Following a great deal of careful and thoughtful work by a number of key individuals and organizations, including the BABCP, the initiative to increase access to psychological therapies (IAPT) has become a reality. As the readers of this journal will now know, this is not an exercise in redistributing resources but rather the creation of an entirely new high quality way of delivering evidence-based psychological therapies to the maximum number of people possible, and doing so in their local area.

This paper describes the nature of the difficulties faced by asylum seekers and refugees who present with traumatic stress symptoms and uses existing cognitive models to better understand theoretical issues in these cases. The focus is on those people for whom traumatic stress symptoms are their main problem/pre-occupation. It is acknowledged that these people may only form a small proportion of those who have experienced such events. This paper does not focus on the important multicultural issues integral to this work. A possible clinical pathway is presented, including the role of exposure/reliving, and how it may be adapted where necessary for people who have experienced multiple traumatic events, often of prolonged duration. Discussion of possible psychosocial understandings of torture and mass violence may be important in this work. A case example is presented that demonstrates how this clinical pathway might unfold in practice.

No randomized controlled trials (RCTs) have been conducted of cognitive behavioural therapy (CBT) for depressed patients who have not responded to antidepressants, yet CBT is often reserved for this group. We conducted a pilot study for a pragmatic RCT of the clinical effectiveness of CBT as an adjunct to pharmacotherapy in primary care based patients with treatment resistant depression (TRD). Patients on antidepressants for at least 6 weeks were mailed a study invitation by their GP. Those who consented to contact were mailed a questionnaire. TRD was defined as compliance with medication (self-report) and Beck Depression Inventory (BDI) ≥ 15. Those who met ICD-10 depression criteria were eligible for randomization and followed after 4 months. Of 440 patients mailed, 65% responded and 72% consented to contact. Ninety-four percent completed the questionnaire and 82 patients (42%) had TRD. Thirty were subsequently identified as ineligible and 10 did not participate further. Twenty-six of the remaining 42 patients met ICD-10 depression criteria and 25 agreed to being randomized. Twenty-three patients completed the 4-month follow-up questionnaire. Recruitment into a RCT to examine the effectiveness of CBT as an adjunct to pharmacotherapy in primary care based patients with TRD appears feasible and should now be conducted.

Perfectionistic people set unrealistic goals and, when they fail to reach them, experience self-criticism and blame. Preliminary research revealed that perfectionism appears to be a characteristic of people who stutter (PWS) (Amster, 1995). The purpose of the present study was to explore perfectionism in PWS and to determine if a modified cognitive behavioral therapy approach alone and combined with Stuttering Modification could help reduce perfectionistic tendencies and stuttering behaviors. Degree of perfectionism and scores of stuttering severity were measured with eight adult PWS and compared at pre-treatment, mid-treatment, after 6-weeks of treatment, and at 15 weeks follow-up, after treatment was withdrawn. Initial open-trial testing showed promising results as perfectionism and stuttering severity were reduced and communication attitudes improved. CBT significantly reduced perfectionism by mid-point. Stuttering decreased significantly throughout all phases of the study. Possible implications are discussed.

An examination was made of the extent to which maternal anxiety predicted response to treatment of children presenting with an anxiety disorder. In a sample of 55 children referred to a local NHS CAMH service for treatment of an anxiety disorder, systematic mental state interview assessment was made of both mothers and children, and both completed self-report questionnaires to assess aspects of anxiety, both immediately before the children received treatment and following treatment. Children of mothers with anxiety disorder overall responded less well to treatment than children of mothers with no anxiety disorder. There was some diagnostic specificity in this in that children of mothers with GAD did as well in treatment as children whose mothers had no anxiety, whereas children of mothers with social phobia did poorly. The outcome for children with anxiety appears to be related to the presence and nature of maternal anxiety. It would seem prudent that treatment of children with anxiety involves assessment of maternal anxiety. It is important to establish in systematic investigation whether treatment of maternal anxiety improves the outcome for child anxiety.

This study explored associations between maternal discipline, maternal trait anxiety and anxiety in preschool-aged children. The sample comprised 47 mothers and their children, aged 2–3 years. Maternal discipline was assessed by maternal self-report; and child anxiety by maternal and play leader report. Positive associations were found between self-reported, ineffective, maternal discipline and symptoms of anxiety in preschool-aged children. Associations were not found between self-reported “verbose” discipline (long reprimands or reliance on talking) and preschoolers' anxiety. There were also no associations between play leaders' reports of preschoolers' anxiety and any of the mothers' self-reported discipline measures. Positive associations were found between maternal trait anxiety and the use of self-reported ineffective disciplinary behaviours. Over-reactive discipline was shown to be a stronger predictor of preschoolers' anxiety symptoms than maternal anxiety or lax discipline. It was concluded that children's internalizing symptoms (according to mother report) may be associated with use of ineffective disciplinary strategies. Increased use of these strategies was also associated with anxiety in mothers, and it is suggested that use of ineffective discipline strategies might partially account for the association between maternal and child anxiety.

