Showing papers in "Behavioural and Cognitive Psychotherapy in 2005"

The Children’s Revised Impact of Event Scale (CRIES): Validity as a screening instrument for PTSD.

Abstract: The Children's Revised Impact of Event Scale (CRIES) is a brief child-friendly measure designed to screen children at risk for Posttraumatic Stress Disorder (PTSD). It has good face and construct validity, a stable factor structure, correlates well with other indices of distress, and has been used to screen very large samples of at-risk-children following a wide range of traumatic events. However, few studies have examined the scale's validity against a structured diagnostic interview based on the DSM-IV criteria for PTSD. In the present study, the CRIES and the PTSD section of the Anxiety Disorders Interview Schedule-Child and Parent Version (ADIS-CP) were administered to a sample of children and adolescents (n=63) recruited from hospital accident and emergency rooms and the validity of the CRIES as a screening tool evaluated. Cutoff scores were chosen from this sample with a low base-rate of PTSD (11.1%) to maximize sensitivity and minimize the likelihood that children with a diagnosis of PTSD would fail to be identified. Cutoff scores were then cross-validated in a sample of 52 clinically referred children who had a high base-rate of PTSD (67.3%). A cutoff score of 30 on the CRIES-13 and a cutoff score of 17 on the CRIES-8 maximized sensitivity and specificity, minimized the rate of false negatives, and correctly classified 75-83% of the children in the two samples. The CRIES-8 (which lacks any arousal items) worked as efficiently as the CRIES-13 (which includes arousal items) in correctly classifying children with and without PTSD. Results are discussed in light of the current literature and of the need for further development of effective screens for children at-risk of developing PTSD.

Mindfulness Groups for People with Psychosis

Abstract: The study's objective was to assess the impact on clinical functioning of group based mindfulness training alongside standard psychiatric care for people with current, subjectively distressing psychosis. Data are presented from the first 10 people to complete one of four Mindfulness Groups, each lasting six sessions. People were taught mindfulness of the breath, and encouraged to let unpleasant experiences come into awareness, to observe and note them, and let them go without judgment, clinging or struggle. There was a significant pre-post drop in scores on the CORE (z =− 2.655, p = .008). Secondary data indicated improvement in mindfulness skills, and the subjective importance of mindfulness to the group process (N = 11). The results are encouraging and warrant further controlled outcome and process research.

Therapist skills : A cognitive model of their acquisition and refinement

Abstract: A new model of therapist skill development is presented. Grounded in information processing theory, it provides a comprehensive framework that accounts for a range of phenomena encountered by trainers and trainees - for example, why different training methods are needed for different elements of therapist skill. The model features three principal systems: declarative, procedural and reflective (DPR). Reflection is identified as central to therapist skill development and, accordingly, a pivotal role is given to a reflective system, which enables therapists to reflect and build on their conceptual (declarative) knowledge and procedural skills. The DPR model incorporates a taxonomy of therapist skills, and explains why different skills develop in different ways at different rates. It highlights the centrality of therapists' perceptual skills, and of when-then rules, plans, procedures and skills (rules that determine when to implement what interventions with which patient under what conditions) in the development of therapist expertise. It makes a distinction between personal and professional selves (the self-schema vs. the self-as-therapist schema); and it identifies the role of the personal self in therapist skill development. While there are still many questions to be investigated, it is hoped that the model will stimulate researchers and provide guidance for trainers.

Safety-seeking behaviours: Fact or function? How can we clinically differentiate between safety behaviours and adaptive coping strategies across anxiety disorders?

Abstract: Safety-seeking behaviours are seen as playing a key role in the maintenance of various anxiety disorders. This article examines their role in panic disorder and social phobia and suggests that, whilst there are clear theoretical differences between safety-seeking behaviours and adaptive coping strategies, the difficult issue in clinical practice is being able to distinguish between the two. It builds on previous work by Salkovskis and colleagues and provides a detailed discussion of the problems in distinguishing between safety-seeking behaviours (direct avoidance, escape and subtle avoidance) and adaptive coping strategies in clinical practice. The suggestion is made that topology can only be a guide to categorizing the two types of responses and they can only be fully distinguished by taking into account the intention of the individual and their perceived function to that individual in the specific context. It is suggested that further analysis of the use of safety-seeking behaviours aimed at avoiding a variety of outcomes at differing levels of catastrophe may provide useful information that would clarify our understanding of the role of such behaviours in maintaining anxiety disorders.

