Showing papers in "Behavioural and Cognitive Psychotherapy in 2007"

The interpretation of, and responses to, changes in internal states: An integrative cognitive model of mood swings and bipolar disorders.

Abstract: A cognitive approach to understanding mood swings and bipolar disorders is provided, with the interpretation of changes in internal state as a central explanatory factor. The model explains how attempts at affect regulation are disturbed through the multiple and conflicting extreme personal meanings that are given to internal states. They prompt exaggerated efforts to enhance or exert control over internal states, which paradoxically provoke further internal state changes, thereby feeding into a vicious cycle that can maintain or exacerbate symptoms. Counterproductive attempts at control are classified as either ascent behaviours (increasing activation), or descent behaviours (decreasing activation). It is suggested that appraisals of extreme personal meaning are influenced by specific sets of beliefs about affect and its regulation, and about the self and relations with others, leading to an interaction that raises vulnerability to relapse. Pertinent literature is reviewed and found to be compatible with such a model. The clinical implications are discussed and compared to existing interventions.

Is Group More Cost Effective than Individual Cognitive Behaviour Therapy? The Evidence is not Solid Yet

Abstract: This paper critically evaluates the empirical evidence of 36 studies regarding the comparative cost-effectiveness of group and individual cognitive behaviour therapy (CBT) as a whole, and also for specific mental disorders (e.g. depression, anxiety, substance abuse) or populations (e.g. children). Methods of calculating costs, as well as methods of comparing treatment outcomes were appraised and criticized. Overall, the evidence that group CBT is more cost-effective than individual CBT is mixed, with group CBT appearing to be more cost effective in treating depression and children, but less cost effective in treating drugs and alcohol dependence, anxiety and social phobias. In addition, methodological weaknesses in the studies assessed are noted. There is a need to improve cost calculation methodology, as well as more solid and a greater number of empirical cost-effectiveness studies before a firm conclusion can be reached that group CBT is more cost effective then individual CBT.

Attitudes Towards Computerized CBT for Depression Amongst a Student Population

Abstract: Some studies of computerized cognitive behaviour therapy (CCBT) have found evidence of its effectiveness, yet a number have reported low uptake and/or completion rates. This study investigated attitudes towards CCBT for depression amongst 122 university students. The credibility of CCBT, expectancy-for-improvement and perceived likelihood of using it were all poor, although a minority (9.8%) stated a preference for CCBT over other interventions. When 20 of the original sample received a demonstration of a CCBT programme for depression, significant increases in credibility, expectancy-for-improvement and in perceived likelihood of using CCBT were found. Numbers stating a preference for CCBT increased to 30%. At both stages, most students stated a preference for CCBT to be accompanied by counselling. Qualitative analysis provided information about factors that might influence these attitudes. Implications for service delivery are discussed.

“Contents May Vary”: A Pilot Study of Treatment Histories of OCD Patients

Abstract: Definitions of treatment failure and the labelling of patients as non-responsive typically require treatments to have been offered and failed. For pharmacological treatments, treatment quality is relatively easy to define; this is much more difficult with psychological treatments. This study examined patient recollections of previous therapy for obsessive compulsive disorder (OCD). A Treatment History Questionnaire was administered to a sample of 57 apparently treatment refractory OCD patients from a specialist national OCD treatment unit and a national charity for OCD sufferers. On average, respondents reported an 8 1 year wait between the obsessional symptoms interfering significantly with their lives and being diagnosed. Forty-three percent recalled having received either cognitive behaviour therapy (CBT) or behaviour therapy as the first treatment; 31% of the group did not know what type of therapy they had received. The components of therapy that respondents recalled were analysed and contrasted with minimal therapy criteria. These criteria appear not to have been met in most patients who understood that they had received "CBT". The implications of this study for assessment of treatment integrity and the classification of patients as "treatment resistant" are discussed.

