Showing papers in "Behavioural and Cognitive Psychotherapy in 2001"

The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions

Abstract: A cognitive approach to the understanding of psychotic symptoms that focuses on the interpretation of intrusions into awareness is outlined. It is argued that many positive psychotic symptoms (such as hallucinations and delusions) can be conceptualized as intrusions into awareness or culturally unacceptable interpretations of such intrusions, and that it is the interpretation of these intrusions that causes the associated distress and disability. It is also argued that the nature of these interpretations is affected by faulty self and social knowledge and that both the intrusions and their interpretations are maintained by mood, physiology, and cognitive and behavioural responses (including selective attention, safety behaviours and counterproductive control strategies). The literature is reviewed and found to be compatible with such a model and the clinical implications are discussed.

A small study of training in motivational interviewing: does one workshop change clinician and client behavior?

Abstract: 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.

The revised cognitive therapy scale (cts-r): psychometric properties

Abstract: 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.

A brief internet-based treatment for panic disorder

Abstract: This study investigated the effectiveness of an Internet-based intervention for people with panic disorder. Twenty-two participants met criteria for panic disorder and were randomly assigned to either the treatment or a self-monitoring control condition. The study took place over 3 weeks and consisted of one week of self-monitoring prior to the intervention group accessing the program for one week, followed by one week of post-intervention assessment. Participants were assessed on measures pertaining to panic, negative affect, body vigilance, anxiety sensitivity and self-efficacy in managing panic. The treatment condition was associated with significant reductions in all variables except anxiety sensitivity and depressive affect. This type of intervention for people with fearful panic attacks holds promise as an efficacious and economical method for treating spontaneous panic.

Social phobia: comments on the viability and validity of an analogue research strategy and British norms for the Fear of Negative Evaluation Questionnaire

Abstract: 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 value of self-practice of cognitive therapy techniques and self-reflection in the training of cognitive therapists

Abstract: Recent publications have suggested that practising cognitive therapy (CT) techniques on oneself may be valuable in the development of cognitive therapists' clinical skills The present study asks: Is this useful? If so, in what ways? We report a qualitative study of the experience of trainees undertaking a CT training course, which included an explicit self-practice (SP) and self-reflection (SR) component Key features of the learning process were: (i) experiencing cognitive techniques from the client's perspective, and (ii) reflecting on this experience that led to (iii) a “deeper sense of knowing” of CT practices The primary learning outcome was an enhancement of therapeutic understandings, which trainees reported to be both professionally and personally useful Professionally, they reported deeper understanding of the therapist's role, the cognitive model and change processes Personally, SP/SR led to greater understanding of themselves, and to the perception of CT as a useful tool for personal change The data also suggested two other positive learning outcomes: an enhancement of therapist skills and therapist self-concept We conclude that SP/SR may be a valuable component in CT training Guidelines and recommendations for inclusion of SP/SR in training courses are discussed

AN INVESTIGATION INTO THE PSYCHOMETRIC PROPERTIES OF THE COGNITIVE THERAPY SCALE FOR PSYCHOSIS (CTS-Psy)

Abstract: Recent research suggests that cognitive-behaviour therapy (CBT) can significantly improve outcomes for patients with severe mental health problems. However, there are no tools specifically designed to assess competence in delivering CBT to psychotic patients. This study investigates the psychometric properties of the Cognitive Therapy Scale for Psychosis (the CTS-Psy) for assessing the quality of CBT with psychotic patients. Inter-rater reliability of trained raters using the CTS-Psy was investigated using taped therapy of trainees engaged in a CBT oriented psychosis training course. Validity was investigated in relation to examining the degree to which the scale could be used to assess a range of therapist ability and patient severity and by assessing the degree to which the CTS-Psy could pick up changes in skill acquisition during the training course over a 9-month period. The CTS-Psy demonstrated excellent inter-rater reliability and good validity in relation to it being able to rate all standards of therapy and all types of patient sessions in the sample studied. In addition, the scale was sensitive to changes in clinical skills during a training course and could discriminate between those who had received training and those who had not.

Group cognitive therapy: treatment of choice or sub-optimal option?

