Background: The development and maintenance of gambling and problem gambling with its corresponding irrational beliefs may be fundamentally linked to patterns of wins and losses during electronic gaming machine (EGM) play. Method: The current study investigated the extent to which irrational thoughts and erroneous perceptions of chance differed based on individual wins or losses. Undergraduate students (n = 45) completed questionnaires assessing irrational beliefs and perceptions of chance prior to and following EGM play with credits rather than money. Results: It was found that players who lost reported a significantly greater decrease in irrational thoughts and erroneous perceptions of chance and significantly fewer superstitious beliefs than winning players following play. Conclusions: Future studies are needed to further investigate the relationship of winning to cognitive distortions to guide education and interventions.

Background: Mindfulness-Based Cognitive Therapy (MBCT) is a promising approach to help people who suffer recurrent depression prevent depressive relapse. However, little is known about how MBCT works. Moreover, participants' subjective experiences of MBCT as a relapse prevention treatment remain largely unstudied. Aim: This study examines participants' representations of their experience of MBCT and its value as a relapse-prevention program for recurrent depression. Method: Twenty people who had participated in MBCT classes for recurrent depression within a primary care setting were interviewed 12 months after treatment. The focus of the interview was on participants' reflections on what they found helpful, meaningful and difficult about MBCT as a relapse prevention program. Thematic analysis was used to identify the key patterns and elements in participants' accounts. Results and conclusions: Four overarching themes were extracted: control, acceptance, relationships and struggle. The theoretical, clinical and research implications are discussed.

Background: Computer based treatment for depression and anxiety has been available for several years and has demonstrated useful clinical effects. Most existing computerized CBT products in the UK that are designed to treat depression and co-morbid anxiety require patients to visit a clinic and require staff input to manage the process. Such intervention adds to the costs and bottlenecks in delivering a clinically effective treatment with mass availability. Internet treatment options are becoming more readily available, although data to support use are not yet strong, and most still require human assessment and telephone support. Blues Begone® is a new computerized CBT program that has been designed to be used at home with minimal human support. Method: This pilot project provides data from an open trial of Blues Begone® with both primary and secondary care patients. Results: One hundred patients started Blues Begone®, 58 completed the program, 72% (n = 42) of completers achieved reliable change and (n = 36) 62% achieved both reliable and clinically significant change, and may be considered to have recovered by the end of the program. Conclusion: These data provide the first demonstration of the potential viability of Blues Begone® as a home based computerized treatment for depression and anxiety.

Background: Perceptual Control Theory (PCT) suggests that psychological distress can be conceptualized as the by-product of conflicted control systems. Method: Using a program of psychotherapy based on the principles of PCT called the Method of Levels (MOL), a 12-month study was conducted with 120 patient participants and 4 clinicians. In this study, analyses of statistical significance were conducted. Qualitative data were also analysed to understand psychotherapy from patients' perspectives. Data were collected on the attendance patterns of patients, their ages, referral problem, and socio-economic background. A standardized questionnaire measured pre and post treatment effects. The null hypothesis of no difference between pre and post treatment scores was examined by the derivation of p values and the construction of 95% confidence intervals. Results: In all cases the null hypothesis was rejected. Conclusions: Results suggest that MOL is a useful form of psychotherapy that warrants further investigation.

Background: Overestimation of threat (OET) is ascribed a pathogenetic role in obsessive-compulsive disorder (OCD). Aims: We hypothesized that OCD patients overestimate their personal but not the average risk for OCD-related events. Specifically, an attenuation of the common “unrealistic optimism” bias (UO) was expected for OCD patients. UO refers to the phenomenon that the subjective likelihood to personally experience a positive event is enhanced compared to other persons and vice versa for negative events. Method: Fifty-three participants with OCD as well as 40 healthy and 23 psychiatric controls participated in an internet survey. They were asked several questions about different event types (positive, negative, and OCD-related): the probability that this event will happen to oneself (block 1), to another person (block 2), comparison between oneself versus another person (block 3), appraisal of consequences (block 4), and prior encounters with event (block 5). Results: No evidence was obtained in OCD to overestimate the overall probability of negative or OCD-related events. However, whereas healthy participants displayed an UO bias, OCD participants perceived themselves as more vulnerable to experience OCD-related events. Conclusions: Results indicate that OCD is associated with inflated personal vulnerability and that this bias is not fully available to the consciousness of OCD participants.

Background: This paper draws on cognitive psychology research and clinical observation to propose a model for the formation of auditory hallucinations that are located externally, and experienced in noisy environments. Method: This model highlights a series of cognitive processes that may make an individual prone to detecting false positives, i.e. believing they have heard something that is absent. A case study is used to illustrate the model. Results: It is suggested that the false positives may be a by-product of a perceptual system that has evolved to reduce false negatives in conditions of threat. The term hypervigilance hallucination is proposed for this type of experience. Conclusion: The clinical implications of the model are discussed.