Trauma-related intrusions and psychosis: An information processing account

Abstract: There is active, current speculation about the relationship between trauma and psychosis. However, little is known about the information-processing mechanisms underlying the development of trauma-related intrusions in this area. Our account highlights the role of contextual integration, i.e. the need for experiential information to be effectively integrated into a temporal and spatial context in order to facilitate voluntary recall. Drawing on existing models of both posttraumatic stress disorder (PTSD) and psychosis (Brewin, 2001; Ehlers and Clark, 2000; Garety et al., 2001; Morrison, 2001), we propose a contextual integration account of trauma-related intrusions. It is argued that the strength of contextual integration, which occurs during encoding, influences the frequency and nature of subsequent intrusive experiences. Consequently, individual differences in schizotypal personality traits, which are known to be associated with levels of contextual integration, are also related to the phenomenology of trauma-related intrusions. Whilst intrusions can be seen to occur within a range of disorders, it is argued that contextual integration may be one key variable in understanding the relationship between an experienced trauma and any consequent psychiatric symptomatology. Implications for clinical interventions aimed at trauma-related psychosis are discussed, along with research aimed at developing the empirical basis for such interventions.

The Effect of Mindfulness Training on Mood and Measures of Fatigue, Activity, and Quality of Life in Patients with Chronic Fatigue Syndrome on a Hospital Waiting List: A Series of Exploratory Studies

Abstract: Three exploratory studies evaluated group mindfulness training (which aims to facilitate non-judgmental attention to present moment experience through the practice of meditation) in patients waiting for cognitive behaviour therapy for Chronic Fatigue Syndrome (CFS). The approaches used were based on Mindfulness Based Stress Reduction, and Mindfulness Based Cognitive Therapy. The first group showed that such training is acceptable to patients and that it results in significantly improved subjective measures of anxiety, and improvements in subjective levels of fatigue that approached significance, when compared to waiting list controls. A second uncontrolled study replicated the findings of the first study and also demonstrated an improvement in quality of life as measured by the Fatigue Impact Scale (FIS). More wide-ranging effects were demonstrated in the final study in which significant improvements in subjective levels of fatigue, anxiety, depression, quality of life and physical functioning were observed following the training programme. These effects were sustained for 3 months. Overall, the findings of the three exploratory studies indicate that MBSR/MBCT has potential for the treatment of patients with CFS.

Social anxiety and the vigilance-avoidance pattern of attentional processing

Abstract: A modified version of the probe detection task was used to investigate the time course of attentional biases for emotional words in high and low socially anxious individuals. Word pairs were presented at two exposure durations, 200 and 500 msec, in order to investigate the different components of attentional bias in anxiety (e.g., vigilance or avoidance of threat). There was evidence of an attentional bias favouring initial vigilance towards (social and physical) threat words and subsequent avoidance of the same stimuli in high social anxiety. In contrast, low socially anxious individuals did not exhibit an attentional preference. The interaction of social anxiety and exposure duration for threat words remained when controlling for general negative affect. Theoretical and clinical implications of the results are discussed.

Parental Cognitions and Adaptation to the Demands of Caring for a Child with an Intellectual Disability: A Review of the Literature and Implications for Clinical Interventions

Abstract: The manner in which parents adapt to the experience of caring for a child with an intellectual disability is generally thought to depend upon a range of variables typically conceptualized within multi-dimensional models. This review briefly describes three such models that share significant common features, incorporating child variables, environmental characteristics, and parental cognitive processes as contributors to parental coping styles or parenting stress. The effects of child and environmental characteristics on parenting stress and coping in parents of children with disabilities have been well documented. It is argued, however, that some aspects of cognitive processes in parents of these children have received less attention from researchers. In particular, there has been a large amount of research into parenting self-esteem, parental attributions, and parental locus of control with parents of other groups of children. This research is reviewed, and it is argued that further research into similar cognitions in parents of children with intellectual disabilities is warranted. Finally, the potential clinical implications of such research are examined in relation to behavioural interventions for children's behavioural difficulties. It is suggested that parental cognitions may influence the acceptability of such interventions and also be associated with their effectiveness.