Abstract: In the present climate of limited resources and long waiting lists, it is not surprising that there is more emphasis on making sure that psychological treatments are not only clinically sound but also cost-effective. One solution to this is to provide time-limited, focused interventions such as cognitive therapy. Another obvious solution is to deliver treatment in groups rather than individually. However, what evidence is there that therapy can be delivered as effectively in groups as individually? This review will look at which different formats have been tried, what the advantages and disadvantages of those formats might be, which client groups have been targeted for cognitive- behavioural group therapy (CBGT), and whether a group format in general offers any advantages over individual CBT. Outcome studies and their implications for the use of CBGT are considered. Results suggest that, in most client groups, there is little difference in efficacy between group and individual CBT, although there is some evidence that results for some types of patient can be disappointing in CBGT. It may be that the best compromise in terms of cost- effectiveness between quality of therapy and quantity of patients treated is offered by large-scale psychoeducational didactic group therapy.

Peritraumatic emotional Hot Spots in memory

Abstract: Individuals with posttraumatic stress disorder (PTSD) frequently report periods of intense emotional distress (''hot spots'') when asked to describe their traumatic experi- ence in detail. ''Primary'' emotions felt during the trauma (i.e., peri-traumatically) are believed to consist mainly of fear, helplessness and horror. We report a preliminary investi- gation into the emotions associated with these hot spots. Patients with PTSD described a wide variety of emotions such as anger, humiliation and guilt present at the time of the trauma. The peri-traumatic cognitions associated with these emotions are also detailed.

I CAN'T SLEEP, MY MIND IS RACING! AN INVESTIGATION OF STRATEGIES OF THOUGHT CONTROL IN INSOMNIA Allison G. Harvey

Abstract: People with sleep-onset insomnia commonly attribute their difficulty falling asleep to intrusive thoughts, worries, or “a racing mind” Previous research has implicated strategies of thought control in the maintenance of symptoms in a number of psychological disorders The purpose of the present study was to compare individuals diagnosed with insomnia (n = 30) and good sleepers (n = 29) for the strategies employed to manage cognitive activity during the pre-sleep period Reappraisal, worry, and suppression were employed more by participants with insomnia than by good sleepers Good sleepers employed social control, replacement, suppression, and reappraisal strategies most frequently, whereas the strategies most frequently employed by insomniacs were suppression and reappraisal The results are discussed in terms of the role of strategies employed to manage pre-sleep cognitive activity in the maintenance and reversal of insomnia

The treatment of deliberate self-harm in borderline personality disorder using dialectical behaviour therapy: a pilot study in a high security hospital

Abstract: Deliberate self-harm (DSH) presents a significant health problem, especially as treatments have not been particularly successful in reducing repetition. Dialectical behaviour therapy (DBT; Linehan, 1993) is one approach that has reported some success in reducing self-harm rates in borderline personality disorder patients, who self-harm frequently, though it remains largely untested outside its original setting. The present study aimed to assess the effectiveness of DBT in self-harming women in an institutional setting in the United Kingdom where self-harm is common. Female patients at Rampton Hospital who were displaying self-harming behaviour and met criteria for borderline personality disorder (N = 10) participated in the full one-year treatment package of DBT. Patients were assessed on self-harm rates and on a number of psychological variables, pre-, during- and post-therapy, including a 6-month follow-up. There was a significant reduction in DSH during therapy, which was maintained at 6-month follow-up. This was paralleled by a reduction in dissociative experiences and an increase in survival and coping beliefs, alongside improvements in depression, suicide ideation, and impulsiveness. The findings are preliminary but the results suggest that DBT might provide an effective treatment for severe self-harm in institutional settings, and also highlight some of the psychological mechanisms that might mediate these improvements in self-harming behaviour.

Intrusive thoughts, responsibility attitudes, thought-action fusion, and chronic thought suppression in relation to obsessive-compulsive symptoms

Abstract: Relationships between obsessive-compulsive symptoms and several cognitive constructs that are theoretically related to such symptoms were investigated among university students. A total of 211 subjects filled in a measure of the frequency of intrusive thoughts based on Clark and de Silva (1985), Salkovskis' Responsibility Attitudes Scale (RAS) (Salkovskis et al., 2000), the Thought-Action Fusion Scale (TAF) (Shafran, Thordarson, & Rachman, 1996), Wegner and Zanakos' (1994) White Bear Suppression Inventory (WBSI), and the Maudsley Obsessive-Compulsive Inventory (MOCI) (Hodgson & Rachman, 1977). The main hypothesis addressed was that in accordance with Salkovskis' model (1996) responsibility and thought suppression serve as mediators between intrusive thoughts and obsessive-compulsive symptoms as measured with the MOCI. The results were consistent with the model.

