A range of clinicians (n = 72) were asked to provide a definition of a schema. The participants were selected from different parts of the broad church of the CBT community, with all having received some training in CBT – although only 26.4% had a formal CBT qualification. Fourteen themes were identified, suggesting that the concept is perceived to be complex. However, the mean number of themes identified per clinician's definition was small: 2.86 (mode = 2). We consider this finding reflects a problem concerning a lack of clarity with respect to the use of one of the key concepts in CBT.

CBT treatment programmes for children and adolescents with anxiety disorders are promising as indicated by efficacy research. Replicating this research in ordinary clinical care is crucial in order to establish the validity of these results and disseminate empirically based treatments to practitioners. This paper presents the first experiences of using a structured programme, the Friends for Life manual, in ordinary clinical care in Norway targeting anxiety problems in children aged between 7 and 12 years. The effects of the treatment are presented as multiple single-case studies. Clinical meaningful change is considered from two perspectives; diagnostic change and changes in self-report measures. At a statistical significance level the treatment effect can be characterized as modest. Independent of the symptom reduction, the children, families and therapist are in the main satisfied with the structured approach indicating the acceptability of the programme.

We describe the results of a randomized controlled trial to assess effectiveness of an anger management group programme, employing a cognitive behavioural framework that was run by the Psychology Service. The treatment group was compared with a control group on a waiting list. The trial was performed at the Southampton CBT Service. The treatment group received a cognitive behavioural anger management programme, initially based on Novaco's approach, but with further development of the motivational components. The control group received no treatment and was on a waiting list. The Novaco Anger Assessment Scale (NAS), State-Trait Anger Expression Inventory (STAXI), Evaluative Beliefs Scale (EBS), Hospital Anxiety and Depression Scale (HAD) and the Clinical Outcomes in Routine Evaluations (CORE) were used to measure anger, belief about self and others, anxiety and depression, and physical and psychological wellbeing. Clients in the anger management group showed statistically significant changes on STAXI, NAS, CORE and EBS subscales at the end of the therapy. The change in depression and anxiety on HAD (depression and anxiety) was not statistically significant. It was not possible to carry out analyses at follow-up due to high dropout rates. We concluded that an anger management programme using CBT was helpful in reducing anger and overall psychopathology.

Individually focused CBT for road traffic accident (RTA)-related post-traumatic stress disorder (PTSD) involving exposure and cognitive restructuring has been shown to be effective. Group CBT interventions provide an opportunity for treatment to be delivered in a cost-effective fashion and may also be ‘normalizing’ for patients, but few evaluations have been published. Many elements of CBT lend themselves well to group presentation, although implementing exposure presents a specific problem. The development and preliminary evaluation of a group (n = 6) targeting RTA-related PTSD is described here. Pre- and post-questionnaire evaluation is accompanied by assessment of patient satisfaction. Four of the group no longer met diagnostic criteria and the remaining two showed clinically significant change in both the number and severity of symptoms. In addition symptoms of depression decreased from the severe to the mild range within the group and there were high levels of participant satisfaction reported. Further research is required to evaluate this and similar packages before group treatment can be advocated as an alternative to individual CBT for PTSD.

The Oracle of Delphi's admonition to ‘know thyself’ may be more difficult than it seems, when it comes to self-assessment of competence in cognitive behaviour therapy (CBT). This paper investigates the accuracy of self-rating of competence in relation to other measures such as ‘direct’ assessment of videotaped sessions or supervisor ratings. Self-assessment of competence is something most of us do and arguably has an important role in professional development, but it may also be biased and unreliable. Two measures were developed, based on the Cognitive Therapy Scale – Revised, to assess student and supervisor assessments of competence at the start and end of a CBT training course. Competence data across a range of measures from a 5-year audit of a postgraduate CBT course is presented and the relationship between self-rated and other-rated measures explored. Results are discussed and it is suggested that trainee self-assessment, while not found in this study to be correlated with other measure of competence, may provide important information about confidence development, and areas where a trainee perceives they have strengths and weaknesses.

Exposure therapy is a widely used and well-evidenced treatment for a variety of avoidance behaviours. This paper offers a modest proposal for an improvement in how it is carried out (‘dynamic hierarchies’). The theoretical and practical context is set out, including some thoughts on the role of appraisals and cognitive dissonance, and some advantages of the method are suggested.