Adherence to Principles of Motivational Interviewing and Client Within-Session Behavior

Abstract: The purpose of this study was to examine whether counselor adherence to Motivational Interviewing (MI) principles was associated with more productive within-session client behavior in a smoking cessation trial for African American smokers. For these analyses 89 baseline counseling sessions of the trial were audiotaped and coded using the Motivational Interviewing Skill Code (MISC). Counselor adherence indicators included a global subjective rating of MI adherence and the frequency of MI-consistent and MI-inconsistent counselor behaviors described in the MISC. Indicators of productive client behaviors included global subjective ratings of within-session client functioning and counselor-client interaction, as well as the frequency of statements by the client favorable toward changing behavior (“change talk”) and resistant regarding changing behavior (“resist-change talk”). Results provided support for the principles of MI. Counselor adherence indexed by both the global subjective rating and MI-consistent behavior frequency was significantly positively associated with global ratings of within-session client functioning and counselor-client interaction, as well as more change talk.

An Exploration into Depression-Focused and Anger-Focused Rumination in Relation to Depression in a Student Population

Abstract: Research has shown an important link between depression and rumination. This study set out to explore depression-focused rumination and anger-focused rumination in relation to shame and entrapment, and depression. 166 undergraduate students completed a battery of self-report questionnaires measuring current depression, rumination on depressive symptoms, rumination on anger, and the frequency of shame-focused and entrapment-focused thoughts. Both depression-focused and anger-focused rumination were related to depression, and to the frequency of shame and entrapment thoughts. In a mediational model, the link between depression-focused rumination and depression was partially mediated by feeling trapped by, and wanting to escape from, one's thoughts and feelings. Thus the link between rumination and depression is complex. Although rumination may contribute to depression by generating a spiral of negative thinking and negative feeling, feeling trapped and unable to control one's rumination, and being flight motivated, may add a further dimension to the depressogenic qualities of rumination.

Cognitive aspects of posttraumatic stress reactions and their treatment in children and adolescents: An empirical review and some recommendations

Abstract: This paper reviews empirical research on cognitive factors associated with the experience of trauma and with the development of posttraumatic stress, Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) in children and adolescents. The review covers three main areas: cognitive experimental and neuropsychological studies; large scale studies on representative samples; and, randomized clinical trial data examining cognitive-behaviour therapy (CBT) interventions. Overall, the conclusions are that progress in all three areas lags far behind that in adult work and that, perhaps, the studies to date raise more questions than they provide answers provided by the studies to date. The paper concludes with detailed empirical recommendations for future research in the three chosen domains.

Do Parenting Programmes for Severe Child Antisocial Behaviour Work over the Longer Term, and for Whom? One Year follow-up of a Multi-Centre Controlled Trial

Abstract: The aim of the study was to see whether there were lasting effects of a behaviourally- based group parenting programme when delivered in a real life, regular clinical practice setting. Follow-up was one year after the end of a controlled trial that involved four local child and adolescent mental health services in London and Southern England. The participants were fifty- nine children aged 3-8 years referred with antisocial behaviour, whose parents received the Webster-Stratton Incredible Years basic videotape group programme. Those in the waiting list control group were not followed up as some went on to receive the same intervention. Measures included the semi-structured parent interview (PACS) and questionnaire (SDQ) about child behaviour. At follow-up, the original improvement in the intervention group was found to have persisted, with no loss of treatment effectiveness (effect size compared to pre-treatment score 0.91 standard deviations, compared to post treatment score − 0.06 SD). The proportion of children in the clinical range before treatment was 68%, at follow-up 37%. Children with the most severe initial problems changed the most; risk factors such as low income, being a lone parent, or being in an ethnic minority did not reduce treatment effectiveness. Parenting groups can reduce serious child antisocial behaviour effectively in the longer term. This is an important ongoing benefit for the children and their families. If this trajectory continues to be maintained in the future, then the poor long-term prognosis, which includes criminality and social exclusion, is likely to be improved.