Predictors of therapeutic failure in slot-machine pathological gamblers following behavioural treatment

Abstract: The aim of this paper was to determine the features of pathological gamblers who dropped out of the treatment or relapsed within a one year follow-up period. The sample consisted of 69 patients selected according to DSM-IV criteria. Results indicated that the only difference between the patients who dropped out of treatment and the ones who completed was the level of state-anxiety. The former were more anxious than the latter. Predictive variables for the therapeutic failure were the dissatisfaction with the treatment, the high level of alcohol consumption, and the neuroticism as a personality variable. Implications of the study for clinical practice and future research in this field are commented upon.

Anger control for people with learning disabilities: a critical review

Abstract: The literature on the use of cognitively based anger control packages of treatment for people with learning disabilities is reviewed. It is found that the experimental evidence for the effectiveness of such treatment is weak. There is, however, good evidence that two of the components of the package, relaxation and self-monitoring, can be effective in their own right, with relaxation being found to reduce anger and self-monitoring to reduce other challenging behaviours. The use of cognitive procedures with people who have learning disabilities is discussed.

Are some types of psychotic symptoms more responsive to cognitive-behaviour therapy?

Abstract: Results are presented from a randomized controlled trial indicating which psychotic symptoms respond to cognitive behaviour therapy. The aim of the study was to investigate whether different types of psychotic symptoms are more or less responsive to cognitive-behaviour therapy compared to treatment received by control groups. Seventy-two patients suffering from chronic schizophrenia who experienced persistent positive psychotic symptoms were assessed at baseline and randomized to either cognitive-behaviour therapy and routine care, supportive counselling and routine care, or routine care alone and were re-assessed after 3 months of treatment (post-treatment). Independent and blind assessment of outcome indicated delusions significantly improved with both cognitive behaviour therapy and supportive counselling compared to routine care. Hallucinations significantly decreased with cognitive-behaviour therapy compared to supportive counselling. There was no difference in the percentage change of hallucinations compared to delusions in patients treated by cognitive behaviour therapy. There was little change in measures of affective symptoms but there was no evidence that a reduction in positive symptoms was associated with an increase in depres sion. In fact, a reduction in positive symptoms was positively correlated with a reduction in depression. There were significant differences in the reductions in thought disorder and negative symptoms with an advantage of cognitive-behaviour therapy compared to routine care.

A randomized trial of brief individual versus group parent training for behaviour problems in children with severe learning disabilities

Abstract: Primary school aged children with severe learning disabilities and behavioural problems were identified from those attending special needs schools in three adjacent Inner London boroughs. In two of the boroughs their parents/carers were randomly allocated to receive 5-7 group- or individually-based intervention sessions aimed at preventing or reducing their child's behaviour problems; teaching and support staff at their schools received a 2-day workshop with the same aims. Children in the third borough served as a “no treatment” control group. Follow-up assessments were carried out shortly after the interventions were completed and 6 months later. Individually-based intervention was superior to group-based intervention in acceptability, attendance, levels of participant satisfaction and the likelihood of reported behavioural improvement. Within the individual intervention group, behaviours that had been targeted for intervention were more likely to show improvements than those that were untargeted. However, in spite of these improvements, there were no significant differences between groups in the absolute frequency or severity of the child's behaviour problems at either post-intervention assessment, and reductions in levels of parental distress noted on completion of the interventions were no longer apparent 6 months later.

Self-focused attention : Commonalities across psychopathologies and predictors

Abstract: Self-focused attention, also thought of a self-absorption, has been linked to a variety of affective states and clinical syndromes, including depression, panic disorder, social anxiety, schizophrenia, and alcoholism. Ingram (1990b) has suggested that self-focus may be a “nonspecific process” that is common across psychopathologies. Studies with nonclinical samples have supported this contention, and the current study assessed whether self-focus was common across various clinically diagnosed groups. A second issue, given this commonality, was to examine the factors across diagnostic conditions to which self-focus was related. One hundred and thirty-eight outpatients were included, and were divided into three groups based on primary diagnosis: “depression”, “panic”, and “other anxiety”. They were assessed with the ADIS-R/IV and completed measures assessing self-focus, affective states, global psychopathology, and problem-solving. Self-focus was common across groups, with minor valence variations. Severity of primary diagnosis predicted total self-focus, with level of depression and trait anxiety predicting negative self-focus. Correlational analyses suggested that self-focused attention is related to general measures of psychopathology and severity, and negatively related to problem-solving. The pattern with negative self-focus was even more pronounced, with significant relationships to all measures of psychopathology, clinician-rated severity, and a negative relationship with problem-solving. Results are discussed in terms of differences between “normal” and problematic self-focus, the causal direction in the relationship between self-focus and negative affect, and the link between self-focus and problem-solving.

