patients and procedures of assignment as well as problems that arose during assignment and completion. The results suggested that problems during the assignation of a task as well as during completion regularly occur. Homework compliance was positively associated both with patients' motivation for therapy, outcome at a later stage of therapy, and the provision of a written note or homework sheets on the task. Regression analyses pointed to patient variables as most crucial for homework compliance. Implications for effective homework use in clinical practice are discussed.

This paper forms the second in a series of three articles on conceptualizations of older people's distress. The focus is on simple and concrete “mini-formulations” that keep the amount of information in them to a minimum, yet retain explanatory and predictive power. Such formulations can be used as the basis for action plans for intervention, while avoiding overburdening the cognitive capacity of the client or therapist. Simple linear and cyclical models are described, as are cognitive triad and dyad models. The uses of “mini-formulations” for group and individual settings are illustrated in a case example of a lady caring for her husband who has dementia.

Depression, anxiety disorders and phobias are common mental health problems associated with considerable occupational and interpersonal impairment. Although there is substantial evidence to support the use of cognitive behaviour therapy (CBT) in the treatment of these disorders, access is limited. Computerized cognitive behaviour therapy (CCBT) is one of a variety of aids to self-management that offer patients the potential benefits of CBT with less therapist involvement than therapist led CBT (TCBT). In this systematic review of the efficacy of CCBT, 16 studies were identified. Of these 11 were RCTS and the remaining 5 were pilot or cohort studies. The quality of studies ranged from poor to moderate (although the criteria used precluded the highest rating). In the studies comparing CCBT with TCBT, five studies showed CCBT have equivalent outcomes to TCBT. One study of depressed inpatients found TCBT to be significantly more effective than CCBT. Four studies found CCBT to be more effective than treatment as usual (TAU). Two studies found CCBT to be no more effective than TAU. Two studies compared CCBT with bibliotherapy. Of these, one study found CCBT to be as effective as bibliotherapy and one found bibliotherapy to be significantly more effective than CCBT on some outcome measures. Although the results of this review are not conclusive, CCBT is potentially useful in the treatment of anxiety disorders, depression and phobias. From the results of this review, we make three recommendations to improve the quality of research in this field, and suggest four areas requiring further research.

This is the third in a series of three papers on cognitive therapy formulation with older people. The aims of this paper are to identify barriers to collaborative conceptualization, and to summarize useful strategies for overcoming these barriers. Obstacles to collaborative conceptualization with older clients have previously been thought of as a consequence of age-related skills deficits. In this paper we focus instead on the barriers created by therapistand client-held prejudicial beliefs. A social cognitive perspective is used to conceptualize stereotypical prejudices. Strategies are described for challenging or reframing prejudicial beliefs, and addressing the mechanisms that perpetuate these beliefs.

Computerized Self-help (CSH) has recently been the subject of a NICE (National Institute of Clinical Excellence) review. This increase in interest is also reflected in the increase in advertising for CSH programmes. We report a national survey of a random sample of 500 therapists accredited with the British Association for Behavioural and Cognitive Psychotherapies, which is the lead organization for CBT in the UK. A total of 329 therapists responded (65.8%). A surprisingly small number of CBT therapists were using CSH (12 or 2.4%) and only 5 or 1% were using it as an alternative to patient-therapist contact. Despite this, over 90% of the responding therapists had not ruled out using CSH in the future, but the majority of these would use it to supplement rather than as an alternative to individual face-to-face therapy. The need to know more about computerized self-help and the need for training in therapy using this modality were seen as the main factors that would have to change to allow the therapists to use CSH. Knowledge of and ability to use computers did not appear to be an important factor as most therapists in this sample used computers on a regular basis. Most therapists were not aware of evidence of the effectiveness of CSH but the minority who did feel able to express views stated that CSH would be less effective than individual face-to-face therapy and result in less client satisfaction.

A psychometric study was conducted with the aim of collecting basic information about anticipatory processing and its relationship to social anxiety. A self-report measure of anticipatory processing was developed and utilized in a large student sample. The results confirmed that such processing is very common before an anticipated feared social event and a significant correlation (r=0.49) between anticipatory processing scores and social anxiety was found, which remained when trait anxiety and depression were controlled. A factor analysis indicated that all items of the measure except for two loaded significantly on one factor and accounted for the 47.3% of the variance. Socially anxious individuals in the study reported that their thoughts about the event were recurrent, intrusive, interfered with their concentration and increased their state of anxiety. Also, they reported that they wished they could avoid the situation. The results are discussed in terms of the Clark and Wells cognitive model of social phobia.