The beliefs about paranoia scale: Preliminary validation of a metacognitive approach to conceptualizing paranoia

Abstract: This study reports the development of a self-report measure to assess metacognitive beliefs about paranoia in non-patients. We aimed to test the specific hypotheses that positive beliefs about paranoia would predict frequency of paranoia, and that negative beliefs about paranoia would predict distress associated with delusional ideation. Three-hundred and seventeen non-patient participants were asked to complete questionnaires assessing beliefs about paranoia, paranoia, dimensions of delusional ideation and trait anxiety. The results showed that four empirically distinct subscales were measured by the beliefs about paranoia scale (negative beliefs about paranoia, beliefs about paranoia as a survival strategy, general positive beliefs and normalising beliefs). The scales possessed acceptable internal consistency and were associated with the measures of paranoia, delusional ideation and anxiety. Consistent with predictions, it was found that beliefs about paranoia as a survival strategy were associated with frequency of paranoia, and negative beliefs were associated with distress associated with delusional ideation. These findings suggest that a metacognitive approach to the conceptualization of paranoia as a strategy for managing interpersonal threat may have some utility. The clinical implications of the findings are also discussed.

Understanding Posttraumatic Stress: Theory, Reflections, Context and Future

Abstract: Exposure to a traumatic event may lead a person to experience posttraumatic stress. But there are wide individual differences in the severity and chronicity of reactions. Some people remain affected for considerable periods of time, but others are able to adjust relatively quickly, and some even go on to report experiencing positive personal changes as a result of experience of trauma. The psychosocial framework proposes that individual variation in response to trauma is attributable to the interaction between various personality and social psychological factors. This is a practical framework for formulation and for developing interventions with people who have problems adjusting to traumatic life experiences. In this paper we provide a retrospective account of the building of the psychosocial framework, and using case examples illustrate its use in formulation and developing intervention with individuals with varying difficulties. We also aim to look beyond this work in the past to subsequent developments and to future directions, in particular the new and emerging field of growth through adversity.

The impact of a novel computerized CBT CD Rom (overcoming depression) offered to patients referred to clinical psychology

Abstract: A new CBT based CD Rom (Williams, Taylor, Aubin, Harkin and Cottrell, 2002) was introduced as a way of offering a clinical psychology waiting-list initiative for patients with depression and depression with anxiety. This study evaluated the impact of this computerized cognitive behavioural therapy (CCBT) on consecutive referrals. Six hourly sessions of the interactive computer programme were offered to clients on the waiting list, to be completed by them with some support from a self-help support nurse. Seventy-eight consecutive referrals were offered an appointment for CCBT; 20 (26%) attended at least one session of CCBT and 14 (70% of starters) completed all six hour-long sessions. Beck Depression Inventory scores (BDI-II) fell from a mean of 28.15 (SD 11.41) to 20.00 (SD 10.41) (p = .000) over the 6-week intervention period using an intention to treat analysis. The discussion asks why only a quarter of patients on this psychology waiting list chose to use a CBT CD-Rom, but also notes that those who did use it had clinically and statistically significant reductions in their reported symptoms of depression.

Stories and Analogies in Cognitive Behaviour Therapy: A Clinical Review

Abstract: The transfer of knowledge occurs most effectively through the stories – the narratives – that we tell others and ourselves about our experiences. Cognitive behaviour therapists may incorporate stories, metaphors and analogies within their daily practice, when assessing suitability for treatment, challenging unhelpful styles of thinking, and addressing maintaining behaviours. The collaborative development of stories can enhance rapport, enable clients to gain a new perspective upon their problems, increase personal impact and clarity of meaning, and reinforce clients' motivation to effect therapeutic change. This paper discusses the use of the story, anecdote, metaphor, analogy, and quotation within cognitive behaviour therapy (CBT). The contribution of other psychotherapies to these forms of therapeutic communication is outlined. Practical examples of stories and analogies that illustrate the main principles of CBT and its application to the treatment of common mental disorders are described. The benefits and limitations of employing individualized analogies and stories within the therapy session are highlighted.