Dysfunctional attitudes and attachment style among clinically depressed adults

Abstract: Previous research has found an association between adult attachment style and symptoms of depression among university students and indicated that this relationship may be mediated by dysfunctional attitudes. The present study represents an initial step toward extending these findings to a clinical sample with more severe forms of depression. A sample of psychiatric outpatients diagnosed with major depressive disorder (n = 54) completed measures of adult attachment style, dysfunctional attitudes, and depression. An association was found between insecure attachment style and depression severity. This association was partially mediated by dysfunctional attitudes. These findings are consistent with cognitive-interpersonal models of depression that propose that adverse early experiences may contribute to vulnerability for depression through the establishment of dysfunctional attitudes.

Rationale for a new measure of competence in therapy

Abstract: Therapy process research has made surprisingly little headway during the past 25 years, which has been attributed to a range of methodological and conceptual problems. As a result, appeals have been made for fresh approaches to psychotherapy process research. Here we provide an experiential learning model as one promising way to crystallize conceptualizations of competence in therapy and to advance research. The model provides an integrative account of the moderators and mediators believed to explain the way that therapy achieves its outcomes. Its breadth takes it beyond the scope of its closest rival, the assimilation model. By way of illustration, the theoretical components of the experiential metaphor were operationalized and mapped onto an existing competence scale, the Cognitive Therapy Scale.

Do cognitive and exposure treatments improve various ptsd symptoms differently? a randomized controlled trial

Abstract: This study (part of a larger one whose main outcomes were reported by Marks, Lovell, Noshirvani, Thrasher, & Livanou, 1998) investigated the impact of exposure therapy and cognitive restructuring alone and combined on the individual symptoms of PTSD and on associated features. Exposure therapy was expected to act mainly on fear and avoidance, and cognitive restructuring mainly on detachment, restricted range of affect, and associated features of PTSD. Seventy-seven PTSD outpatients were randomly allocated to one of four treatments: 1) exposure alone; 2) cognitive restructuring alone; 3) combined exposure and cognitive restructuring; or 4) relaxation (placebo control). The active treatments were superior to relaxation in improving clusters of PTSD symptoms and associated features and some but not all individual symptoms and associated features of PTSD. Exposure and cognitive restructuring improved almost all individual symptoms similarly.

Schema therapy: the next generation, but should it carry a health warning?

Abstract: 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.

Selective memory bias in women with bulimia nervosa and women with depression

Abstract: Memory bias for weight and shape, and for food related words, was investigated in women with bulimia nervosa (12), women with depression (12) and female nonclinical controls (18). The aim of this study was to investigate whether women with bulimia nervosa demonstrate memory biases congruent with their primary concerns. Participants listened to target and control words. They performed a self-referent encoding task and recall memory was assessed. The results indicated that women with bulimia nervosa demonstrated a bias to recall positive and negative weight and shape related words compared to emotional words, but not compared to neutral nouns and body words. Memory biases for food related words were not found to be specific to women with bulimia nervosa, but were also found in women with depression. Contrary to previous research the recall bias for food related words was related to levels of hunger, in both groups. The findings provide partial support for memory biases for weight and shape, but not food related information in bulimia nervosa. These findings and their implications for existing research on information processing in eating disorders are discussed.

Cognitive emotional reactions of care staff to difficult child behaviour

Abstract: The attributions parents make about the problem behaviour of their children have been shown to be important determinants of their emotional and behavioural reactions to such behaviour. However, this relationship has not been studied in carers of children in residential settings. In this paper we apply Weiner's attributional model of helping to the self-predicted behaviour of 47 carers in residential children's homes in the U.K. Participants identified causes for four children's behaviours, made attributions about these behaviours on dimensions of internality, controllability, globality and stability, reported their emotional reactions to the behaviours on the dimensions of anger and sympathy and reported their likelihood of making extra effort to help in working with these behaviours. Results showed that attributions of controllability and globality, and the emotional response of sympathy were important in predicting reported likelihood of helping. The implications of these results for carer training are discussed.