Conceptualizing Empathy in Cognitive Behaviour Therapy: Making the Implicit Explicit

Abstract: Although empathy has been shown to play an important role in therapeutic outcomes for cognitive-behaviour therapy (CBT) as for other therapies, there has been remarkably little discussion or research on empathy in the CBT literature. This paper seeks to make the implicit explicit: to conceptualize the nature and function of therapeutic empathy within CBT. It proposes a model of therapeutic empathy with four key elements: Empathic attunement, Empathic attitude/stance, Empathic communication, and Empathy knowledge. The model points to the importance of the "person of the therapist" and self-reflection in the development of therapeutic empathy; and describes how the specific contribution of CBT knowledge and skills can help therapists understand clients' moment-to-moment experiences and, if used sensitively, can enhance the empathic process. The paper indicates how therapists may use different modes of empathic processing to process experience under different circumstances, and how empathy fulfils a variety of functions within CBT. This conceptualization has considerable implications for therapists, trainers, supervisors and researchers including: more accurate identification and targeted strategies to address therapeutic empathy problems; recognition of the value of personal experiential work and self-reflection in empathy training; increased understanding of the functions of empathy; and development of finer-grained clinical and research measures.

Does Interpreter-Mediated CBT with Traumatized Refugee People Work? A Comparison of Patient Outcomes in East London

Abstract: There is controversy about the value of psychological interventions offered to refugee people through an interpreter, but little empirical evidence in this field. This study compared routine clinical outcomes of three groups of PTSD patients receiving CBT: refugees who required interpreters; refugees who did not require an interpreter; and English-speaking non-refugees. The aim of the study was to ascertain whether interpreted CBT is feasible. All three groups attended a similar number of sessions and showed significant improvements after treatment. Refugees receiving treatment with and without interpreting did not differ in treatment outcomes. The findings suggest that interpreters can be used with positive outcome in treating PTSD patients with CBT. This study supports NICE (2005) recommendations that CBT should be offered regardless of language need.

The Ups and Downs of Cognitive Therapy Training: What Happens to Trainees' Perception of their Competence During a Cognitive Therapy Training Course?

Abstract: One- and two-year cognitive therapy training programs are increasingly popular in the UK and overseas. Previous research has indicated that trainees show gains in competence, though this may at times be accompanied by self-doubt and stress. The present study sought specifically to gain the trainees' perspective: What happens to self-perception of competence (SPC) during cognitive therapy training - does it change over time? Do all elements of cognitive therapy skill show the same changes in SPC? Do individuals show different patterns of change? What environmental and internal factors influence changes in SPC? Twenty-four trainees on a one-year part-time training course completed a self-rated assessment of competence at six time points during the course. They also reported attributions about experiences that might have contributed to increases or decreases in SPC. Results demonstrated that SPC increases significantly over time, but there is considerable variation across different skills, and between individuals. A model developed from trainees' qualitative data indicated that the prime influences on SPC were new learning opportunities (acquiring knowledge, implementing knowledge, external evaluation, experiences with clients), self-reflection on performance, increased awareness of the standards required of a cognitive therapist, and emotional state, in particular emotionally salient memories and current stress. Practical implications of the findings for trainees, trainers and supervisors are discussed.

Factors associated with competence in cognitive therapists

Abstract: As a result of its expanding evidence base from randomized controlled trials, cognitive therapy is becoming increasingly widely practised in the treatment of many mental health problems. However, little is known about the extent to which it is carried out competently in practice, nor about what characteristics of therapists may be associated with competence. In therapists claiming to practice cognitive therapy, this study examined the relationship of a number of therapist factors, including training, profession, experience, supervision and accreditation, to competence. Therapists (n = 24) taped a mid-treatment cognitive therapy session. An independent rater, blind to information about the therapist, assessed the competence shown by the therapist during this session using the Cognitive Therapy Scale (CTS). Five randomly selected tapes were rated by a second rater and the inter-rater correlations were high. Although all therapists had received some cognitive therapy training during basic professional qualification, therapists with formal post-qualification training in cognitive therapy showed significantly higher levels of competence than those without. Psychologists were rated as more competent than therapists from other professions on one of the CTS subscales (Interpersonal Effectiveness). Number of years of experience, frequency of supervision, and accreditation were unrelated to ratings of competence. A number of accredited cognitive therapists scored well below a widely used criterion of competence.