Young Children's Ability to Engage in Cognitive Therapy Tasks: Associations With Age and Educational Experience

Abstract: In two linked studies we examined children's performance on tasks required for participation in cognitive therapy. In Study 1 we piloted some new tasks with children aged 5 to 11 years. In study 2 the effects of IQ, age and educational experience were examined in children aged 5 to 7 years. In study 1, 14 children aged 5 to 11 completed three tasks related to cognitive therapy; generating post-event attributions, naming emotions, and linking thoughts and feelings. Study 2 used a between-subjects design in which 72 children aged 5, 6, or 7 years from two primary schools completed the three tasks and the Block Design and Vocabulary sub-tests from the WISC III or WPPSI-R. Children were tested individually during the school day. All measures were administered on the same occasion. In study 2 administration order of the cognitive therapy task and the WISC III/WPPSI-R were randomized. The majority of children demonstrated some ability on each of the three tasks. In study 2, performance was associated with school and with IQ but not with age. There were no gender differences. Children attending a school with an integrated thinking skills programme and those with a higher 1Q were more successful on the cognitive therapy tasks. These results suggest that many young children could engage in cognitive therapy given age-appropriate materials. The effects of training in relevant meta-cognitive skills on children's ability to use concepts in CBT may warrant further research.

Patient Treatment Adherence in Cognitive Behaviour Therapy for Acute Psychosis: The Role of Recovery Style and Working Alliance

Abstract: Treatment non-adherence is a common problem in mental health services but little is known about non-adherence to psychological therapy for psychosis. The main aim of the present study was to investigate the role of patients' recovery style and the therapeutic alliance in provoking or forestalling patient drop-out from cognitive behaviour therapy (CBT) for psychosis. Ratings were made by two independent observers on 29 recordings of sessions from a controlled trial of CBT for psychosis. Sessions of 10 patients who dropped out of treatment prematurely were matched with sessions of 10 patients who stayed in. Another nine sessions were selected at random from the middle and late stages of treatment so that the sample was representative of all sessions in the trial. Patients who dropped out of treatment, compared with those who stayed in, were less engaged in treatment, showed less agreement with their therapists, and had a sealing-over recovery style before they dropped out but did not differ in their therapeutic bonds. The results suggest that the premature termination of the drop-outs was not provoked by the therapists but was due to the patients' lack of curiosity about their psychotic episodes and minimization of the impact of their illness.

Testing a Brief Cognitive-Behavioural Intervention to Improve Extreme Shape Concern: A Case Series

Abstract: The successful treatment of extreme shape concern in patients with eating disorders has been shown to be important for their sustained recovery. This case series reports a preliminary investigation of the effects of a new brief cognitive-behavioural intervention for extreme shape concern. The intervention, which is implemented in a single 2-hour session, addresses four mechanisms hypothesized to contribute to the maintenance of extreme shape concern and is designed to be suitable as an adjunct to existing treatments for eating disorders. Participants were five women with extreme shape concern and three female patients with eating disorders. The results indicate that the intervention was effective to various degrees in each participant, and suggest that the intervention warrants further investigation. In particular, methods of increasing the potency of the intervention should be investigated, and its efficacy tested in a larger controlled study.

Clinical Perfectionism: A Preliminary Qualitative Analysis

Abstract: A cognitive-behavioural analysis of clinical perfectionism has recently been proposed. The aim of this study was to explore the phenomenology of clinical perfectionism and its putative maintaining mechanisms. Of the 21 participants, 15 were judged to have the core psychopathology of clinical perfectionism. The data obtained were largely consistent with the model. In particular, self-imposed dysfunctional standards, continual striving and adverse consequences appeared to be highly salient features of those people who had the core psychopathology of clinical perfectionism but not of those without. A number of other possible maintaining factors not originally described in the model were also identified.