Background: Researchers have begun to scrutinize the assumption that active processing in response to a traumatic event is beneficial whereas avoidance of thoughts, emotions and reminders about the traumatic event is detrimental. Indications that avoidance is not always detrimental come from studies on grief and debriefing. Aims: In an analogue experimental study, the hypothesis was tested that conceptually-driven processing immediately after a distressing film is more successful in reducing analogue PTSD symptoms than suppression of thoughts and images related to the film. Method: Ninety students watched a distressing film after which they were instructed to either elaborate on the meaning of the film (conceptual processing) (n = 31), suppress all thoughts and images of the film by performing a task (n = 29), or were given no instruction (n = 30). Four hours later, analogue PTSD symptoms were assessed. Results: The results showed that conceptually-driven processing does not result in fewer analogue PTSD symptoms than suppression. Conclusions: It is speculated that suppression may only be dysfunctional when individuals interpret their symptoms negatively or when suppression is believed to be dysfunctional.

Background: A better understanding of relationships between adolescent depression and family functioning may help in devising ways to prevent development of depression and design effective therapeutic interventions. Aims: This study explored the relationship of parental emotional attitudes, (perceived criticism and expressed emotion) to adolescent self-evaluation and depression. Methods: A sample of 28 clinic-referred adolescents and their mothers participated. The Five Minute Speech Sample was used to measure parental expressed emotion, and the adolescents completed the Children's Depression Inventory, Self-Perception Profile for Children global self-worth scale, a self-criticism scale and a perceived parental criticism scale. Results: There was partial support for a model of adolescent negative self-evaluation as a mediator in the relationship between parental emotional attitudes and adolescent depressive symptoms. The data also supported an alternative hypothesis whereby adolescent depressive symptoms are related to negative self-evaluation. Conclusions: The overall pattern of results emphasizes the significance of adolescents' perceptions of parental criticism, rather than actual levels, in understanding the relationship between parental emotional attitudes and adolescent depressive symptoms.

Background: Cognitive Behaviour Therapy self-help has been recommended in the NICE guidelines for the treatment of anxiety and depression. However, little is known about who benefits from self-help and the potential drawbacks and problems of using this approach. Aims: To address the current gap in knowledge, we contacted accredited BABCP practitioners to examine practitioner use and attitudes to self-help, current trends of use, and to identify possible problems with this therapy. Method: A 50% random sample of all accredited BABCP practitioners was approached, and the overall response rate for the survey was 57.6%. Results: Self-help materials were seen positively by therapists and were used by 99.6%, mainly as an adjunct to individual therapy. Only 38.2% had been trained in the use of self-help, with those trained being more likely to recommend self-help. Higher levels of patient motivation, credibility, likely adherence, self-efficacy and a lower degree of hopelessness were the five factors identified by more than 70% of respondents as predicting successful patient outcome with self-help. Non-compliance and a lack of detection of a worsening of the patient's clinical state due to reduced therapist contact were viewed as being the most important problems with self-help by more than 70% of respondents. Conclusions: Preferable patient characteristics for self-help have been identified, as have potential problems and adverse consequences.

Background: There is a growing quest for anger management techniques especially in underserved populations. Patients with a substance abuse history often have untreated anger problems. Aims: To test a new comprehensive program for prevention, intervention, and remediation of anger in chemically-dependent patients. A secondary aim was to explore any anger differences between males versus females. Method: Twenty-six participants (13 male, 13 female) completed three phases of treatment plus follow-up. Dependent measures were six subscales of the (STAXI) questionnaire and self-monitored frequency, duration, and intensity of anger. Results: A significant multivariate effect of phase of study accounted for 42% of the variance in STAXI scores. Univariate F-tests confirmed significant changes on all STAXI subscales. Most of these were between pre and post phases of the study, the effect sizes = +0.8 for state anger and +0.99 for trait anger. For self-monitored variables, significant reductions emerged between treatment phases, the average pre-post effect size = +1.02. Gender did not affect STAXI scores although females had more self-monitored anger, particularly anger episodes. Conclusions: Findings suggest cumulative efficacy of the anger treatment program. That trait anger declined more than state anger may indicate characterological change in addition to situational change; anger frequency and duration declined more than intensity in keeping with other reports that intensity peaks suddenly and is less modifiable. That males and females were generally similar in anger is worth noting in relation to other studies. Finally, participant attrition is discussed as a problem and a possible index of treatment outcome.

