Ten volunteers kept written records of self-selected, daily events for a one-week period. After four months, they were given a surprise recognition test. This test consisted of original memories and several types of foils. In line with previous findings of Barclay and Wellman, it was found that acceptance of foils as one's own memories is a relatively common phenomenon. This suggests that pseudomemories may also occur in the absence of suggestions and repeated interviews and, more generally, that autobiographical memory is intrinsically unreliable.

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

A suppression-mention task was used to evaluate the influence of increasing the incentive to suppress on subsequent enhancement and/or rebound effects. The experimental group suppressed neutral thoughts with a financial incentive for performance. A bogus pipeline was used to control for honesty. Two control groups, one with the bogus pipeline and one without, were asked to suppress the thought without the possibility of financial reward contingent on performance. Results showed that the group with a possible financial reward, although more successful in suppressing the thought, were still unable to suppress the thought. No enhancement or rebound effects were observed.

Patients' beliefs about the causes of anxiety problems have received comparatively little attention. In the present study, agoraphobic patients rated the contribution of eight factors in causing their condition. They also selected the major cause of their agoraphobia and evaluated that in relation to the elements of attributional style. The most commonly selected major cause was stress, which also attracted the highest average ratings. This was followed in frequency by disposition (being a naturally nervous person), circumstances (staying home too much) and childhood experiences. Depression was associated with stronger beliefs in the contribution of several of the causal factors and with rating the major cause as more stable and global. Anxiety was associated with a stronger belief in medical illness as a cause, and with a lower sense of controllability of the major causes. These results suggest that agoraphobic patients' views of the causes of their condition vary, and could usefully be evaluated in relation to the provision of treatment in order to modify the way treatment options are presented to the patients.

Behavioural or, in more general terms, problem analysis is usually regarded as the prerequisite of behaviour therapy. In behaviour therapy research, however, problem analysis does not play a key role. Patients are usually assigned to treatment methods on the basis of clinical diagnosis. It could be assumed that the lack of attention to the patient's individual characteristics should lead to poorer therapy outcome results. However, empirical data of a project reviewed in this paper in fact showed that assigning patients to standard treatment merely on the basis of clinical diagnoses provides results equal to or even better than those of optimized individual therapy strategies. Two premises of problem analysis were therefore tested. It could be shown that therapists would diagnose different problem conditions not only for patients with different types of phobia, but also, as expected, for patients with identical diagnoses. However, this did not—as would be expected according to the second premise of problem analysis—result in choosing different individual therapy strategies. One reason for these findings could be that behaviour therapy research has been able to provide treatment programs that have been differentiated and gradually optimized for specific diagnostic groups. To decide on the application of these treatment programs, clinical diagnoses are necessary. It is suggested that clinical diagnosis and problem analysis should be complementary. An integrative model is suggested.

This paper reviews cognitive theories of eating disorders as they are usually applied in treatment. More recent theoretical contributions and theory that is not widely applied are also reviewed. A set of hypotheses is derived from these theories and evidence for the validity of each hypothesis is discussed: this includes evidence from treatment studies, questionnaire studies and from experimental psychology. Following review of existing evidence, the paper summarizes the current status of cognitive theory in eating disorders. It then considers ways in which theory and research could be developed in order to improve and extend our understanding of cognitive content and processes in eating disorders. Limitations of existing models are highlighted and gaps in our knowledge, including knowledge of variables that typically have a central role in cognitive theory, are identified. Further strategies to test the validity of hypotheses derived from cognitive theory are suggested, together with strategies that might extend existing theory. It is concluded that much further research is needed, both to test the validity of existing theoretical contributions and to extend theory so that it will be more useful in clinical practice.

The extent of intrusive traumatic memories of upsetting childhood experiences was investigated in independent samples of female subjects: out-patients with a primary diagnosis of unipolar major depression, women recovered from clinical depression, and healthy controls who had never experienced major depression. Subjects completed self-report questionnaires to measure levels of depression, and intrusive memories of traumatic childhood events. There were no differences between the groups in whether or not they experienced intrusive memories, but severity of intrusions varied significantly. The depressed sample reported significantly more intrusion and avoidance than the recovered or control groups, and the recovered sample reported normal levels of intrusion but higher levels of avoidance of traumatic memories than controls. Severely depressed subjects reported significantly higher levels of intrusion and avoidance than moderately depressed subjects. Implications for psychological models and for the treatment of depression are discussed.