Emotional images may be viewed as propositional structures (Lang, 1977), and involve a range of modalities, including cognitive processes. Early memories, however, are often experienced non-verbally (Pillemer, 1998). Self-generated and spontaneous images were investigated in a spider anxious group (N=29) and a non spider anxious group (N=30). Participants completed self-report measures and a detailed semi-structured interview. The spider anxious, compared to the control group, reported more modalities, particularly skin and internal body sensations, in a self-generated spider image than in a control image. Their spider image was also associated with more anxiety, greater intent and vividness, and skin and body sensations that lasted longer. It was also associated with more negative self and other related core beliefs. Themes in core beliefs included loss of control, negative self-evaluation and vulnerability. Most of the spider anxious group reported spontaneous, recurrent images associated with their fear of spiders. Visual, body, skin and auditory sensations were noted. These images were linked to negative self and other related beliefs. Over half identified an associated early memory containing content, emotional meaning and modalities similar to that identified in the initial image. Implications for the treatment and cognitive theory of phobias are considered.

This paper presents a single case study investigating the use of cognitive behavioural therapy (CBT) with an adolescent experiencing a psychotic episode. The participant was a 15-year-old girl with first episode psychosis, who was an inpatient in an adolescent psychiatric unit. Progress was evaluated using an AB time series design, lasting 16 weeks in total. After a baseline assessment (A) the participant received a 16-week CBT intervention for psychosis (B). The effectiveness of the intervention was investigated with relation to psychotic symptoms, self-esteem, recovery style, person evaluations, anxiety and depression. The results indicated that there were some improvements in symptoms of anxiety, depression and psychosis but were inconclusive for the other measures. It is argued that the maintenance of negative person evaluations had a detrimental effect on the participant's ability to increase self-esteem, change recovery style and further reduce psychotic symptoms, anxiety and depression. The impact of environmental factors on the progression of the participant's illness is considered and the findings are discussed in relation to previous literature.

Mindfulness training (MT) is a meditation-based approach that, on its own or in alliance with cognitive therapy, can effectively impact on several therapeutic targets such as recurrent depression, some anxiety problems, and chronic physical pain. This article outlines how mindfulness training complements cognitive-behavioural therapy (CBT), and why it may be particularly useful to older people. The range of potential applications of MT is examined, followed by considerations of the evidence to date and both the advantages and dangers of current developments within the various MT programmes. The author's ongoing research on Mindfulness-based Cognitive Therapy (MBCT) for older people with recurring depression is described, as is the use of Mindfulness-based Stress Reduction (MBSR) in routine clinical practice. Suggestions are provided regarding future research into the range of applications of MT with older people.

Although low frequency challenging behaviour (that which occurs less than once a day) is common, very little research has been done into its analysis or treatment. It is suggested that the methods of analysing high frequency challenging behaviour, such as experimental functional analysis, will not be applicable with low frequency challenging behaviour. The use of correctional analysis of case records is considered as a method for generating hypotheses as to why a client is showing low frequency challenging behaviour. It is noted that using simple correlations is a method that can provide only limited information as to the relationship between a challenging behaviour and other events. A method that can reveal more about the temporal relationship between environmental events and challenging behaviour is time base lag sequential analysis. Three case studies are presented in which time base lag sequential analysis was used to analyse the relationship between challenging behaviour and possible causal factors.

The purpose of this study was to evaluate a new brief training programme in Cognitive Behavioural Therapy (CBT) within a waiting list control group design. A consecutive sample of 90 mental health professionals were allocated routinely by their managers to be trained in CBT. Over 12 week training periods, these 90 professionals received a total of 48 hours of shared learning, covering core CBT theory and techniques for depression and anxiety. An experiential workshop format was utilized throughout and a comprehensive outcome evaluation was conducted, using multiple measures and methods. The findings indicated that the training was effective in terms of the favourable reactions of the participants, the knowledge and skills they gained, and the generalization of this learning to their work environment. It is concluded that brief shared training in CBT can be successful, in line with current NHS priorities.