Chronic childhood adversity, negative life events, and anxiogenic parenting behaviours have all been implicated in the development and maintenance of childhood anxiety disorders. However, few studies have addressed whether these factors are associated with particular types of childhood anxiety disorders.

The aims of this study were to investigate whether specific associations were obtained between specific types of childhood anxiety disorder – namely, social anxiety disorder (SOC), separation anxiety disorder (SEP) and generalized anxiety disorder (GAD) – and the nature of particular forms of psycho-social risk – namely, chronic childhood adversity, negative life events, and particular forms of parenting behaviours.

Two-hundred and ten children (aged 7–12 years) who met diagnostic criteria for SOC, SEP or GAD and their primary caregivers completed questionnaire measures on chronic childhood adversity and negative life events. In addition, dyads participated in two laboratory-based assessments of parent–child interactions.

We found little evidence for disorder specificity for chronic childhood adversity and negative life events, except in the case of separation anxiety disorder. Anxious children with separation anxiety were more likely than children with other forms of anxiety disorders to live with a single parent, experience more frequent parent arguments, and more negative life events. No group differences in observed parenting behaviours were found.

Childhood SEP may be particularly associated with family challenges which may need specific consideration to optimize prevention and/or treatment. Beyond this, there is limited evidence of specific associations between family and environmental factors and specific types of childhood anxiety disorders.

Around two-thirds of patients with auditory hallucinations experience derogatory and threatening voices (DTVs). Understandably, when these voices are believed then common consequences can be depression, anxiety and suicidal ideation. There is a need for treatment targeted at promoting distance from such voice content. The first step in this treatment development is to understand why patients listen to and believe voices that are appraised as malevolent.

To learn from patients their reasons for listening to and believing DTVs.

Theoretical sampling was used to recruit 15 participants with non-affective psychosis from NHS services who heard daily DTVs. Data were obtained by semi-structured interviews and analysed using grounded theory.

Six higher-order categories for why patients listen and/or believe voices were theorised. These were: (i) to understand the voices (e.g. what is their motive?); (ii) to be alert to the threat (e.g. prepared for what might happen); (iii) a normal instinct to rely on sensory information; (iv) the voices can be of people they know; (v) the DTVs use strategies (e.g. repetition) to capture attention; and (vi) patients feel so worn down it is hard to resist the voice experience (e.g. too mentally defeated to dismiss comments). In total, 21 reasons were identified, with all participants endorsing multiple reasons.

The study generated a wide range of reasons why patients listen to and believe DTVs. Awareness of these reasons can help clinicians understand the patient experience and also identify targets in psychological intervention.

The effects of the use of objective feedback in supervision on the supervisory relationship and skill acquisition is unknown.

The objective of this study was to evaluate the effects of two different types of objective feedback provided during supervision in motivational interviewing (MI) on: (a) the supervisory relationship, including potential feelings of discomfort/distress, provoked by the supervision sessions, and (b) the supervisees’ skill acquisition.

Data were obtained from a MI dissemination study conducted in five county councils across five county councils across Sweden. All 98 practitioners recorded sessions with standardized clients and were randomized to either systematic feedback based on only the behavioral component of a feedback protocol, or systematic feedback based on the entire protocol.

The two different ways to provide objective feedback did not negatively affect the supervisory relationship, or provoke discomfort/distress among the supervisees, and the group that received the behavioural component of the feedback protocol performed better on only two of the seven skill measures.

Objective feedback does not seem to negatively affect either the supervisor–supervisee working alliance or the supervisees’ supervision experience. The observed differences in MI skill acquisition were small, and constructive replications are needed to ascertain the mode and complexity of feedback that optimizes practitioners’ learning, while minimizing the sense of discomfort and distress.

A novel CBT-based intervention, tailored for young people, was developed in response to concerns about traditional diagnostically based approaches. Psychology of Emotions workshops use a normative approach to emotional difficulty instead of a diagnostic framework.

To evaluate the acceptability and efficacy of Psychology of Emotions workshops within an IAPT service for young people aged 16–25 years.