Background: The importance of supervision is increasingly recognized, yet it remains little understood, impairing research and practice. Specifically, the CBT supervision model provides a relatively “heartless” account of professional development, which may undermine its effectiveness. Method: A theoretical review of emotions in supervision and learning is provided, to summarize relevant theoretical and empirical literature. The objectives are to clarify the role of emotions in CBT supervision, and to use this understanding to outline an emotionally-attuned model, illustrating its application to two critical aspects of CBT supervision (the development of a learning alliance and enhancing professional competence). Conclusion: The reviewed literature (theory and research evidence) supports the explicit and systematic incorporation of emotions into CBT supervision. Conceptually, this can be achieved by integrating Lazarus's (1991) general theory of emotion with the CBT model. The illustrations of this augmented model indicate its value in understanding and managing both the “rupture-repair” cycle that can affect the supervisory alliance, and the “deskilling-development” pattern that appears to be necessary for the acquisition of competence. We propose that CBT supervision might usefully be guided by our expanded model, as this affords greater internal consistency and may be more effective educationally.

Background: The likelihood of developing depression increases throughout adolescence. Aims: Understanding the relative contribution of psychosocial and cognitive variables to depressive symptoms during the transitional stage of late adolescence should increase the scope for effective prevention and intervention. Method: The Inventory of Parent and Peer Attachment (IPPA), Adolescents' Cognitive Style (ACSQ), Relationship Rating Scales (RRS), The Life Events Checklist, and the Children's Depression Inventory (CDI) were completed by 140 adolescents aged 16–18 years. Results: Alienation from parents and peers, helpless attributional style, gender, and perceived criticism from teachers contributed significantly to variance in scores for depressive symptoms. Negative self-inference and helpless attributions moderated the relationship between perceived criticism and depression in male participants. Conclusions: Different approaches to intervention may be more successful for males and females.

Aims: The present study aims to determine whether cognitive-behavioural minimal contact bibliotherapy is acceptable to participants suffering from DSM-IV-TR hypochondriasis, and whether this intervention is able to reduce hypochondriacal complaints, as well as comorbid depressive complaints and trait anxiety. Method: Participants were assigned to either an immediate treatment condition, or subsequently to a waiting list condition. Participants were sent a book, Doctor, I Hope it's Nothing Serious?, containing cognitive behavioural theory and exercises. Measures were taken pre, post and at follow-up (after 3 months). Those in the waiting list group received a second pre-assessment, and were then enrolled in the bibliotherapy. Results: Results showed that participants were accepting of the cognitive-behavioural theory. Furthermore, results showed beneficial effects of the intervention: all effect measures decreased significantly over time, with the largest effect at post-assessment. However, a large amount of questionnaires were not returned. Conclusion: It is concluded that bibliotherapy may be an efficient aid in reducing hypochondriacal and comorbid complaints, but due to data attrition and methodological flaws should first be studied further.

Background: Utero-vaginal agenesis, also called the Mayer-Rokitansky-Küster-Hauser Syndrome (MRKH), is a congenital abnormality of the female genital tract, characterized by the non-formation of the vagina and the uterus. It is a common cause of primary amenorrhoea. Little is known about the psychological impact and management of this condition. Method: We describe a specific model of the core negative psychological impact of diagnosis and medical treatment of MRKH and a cognitive-behavioural therapy of MRKH based on the model (CBT-MRKH). The Medical Research Council's (2002) framework for the development and evaluation of complex health interventions was used for intervention development and evaluation. Results: Evidence from a recent cross-sectional study and a small randomized controlled trial (RCT) provides preliminary support for the model and treatment (Heller-Boersma, Schmidt and Edmonds, in press; Heller-Boersma, Schmidt and Edmonds, 2007), and this is further validated by extensive qualitative material gathered over the course of the RCT from participants. Conclusions: The model and treatment described may also be applicable to a number of other congenital or acquired gynaecological conditions such as premature ovarian failure, breast cancer, early onset endometrial cancer, female genital mutilation, Turner's Syndrome, ovarian dys/agenesis or, Complete Androgen Insensitivity Syndrome, all of which have a psychological impact not dissimilar to MRKH in terms of these women's sense of self and femininity.

Background: A theoretical and empirical base for CBT training and supervision has started to emerge. Increasingly sophisticated maps of CBT therapist competencies have recently been developed, and there is evidence that CBT training and supervision can produce enhancement of CBT skills. However, the evidence base suggesting which specific training techniques are most effective for the development of CBT competencies is lacking. Aims: This paper addresses the question: What training or supervision methods are perceived by experienced therapists to be most effective for training CBT competencies? Method: 120 experienced CBT therapists rated which training or supervision methods in their experience had been most effective in enhancing different types of therapy-relevant knowledge or skills. Results: In line with the main prediction, it was found that different training methods were perceived to be differentially effective. For instance, reading, lectures/talks and modelling were perceived to be most useful for the acquisition of declarative knowledge, while enactive learning strategies (role-play, self-experiential work), together with modelling and reflective practice, were perceived to be most effective in enhancing procedural skills. Self-experiential work and reflective practice were seen as particularly helpful in improving reflective capability and interpersonal skills. Conclusions: The study provides a framework for thinking about the acquisition and refinement of therapist skills that may help trainers, supervisors and clinicians target their learning objectives with the most effective training strategies.