The Availability of Cognitive Behaviour Therapy Within Specialist Child and Adolescent Mental Health Services (CAMHS): A National Survey

Abstract: The National Institute for Clinical Excellence has recommended cognitive behaviour therapy (CBT) for a number of common child and adolescent mental health disorders. The aim of this study was to clarify the practice of CBT within specialist child and adolescent mental health services in the United Kingdom. A survey was distributed to specialist child mental health workers through national organizations and professional bodies. Approximately 10% of specialist CAMHS professionals replied (n = 540). One in five reported CBT to be their dominant therapeutic approach, whilst 40% rarely used CBT. Specialist post-qualification training had been undertaken by 21.0% of respondents, with over two-thirds identifying training needs in the core skills of CBT. This survey suggests that the capacity of specialist CAMHS to meet the requirements of NICE in terms of the availability of CBT skills is doubtful. There is a need to develop CBT training and supervision infra-structures.

Fight Fire with Fireflies! Association Splitting: A Novel Cognitive Technique to Reduce Obsessive Thoughts

Abstract: A novel cognitive technique, termed "association splitting", aimed at reducing obsessive thoughts, is introduced. Association splitting draws upon the so-called "fan effect" of associative priming. Transposing this principle to the treatment of obsessive-compulsive disorder (OCD), we hypothesized that the sprouting of new and the strengthening of existing neutral associations to core OCD cognitions will reduce their fear-evoking properties by depriving the chain of OCD-related cognitions of associative strength. To test the feasibility and efficacy of this approach, an internet intervention study was implemented. Initially, 38 subjects with OCD obsessions took part in an assessment. After completion of the survey they were then sent a self-help manual. Three weeks later, participants were re-contacted. One-third of the participants responded to the treatment (at least 35% decline on the Y-BOCS scale). The completer analysis revealed a response rate of 42%. It is suggested that association splitting may lead to symptom relief in a subgroup of participants and may represent a useful addition to the tool box of cognitive-behavioural techniques.

Examining cognitive models of obsessive compulsive disorder in adolescents

Abstract: Three influential theoretical models of OCD focus upon the cognitive factors of inflated responsibility (Salkovskis, 1985), thought-action fusion (Rachman, 1993) and meta-cognitive beliefs (Wells and Matthews, 1994). Little is known about the relevance of these models in adolescents or about the nature of any direct or mediating relationships between these variables and OCD symptoms. This was a cross-sectional correlational design with 223 non-clinical adolescents aged 13 to 16 years. All participants completed questionnaires measuring inflated responsibility, thought-action fusion, meta-cognitive beliefs and obsessive-compulsive symptoms. Inflated responsibility, thought-action fusion and meta-cognitive beliefs were significantly associated with higher levels of obsessive-compulsive symptoms. These variables accounted for 35% of the variance in obsessive-compulsive symptoms, with inflated responsibility and meta-cognitive beliefs both emerging as significant independent predictors. Inflated responsibility completely mediated the effect of thought-action fusion and partially mediated the effect of meta-cognitive beliefs. Support for the downward extension of cognitive models to understanding OCD in a younger population was shown. Findings suggest that inflated responsibility and meta-cognitive beliefs may be particularly important cognitive concepts in OCD. Methodological limitations must be borne in mind and future research is needed to replicate and extend findings in clinical samples.

Prediction of Cognitive Behavior Treatment Outcome for Children with Anxiety Disorders: Therapeutic Relationship and Homework Compliance

Abstract: We examined a non-specific or relationship variable as well as a specific or technical variable (i.e. homework compliance) and their prediction of cognitive behavioral treatment (CBT) outcome for children with anxiety disorders. Therapist ratings of the therapeutic relationship (TR), but not homework compliance (HC) predicted CBT outcome at posttreatment (n = 138) and at I -year follow-up (n = 121) for anxious children (aged 9 to 13 years). Findings from this study suggest the therapeutic relationship is a hardy non-specific factor in CBT of anxious children. Implications for the treatment of children with anxiety disorders using CBT and recommendations for research are offered.