Assessing the take up and acceptability of a self-help room used by patients awaiting their initial outpatient appointment

Abstract: This open study measured the proportion of routine referrals from primary care to a psychiatric sector team with symptoms of anxiety and/or low mood who chose to take up the option of attending a self-help room to use the CBT self-help manual Mind over mood during a 6-week waiting list period. It assessed changes in psychological health, dysfunctional attitudes and degree of hopelessness during the period of use of the self-help manual, as well as patient satisfaction with it. Twenty-two of 42 consecutive referrals attended the room (mean 3.55 sessions - SD 1.71). The Beck Hopelessness Scale (BHS), the General Health Questionnaire (GHQ), and Dysfunctional Attitudes Scale (DAS), as well as measures of patient participation and satisfaction, were completed at the beginning and end of the 6-week period for those patients who attended the room. All three scale scores fell significantly over the study period, and the DAS and BHS scores at 6 weeks were negatively correlated with the number of sessions attended. The patients generally judged that the self-help intervention was acceptable and effective, and that their knowledge in a number of key areas had been improved. Conclusions regarding effectiveness are limited by the absence of control group data; nonetheless, this study does suggest that the provision of a self-help room containing Mind over mood is useful for patients with anxiety and low mood on a waiting list for a psychiatric outpatient assessment.

The “safety seeking behaviours” construct and its application to chronic pain

Abstract: Paralleling developments in other areas of clinical psychology, psychological theories of chronic pain have evolved from the purely behavioural models of several decades ago, to those that have increasingly recognized the importance of cognitive constructs (without necessarily neglecting the influence of behavioural factors that remains significant). As is well established in the domains of anxiety and depression, pain related cognitions and coping strategies are now considered to be just as, if not more, important as behavioural constructs such as reinforcement contingencies. At the same time, however, some of the exciting developments in other clinical areas have only just begun to receive due attention from those interested in pain. In particular, the “safety seeking behaviours” construct, which has received a considerable amount of attention in recent years from anxiety researchers, appears to have been virtually ignored by those researching pain. Although related constructs such as “fear avoidance” have increasingly been recognized and investigated, specific reference to safety behaviours (in relation to pain) does not seem to have occurred. This paper presents a brief overview of how the concept of safety seeking behaviours could be applied to chronic pain patients. Although not advancing a radically new approach, it is argued that there are theoretical and clinical advantages to integrating safety seeking behaviours in to psychological models of pain.

Cognitive inhibition in obsessive-compulsive disorder: application of a valence-based negative priming paradigm

Abstract: We used a negative priming paradigm to test for deficits in cognitive inhibition in patients with obsessive-compulsive disorder (OCD), and to examine whether they exhibit greater inhibitory deficits when lexical targets are threat-related than when they are neutral. The results indicated that OCD patients, relative to healthy control participants, exhibited only marginally significant (p < .10) deficits in negative priming at short (100 ms), but not long (500 ms), stimulus onset asynchronies. There was no evidence that OCD patients exhibited disproportionate difficulty inhibiting negative words, nor was there any evidence that negative priming deficits differed between OCD checkers and OCD noncheckers.

Telephone cognitive behaviour therapy for chronic fatigue syndrome in secondary care: a case series

Abstract: Guy’s, Kings and St Thomas’ School of Medicine, London, U.K.Abstract. Four randomized controlled trials have shown out-patient cognitive behaviourtherapy reduces fatigue and disability in people suffering from chronic fatigue syndrome(CFS). However, some patients referred to Kings College Hospital, London are unable toattend regular appointments. We therefore developed a self-help treatment manual usingcognitive-behavioural principles for patients to use at home with telephone contact with atherapist. Nine consecutive patients with a diagnosis of CFS who were unable to attendregular out-patient appointments used this self-help treatment approach at home. The therap-ist (MB) carried out a face-to-face assessment at the hospital. Subsequently, patients hadfortnightly telephone appointments to discuss their progress, plan and discuss their home-work 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 healthimproved at discharge and gains were maintained at 6-month follow-up. Self-treatment athome guided by a manual with fortnightly telephone sessions was helpful in the treatmentof patients with chronic fatigue syndrome. A randomized controlled trial is underway tocompare telephone cognitive behaviour therapy with out-patient cognitive behaviour therapy.Patients with other conditions such as chronic pain who are unable to travel for regularappointments may benefit from a home-based treatment package involving therapist contactby phone.Keywords: Chronic Fatigue Syndrome, cognitive behaviour therapy, telephone, manual.

Controlling angry aggression: a pilot group intervention with personality disordered offenders

Abstract: 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.