Cognitive behaviour therapists working in the field over the last 10 years will have witnessed a shift to more schema focused forms of therapy. While these approaches have been introduced to treat people with personality disorders, they have also had a strong influence on the treatment given to people suffering from Axis I disorders. Indeed, it is my impression that many therapists are now of the opinion that they are not doing proper cognitive behaviour therapy (CBT) unless they have undertaken a detailed history of a patient's early childhood and, along the way, unearthed a couple of core beliefs. This paper outlines some of the pitfalls concerning the shift of emphasis towards schema focused techniques. While it is acknowledged that schema work is a development of “traditional” CBT, it is proposed that schema therapy is being employed without adequate assessment of its appropriateness, especially when used in primary care settings with people with no prior history of psychiatric problems. This paper provides some anecdotal details about therapists' difficulties in using schema techniques. These examples stress the need for good supervision, highlighting the responsibility of therapists to ensure that the patient receives the most appropriate form of therapy. This work recognizes the importance of schema focused approaches, but suggests that they are being used too pervasively, and too often by people with neither sufficient training, nor adequate grounding, in the empirically validated “traditional” CBT approaches.

Consistent with cognitive-behavioural formulations of Obsessive-Compulsive Disorder (OCD), recent research has supported the association between obsessive-compulsive phenomena, specific dysfunctional beliefs and negative affective states. However, such research has not been conducted across sufficiently different cultural contexts using the same measures in comparable samples. In the present study, university psychology students from Australia and Italy completed questionnaire measures of obsessive-compulsive phenomena, inflated responsibility, perfectionism, guilt, depression, and anxiety. Australian and Italian cultures can be seen to differ in a number of ways that could impact on the pattern of expected interrelations between these measures. Similarities in the factor structure and psychometric properties of the measures were apparent across the two cultural contexts, suggesting the appropriateness of cross-cultural comparisons in the pattern of intercorrelations. Significant interrelations were found between the measure of obsessive-compulsive phenomena, dysfunctional beliefs and negative affect in both cultural contexts. While there were some differences in the specific patterns of interrelations, these were few in number and, generally, could be explained by sociocultural factors or stereotypes, although the overall pattern of intercorrelations was stronger for the Australian cohort. The results suggest that cognitive-behavioural formulations of OCD can be generalized across these two different cultural contexts, although idiosyncratic cultural factors may need to be considered in developing cognitive-behavioural treatments.

This paper discusses the viability of an analogue research design for studying key processes in social phobia by comparing individuals who score high and low on the Fear of Negative Evaluation Scale (FNE: Watson & Friend, 1969). Research indicates remarkable consistency in the processes that distinguish patients with social phobia from controls and high FNE volunteers from low FNE volunteers. Unfortunately, all existing FNE norms are based on North American populations. The present paper presents British student norms and suggests possible cut-off points for defining groups for analogue research. Advantages of the analogue strategy include rapid piloting of new paradigms and the use of more complex experimental designs that require substantial sample sizes. Limitations of analogue research are also highlighted.

The existing scale for assessing competence in cognitive therapy (CTS) dates from 1988 and only the previous version of 1980 has been validated to any extent. A revised version, the CTS-R, was devised to improve on the CTS by: eliminating overlap between items, improving on the scaling system, and defining items more clearly. Kolb's well-known educational model was used as a guideline. In the new 14-item scale, three new items measure general therapeutic flair, the facilitation of emotional expression, and therapist's non-verbal behaviours (optional). We hypothesized that the CTS-R would prove more user friendly and demonstrate satisfactory reliability and validity. Twenty-one mental health professionals undergoing training in cognitive therapy provided 102 video-tapes of therapy with 34 patients, reflecting three stages of therapy. The tapes were rated by four expert raters, in a balanced design. The CTS-R showed high internal consistency and adequate average inter-rater reliability. Reliability for individual items varied widely among pairs of raters. Validity was demonstrated by improved ratings of competence for trainees who saw patients early and later during the course of training. Although raters found the CTS-R a more useful tool than the CTS and satisfactory reliability and validity were demonstrated, more refinement is needed in item definition. The study has led to modifications in the CTS-R, which are in the process of evaluation.