Empirically grounded clinical interventions: Clinical implications of a psychological model of mental disorder

Abstract: Kinderman (2005) presented a psychological model of mental disorder, based on a critique and reformulation of the biopsychosocial model. Kinderman suggested that disruption or dysfunction in psychological processes is a final common pathway in the development of mental disorder. These processes include, but are not limited to, cognitive processes. This 'mediating psychological processes model' proposes that biological and environmental factors, together with a person's personal experiences, lead to mental disorder through their conjoint effects on these psychological processes. The clinical implications of this model are discussed further here. It is proposed that formulations rather than diagnoses should predominate clinical planning, that these formulations should detail the hypothesised disruption to psychological processes or mechanisms, that psychological therapies should receive higher priority, and that medical, social and even psychological interventions are most likely to be clinically effective if they are designed on the basis of their likely beneficial impact on underlying psychological mechanisms.

Self-efficacy for social situations in adolescents with generalized social anxiety disorder

Abstract: Self-efficacy is a potentially useful concept when applied to Social Anxiety Disorder (SAD). The aims of the current study were to examine the psychometric properties of the Self- Efficacy for Social Situations Scale (SESS; Gaudiano and Herbert, 2003) and to investigate the relationship between self-efficacy and anxiety in an adolescent sample with generalized SAD. Results replicated those found in a previous adult SAD sample. The SESS showed high internal consistency and good construct and criterion-related validity. The SESS also predicted subjective anxiety and perceived performance in social role play tests after controlling for social anxiety severity. Furthermore, self-efficacy more clearly predicted self-ratings in contrast to observer ratings of performance in social role play tests. Finally, changes in social self- efficacy were strongly associated with changes in social anxiety symptoms following treatment, even after controlling for changes in fear of negative evaluation. Treatment implications for adolescent SAD are discussed.

Help-seeking for depression: The role of beliefs, attitudes and mood

Abstract: This study aims to explore help-seeking thresholds, beliefs and attitudes about depression and establish how these are affected by previous treatment for depression, the type of treatment received, and current depression. Participants were a cohort of 42 individuals previously diagnosed with Major Depressive Disorder (MDD) in two groups according to previous treatment for depression; 12 individuals previously diagnosed with a psychological disorder other than MDD; and 48 individuals from a community sample. Five self-report questionnaires measured thresholds for help-seeking, beliefs about depression, current depression and self-management skills. Between-group comparisons were made for help-seeking thresholds and beliefs about depression. Results showed lower thresholds for professional help-seeking in those who had previously received psychological treatment than in those treated with antidepressants only and non-clinical controls. Perceived stigma was negatively associated with help-seeking. Depressed mood was associated with delayed help-seeking and symptom recognition, even in those who had previously received treatment for depression. We conclude that relapse prevention interventions may educate patients about the effects of depression on help-seeking. Further research should clarify the extent to which help-seeking co-varies with depressed mood. More work is needed to reduce the stigma associated with depression.

Diary records of thought suppression by individuals with obsessive-compulsive disorder

Abstract: Impairment in mental control is a primary complaint of many sufferers of obsessive-compulsive disorder (OCD). Most OCD sufferers work very hard to rid themselves of their obsessions, to little avail. Although active resistance is a defining feature of obsessions, it is typically not assessed in measures of OCD severity and little is known about the frequency of attempts at thought control or its impact on functioning while control strategies are engaged. In the present study, 37 individuals diagnosed with OCD kept a diary of their suppression attempts over a 3-day period, recording the circumstances under which the attempt at suppression occurred, the suppression strategy used, its outcome, and its impact on concentration, mood, peace of mind, and ability to proceed with planned activities. Results indicated that individuals with OCD engage in frequent, strenuous, time-consuming and ultimately unsuccessful attempts to control thoughts. Suppression was used as a means of avoiding the hassles associated with experiencing an obsession and with performing a compulsive ritual. Consistent with other research, suppression was also used as a means of neutralizing harm potentiated by the obsession. These findings suggest that thought suppression efforts and their impact may contribute significantly to the severity of impairment associated with OCD, and that it might be useful for clinical and research purposes to evaluate suppression as a severity indicator.