This was a mixed-methods study, evaluating routinely collected self-report measures of depression and anxiety, and qualitative feedback forms. The main outcomes were rates of attendance, change in symptom severity, and participant views of the intervention.

From January to September 2016, 595 young people were invited to attend the Psychology of Emotions workshops, of whom 350 (58.8%) attended at least one session. Young people who attended all six sessions (8.1%) experienced significant reductions in self-reported anxiety (d = .72) and depression (d = .58) and 35.5% were classified as recovered at completion. Those who attended at least two sessions (41.3%) reported smaller but significant improvements in anxiety (d = .42) and depression (d = .45); 22.0% were classified as recovered at the last session attended. Participants provided largely positive feedback about the intervention.

Psychology of Emotions is a promising treatment option, delivered outside of a diagnostic framework, for young people with mild to moderate mental health difficulties seen within IAPT services. Better understanding reasons for non-attendance might enable the intervention to be made accessible to more young people.

Social anxiety is common among adolescents in Pakistan and is associated with low self-esteem. Among the recommended treatments, cognitive behavioural therapy (CBT) is effective, and self-help approaches are encouraged.

To determine the effectiveness of culturally adapted CBT-based guided self-help (CACBT-GSH) intervention, using a manual ‘Khushi aur Khatoon’, for treating social anxiety when added to treatment as usual (TAU) compared with TAU only.

A total of 76 adolescents with social anxiety aged 13–16 years from six schools in Multan, Pakistan were recruited into this randomized controlled trial. Participants were divided into intervention and control groups in a 1:1 ratio. Social anxiety, self-esteem and fear of negative evaluation were assessed through the Liebowtiz Social Anxiety Scale for children and adolescents, the Rosenberg Self-Esteem Scale and the Brief Fear of Negative Evaluation, respectively, at baseline and at the end of the study. Guided self-help using culturally adapted CBT (CACBT)-based self-help manual (eight sessions, one session per week) was provided to the intervention group. The effect of the CACBT-GSH intervention was analysed with ANCOVA.

There was a statistically significant difference between the intervention and the control groups in favour of intervention. Participants in the intervention group showed reduced symptoms of social anxiety (p < .001), fear of negative evaluation (p < .001) and enhanced self-esteem (p < .001).

The study demonstrated the effectiveness of CACBT-based guided self-help intervention in treating social anxiety and addressing the symptoms associated with it.

Post-traumatic stress but also aggressive attitudes and behaviour can be found in adolescents living in a context of ongoing community and gang violence in the low-income urban areas of Cape Town, South Africa.

We investigated the long-term effects (15–20 months after therapy) of (a) Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET) and (b) the cognitive behavioural intervention ‘Thinking for a Change’ (CBT) on post-traumatic stress disorder (PTSD) and aggression compared with a waiting list.

Fifty-four young males participated in the treatment trial, of which 17 completed the FORNET intervention, 11 the CBT intervention, and 26 were on a waiting list. The primary outcome was the change score for the Appetitive Aggression Scale; secondary outcomes were the PTSD Symptom Scale-Interview change scores, and the number of perpetrated violent event types.

The reduction in scores for PTSD that had been observed in FORNET completers at the first follow-up were still significant at the second long-term follow-up (Cohen’s d = 0.86). In this treatment arm (FORNET), the scores for appetitive aggression were also significantly reduced (Cohen’s d = 1.00). There were no significant changes observed for CBT or for the waiting list.

The study indicates that FORNET can successfully reduce post-traumatic stress as well as the attraction to violence even for individuals living under conditions of continuous traumatic stress.

Sleep and mood are known to be linked and this is particularly evident in people with a diagnosis of bipolar disorder (BD). It has been proposed that psychological interventions improving sleep can be a pathway for improving mood. In order for a psychological sleep intervention to be appropriate, the common cognitive processes maintaining the range of sleep disturbances need to be investigated.

This study aimed to explore and identify expert consensus on positive and negative sleep appraisals in the context of low and high mood states, using the Integrative Cognitive Model as a theoretical guide.