Cognitive models have linked individual differences in the appraisal of traumatic events and their sequelae to the persistence of post-traumatic stress disorder (PTSD). A pilot study investigated this proposal with victims of assault. Eleven assault victims suffering from persistent PTSD and 9 victims who had recovered from PTSD were interviewed retrospectively and compared on potentially relevant cognitive factors. Groups were comparable in terms of characteristics of the assault, gender, age, and initial PTSD severity. Participants with persistent PTSD were less likely than those who had recovered to have engaged in mental planning during the assault and more likely to have experienced mental defeat, and to indicate negative appraisals of their actions during the assault, of others' reactions after the assault, and of their initial PTSD symptoms. They were also more likely to indicate global negative beliefs concerning their perception of themselves, their world or their future. These cognitive factors may maintain PTSD symptoms either directly or by motivating the individual to engage in behaviour that prevents change.

In outpatients with recurrent major depression who failed to respond to acute treatment with antidepressant medication, this study compared the effects of follow-up treatment with cognitive therapy with those of follow-up treatment with medication. In the small number of patients treated, there were some indications of response to cognitive therapy. A greater number of patients responded at least partially to cognitive therapy according to one of the two response criteria, and mean scores on two measures of depression changed to a greater extent with cognitive therapy than with continued medication. Results are consistent with previous studies, but replication is required due to the small numbers involved. The potential implications for provision of treatment are discussed.

Restrained eaters have been found to overeat after various events or so-called disinhibitors, such as eating a preload or strong emotional states. Little research has focused on why such events lead to a break of the restrained eaters' control and to overeating. The present study examines the role of cognitive distraction as a possible mechanism underlying these effects. Two experiments were conducted, both designed to test hypotheses derived from Wegner's Ironic Process Theory and focusing on the behavioural consequences of cognitive control over eating. In both experiments subjects were tested in a 2 (restrained/unrestrained) by 2 (distraction/no distraction) design. The results do not confirm the prediction flowing from the Ironic Process Theory: cognitive distraction does not lead to overeating in restrained eaters. Implications of these findings for the Boundary Model are also discussed.

The present study examined the efficacy of eye movement desensitization and reprocessing (EMDR) in the treatment of a specific phobia. Twenty-four spider phobic subjects were randomly assigned to either (1) an EMDR group (n=8), (2) an imaginal exposure group (n=8), or (3) a control group (n=8). Both the EMDR and the imaginal exposure group underwent a one-hour treatment. The control group initially received no treatment, and waited for one hour. Next, all groups received exposure in vivo. Treatment outcome was evaluated with a standardized Behavioural Avoidance Test (BAT). No evidence was found for EMDR being more effective than imaginal exposure or waiting list control. In fact, only exposure in vivo therapy resulted in significant improvement on the BAT.

The Obsessive Compulsive Thoughts Checklist (OCTC; Bouvard, Mollard, Cottraux, & Guerin 1989) is a 28 item questionnaire. Patients rate their degree of disturbance of the past week on a 5-point scale. The validation study and factor analysis of the OCTC is presented. Three groups were compared: patients suffering from obsessive compulsive disorders (n = 122), patients suffering from panic disorder with agoraphobia (n = 61) and a control group (n = 80). The three groups were comparable in age and sex. Obsessive compulsive patients scored significantly higher than both agoraphobic patients and control subjects. Spearman rank correlations were used to compute convergent validity in a sub-group of obsessive compulsive patients (n = 96). The Obsessive Compulsive Thoughts Checklist correlated positively with the Compulsive Activity Checklist (rho =. 62; p <. 0001). The total score was also positively correlated with the Yale-Brown Obsessive Compulsive Scale (YBOCS total scale: rho =. 42; p <. 0001; YBOCS obsession scale: rho =. 40; p <. 0001; YBOCS compulsion scale: rho. 37; p =. 0002). The factor structure was studied both on the sample which included agoraphobic patients and controls (n = 141) and on the obsessive compulsive patients only (n = 122). In both analyses, three identical factors were found: – factor 1: checking/perfectionism-orderliness – factor 2: responsibility/dread of harming others – factor 3: washing/contamination. Results support the validity and the internal consistency of the Obsessive Compulsive Thoughts Checklist. The factor analysis indicates that the OCTC is a three dimensional scale, reflecting a pathological need to check, a pathological sense of responsibility and a pathological need to wash, probably due to distorted thoughts about perfectionism and orderliness, an excessive need for control and fear of contamination.