Self-help : Towards the next generation

Abstract: Reproduced with permission of the publisher. Copyright © 2006 British Association for Behavioural and Cognitive Psychotherapies

A New Cognitive Behavioural Parenting Intervention for Families of Young Anxious Children: A Pilot Study

Abstract: Childhood anxiety disorders often have a poor prognosis. Despite this, there are currently no published treatment protocols for young children with anxiety difficulties. Individually focused therapies (e.g. CBT) are useful for older children, but likely to be less so for this group. This paper describes a pilot investigation of a new CBT based parenting intervention for the treatment of children aged 9 years and under. Sixteen parents of 11 anxious children took part in a 10-week intervention, completing the Child Behaviour Checklist at three time points. The intervention was based on a new cognitively enhanced parenting package, with an emphasis on coping with internalizing symptoms, and with additional modules on the specific skills needed for managing anxiety. All children were reported to experience substantial decreases in their internalizing symptoms by the end of the study. Parents' satisfaction with the intervention was high. This is a promising new intervention for the treatment of a currently neglected group.

Interview anxiety: Taking the perspective of a confident other changes inferential processing

Abstract: Previous research with an on-line processing task found that individuals without social anxiety generate benign inferences when ambiguous social information is encountered, but people with high social anxiety or social phobia do not (Hirsch and Mathews, 1997, 2000). In the present study, we tested if it is possible to induce a benign (or less negative) inferential bias in people who report anxiety about interviews by requiring them to take the perspective of an interview confident person, rather than their own. High interview anxious volunteers were allocated to read descriptions of job interviews, either taking their own perspective in the described situation or that of a confident interviewee. At certain points during the text, a target letter string appeared and participants were asked to indicate whether it formed a word or a non-word (lexical decision). Some of the lexical decisions occurred in the context of ambiguous text that could be interpreted in both a threatening and a benign manner. In a baseline condition, decisions were made following text for which there was only one possible inference (either threat or benign). The results indicated that, compared to the self referent condition, participants who adopted the perspective of a confident other person showed enhanced inhibition of threat inferences.

The motivational interviewing skill code : Reliability and a critical appraisal

Abstract: The Motivational Interviewing Skill Code (MISC) is a coding system developed to measure adherence to motivational interviewing (MI). MI is an effective clinical style used in different treatment situations. Counsellors practising MI have to follow general principles and avoid certain traps. In the present study, the content of the MISC is compared with the general principles of MI and the traps to avoid in MI. Investigation of the content validity raises some questions. All general principles are represented but the traps to avoid in MI are not fully covered. The consequences of this under-representation are shown in transcripts of a selection of well-conducted MI training sessions. The reliability of the MISC was investigated by having five independent coders code 39 MI training sessions of different counsellors. The reliability of the MISC is reasonable. The five coders agreed to a large extent on the absolute ratings but the intraclass correlations were low. Although the MISC can be a useful research tool for process research of MI, it remains a labour-intensive instrument and for teaching and practice audit development of a more simple coding system is recommended.

The Development and Preliminary Evaluation of a Schema Questionnaire for Children (SQC)

Abstract: This study describes the development and initial evaluation of a cognitive schema questionnaire for children. The Schema Questionnaire for Children (SQC) was designed to capture the 15 early maladaptive schemas proposed by Young (1990). Face validity of the questionnaire items as assessed by a group of CBT experts (n=16) was good. Concurrent validity was assessed by asking 47 school children aged 11–16 years of age to complete both the (SQC) and a British version of the 75 item Young's Schema Questionnaire short form (YSC-S). Significant correlations were obtained for 10 of the 15 schemas, with a further two approaching statistical significance. Although some of the correlations were modest, these initial results suggest that the SQC may be a valid quick and developmentally appropriate way of assessing Young's maladaptive schema in children.

