Background: Mental contamination is a phenomenon whereby people experience feelings of contamination from a non-physical contaminant. Rachman (2006) proposes that standard cognitive behavioural treatments (CBT) need to be adapted here and there is a developing empirical grounding supporting the concept, although suggestions on adapting treatment have yet to be tested. Method: A single case study is presented of a man with a 20-year history of severe treatment resistant Obsessive Compulsive Disorder (OCD) characterized by mental contamination following the experience of “betrayal”. He was offered two consecutive treatments: standard CBT and then (following disengagement with this) a cognitive therapy variant adapted for mental contamination. Clinician and patient rated OCD severity was measured at baseline and the start and end of both interventions. Results: Six sessions of high quality CBT were initially attended before refusal to engage with further sessions. There were no changes in OCD severity ratings across these sessions. A second course of cognitive therapy adapted for mental contamination was then offered and all 14 sessions and follow-ups were attended. OCD severity fell from the severe to non-clinical range across these sessions. Conclusions: The need to consider adapting standard treatments for mental contamination is suggested. Limitations and implications are discussed.

Background: The experience of having a child diagnosed with type 1 diabetes mellitus (T1DM) can negatively impact on the mother's well-being and trigger posttraumatic stress symptoms. To date, only one study has examined the role of non-cognitive factors in predicting the occurrence of PTSD in parents of children diagnosed with diabetes. However, in the broader PTSD literature is has been shown that both non-cognitive variables and cognitive variables predict PTSD in traumatized populations. Aims: The current study aimed to investigate the relationship of both non-cognitive (trauma severity, psychiatric history and social support) and cognitive variables (negative cognitive appraisals and dysfunctional cognitive appraisals) with PTSD in mothers of children recently diagnosed with diabetes. Method: A single group survey design and self-report questionnaires were used to investigate the relationship between both non-cognitive (trauma severity, psychiatric history and history of trauma, and social support) and cognitive factors (negative cognitive appraisals and dysfunctional strategies) and PTSD symptoms in mothers of children who had been diagnosed with type 1 diabetes in the last 5 years. Results: All cognitive variables were positively associated with PTSD symptoms. In contrast, of the non-cognitive variables, only social support was significantly (negatively) associated with PTSD symptoms. Moreover, regression analysis found that cognitive variables explained variance in PTSD symptoms over and above that contributed by the non-cognitive variables. Conclusions: This supports the cognitive model of PTSD. The implications of the study with regards to early detection of and therapies for PTSD in this population are discussed.

Background: Regulatory control of cognition is implicated in the amplification of mood variability in cyclothymia. Aims: This study examined whether cognitive behavioural therapy (CBT) directed at enhanced awareness and mood change could change global functioning, mood variability and regulatory control. Method: Using a prospective single case experimental design, mood and cognitive control ratings were recorded every 4 hours for 51 weeks by a patient diagnosed with cyclothymia, including a 5-week baseline, a 35-week (19 session) CBT intervention period and an 11-week follow-up period. Results: Findings indicated that the patient experienced reduced mood variability and greater regulatory control, became happier and less anxious but felt less energetic. Following CBT, high energy became negatively associated with positive mood, and this change was mediated by an increase in control over thoughts. Conclusions: The results suggest that CBT directed at cognitive control and mindfulness skills may help in the treatment of cyclothymia.

Background: Children of parents with bipolar disorder are at increased risk of disturbance. Aims: This study examined relationships between parental mood, parenting, household organization and child emotional and behavioural adjustment in families with a parent with bipolar disorder to determine areas of specific need for parenting support. Method: 48 parents were recruited through advertisements via self-help organizations. The study was conducted online. Parental mood and activity was assessed by self-report questionnaires (CES-D, ISS, MDQ and SRM); parenting was assessed using the Parenting Scale (PS). The SDQ was used to assess the parent's view of their child's emotional and behavioural difficulties. The Confusion, Hubbub and Order Scale (CHAOS) assessed household organization. Results: Parents reported high levels of difficulties across all measures and scores were above clinical cut-offs on most scales. Children were reported as showing high levels of disturbance on the SDQ, including all sub-scales. Parenting and depression scores were significantly positively correlated, as were depression, parenting and CHAOS score. Regression analyses indicated that CHAOS was the strongest predictor of Total Difficulties and Emotional Symptoms on the SDQ. Conclusions: Families are likely to benefit from interventions tailored to meet their parenting needs.