A Delphi approach was utilized to allow clinical and research professionals, with experience in the field of BD, to be anonymously consulted about their views on sleep appraisals. These experts were invited to participate in up to three rounds of producing and rating statements that represented positive and negative sleep appraisals.

A total of 38 statements were developed and rated, resulting in a final list of 19 statements that were rated as ‘essential’ or ‘important’ by >80% of the participants. These statements represent the full range of extreme sleep appraisals this study had set out to explore, confirming the importance of better understanding and identifying positive and negative sleep cognitions in the context of high and low mood.

The statements reviewed in this study will be used to inform the development of a sleep cognition measure that may be useful in cognitive therapy addressing sleep disturbances experienced along the bipolar spectrum.

Perfectionism is a transdiagnostic risk factor across psychopathology. The Clinical Perfectionism Questionnaire (CPQ) was developed to assess change in order to provide clinical utility, but currently the psychometric properties of the CPQ with adolescents is unknown.

To assess the factor structure and construct validity of the CPQ in female adolescents.

The CPQ was administered to 267 females aged 14–19 years of age. Confirmatory factor analysis (CFA) was used to examine the validity of the two-factor model and a second-order factor model. Pearson correlations were used to evaluate the relationships between the CPQ and a wide range of measures of perfectionism, psychopathology and personality traits.

The study demonstrated internal consistency, construct validity and incremental validity of the CPQ in a sample of female adolescents. The CFA in the present study confirmed the two-factor model of the CPQ with Factor 1 relating to perfectionistic strivings and Factor 2 representing perfectionistic concerns. The second-order two factor model indicated no deterioration in fit.

The two-factor model of the CPQ fits with the theoretical definition of clinical perfectionism where the over-dependence of self-worth on achievement and concern over mistakes are key elements. The CPQ is suitable for use with female adolescents in future research that seeks to better understand the role of perfectionism in the range of mental illnesses that impact youth.

‘DISCOVER’ one-day cognitive behavioural therapy (CBT) workshops have been developed to provide accessible, developmentally sensitive psychological support for older adolescents experiencing emotional difficulties. Previous school-based evaluations of the DISCOVER model have shown positive outcomes.

The current study aimed to test the model for clinically referred adolescents, in real-world settings.

A randomized controlled trial (RCT) assessed feasibility, acceptability and preliminary outcomes of the DISCOVER intervention, in comparison with usual care, for 15- to 18-year-olds with emotional difficulties. Participants were recruited from outpatient clinic waiting lists in UK child and adolescent mental health services (CAMHS). Research feasibility indicators included rates of recruitment, randomization, intervention participation (group workshops and individualized follow-up telephone calls), and data collection (at baseline and 8-week follow-up). Intervention acceptability was assessed using a structured service satisfaction questionnaire and semi-structured qualitative interviews with intervention participants. Preliminary clinical outcomes were explored using adolescent-reported validated measures of depression, anxiety and well-being.

n = 24 participants were randomized to intervention and usual care groups. Workshop attendance was good and high levels of treatment satisfaction were reported, although feasibility challenges emerged in recruitment and randomization. Trends were found towards potential improvements in anxiety and well-being for the intervention group, but the effect estimate for depression was imprecise; interpretability was also limited due to the small sample size.

DISCOVER appears to be a feasible and acceptable intervention model for clinically referred 15- to 18-year-olds with emotional difficulties. A full-scale RCT is warranted to evaluate effectiveness; protocol modifications may be necessary to ensure feasible recruitment and randomization procedures.

Whilst data-driven processing (DDP) during trauma has been shown to play a role in poor memory integration and is associated with post-traumatic stress disorder (PTSD) re-experiencing symptoms, the pre-trauma risk factors and related cognitive mechanisms are uncertain.

This experimental study aimed to investigate predictors of peri-traumatic DDP, as well as its role in attention bias to threat and free recall.

A virtual reality video was used to simulate an analogue trauma. Questionnaires, a free recall task, and an eye-tracking measure assessed cognitive changes after exposure.

