The present study had two purposes: 1) to examine the relationship between tendency to experience obsessional intrusive thoughts and tendency to worry; 2) to replicate and extend earlier findings (Purdon and Clark, 1993, 1994) on appraisal and thought suppression strategies in the persistence and control of obsessional intrusive thoughts. A sample of 160 college students were administered the Revised Obsessional Intrusions Inventory (ROII), the Penn State Worry Questionnaire (PSWQ), the Beck Depression Inventory (BDI), and the White Bear Suppression Inventory (WBSI). The ROII total score had minimal association with worry, trait thought suppression, or depressive symptoms, thereby supporting the distinctiveness of obsessional intrusive thoughts. Hierarchical multiple regression analyses revealed that cognitive appraisal, especially worries that the intrusion might come true in real life, accounted for a significant amount of variance in thought frequency and controllability. Thought suppression strategies accounted for substantially less variance in both frequency and control of intrusive thoughts. The results are discussed in terms of their support for Rachman's (1993) and Salkovskis' (1985, 1989) theories regarding the role of personal responsibility in the persistence of obsession-like intrusive thoughts.

The magnitude of the problem of relapse and recurrence in depression is outlined and it is contended that this is now the major treatment issue facing clinicians. Studies demonstrating a longer term prophylactic effect of Cognitive Behaviour Therapy (CBT) are briefly reviewed and it is concluded that these methods have significantly impacted on relapse rates in unipolar depression. Nevertheless, it is argued that there is little cause for complacency due to the still significant rate of relapse which is found with CBT. While promising cognitive behavioural methods have been developed in the field of addictive disorders, there is a clear need for similar clinical advances in the area of recurrent depression. Some strategies which may have potential for promoting maintenance and preventing relapse are briefly outlined. The importance of developing a coherent model for assessing relapse risk and guiding decisions regarding treatment and after care strategies is emphasized. Lastly, future research directions in this important area are briefly considered.

It is of interest to link behavioural paradigms with the past and see whether the cultural roots of behavioural and cognitive therapies can be found in medieval literature. In this context the attention is drawn to the Icelandic Sagas. Iceland was destined to become a chosen sanctuary for Norse culture, a place where the memories and history of Northern Europe were more diligently preserved than anywhere else, and recorded in books that are today the richest source of knowledge of the Viking Age.

Intrusive thoughts are variously reported as images, thoughts, doubts, impulses etc. Recent accounts of emotional processing make important distinctions between cognitive activity in verbal form and images. The comparison of verbal intrusions and images was made on archival data about intrusive cognitions from 628 university students. Images and doubts (a verbal form) occurring together were perceived as more difficult to dismiss than either images or doubts alone. In addition, images and doubts together were more frequent, more probable, and required more effort to counter than images alone. Likewise, images and doubts together and doubts alone were more worrisome and more frequently triggered by various stimuli than images alone. These results suggest that cognitive intrusions identified as a mixture of doubts and images are qualitatively different and more troublesome than those identified as either doubts or images. These findings are discussed in terms of current accounts of emotional processing.

A number of studies have indicated that the right hemisphere is specialized for (negative) emotions. Some authors have suggested that this specialization stems from the cognitive characteristics of this hemisphere. More specifically, the verbal and analytic approach that characterizes left hemisphere functioning would inhibit emotional reactions, whereas the imaginal and global approach that characterizes right hemisphere functioning would facilitate emotional reactivity. The present study examined whether these two cognitive strategies have, indeed, different effects on emotional responsivity. Subjects were exposed to a series of aversive slides. One group (n = 14) was instructed to process the slides in a verbal/analytic manner. The second group (n = 14) employed an imaginal/global strategy while viewing the slides. The third group (n = 14) was a control group that received no explicit instructions. Self-reported emotions, skin conductance responses, heart rate frequency, and eye blink startles were recorded. There were no differences between the three groups with regard to any of these variables. Thus, no evidence was obtained to support the idea that processing modes (i.e., verbal/analytic versus imaginal/global) have a differential impact on emotional reactivity. The implications for theories about lateralization of emotions and for cognitive therapy are discussed.