Four randomized controlled trials have shown out-patient cognitive behaviour therapy reduces fatigue and disability in people suffering from chronic fatigue syndrome (CFS). However, some patients referred to Kings College Hospital, London are unable to attend regular appointments. We therefore developed a self-help treatment manual using cognitive-behavioural principles for patients to use at home with telephone contact with a therapist. Nine consecutive patients with a diagnosis of CFS who were unable to attend regular out-patient appointments used this self-help treatment approach at home. The therapist (MB) carried out a face-to-face assessment at the hospital. Subsequently, patients had fortnightly telephone appointments to discuss their progress, plan and discuss their homework and any problems. Outcome was evaluated using measures of functional impairment, fatigue, mood and general health before and after treatment and at 3 and 6-month follow-up. Eight patients completed treatment. Functional impairment, fatigue and general health improved at discharge and gains were maintained at 6-month follow-up. Self-treatment at home guided by a manual with fortnightly telephone sessions was helpful in the treatment of patients with chronic fatigue syndrome. A randomized controlled trial is underway to compare telephone cognitive behaviour therapy with out-patient cognitive behaviour therapy. Patients with other conditions such as chronic pain who are unable to travel for regular appointments may benefit from a home-based treatment package involving therapist contact by phone.

Professional training in motivational interviewing, as on many other topics, is often delivered via a one-time clinical workshop. To what extent do practitioners actually acquire skillfulness through such training? Twenty-two counselors participated in training, of whom 15 completed a study of changes in practice behavior up to 4 months after a motivational interviewing workshop. In addition to self-report questionnaires, they provided taped practice samples before and after training, which were coded for counselor and client behavior. On paper-and-pencil measures, participants reported large increases in motivational interviewing skills. Observational measures reflected more modest changes in practice behavior that were often retained 4 months after training. Clients, however, did not show the response changes that have been found to be predictive of better outcomes with motivational interviewing. While practice behavior changed to a statistically significant extent, the effect of training was apparently not large enough to make a difference in client response. Possible implications for training and quality control of psychotherapies are considered.

In this paper, we describe the progress of four male, legally-detained personality disordered offenders in a group treatment programme for angry aggression. “Controlling angry aggression” is a 15-session, structured, cognitive-behavioural programme that is part of a wider integrated, multidisciplinary treatment programme run within a specialist personality disorder treatment unit. Psychometric tests showed that three of the four patients improved over the course of the treatment programme. Behaviour ratings of staff and patients concurred, allowing confidence in patients' self-report of anger. No change in behaviour was evident over time for any patient, but initial low rates of aggression allowed little room for improvement. Self-monitored anger and aggression scores did vary markedly over time, and since behaviour remains stable despite anger, this indicates that these patients can control their behaviour. One patient did not improve, and reasons for this are examined, concluding with a reminder of the need for rigorous selection of patients for treatment programmes.

This study tested the use of a problem solving measure (The Problem Solving Scale: Center for Cognitive Therapy, 1988) as a predictor of outcome in patients receiving cognitive behaviour therapy (CBT) in an NHS psychotherapy service. Lower scores at assessment on the Problem Solving Scale (PSS) were predicted to be associated with poorer outcome for all diagnoses (but particularly depression) and higher dropout. The PSS predicted outcome for depressed patients receiving CBT, but not anxious patients or patients with other disorders. Poorer problem solving was not associated with dropout from therapy. Components of the scale that were most closely correlated with global outcome seemed to reflect the behavioural activation and cognitive restructuring skills taught in CBT for depression. Since this is the second study to connect PSS scores with outcome in depression (Scott, Harrington, House, & Ferrier, 1996), the possibility that aspects of learned resourcefulness are relevant to patients' suitability for CBT remains alive, and further research in this area is indicated.

In a pilot study we aimed to assess needs for care (and gaps in service provision) in readmitted psychiatric patients. Semi-structured interviews using the Cardinal Needs Schedule were conducted, and case notes were examined. Most readmitted patients had many needs (clinical and social) that were not being met in the community. Psychological interventions were required to meet many of the clinical needs, while a broad range of interventions was required to meet social needs. There was a poor match between the needs identified by the Cardinal Needs Schedule and those identified at discharge planning.

Ehlers and Clark (2000) recently published a rigorous cognitive behavioural model of PTSD. Part of the model explains how the phenomenon of “affect without recollection” can emerge in PTSD. This happens when the re-experiencing phenomena occur without explicit or conscious recall of the parts of the traumatic event from whence the phenomena originated. The following paper presents a case study of a man with PTSD and head injury in which there was complete organic amnesia for the trauma but where re-experiencing of the event occurred via implicit conditioned responses to reminders of the event. It provides elegant supportive evidence for the phenomenon of “affect without recollection” where both PTSD and severe head injury are present.