Regression analysis demonstrated that trait dissociation at pre-exposure to trauma significantly predicted DDP. Attention bias towards threat-related images was found. Results showed that DDP and poorer free recall predicted attention bias to threat images and higher levels of DDP actually predicted higher overall scores in the free recall task.

This study showed that DDP is strongly linked to dissociative traits, and along with memory disintegration it may predict attention changes after exposure to a trauma.

This study investigated the effects of group cognitive behavioural therapy (CBT) for patients with bipolar disorder. The development of CBT for this disorder is relatively under-explored.

Participants with bipolar I or II disorder were treated with group CBT in addition to treatment as usual. The effectiveness of the protocol was explored through sequence analysis of daily mood monitoring prior to, during and after the intervention. Also, a repeated measures design was used assessing symptomatology, dysfunctional attitudes, sense of mastery, psychosocial functioning, and quality of life at start and end of intervention, and at follow-up 2 and 12 months later.

The results indicate that variation in mood states diminished over the course of the intervention. Also, there was a change from depressive states to more euthymic states. Greater number of reported lifetime depressive episodes was associated with greater diversity of mood states. There was an increase in overall psychosocial functioning and self-reported psychological health following the intervention. Improvement continued after treatment ended until follow-up at 2 months, and measured 1 year later, for outcomes representing depression, general psychosocial functioning and self-reported psychological health. Due to small sample size and the lack of a control group the results are preliminary.

The results of this pilot study suggest that both offering CBT in group interventions and sequence analysis of time series data are helpful routes to further explore when improving standard CBT interventions for patients suffering from bipolar disorder.

Since the significance of metacognition as the theoretical basis of a psychological intervention for schizophrenia first emerged, there have been ongoing attempts to restore or strengthen patients’ metacognitive abilities.

A Korean version of the metacognitive training (MCT) program was developed, and its effects on theory of mind, positive and negative symptoms, and interpersonal relationships were examined in stable outpatients with schizophrenia.

A pre-test–post-test design with a control group was used. The participants were 59 outpatients (30 in experimental group, 29 in control group) registered at five mental health facilities in a city in South Korea. The developed MCT program was applied for a total of 18 sessions, 60 min per session, over a period of 14 weeks. The hinting task, false belief task, Scale for the Assessment of Positive and Negative Symptoms, and Relationship Change Scale were used to verify the effects of this program. Data were analysed by the chi-square test, t-test, and Mann–Whitney U-test using the SPSS/PASW 18.0 statistics program.

The general characteristics, intelligence, and outcome variables of the two groups were homogeneous. After the intervention, the experimental group showed significant improvements in theory of mind, positive and negative symptoms and interpersonal relationships compared with the control group.

These results suggest that the MCT program can be a complementary psychotherapy that contributes to symptom relief and interpersonal functioning in patients with schizophrenia, and is effective in the Korean culture, beyond the Western context.

While suppression is associated with detrimental post-traumatic psychological adjustment, research has not considered the effect of culture on this relationship.

This study investigated cultural differences in the effects of expressive suppression, whilst watching a traumatic film, on subjective distress, psychophysiological responses and intrusive memory.

Australians of European heritage or East Asian Australian participants (n = 82) were randomly assigned to either a suppression group (instructed to suppress their emotions during the film) or a control group (no instructions regarding emotion management). Electrodermal activity, heart rate and heart rate variability (root mean square of the successive differences; RMSSD) were measured pre-, during and post-film. Participants reported the number of film-related intrusions in the 5 min and 7 days post-viewing.

While the European Australian group did not differ significantly on RMSSD, the East Asian suppression group scored significantly higher on RMSSD during the film than the East Asian control group. Second, those in the suppression groups, regardless of cultural background, reported significantly fewer intrusions immediately post-film than controls. Third, we found that for the European Australian group, change in heart rate interacted with group (control versus suppression) when predicting weekly intrusions. However, for the East Asian group change in heart rate did not interact with group when predicting weekly intrusions.

The findings are discussed in the context of current research on culture and emotion regulation and implications for post-traumatic stress disorder.

