The aim of this review was to ascertain whether an examination of the theory of structural dissociation of the personality (TSDP) and its treatment may lead to recommendations in the treatment of dissociative identity disorder (DID) and other trauma-related disorders utilizing CBT. An analysis of the neurobiology of trauma will aid this process. The literature review considers a variety of literature on TSDP. Several themes were identified which suggested that dissociation refers to a structural dividedness of the personality and that there is a psychobiological pathway for all trauma-related disorders. Additionally the role of bottom-up vs. top-down processing was explored. Recommendations for the treatment of trauma-related disorders using CBT have been made.

Government policy, like evaluations of clinical practice, indicates the growing importance of supervision in fostering practitioner development and in improving the fidelity of therapies. However, instruments with which to measure competent supervision are often problematic, thereby hampering these key activities (e.g. they are rare, rely on self-ratings by participants, and psychometric data can be limited). To contribute to progress, this paper reviews the current options for measuring competent clinical supervision by means of direct observation, a favoured approach within cognitive behaviour therapy (CBT). We systematically reviewed 10 existing instruments that were designed to observe and quantify competent supervision, focusing on three broad criteria for sound measurement (i.e. an instrument's Design, Implementation, and Yield: DIY). Suggestions for future research on instruments that can fulfil the functions that are provided distinctively through direct observation are outlined.

Self-help therapies, such as bibliotherapy, are becoming increasingly more available to the general population as a treatment for psychological disorders, such as depression and anxiety. However, relatively few of these self-help books are properly evaluated to test their treatment efficacy. Two studies aimed to test a new self-help book to treat fears, phobias and anxiety in order to see if symptoms of anxiety and associated symptoms, such as functioning and coping, were improved compared to baseline scores and a waiting-list control group. Study 1 adopted a minimal guided approach (experimental group: n = 25; waiting-list control group: n = 29) whereas Study 2 adopted a non-guided approach (experimental group: n = 17; waiting-list control group: n = 16). In both studies, functioning and coping were improved and the current state of phobic symptoms was reduced. The main phobia improved only when adopting a guided approach and general psychological distress only reduced when adopting a non-guided approach. These studies provide preliminary support for a modest effect in a subclinical population. The results could have good implications for the treatment of anxiety and the use of self-help methods as an additional treatment aid or as a preventative treatment.

Clinical supervision plays a recognized role in facilitating practitioner development and in promoting therapeutic fidelity, but instruments that can support such activities by measuring competence in supervision are rare and often psychometrically compromised. As part of a research programme intended to raise the empirical status of supervision, we describe the initial psychometric development of a new instrument for observing competence (Supervision: Adherence and Guidance Evaluation; SAGE). This instrument is suitable for measuring CBT supervision, and can be administered by self-rating or by an independent observer. Preliminary tests of the reliability and validity of SAGE suggest that it is a promising tool for evaluating supervision. In addition, SAGE can be applied readily and has good utility. In these respects, SAGE appears to have some advantages over existing instruments, and may therefore provide a basis for enhancing research and practice in CBT supervision. Suggestions for future research on SAGE are outlined, particularly the need for a generalizability analysis.

Cognitive behaviour therapy (CBT) has been found to be effective in treating mental health problems in the UK, but little has been done to evaluate the potential of CBT in developing countries. This paper aims to discuss the development and implementation of a CBT training course for clinicians working in Tanzania's main psychiatric hospital in the capital city, Dodoma. A 12-session training course in CBT was delivered to nine clinicians. An outcome evaluation was conducted using multiple measures and methods, taken before and after the training. Information on cultural adaptations of the training was obtained. All participants completed the course, but there were several obstacles to full completion of the evaluation measures. Despite this, there were significant improvements in clinicians’ basic understanding of CBT concepts, and their ability to apply the CBT model to formulate and recommend treatment strategies in response to a clinical case. Qualitative information indicated the potential of developing CBT training and implementation further. As a pilot study, this investigation shows the promise that CBT holds for mental health services in Tanzania. Further research into the training and clinical effectiveness of CBT in Tanzania is indicated.

Clinical supervision is an essential component of psychological work with clients. This article presents views of a group of primary-care mental-health workers on the introduction of clinical supervision. A focus group interview was analysed. The key themes extracted were: the supervisor's approach that provided an educative, safe, boundaried space that allowed exploration, support and validation; the advantages and disadvantages of group supervision; helpful and unhelpful ingredients of supervision; the governance and facilitative functions of supervision; and the dangers inherent in not having supervision for both client and worker. Key recommendations are made encompassing: training in supervision and a psychological approach; encouraging theory–practice consolidation; balancing competency with curiosity; and reviewing supervision regularly. Limitations of the study are also discussed.

There are theoretical challenges in distinguishing obsessions from overvalued ideas (OVIs) and delusions. The latter can be defined by its rigid nature and unusual content, but obsessions and OVIs are also reported with such characteristics. Clinically, what are the implications when this distinction is not entirely clear? In this case study, these issues are explored with a man who presented with commonly reported symptoms of obsessive compulsive disorder (OCD) and a belief about transforming into a giant fly. Clinically meaningful gains were made following a course of 17 sessions of CBT, providing some additional support for the effectiveness of CBT for abnormal beliefs within OCD.