A measure of everyday risk-taking, the Everyday Risk Inventory (ERI), was developed to assess avoidance of potentially harmful ordinary activities, and some of its psychometric properties were studied. The hypothesis that outpatients with obsessive compulsive disorder (OCD) would score lower than non-patients on this and other measures of risk-taking was tested. The ERI showed good internal consistency and excellent test-retest reliability. It successfully differentiated OCD patients from non-clinical subjects. Consistent with research on sensation seeking, both age and gender were related to ERI scores, with older subjects and females showing greater risk avoidance. The ERI correlated moderately strongly with other measures of risk-taking and showed, as expected, a less strong negative association with measures of responsibility and value orthodoxy. Preliminary findings indicate that the ERI is a useful instrument for assessing non-pleasurable ordinary risk-taking. Findings are discussed in relation to possible dimensions of risk-taking in existing research on decision-making and the need for research on other patient populations.

The effect on psychological and immune function measures of a 6-week psychological intervention for anxiety states was evaluated in cancer patients who had already completed medical treatment for a tumor. Ten patients were treated with anxiety management and stress inoculation training while another ten served as a waiting list control group. The treated group showed a slight improvement in psychological variables but there were no group differences in immunological measures. Changes in the latter were, however, correlated with changes in psychological variables, notably, an increase in the T4/T8 ratio, with an improvement in the Quality of Life index.

This article is intended to promote consideration and discussion of ethical issues in motivational interventions. The popular concept of client “denial” encompasses a broad range of motivational behaviors including lying, perceptual bias, unawareness, ambivalence, resistance and reactance. The “problem of motivation” typically arises when a therapist perceives a problem and sufficient need for change in someone who does not share this perception. In considering how to respond to such situations, one can conceive of a continuum of levels of readiness to change, and of therapeutic strategies ranging from passivity to coercion. Ethical concerns arise when there is a perceived mismatch between readiness level and intervention strategy. Motivational interviewing is a middle way between passivity and coercion, seeking to evoke intrinsic motivation for change by making salient the inconsistency of problem behavior and that which is more deeply valued. The concern that this approach is “manipulative” combines a descriptive element and an evaluative component. Three possible descriptive meanings are discussed: that it effectively alters behavior, that it does so in persons not seeking or requesting change, and that it may operate through processes not immediately apparent. Ethical concerns regarding motivational intervention are considered within this broader context.

Until the mid 1980s Type A Behaviour (TAB) was considered to confer the same magnitude of risk for CHD as smoking, hypertension and raised serum cholesterol. As such, it was considered a suitable target for modification, particularly in post-infarction populations. More recently, three arguments have been suggested that counter such optimism: (i) recent evidence may suggest TAB is not predictive of heart disease in post-infarction populations; (ii) interventions do not influence physiological processes underpinning TAB and, accordingly, do not reduce risk for disease progression; (iii) there are other, more useful, interventions that may be conducted with cardiac patients. The validity of each of these challenges is critically examined. It is concluded that interventions to modify TAB in patients with manifest heart disease are still of value in reducing risk for further disease progression.

In the last 10 years, as part of the push towards greater community provision of services for the psychiatrically disabled in the UK, assessment has assumed a prominent position. A variety of different assessment instruments have been employed, including assessment of patient attitudes and opinions, of the environment, social networks and basic living skills (Carson, 1991; TAPS, 1992). Amongst the differing assessment types, behaviour rating scales have a distinct contribution. They are particularly applicable to group settings such as hostels or hospital wards and have the advantage of being objective, behavioural, able to measure change in functioning over time or due to some intervention; and most importantly, they yield numerical scores which can be assessed against “hard data” in the form of norms or scores from other populations, especially those from other countries.

This article reports on some psychometric features of the Therapist Client Rating Scale (TCRS), an instrument that claims to measure the therapeutic relationship in behaviour therapy sessions. A study is described in which the TCRS was completed after each therapy session by 28 obsessive-compulsive patients undergoing behaviour therapy, as well as by the therapists. The perception of patient behaviour correlated significantly with the treatment outcome. Further examination on the reliability and validity of the TCRS is recommended.

A history of sexual abuse is reported by a large proportion of women with psychological disorders. Cognitive approaches to therapy for this group aim to change the dysfunctional cognitions that are associated with abusive experiences, but often lack a clear model of the psychological processes that might be involved. This study examines the relationship between the overt cognitive correlates of sexual abuse (self-denigratory beliefs) and the covert correlates (information-processing bias). Women with psychological disorders who reported a history of sexual abuse had greater levels of self-denigratory beliefs and of information-processing bias than women who had a history of abuse but had no psychological disorder. The difference in overt self-denigratory cognitions was partly explained by the clinical women's higher level of covert information-processing bias. The information-processing bias appears to reflect a specific schema, which involves beliefs about the individual having been “contaminated” by the abusive experience. Therapeutic implications are discussed, including targets for treatment and evaluation. Further research is needed, to allow these cognitive correlates to be understood in relation to different psychological syndromes and symptoms.