Successful Psychotherapy Reduces Hypervigilance in Borderline Personality Disorder

Abstract: The aims of the present study were to investigate whether selective attention in borderline personality disorder (BPD) is content-specific and influenced by treatment. Comparisons were made between emotional Stroop interferences of stimulus types that were related and unrelated to hypothesized BPD schemas (1) of patients with BPD (n = 24) and nonpatient controls (n = 23), and (2) of BPD patients (n = 16) at start and end of an intensive, 3-year lasting treatment. Patients with BPD showed general hypervigilance, i.e. attentional biases for both schema related and unrelated emotional stimuli. Hypervigilance was completely reduced to normalized levels in recovered patients (n = 6), but not in non-recovered patients (n = 10) at the end of treatment. The findings support the possibility of structural change in BPD.

Conducting successful supervision : Novel elements towards an integrative approach

Abstract: In recent years that has been an increasing interest in supervision within the UK's cognitive behaviour therapy (CBT) community. This is because the role of supervision has begun to be recognized in relation to the delivery of effective clinical services (Department of Health, 1998), and because of a clear recognition of the need to ensure that CBT practitioners are competent. Perhaps less well recognized in CBT are a number of interesting educational approaches to supervision, ones that may make supervision more successful. This paper summarizes some of these theories from a CBT perspective. Whilst the evidence base does not yet justify being too prescriptive, it is argued that some of these theories, such as Vygotsky's notion of the "Zone of Proximal Development", provide helpful prompts for reflecting on CBT supervision. An integrative model is constructed from these theories, with illustrative examples and suggestions for future research.

Determining What is Important in a Good Formulation

Abstract: Research suggests that there is low inter-rater reliability between therapists when asked to formulate the same case and that there may be discrepancies in what is considered an essential part of a formulation. The present study aimed to explore the diversity of therapists' viewpoints regarding the purpose and essential features of a cognitive-behavioural therapy (CBT) case formulation of depression. A Q-sort methodology was used in order to render these beliefs operational. Seven experienced CBT therapists participated in the construction of 86 statements, capturing concepts considered relevant to a CBT formulation of depression. This Q-sort was then administered to 23 therapists, who rated these statements in terms of their importance using a Q-sort procedure. Three factors emerged, suggesting three dominant opinions as to the importance of features of a formulation. A “state” CBT factor, focusing on the “here and now”, accounted for most variance; followed by a second factor emphasizing “function and process” and a third factor emphasizing “trait” components. Whilst there was some agreement between what was considered to be least important in a formulation, the emergence of three distinct viewpoints suggests a lack of complete consensus amongst the therapists.

Does Anticipation Help or Hinder Performance in a Subsequent Speech

Abstract: This study examined the effects of anticipatory processing on a subsequent speech in high and low socially anxious participants. Forty participants (n = 20 in each group) gave two speeches, one after no anticipatory processing and one after 10-minutes of anticipatory processing. In anticipatory processing, high socially anxious participants were more anxious, and experienced more negative and unhelpful self-images than low socially anxious participants did. However, both groups rated memories of past speeches as having a somewhat helpful effect on their speech preparation. High socially anxious participants tended to use the observer perspective more in the anticipated speech, while, in the unanticipated speech, they might have been switching between observer and field perspectives. Low socially anxious participants tended to use the field perspective in both speeches. High and low socially anxious participants reported better speech performances after the anticipated, compared to after the unanticipated speech. Results suggest that anticipatory processing may have both positive and negative effects on socially anxious individuals' cognitive processing and performance before and during a speech.