Brief Cognitive Behavioural Therapy for Depression Associated with Parkinson's Disease: a Single Case Series

Abstract: The feasibility of a brief home based cognitive behavioural intervention for depression associated with Parkinson's Disease (PD) was evaluated. Five depressed patients with PD participated. Their ages ranged from 54 to 82 and they all attended a movement disorder clinic. Outcome was assessed using mood and quality of life inventories (Beck Depression Inventory; Geriatric Depression Scale; Parkinson's Disease Quality of Life Questionnaire). Four individuals demonstrated a clinically reliable reduction of symptoms according to the GDS scores, with greater improvement reported for the two individuals with more severe pre-therapy levels of depression. The BDI findings suggested most of the improvement related to the cognitive dimensions of guilt, pessimism and failure. Overall, the change in mood was not accompanied by an enhancement of perceived quality of life, and little variation in the frequency of activities was reported over the course of therapy. Possible explanations for the findings are considered along with implications for theory and clinical practice.

Outcome of Cognitive-Behavioural Treatment for Health Anxiety (Hypochondriasis) in a Routine Clinical Setting

Abstract: It has now been established in several randomized controlled trials that specialist cognitive-behavioural therapy (CBT) is an effective treatment for severe and persistent health anxiety (diagnostically, "Hypochondriasis"). It has not yet been established whether or not such results will generalize from academic research centres to routine clinical settings. The present study was designed to address the issue of generalization by evaluating the outcome of a consecutive series of patients meeting diagnostic criteria for hypochondriasis, treated using CBT in a non-academic clinic in Copenhagen, Denmark. The delivery of the treatment was

Process and outcome of a non-guided self-help manual for anxiety and depression in primary care: A pilot study

Abstract: Self-help interventions in mental health are increasingly seen as one way of overcoming problems with access to psychological therapy, but there is insufficient evidence of effectiveness in routine care settings. This paper investigates the process and outcome of a non-guided self-help manual for anxiety and depression compared to a waiting list control in a primary care setting. Patients with mild to moderate mental health problems were recruited from routine GP referrals to the local Primary Care Mental Health Team. Thirty patients were randomly assigned to either non-guided self-help or a waiting list control group. Patients completed outcome measures at baseline, 6 weeks and 12 weeks. Intention to treat analysis found no significant differences between the two groups on measures of anxiety or depression at 12 weeks. Between 40% to 50% of patients in both groups were no longer clinical cases at the end of the trial. However, there was a high level of satisfaction with the self-help manual. Within the limitations of the small sample size, the study does not support the hypothesis that non-guided self-help is superior to waiting list control in the treatment of anxiety and/or depression in primary care.

Processes for systemic cognitive-behavioural therapy with children, young people and families

Abstract: In cognitive-behavioural therapy with children, young people and families, formulation-based practice ensures that interventions are based on underlying causative and maintaining processes. Importantly, however, developmental, attachment, family, systemic and other perspectives must be incorporated into therapy. This paper describes a template for systemic cognitive-behavioural formulation that facilitates incorporation of the necessary range of perspectives including processes more traditionally expressed through other psychotherapeutic modes of working. Case formulation based on this template is sufficiently comprehensive, yet simple enough to derive collaboratively and leads to a distinct clinical process for working with individuals, families and wider support systems. This generic formulation process is appropriate for use across the range of presentations encountered in child and adolescent mental health practice and provides a structure for therapist training. It requires formal evaluation and has implications for future research.

Cognitive Behavioural Therapy and Homelessness: A Case Series Pilot Study

Abstract: This paper describes a project set up to treat four homeless men using cognitive behavioural therapy (CBT). The referral criteria were that individuals had alcohol and/or substance misuse problems, were roofless (i.e. sleeping rough) immediately before the intervention began and found it difficult or impossible to access hostel places in Southampton. Excessive alcohol use, violence (against self, others and property) and prison sentences were all features of their presentation. The project involved three levels of CBT intervention provided by the clinical psychologist: 1) training for the staff to enable them to work within this model; 2) continued supervision within model to ensure consistency and sustainability; 3) individual formulation (description of the problem within the CBT framework) and psychotherapy. The house itself was also run on a collaborative basis. A number of measures including mental health and social functioning constructs were used to evaluate the project, in addition to some qualitative data. All residents reduced incidents of theft, violence and alcohol consumption. Risk to self and others was also reduced for all residents. Perceived self-efficacy increased slightly for all residents, and staff perceived that they could be more effective, less hopeless, and therefore possibly less stressed as a result of training. More data will be gathered over time.