A new model of worry is presented, differing from previous work in which worry was set within a broader theory of anxiety. It is proposed that threat is initially evaluated in terms of imminence, likelihood, and cost set against perceived self-efficacy; this evaluation can produce worry as a relatively automatic response. Worry serves the functions of alarm, prompt, and preparation; in terms of processes, it leads to an unfocused attentional style, sensitivity to emotional information, and arousal (which produces self-absorption). Threat (and worry) are maintained if there are elevated evidence requirements or inappropriate problem solving. The therapeutic implications of the model are discussed briefly.

The Early Signs Scale (Birchwood et al., 1989) for the monitoring of prodromal symptoms was used with a schizophrenic inpatient with severe residual psychotic symptoms. Marked changes in the scores were obtained in both self and observer reports during a period in which the patient was considered to “relapse”. The results suggest the possible wider applicability of the Early Signs Scale to patients who experience severe residual symptoms between relapse episodes.

Recent advances have been made in the treatment of post-traumatic stress disorder (PTSD). Cognitive behavioural techniques have been reported in controlled trials to be very effective in reducing arousal symptoms associated with post-traumatic stress disorder, such as sleep disturbance, hypervigilance, intrusive thoughts and flashbacks. It remains unclear from the literature, however, how well these treatment modalities can alleviate post-traumatic stress disorder where the predominant clinical features are associated with depersonalization and dissociative states. Depersonalization is evident in a significant proportion of individuals presenting with PTSD and yet does not appear to be amenable to exposure based therapies. A case study presented suggests methods through which depersonalization may be addressed within the therapeutic context.

In recent years, there has been considerable debate about how accurately people remember emotionally significant information. Early studies concerned with “flashbulb memories” claimed that emotional memories are accurate and persistent. However, recent studies indicate that flashbulb memories are subject to deterioration over time. This finding fits with the idea that individuals who have experienced a traumatic event do not retain all the details of the trauma equally well. Instead, they have relatively good memory for central detail information and relatively poor memory for peripheral details of the traumatic situation. Using self-report data of a normal, healthy sample, Christianson and Loftus (1990) found evidence for this idea. The current study is an attempt to replicate Christianson and Loftus' finding in a normal student population (N = 106). Subjects were asked to describe their most traumatic situation. They rated the vividness of the memory, the intensity of emotion at the time of the trauma and at the time of recall, the amount of reliving, and the amount of central and peripheral detail information remembered. Results indicate that subjects who reported strong emotion at the time of the trauma remembered significantly more central detail information than subjects with relatively low past emotionality ratings. However, no differences in the amount of peripheral detail information remembered were found.

The influence of the personality of asthmatic children and their mothers on the course of their illness is analysed, taking as a basis a sample of 48 asthmatic children. This is done through the assessment of the role of personality in the change that takes place, after the application of various psychological treatments (relaxation, systematic desensitization and stress inoculation) in three variables: number of days of illness, symptomatic relief drug use and school absences. The results obtained highlight the influence of personality on therapeutic success. Consequently, this study shows the importance of tending to personality traits in order to forecast and improve the effectiveness of psychological treatment.

There is increasing interest in the use of psychological therapies for depressive disorder in primary care. This paper describes a pilot study using an abbreviated form of cognitive therapy as an adjunctive treatment for major depressive disorder in primary care. Seven primary care patients received an abbreviated cognitive intervention package in addition to their usual treatment. The patients were assessed before and after intervention using observer and self rating measures of depression and their subjective evaluation of the intervention was sought. Four of the subjects showed 50% change in depression ratings at the end of the intervention and only one of the group was taking antidepressant medication. The intervention was generally well accepted by patients and feasible within the time constraints. The initial results are encouraging and a randomized control trial of this brief intervention is now underway.

Therapeutic management of obsessional ideas without compulsions is considered to be a rather difficult clinical problem. This report discusses the case of a 24-year old lady with a nine year history of recurrent Obsessive-Compulsive Disorder which most recently presented with a year-long obsessional rumination concerning her superstitious personal responsibility for the accidental death of her cousin. Repeated audio-taped listening to the cognitively restructured content of her obsession resulted both in a rapid elimination of her ruminations and the alleviation of her depressive and general psychopathology.

In a rejoinder to a recent paper in this journal (Day et al., 1993) based on the “Two Plus One Model”, this article attempts to point out a number of important self-contradictions and flaws within the “two plus one” approach. These problems have a bearing on its claims to be a new and efficient way of utilising clinical resources.