Not lost in translation : Protocols for interpreting trauma-focused CBT

Abstract: This paper describes the development of protocols with interpreters employed in an East London psychological trauma clinic. The service treats traumatized refugee people with cognitive methods, according to the National Institute for Clinical Excellence (NICE) Guidelines for PTSD. NICE states that language should not be a barrier to treatment, but provides no further guidance to achieve this. These protocols for interpreting CBT are designed to be explicit, consistent and ethical. A telephone poll from a recent UK-wide trauma survey, a focus group with local interpreters, and practitioner reflection were all used to develop and refine the protocols and their rationale, which are described, together with implications for future culturally sensitive practice and research.

Evaluation of DBT Emotional Coping Skills Groups for People with Parasuicidal Behaviours

Abstract: Five 18 week skills training groups based on Dialectical Behaviour Therapy (DBT) were provided for 34 participants with parasuicidal behaviours; 26 participants completed the programme. Monthly support/education groups for their keyworkers were also provided. Inpatient admissions decreased by 30% and out-patient appointments for those without admission by 61% over the 18 months from the initial pre-group formulation meeting, compared with the preceding 18 months. Statistical analysis (N = 17) showed significant reduction in CORE scores over the intervention period, and a similar effect in scores on the Work and Social Adjustment Scale. User satisfaction was high and drop out low (23.5%). Results indicate DBT skills group might be a useful service where full DBT is unavailable.

Service-user satisfaction with CBT for psychosis

Abstract: Service user satisfaction with Cognitive Behavioural Therapy (CBT) for psychosis was examined with the Satisfaction with Therapy Questionnaire (STQ; Beck, Wright, Newman and Liese, 1993). Sixty-five service-users completed the STQ at the end of therapy, and 40 3-month post therapy. Overall, the majority of service-users were satisfied with therapy. Satisfaction was unaffected by service-user demographics or service issues, and remained stable over the 3-month follow-up. Belief in the extent to which CBT skills/knowledge had been gained predicted overall satisfaction at the end of therapy, while there was a near-significant effect for belief about the usefulness of homework(s) to predict overall satisfaction at 3-month follow-up. These results suggest that (i) CBT for psychosis is an acceptable intervention to service-users, regardless of their demographic characteristics or service issues; (ii) the specific aspects of CBT, not the non-specific attributes of therapy, predict overall satisfaction; (iii) homework setting may be important in ensuring ongoing satisfaction post-therapy.

Self-esteem and psychosis : A pilot study investigating the effectiveness of a self-esteem programme on the self-esteem and positive symptomatology of mentally disordered offenders

Abstract: The importance of self-esteem in the development and maintenance of psychotic experiences has been shown in previous research. However, there has been little research into the role this plays in individuals with psychosis and forensic histories. The current study investigated the effectiveness of a standardized group programme for improving self-esteem in individuals with psychosis living in high security settings. Fifteen participants were included in the group programme and measures were taken to record changes in self-esteem and symptomatology. The results demonstrated significant improvements in self-esteem over the course of the group intervention, with some effects maintained at 3-month follow-up. Improvements in depressed mood were also found. The results demonstrated the effectiveness of a group intervention for self-esteem in individuals with psychosis. The findings of this study, alongside implications for further research, are discussed.

Parent-Child Relationships and the Verbal Information Pathway to Fear in Children: Two Preliminary Experiments

Abstract: Parenting styles and the parent-child bond are associated with anxiety in children. Despite this association, little is known about the mechanism through which parenting has its effect. One possibility is that parenting interacts with other known pathways to fear. Two experiments are reported that look at the interaction between parenting styles and parent-child relationships and the verbal information pathway to fear. In Experiment 1, a punitive maternal parenting style was found to interact with the effect of threat information about a novel animal in 6-9-year-old children. Maternal warmth, neglect, overprotection and accurate monitoring were not found to have a significant effect. Experiment 2 showed that children reporting a greater number of negative interactions with their fathers had greater increases in fear beliefs about novel animals after both threat and no information. The quality of mother-child relationships did not significantly interact with the verbal information pathway. These experiments offer preliminary evidence that parenting practices influence how children react to negative information, which offers some insight into the potential causes of the association between parenting and anxiety in children.