Many people with psychosis experience persecutory delusions and report negative schematic beliefs and intrusive mental images which may be maintaining factors for psychotic symptoms.

This study examined the feasibility and acceptability of a new psychological therapy targeting schemas and images (iMAPS therapy).

The study used a randomised multiple baseline design. Participants with first episode psychosis were randomised using a multiple baseline design with 2–5 assessments. Six sessions of therapy, consisting of a combination of imagery techniques and imagery rescripting techniques, was used. In each session, participants completed a Mental Imagery in Psychosis Questionnaire (MIPQ) and imagery interview. Mood and delusional beliefs (PSYRATS) were also measured at each session.

Five participants with first episode psychosis completed the baseline visits and attended all therapy sessions. One participant declined the final assessment. Results demonstrated significant reductions in negative schematic beliefs, delusions, imagery distress and other measures of schema (YSQ, SMI). Although multiple baseline randomisation strengthens the study, it lacked a control arm and blind assessments.

iMAPS appears a feasible and acceptable treatment for psychosis, and further evaluation is indicated.

Envy is depicted as motivating destructive desires and actions intended to spoil or destroy that which is envied.

To develop a new valid and reliable measure of malicious envy (C-BRES), which included items representing the cognitive, emotional and behavioural responses empirically associated with this emotion.

A total of 203 adults completed the new 22-item cognitive and behavioural responses to envy scale (C-BRES). Exploratory factor analysis was carried out to test for reliability and internal consistency of the C-BRES. Evidence towards the concurrent construct validity (convergent and discriminant) of the C-BRES was assessed through correlations with the Dispositional envy scale and other measures of psychosocial outcomes empirically linked to envy.

Factor analysis for categorical data identified five dimensions of envy, namely: injustice, hostility, malicious action tendencies, malicious feelings and behavioural responses. The reliability indices of the five factors and the total scale were satisfactory (>0.85). Evidence towards the concurrent construct validity (convergent and discriminant) of the C-BRES is reported. In particular, envy was associated with higher levels of depression, psychoticism, neuroticism, anger and lower levels of self-esteem and quality of life.

All findings support the psychometric adequacy of the C-BRES.

To better understand the maintenance of chronic fatigue syndrome (CFS), a valid and reliable measure of cognitive and behavioural responses to symptoms is required. Such a measure could also assess beliefs and coping behaviours in the context of fatigue in other somatic conditions.

We aimed to establish the psychometric properties of both the Cognitive and Behavioural Responses Questionnaire (CBRQ) and its shortened version (CBRQ-S) in adolescents with CFS.

The full questionnaire was completed by a clinical cohort of adolescents (n = 121) presenting to specialist CFS units in the UK.

Both the CBRQ and CBRQ-S had good internal consistency. The CBRQ scores were strongly associated with depression, anxiety, school and social functioning, but weakly associated with fatigue and physical functioning, providing evidence of validity.

Both the 40-item and the 18-item versions of the CBRQ were found to be reliable and valid in adolescents with CFS. To minimize unnecessary burden, the 18-item version is favoured. Using this assessment tool in future studies, including intervention studies, may help to better target interventions during clinical practice and improve outcomes.

Cognitive models of psychopathology suggest that negatively biased thinking styles are involved in the development and maintenance of emotional disturbances.

The present study examined the relationships between negative cognitive errors and indices of mental health status (i.e. anxiety and depression) in New Zealand adolescents.

A community sample of 490 youth aged 16–18 years completed an anonymous online survey consisting of the Children’s Negative Cognitive Error Questionnaire (CNCEQ), the Trait subscale of the State-Trait Anxiety Inventory (STAI-T) and the Center for Epidemiologic Studies Depression Scale (CES-D).

Negative cognitive errors correlated positively with greater levels of anxious and depressive symptoms. Hierarchical regression analyses indicated that overall cognitive error score was a strong predictor of adolescents’ self-reported anxious symptoms and, to a lesser extent, depressive symptoms. Moreover, cognitive errors significantly differentiated between adolescents with high scores from adolescents with low scores on both the anxiety (STAI-T) and the depression (CES-D) scales.