Background: This study examined characteristics of members of the public who self-referred and the effectiveness of psycho-educational CBT self-confidence workshops when run in routine practice. Method: Repeated measures were employed at pre- and post-workshop stages. Results: Of the 56 members of the general public who self-referred to the workshops, 70% were above the clinical cut-offs for Global Distress (CORE OM) and 86% were above the clinical cut offs for depression symptomatology (CES-D). Follow up data (n = 31) showed significant reduction in self-reported distress and depression at 4-week follow-up. A further analysis showed that those whose scores were above the clinical threshold at initial presentation benefited most but those with scores below the threshold did not seem to benefit. Conclusions: This study demonstrates that psycho-educational CBT workshops attract those with high levels of distress and depression, and have potential as a cost effective means of disseminating psychological interventions.

Background: Although psychosocial treatments for pain have been found to be effective in reducing self-reported pain, physician visits, and in improving mood, the research has largely focused on younger persons. As such, there is a paucity of related studies involving older adults. Method: We implemented and evaluated a 10-session psychosocial (i.e. cognitive behavioural orientation) pain management program that was specifically designed for older adults. The intervention was delivered either in the participants' homes or in bookable rooms in seniors' residence buildings. Ninety-five community dwelling seniors with at least one chronic pain condition were assigned to either a treatment or a wait-list control condition. An assessment battery was administered to treatment participants immediately before the program started, immediately post-treatment, and 3-months post-treatment. Comparable data were obtained from control group participants, although 3-month follow-up data were not available for the control group. Outcome variables included pain intensity, coping strategy usage, pain beliefs/appraisals, and perceived life stressors. Results: Although decreases in pain intensity were observed in both the treatment and wait-list control groups, the intervention was found to result in fewer maladaptive beliefs about pain and greater use of relaxation, which is considered to be an adaptive coping strategy. Conclusions: Although some treatment benefits were identified (e.g. change in pain-related beliefs), future research should test the effectiveness of a cognitive behavioural treatment program tailored for seniors with participants who are experiencing higher pain intensities than those reported by our sample (i.e. those who experience a higher level of pain at baseline may represent a more suitable sample for assessing the effectiveness of our intervention in reducing pain intensity).

Background: Cognitive-behaviour therapy (CBT) is the recommended psychological treatment for obsessive compulsive disorder (OCD) in young people. Access to CBT may be limited by a number of factors, including lack of trained therapists, and geographic or financial factors preventing access to a specialized service. Telephone delivery of CBT represents one way of overcoming some of these accessibility issues. This pilot study describes outcomes for a telephone-based cognitive-behavioural treatment for obsessive-compulsive disorder (OCD) in young people. Method: Ten participants, aged 13 to 17 years, and their parents received up to 16 sessions of telephone CBT (TCBT). Measures of OCD symptoms were obtained using multiple informants and a repeated measures design. Assessments were conducted at pre-treatment, post-treatment, and at 6- and 12-month follow-up. Results: Improvements were found for OCD symptoms across all informants. Family satisfaction with treatment over the telephone was high. Conclusions: The findings suggest that TCBT is a clinically effective, feasible and acceptable means of service delivery that offers the potential to make CBT a more accessible treatment for young people. TCBT requires further evaluation in randomized, controlled trials to compare effectiveness with face-to-face CBT, which currently represents the usual care model.

Background: The term “socialization to the model” is frequently used in the Cognitive Behavioural Therapy (CBT) literature, but it is unclear exactly what constitutes socialization to the model and there is a paucity of research in this area. Aims: This study aimed to develop a working definition of “socialization to the model”. Method: A three-round electronic Delphi technique was used to generate data and to achieve a consensus agreement amongst a panel of experts (N = 9) in response to two questions pertaining to what constitutes “socialization to the model”. Results: All elements generated in response to the primary question at the first round were retained throughout and scored an IQR of ≤1 at the final round, indicating a consensus that all elements were either essential or important to accurately defining socialization to the model. The panel also reached a consensus on five elements considered to be “indicators” of socialization to the model, the secondary question. Conclusions: A working definition of socialization to the model is presented and discussed. This definition has implications for both clinical practice and research.

Background: The present paper describes the cognitive-behavioural approach evolved and adapted to treat survivors of the London bombings experiencing fear and avoidance of public transport (travel phobia). Method: Treatment outcomes for a consecutive case series (N = 11) are reported. Results: All individuals who completed treatment (N = 10) had returned to their pre-bombing use of transport and reported minimal symptoms. Conclusions: The need for appropriately tailored treatment based on differential diagnosis and formulation and the importance of incorporating skills for treatment of posttraumatic stress disorder are discussed.