What is Seen Through the Looking Glass: The Impact of Training on Practitioner Self-Rating of Motivational Interviewing Skills

Abstract: Training efforts for evidenced based treatments require evaluation, yet the value of practitioner self-reports of skills acquisition has been questioned. Thus, a key issue concerns how accurately practitioners assess their own clinical skills. In the current study, 23 community practitioners participated in training of Motivational Interviewing (MI), completed standardized patient (SP) interviews before and after training, and provided self-ratings of MI elements after each interview. Interview recordings were later coded independently. Results suggest training contributed to: 1) reasonable agreement between practitioner and independent ratings; and 2) more effective use of MI, despite a tendency for practitioners to underestimate training gains. This micro-analysis of training documents initial skill gains along with increased practitioner self-awareness. Further, it exemplifies how practitioner self-ratings and objective skill assessment methods may be used in tandem to more fully describe practitioner learning.

The Feasibility and Effectiveness of Computer-Guided CBT (FearFighter) in a Rural Area

Abstract: Evaluations of computer-guided CBT (CCBT) suggest that this is a promising approach to closing the gap between the demand for, and the supply of, CBT. However, additional studies are required that are conducted by researchers independent of the programme developers, and include a wider range of participants. This independent study examined the viability of CCBT for panic and phobic anxiety in an unselected sample of referrals in remote and rural areas of Scotland. Outcome was assessed by a wide range of outcome measures, completed before and after treatment, and at 4-month follow-up. Participants experienced few difficulties in using the programme, and GPs and participants regarded CCBT as acceptable and useful. Major improvements were obtained, with several large effect sizes, which remained at follow-up. It was concluded that computer-guided CBT can play a useful part in delivering CBT services in rural areas; and that self-help CBT may be the only treatment option available to some sufferers.

Emotional Avoidance Among Alcohol and Opiate Abusers: The Role of Schema-Level Cognitive Processes

Abstract: This study considered the role of schema-level cognitive processes in alcohol and opiate abuse. It examined the hypothesis that alcohol abuse will be associated with the use of "blocking" behaviours to reduce the experience of emotions (secondary avoidance of affect), while opiate abuse will be associated with a tendency to avoid emotions being activated in the first place (primary avoidance of affect). The sample consisted of 30 patients who abused alcohol, and 30 who abused opiates. Each completed the Young Compensatory Inventory (YCI) and the Young-Rygh Avoidance Inventory (YRAI). There were no differences between the groups in their absolute levels of schema processes (YCI and YRAI scores). However, they differed in the way in which the severity of use was associated with the level of YRAI behavioural-somatic avoidance. Among alcohol abusers only, severity of use was greater in those who were more likely to avoid affective arousal in this way. This association with severity was not found among opiate abusers. Implications are discussed for existing treatments and for the use of schema-level cognitive behavioural interventions with substance-using populations.

Cognitive Behavioural Therapy for Anger Management: Effectiveness in Adult Mental Health Services

Abstract: This paper reports on the development and running of an anger management service that has been provided in Southampton for the past decade. It discusses some of the challenges that the service has had to face, (including over-popularity with referrers and high attrition rates) and describes the model that is used. The paper also examines the outcome of one particular therapeutic group. The results of this evaluation show that those who drop out of the group have higher initial depression and poorer self-esteem compared to those who remain in the group. In addition, those who complete the anger management group show improvements in anger control and have improved self-esteem. The paper concludes with practice recommendations.

Using Homework Assignments in Psychotherapy: Differences by Theoretical Orientation and Professional Training?

Abstract: Prior research has shown that psychology-trained practitioners use homework assignments, but no prior research has sought to survey the clinical practice of other mental health professionals. Three hundred and thirty-three mental health professionals from counselling, medical, nursing, psychology, and social work training backgrounds were surveyed regarding their use of homework assignments in psychotherapy. The vast majority of the sample (83%) reported the use of homework assignments, and those practising cognitive-behavioural therapy indicated a greater frequency and degree of specificity in assigning homework. However, it was noteworthy that all theoretical and professional groups in the present study reported some use of homework assignments.