These findings lend support to the generalizability of Beck’s cognitive theory to a New Zealand adolescent population and highlight the importance of focusing on prevention and early intervention programmes that directly target these faulty or biased ways of thinking in adolescents with anxious and/or depressive symptoms before meeting diagnostic criteria.

Reassurance seeking (RS) in obsessive compulsive disorder (OCD) is commonly addressed in cognitive behavioural therapy (CBT) using a technique called reducing accommodation. Reducing accommodation is a behaviourally based CBT intervention that may be effective; however, there is a lack of controlled research on its use and acceptability to clients/patients, and case studies suggest that it can be associated with negative emotional/behavioural consequences. Providing support to encourage coping with distress is a cognitively based CBT intervention that may be an effective alternative, but lacks evidence regarding its acceptability.

This study aimed to determine whether support provision may be a more acceptable/endorsed CBT intervention for RS than a strict reducing accommodation approach.

Participants and familiar partners (N = 179) read vignette descriptions of accommodation reduction and support interventions, and responded to measures of perceived intervention acceptability/adhereability and endorsement, before completing a forced-choice preference task.

Overall, findings suggested that participants and partners gave significantly higher ratings for the support than the accommodation reduction intervention (partial η2 = .049 to .321). Participants and partners also both selected the support intervention more often than the traditional reducing accommodation intervention when given the choice.

Support provision is perceived as an acceptable CBT intervention for RS by participants and their familiar partners. These results have implications for cognitive behavioural theory and practice related to RS.

Despite their use in clinical practice, there is little evidence to support the use of therapist written goodbye letters as therapeutic tools. However, preliminary evidence suggests that goodbye letters may have benefits in the treatment of anorexia nervosa (AN).

This study aimed to examine whether therapist written goodbye letters were associated with improvements in body mass index (BMI) and eating disorder symptomology in patients with AN after treatment.

Participants were adults with AN (n = 41) who received The Maudsley Model of Anorexia Treatment for Adults (MANTRA) in a clinical trial evaluating two AN out-patient treatments. As part of MANTRA, therapists wrote goodbye letters to patients. A rating scheme was developed to rate letters for structure and quality. Linear regression analyses were used to examine associations between goodbye letter scores and outcomes after treatment.

Higher quality letters and letters that adopted a more affirming stance were associated with greater improvements in BMI at 12 months. Neither the overall quality nor the style of goodbye letters were associated with improvements in BMI at 24 months or reductions in eating disorder symptomology at either 12 or 24 months.

The results highlight the potential importance of paying attention to the overall quality of therapist written goodbye letters in the treatment of AN, and adopting an affirming stance.

Although internet-based cognitive behaviour therapy (ICBT) is an effective treatment for social anxiety disorder (SAD), a substantial proportion of patients do not achieve clinically significant improvement. More research is needed to identify which factors predict treatment adherence and outcomes.

The aims of this study were to (1) identify demographic and clinical factors associated with treatment adherence and outcomes in ICBT for social anxiety in China, and (2) explore whether low-intensity therapist support results in improved treatment adherence or outcomes.

Participants were assigned to either therapist-guided (N = 183) or self-guided ICBT (N = 72). Level of social anxiety was measured at both pre- and post-treatment. Treatment adherence and outcomes were analysed using a two-step linear and logistic regression approach. Clinical and demographic characteristics were examined.

No significant group differences were found for treatment adherence or outcomes between the therapist-guided and self-guided conditions. Participants diagnosed with SAD were significantly less likely to drop out (OR 0.531, p = .03) compared with subclinical participants with social anxiety symptoms. Older participants (B = 0.17, SE = 0.04, p = .008) and participants with a diagnosis of SAD (B = 0.16, SE = 0.44, p = .01) tended to complete more modules. Participants who completed more modules (B = 0.24, SE = 0.03, p = .01) and participants who identified as female (B = –0.20, SE = 0.18, p = .04) reported greater reductions in SAD symptoms.

Understanding of factors related to adherence and outcome is necessary to prevent drop-out and optimize outcome.