The production of a cognitive formulation is an essential skill for both novice and expert cognitive behaviour therapists. It provides the focus for therapy, and helps prevent important parts of the case being over-looked. One problem faced by therapists is that the production of such a written formulation may be time consuming and difficult to amend as new information comes to light. The use of Mind Maps allows a flexible summary of the case to be created. This may be of use to both the therapist and their supervisor in providing a clear, structured and easily updated statement of the essential features of the case.

This article deals with the modification of self-statements as a specific strategy in cognitive therapy. A method is described in which patients modify their self-talk by reading aloud positive self-statements that are incompatible with original self-deprecatory thoughts. Next, several cases are presented that illustrate how this intervention can effectively be integrated in the treatment of various disorders. In the discussion, the indications for using this intervention are considered and compared to other cognitive strategies.

Intrusions and perseverations, although often associated with psychiatric disorders, have a functional role within the information processing system (Eberly, Harkness, & Engdhal, 1991). Research suggests that these phenomena act as conscious aide memoires (Kvavilashvili, 1987) informing the cognitive system that there are prospective tasks to be done (i.e. tasks started, or intentions made, but not finished). In the case of psychiatric problems, the intrusions and perseverations may reflect the presence of unresolved issues that require further processing. The current paper outlines this hypothesis and presents the Zeigarnik effect (Zeigarnik, 1927) as one potential factor amongst others helping to maintain the incidence of intrusions. The paper also describes the possible modus operandi of this effect in terms of post-traumatic stress, obsessive-compulsive disorder and general-anxiety disorder. A number of treatment strategies are discussed which may decrease the incidence of Zeigarnik intrusions.

l“Social support” refers to the informal provision of emotional, informational and practical help to those in distress. Its importance as a buffer against stressors is gaining in acceptance, but most measures of social support are based on self-report. Therefore, the purpose of the present study was to develop an observational tool with which to record objectively the duration, subject matter and form of client utterances, relating these to corresponding helper responses. This yields their respective speech profiles, together with an analysis of the contingencies. The potential value of this approach is illustrated in terms of clients attending hairdressing salons in a psychiatric hospital (N = 20) and in the local town (N = 19). Clear and predicted differences in the support elicitation skills of these two groups provided evidence of the instrument's validity, and good inter-rater reliability was also demonstrated. Applications for the instrument are outlined.

The aim of this study was to develop and evaluate the feasibility of a cognitive behavioural treatment for unexplained chest pain (UCP), based on the cognitive model of UCP. Ten patients were treated. The diagnosis had been made by a cardiologist two years before the start of treatment. The treatment incorporated breathing and relaxation training, identifying and challenging beliefs about the cause of UCP, behavioural experiments and problem solving for social problems. Patients improved significantly with regard to intensity and duration of chest pain, anxiety and functional limitations. Moreover, the reduction of scores for fear of bodily sensations and of credibility ratings of idiosyncratic disease related negative automatic thoughts was significant. The changes in scores for the inclination to interpret bodily sensations catastrophically almost reached the level of significance. These results suggests that therapy results may be cognitively mediated.

Preliminary findings are reported from a specialist unit for difficult to manage patients (those patients who have severe behavioural problems in addition to a mental illness). Staff attitudes and residents' psychiatric and social needs were assessed after the unit had been open for just over a year. The effect on residents' behaviour and symptoms over the course of that year was also evaluated. Findings showed that staff attitudes were resident orientated and that interactions between staff and residents and of staff with each other were almost always positive. These findings compared favourably with data collected on three other continuing care units in the same Trust and with data from previously published studies. The Cardinal Needs Schedule, a recent adaptation of the MRC Needs for Care Assessment Schedule, appeared to be a useful way of identifying unmet needs of the residents and gaps in service provision. Over the course of the year, behaviour in one third of the residents improved sufficiently for them to be considered suitable for potential discharge into community based accommodation. Implications of the findings for specialist units for difficult to manage patients are discussed, together with suggestions for further research.

Paranoid delusions are associated with an abnormal attributional style that serves the function of preventing the activation of latent discrepancies between self-perceptions and self-ideals at the expense of contributing to the paranoid patient's negative perceptions of the intentions of others. In this case study we describe a therapeutic strategy designed to allow a patient suffering from persecutory delusions to re-attribute negative life experiences to situational causes rather than to a conspiracy directed towards himself. It was hypothesized that no resistance was encountered from the patiet because no attempt was made to re-attribute negative events to internal causes. A reduction in paranoid ideation, which was maintained at follow-up, was accompanied by changes on formal measures of attributions. The implications of these findings for cognitive models of paranoid ideation, and for the development of interventions for deluded patients are discussed.