Data collected from clinical populations indicate that magical ideation (MI) may play a causal or a mediating role in the expression of obsessive compulsive symptoms. If this is the case then when targeted in treatment, symptoms of obsessive compulsive disorder (OCD) should be altered. Two individuals diagnosed with OCD received a trial treatment targeting magical thinking. The intervention consisted of a series of procedures designed to undermine superstitious/MI without targeting obsessions or compulsions. The procedures involved critical analysis of the following material: (1) a free astrology offer; (2) a horoscope prediction exercise; (3) a description of four different cultural explanations of the origin of fire; (4) an instructive guide for Tarot card readers; (5) a report of a UFO sighting; (6) a video-clip describing a cult festival; (7) a description of a ‘hoax’ channeler and (8) a superstition exercise. Measures of obsessive compulsive symptoms, superstition, MI and thought–action fusion were administered pre-treatment, post-treatment and at 3 months’ follow-up. According to the twofold criterion of Jacobson et al. (Behaviour Therapy 1984, 15, 336–352), following treatment the patients were identified as being recovered on measures of magical and superstitious thinking and on the Padua Inventory.

Gastrointestinal distress is a common symptom of anxiety. While these symptoms are usually transient and not severe, in some cases they can cause significant impairment. This report details the treatment of a 45-year-old male who presented with symptoms of diarrhoea and vomiting which occurred every time he travelled more than 10 miles away from his home. These symptoms arose suddenly and without warning, and on at least two occasions the vomiting was so severe that it caused the patient to vomit blood. Due to this problem, the patient had developed agoraphobia which had affected his life for over 15 years. The patient was treated in 14 sessions which involved educating him about gastrointestinal reactivity and having him perform a series of emotional tolerance, opposite-action, and real-life exposure exercises. After receiving treatment, the patient embarked on a series of vacations and business trips, all without experiencing diarrhoea or vomiting, and a follow-up assessment showed that the treatment gains were maintained 1 year later.

Competencies for psychiatric training have been developed that reflect what psychiatrists have to be able to do in order to function in their role. Although the need for a formally delivered psychotherapy experience is assumed and associated competencies are represented in the curriculum, it is not clear which competencies thereby achieved can be translated into generic practice. This paper reports the outcomes of a workshop held at an academic regional meeting of the Royal College of Psychiatrists. Potential competencies to be achieved following training and experience in CBT were presented. Small group review of the frameworks and subsequent feedback demonstrated broad support for requirements of CBT knowledge and attitudinal competencies that could inform day-to-day practice, within a generic psychotherapeutic skills framework. New competencies that were related to CBT and considered meaningful in daily psychiatric practice emerged. Further development of these ideas from the workshop in this paper leads to a set of coherent competencies that would be helpful in non-CBT specialist practice and are congruent with the context of generic psychiatric practice. These enable models of training other than the delivery of a single ‘brief’ psychotherapy case to be considered.

The third wave of cognitive behavioural therapies has a developing evidence base and there is an increasing demand for specialist training. However, methods for training clinicians have not yet been evaluated in terms of effectiveness and usefulness. This evaluation seeks to assess: (1) the effectiveness of one-day introductory Acceptance and Commitment Therapy (ACT) workshops for clinicians in a NHS setting in terms of increasing knowledge of ACT; (2) the impact of experiential techniques as a method for delivering ACT training. A total of 73 participants took part in the workshops and completed questionnaires were administered pre-workshop and post-workshop; a further 29 participants completed follow-up questionnaire after 12 months. Participants demonstrated an increase in ACT knowledge, indicated that their interest had been stimulated, viewed the workshop positively and reported that their clinical work had been influenced by the workshop. In terms of the training process, experiential techniques are integral to ACT practice and training. Participants reported that their training experiences and engagement with the training group had not been aversive. Moreover, there was no evidence that participants’ own levels of experiential avoidance had affected training outcomes.

Despite the acknowledged importance of clinical supervision, controlled research is minimal and has rarely addressed the measurement or manipulation of clinical supervision, hampering our understanding and application of the different supervision methods. We therefore compared two related approaches to supervision, cognitive-behavioural (CBT) and evidence-based clinical supervision (EBCS), evaluating their relative effectiveness in facilitating the experiential learning of one supervisee. Drawing on a multiple-baseline N = 1 design, we gathered mostly qualitative data by means of an episode analysis, a content analysis, a satisfaction questionnaire, and interviews with the supervisor and supervisee. We found that the EBCS approach was associated with higher supervision fidelity and increased engagement in experiential learning by the supervisee. This case study in the evaluation of supervision illustrates the successful application of some rarely applied qualitative methods and some potential supervision enhancements, which could contribute to the development of CBT supervision.

The inpatient unit faces many challenges in the effort to deliver comprehensive psychiatric care to acutely ill patients with minimal lengths of stay. Cognitive behaviour therapy (CBT), a structured, problem-focused, time-limited form of treatment has been shown to be a promising intervention with the inpatient population. This paper describes a group-oriented inpatient CBT programme for women and reports pilot data on the experiences of 78 adult female patients. Repeated-measures ANOVAs revealed that participants exhibited improved psychosocial functioning from admission to discharge, with gains maintained at 1 month post-discharge. Partial correlations indicated that participation and engagement in CBT groups is related to improved functioning at discharge. Participants diagnosed with major depressive disorder, bipolar disorder, and psychotic disorders all evidenced similar positive treatment trajectories, suggesting that group-oriented CBT programming may be a useful addition to standard inpatient care.