Attention Training (ATT) is an auditory attention-focusing technique that attempts to reduce the perseverative self-focused processing characteristic of anxiety and mood disorders. The present study investigated the effects of one session of ATT in the reduction and reappraisal of intrusive thoughts in a university sample reporting high levels of obsessive-compulsive symptoms. One-hundred and eight participants identified their most distressing intrusive thought and spent 7 minutes monitoring their stream of consciousness while recording occurrences of the identified thought. They then rated the unpleasantness of the intrusive thought, their attempts to dismiss the thought from consciousness, and their perceived success in reducing the frequency of the thought. Participants were then randomly assigned to receive one session of ATT, thought replacement instructions (TR), distraction instructions (DI), or no intervention (CONT). Participants then repeated the thought monitoring interval and ratings. ATT was expected to be the most effective in decreasing the frequency and unpleasantness of intrusive thoughts. However, contrary to hypotheses, all groups reported similar decreases across intervals. Implications of these findings are discussed.

There is uncertainty about the role of avoidance behaviours in recovery from loss. Some authors have noted that avoidance exacerbates grief, whereas others have claimed that avoidance, at some times during the grieving process, can foster recovery. In the current study, it was hypothesized that avoidance behaviours are particularly detrimental when mourners have threatening misinterpretations about the consequences of confronting the loss, but less detrimental when mourners do not have such misinterpretations. To test this hypothesis, 400 mourners completed questionnaires tapping threatening misinterpretations, avoidance, and complicated grief (CG) and depression. In support of the prediction, situational avoidance, ruminative avoidance, and efforts to maintain ties with the deceased were only linked with depression in those who strongly endorsed misinterpretations. In addition, misinterpretations magnified the associations of ruminative avoidance and efforts to continue ties, with CG. Findings suggest that avoidance interacts with threatening misinterpretations in affecting particular emotional problems after loss.

Self help approaches are increasingly being used in healthcare settings through over 100 book prescription schemes in the UK. The use of Cognitive Behavioural Therapy (CBT) self-help materials for depression is advocated as part of stepped care service models. This study assesses how the reading ages of the most recommended self-help books for depression compare to British literacy levels. A cross sectional survey was carried out. The most recommended self-help books for depression were identified; seven CBT based self-help books were included in this study as well as a widely used booklet for depression. Readability scores and reading ages were calculated for a randomly generated selection representing 15% of each selected book using the Readability Studio® software to generate a wide range of key readability and comprehension scores. The reading ages of the selected books were between 12.6 and 15.4. Reading ease varied amongst the texts, and their complexity (percentage of unfamiliar words, range: 14.8% – 22.6%). A significant proportion of the UK population would struggle to use some of the current CBT-based self-help books recommended. For some patient groups, non text based self-help materials as well as shorter and more easily read written materials may be more appropriate. To our knowledge, this is the first study to address this question. Publication of the reading ages of the recommended books within the book prescription schemes may allow for a more accurate match between the book and the reader.

Five variables were investigated with regard to their possible predictive value for cognitive behavioural treatment (CBT) outcome in a large sample of panic disorder (PD) patients. The variables were initial symptom severity, comorbid anxiety or depressive disorders, comorbid cluster C personality disorders, and initial motivation for treatment. A total number of 161 PD patients received a standardized CBT of 15 sessions. Assessments of predictive variables took place prior to treatment. Outcome measures were assessed at pre- and posttreatment. The patients had significantly improved after the treatment. None of the variables, separately or together, affected CBT outcome, save initial severity of panic disorder symptoms, which was positively associated with posttreatment symptom severity. Since research efforts failed to produce consistent predictors for CBT treatment outcome in panic disorder thus far, the usefulness of future outcome prediction research in panic disorder by pre-treatment demographic, disorder-related, psychological, or socio-psychological variables is put into question.

An increasing body of research in support of cognitive-behavioural therapy (CBT) for adolescent depression has emerged during the last two decades. However, it has been suggested that empirically supported treatments are seldom carried out in clinical practice. Although the reasons for this are likely to be diverse, it is argued that mental health services have an ethical responsibility to offer evidence-based interventions. Whether empirically supported interventions, such as CBT, are consistently offered to depressed adolescents attending Child and Adolescent Mental Health Services (CAMHS) is currently unknown. A primary aim of this study was to survey the use of CBT for depression in a number of United Kingdom (UK) CAMHS settings. A postal questionnaire was sent to 117 members of the BABCP Children, Adolescents and Families Special Interest Branch, of which 44 completed questionnaires were returned. Descriptive statistics indicate that just over half of the organizations represented routinely offered CBT to depressed adolescents. CBT practice and the transportation of evidence-based research findings to CAMHS settings are discussed.

Behavioural and Cognitive Psychotherapy is an international multidisciplinary journal for the publication of original research, of an experimental or clinical nature, that contributes to the theory, practice and evaluation of behaviour therapy. As such, the scope of the journal is very broad and articles relevant to most areas of human behaviour and human experience, which would be of interest to members of the helping and teaching professions, will be considered for publication.