Background: The perceived control of intrusive thoughts is important in our understanding of a variety of psychological disorders, but particularly in Obsessive Compulsive Disorder (OCD). Little research has explored thought control strategies in younger populations, despite the frequent onset of OCD in childhood. Aims: This study examined thought control strategies and meta-cognitive beliefs in relation to Obsessive Compulsive (OC) interference scores in an adolescent sample. Method: A non-referred sample of 151 adolescents aged 13–16 completed the Thought Control Questionnaire, the Meta-Cognitions Questionnaire – Adolescent version, and the Leyton Obsessional Inventory – Child Version. Results: Adolescents reported using distraction and worry as thought control strategies as much as adults, but social control and reappraisal less frequently, with adolescent males also reporting less use of punishment as a strategy. The strategies of worry and punishment, and positive beliefs about worry, uncontrollability and danger beliefs (UCD) and superstition punishment and responsibility beliefs (SPR) predicted OC interference scores. Furthermore, these meta-cognitive beliefs mediated the relationships between punishment and worry and OC interference scores. Conclusions: Given the similarities between our results and those from research exploring these variables in adults, it is proposed that cognitive behavioural models of OCD that have been developed in adult populations may be relevant to adolescents, but that meta-cognitive beliefs about superstition, punishment and responsibility may be important in adolescence.

Background: Body dysmorphic disorder (BDD) is relatively common in adolescents and can have serious negative consequences. However, the treatment of BDD in young people has received virtually no empirical attention to date, and the evidence-base for cognitive behaviour therapy (CBT) in this population is limited to a small number of single case reports. Aims: This study aimed to investigate treatment outcomes associated with CBT, primarily consisting of exposure and response prevention, in a group of young people with BDD. Method: Six adolescents with a diagnosis of BDD received a course of developmentally appropriate CBT for BDD with parental involvement. BDD and depressive symptoms were evaluated at pre-treatment, post-treatment and at 3- or 6-month follow-up, using the Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS) and the Beck Depression Inventory-Youth, respectively. Results: Scores on the BDD-YBOCS indicated a 44% improvement in BDD symptoms at post-treatment and a 57% improvement at follow-up for the group. Considering response as a ≥30% reduction in BDD-YBOCS score, four of the six adolescents were classified as treatment responders. Improvements in depressive symptoms were observed among the treatment responders, but not the non-responders. Conclusions: These findings indicate the potential efficacy of CBT, including exposure and response prevention for adolescents with BDD, and highlight the need for further controlled trials.

Background: Perseveration, persistence and perfectionism are traits that have been suggested to be relevant to the eating disorders. This study explored the levels and correlates of these three traits in the eating disorders and control groups. Method: A measure of these three elements (the Persistence, Perseveration and Perfectionism Questionnaire - PPPQ-22) was administered to 99 women with eating disorders, 25 women with other psychiatric disorders, and 91 non-clinical women. Differences in PPPQ-22 scores across groups were measured, as were the associations between PPPQ-22 scores and eating attitudes. Results: The eating disordered groups showed lower levels of persistence (the drive towards goal achievement) than the non-clinical group, but did not show higher levels of perseveration (the following of rules, without considering whether goals are achieved). Both women with eating disorders and non-clinical controls showed correlations between eating disorder symptoms and perseveration. Conclusions: The current study, using a relatively new measure, suggests that low levels of persistence, rather than high levels of perseveration, may be implicated in the eating disorders. It was less clear that perfectionism per se was a useful construct in understanding eating pathology. If confirmed by future research, persistence should be considered in treatment of these complex and challenging conditions.

