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.

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.

This paper presents a cognitive behavioural perspective on factitious disorder. The DSM-IV definition will be given and aetiological and epidemiological information will be presented, whilst noting the difficulty in collecting data from this group. The difficulty in engaging the patient will be addressed. In assessing the patient, the role of early experiences, the beliefs about their feigning of symptoms, the gains from this behaviour and the reaction of others will be considered. The similarities with somatization and malingering will be discussed. A model of this disorder based on the Beckian approach will be given as will an explanation of why this disorder may become chronic. A treatment strategy will be suggested looking at helping the patient understand their disorder, discussing with them the pros and cons of alerting others to their feigning behaviour, helping them get their needs met in a more appropriate way, looking at the risks involved in the behaviour, and addressing issues of abuse.

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.

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.

This research investigated the efficacy of an operantly cognitive-behavioural trauma treatment protocol (TTP) in two cases that had previously been treated unsuccessfully with EMDR. In line with previous research, both participants improved following TTP, to the extent where one of the participants was asymptomatic at post-treatment and 3 month follow-up. These cases also demonstrate the ability of a cognitive-behavioural intervention to successfully treat childhood sexual abuse victims later in life.

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.

In the self-regulation of anger, it is unclear whether the effects are due to self-monitoring or actual self-intervention. This is especially important in the light of the reactivity often attributed to self-monitoring. The present study compared both procedures within a reversal design involving college students with moderate levels of anger. Intervention consisted of behavioral contracting and relaxation as well as cognitive strategies of reappraisal and imagery. Measures included anger frequency, duration, and intensity, all of which were obtained in naturalistic settings. Results revealed significant and dramatic reductions in anger frequency and duration during self-intervention but no such improvements with self-monitoring apart from a slight reduction in anger intensity. The return to baseline self-monitoring was associated with no relapse in anger but a maintenance of treatment gains. Secondary findings of interest were a correlation between anger intensity and anger duration and a predominance of anger directed at persons rather than situations. In general, the outcome of this study adds strength to the inference that cognitive-behavioral self-interventions are effective for anger and that this effectiveness goes beyond mere reactivity. The effects are most pronounced for anger frequency and duration and this offers clues for future focal points in the practice of anger management.

This study describes the treatment of severe obsessive-compulsive disorder in a 14-year-old male with an experimental single case design. Onset of OCD was at age 12. He had been hospitalized for 6 months the year before consulting. Almost all life spheres were affected by OCD. An initial behavioural intervention, which targeted tooth brushing, was used as a springboard to understand OCD and the process of change was framed within a cognitive account of OCD. The approach was then applied to a number of different targets within a unified framework. There was a 46% reduction in Y-BOCS score at post-treatment and 67% reduction through to 11-month follow-up. Points discussed include the involvement of other professionals, the changing role of the family as treatment progressed and as the patient started to seek more autonomy, and the choice of the initial target.

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

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.

In the course of studies of behavioural parent training with the families of young children who were demonstrating serious conduct disorders, a substantial proportion of the parents reported, without the information being solicited in any way, that their children had become far more loving and demonstrative than formerly. They were surprised and delighted by this development. The concepts of “attachment” and “attachment behaviours” are explored and the usefulness of learning theory in understanding the extinction and recovery of attachment/attachment behaviours is discussed. This formulation may provide a bridge between cognitive learning theory on the one hand and attachment theory on the other.

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.

Selective attention for bodily sensations is often found in patients with panic disorder. Whether this may be the result of fear was investigated in a group of normal subjects. Subjects were made to fear an acceleration in their heartbeats or an increase in their muscle tension by threatening them with an electric shock should this occur. When subjects were under threat of these shocks, attention for ECG and EMG feedback was measured. Although the task seemed sensitive to the manipulation, no evidence was found for selective attention for fear-relevant information. Several shortcomings of the task are discussed.

Individuals with posttraumatic stress disorder (PTSD) frequently report periods of intense emotional distress (“hot spots”) when asked to describe their traumatic experience 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 investigation 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.

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

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

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.

A combination of synchronous reinforcement and verbal prompts (automatically delivered through portable technology) was used to promote performance fluency in a person with profound intellectual disability and blindness. Performance fluency was measured on indoor walking and task engagement. Data indicated that the combination of reinforcement (favourite songs) and prompts was quite effective; it increased the distance covered per minute and the number of objects disassembled per minute. Implications of the findings are discussed.

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.