Background: When using Motivational Interviewing (MI), once resistance or ambivalence are resolved and motivation is solidified, many practitioners struggle with how best to transition the discussion toward action planning, while still retaining the spirit and style of client centeredness, i.e., moving from the WHY phase to the HOW phase of counseling in a style that is MI-consistent. For many, there is a perception that the counseling style, skills, and strategies used to build motivation are distinct from those used in the action planning phase. The WHY to HOW transition does not, however, necessitate abandoning a client-centered style for a more overtly educational or directive style. Goal setting, action planning, provision of advice, and relapse prevention can be implemented from an autonomy supportive, MI consistent framework. Method: To this end, this article will present a new class of reflection, which we have termed “action reflections”, that can be used to help bridge the WHY-HOW gap. Action reflections (AR) allow the clinician to maintain a tone and orientation that are consistent with MI, i.e. autonomy support; guiding versus directing, during the action phase of counseling. They differ from reflecting change talk as they focus not on the WHY of change, but the HOW, WHEN, or WHERE. Action Reflections (ARs) also differ from the more common type of reflections such as those that focus on client feelings, rolling with resistance, or acknowledging ambivalence as ARs usually contain a potential concrete step that the client has directly or obliquely mentioned. Like any type of reflection, ARs represent the clinician's best guess for what the client has said or, more apropos here, where the conversation might be heading. Conclusion: This article describes the various types of ARs and provides examples of each to help clinicians incorporate them into their behavior change counseling.

Background: Online CBT training is in its infancy. The initial studies have varied program characteristics and trainee groups, but results appear promising. At this stage, there is a need to evaluate programs with different characteristics to determine which are useful, and which are not. Method: This paper reports a preliminary evaluation of an online CBT training package, OCTC Online, which is distinguished from other online programs by its particularly strong focus on video presentations by trainers, accompanying PowerPoint slides, and video demonstrations of key clinical techniques. Participants (N = 94) completed online rating scales and questionnaires assessing (a) their satisfaction with the training; (b) their self-rated knowledge and confidence about the topics discussed (pre- and post-training); and (c) a multiple choice questionnaire (MCQ) objective test of knowledge (also pre- and post-training). Results: Results showed that on average students were highly satisfied with the online training modules, their self-rated confidence increased significantly, and so did their scores on the MCQ. Conclusions: The study has significant limitations but nevertheless contributes to the growing body of evidence that online training may have a useful part to play in enhancing therapists’ knowledge of CBT theory and techniques, and their confidence in using the techniques.

Background: Generating alternative interpretations is a widely used technique in cognitively-oriented treatments for psychosis, including social cognitive treatments. However, research on judgment and decision-making suggests that this technique may backfire among individuals with cognitive deficits. Aims: Mary/Eddie/Bill (MEB) was developed as an alternative approach to help improve Theory of Mind, attributional bias and Jumping to Conclusions in psychosis. An initial pilot trial was conducted to evaluate the tolerability and potential efficacy of MEB. Method: Twenty-four outpatients with psychotic disorders participated in an uncontrolled trial. Social cognition, social functioning, and participant feedback were assessed. Results: Treatment completers exhibited statistically significant improvements in Theory of Mind, social cognitive overconfidence and self-reported social engagement, and reported positive experiences with MEB. No improvements were observed in attributional bias. Conclusions: Given that there are risks associated with the use of traditional generating-alternatives techniques, the current findings support ongoing development of MEB and similar approaches.

Background: Increasingly, clinical psychologists and CBT trained clinicians work with and within teams. The cognitive model enables us to formulate the processes maintaining distress, and work with people to effect change. The model tends to be used to understand individuals’ difficulties, but may be effective in making sense of problems within teams. Aims: This study aimed to (i) explore the value of the cognitive model in formulating key staff-service user relationships; and (ii) determine whether such an approach would yield useful team based interventions. Method: The cognitive interpersonal model was used to develop an idiosyncratic conceptualization of key staff-service user interactions in an in-patient setting. This then informed management team planning aimed at improving provision for service users, and staff experience. Additionally, frequency of challenging behaviours and levels of staff burnout were assessed before and after service changes, as preliminary outcome data. Results: The team formulation was effective in (i) making sense of interactions contributing to the maintenance of service users’ challenging behaviours and staff burnout, and (ii) deriving systemic interventions likely to effect change. This was then used to guide service development planning. In support of a CBT approach to understanding and intervening with teams, preliminary data indicate that staff burnout and incidents of challenging behaviours reduced over time. Conclusion: The cognitive interpersonal model can be used to formulate relationships within teams and guide systemic change. This is likely to have a beneficial impact for both service users and staff.