Socially anxious individuals hold negative beliefs about their appearance, abilities and personality. These negative self-conceptions increase expectations of negative evaluation from others and, consequently increase anxiety. Self-verification theory states that individuals seek, accept and prefer feedback that is congruent with their self-conceptions. This study explored the assumptions of self-verification theory in social anxiety. This was achieved by examining the type of feedback socially anxious individuals seek and how positive and negative feedback is processed. Results from an undergraduate sample (n = 84) indicate that socially anxious individuals were no more or less likely to seek negative feedback than individuals with low social anxiety. However, participants with greater social anxiety rated positive feedback as less accurate, rated negative feedback as more accurate, and were more comfortable with negative feedback, compared to participants with low social anxiety. Greater social anxiety was also found to predict increased discomfort with positive feedback, and fear of negative evaluation fully mediated this relationship. These findings suggest that self-verification processes operate in social anxiety and highlight the need for researchers to include measures of fears of evaluation when examining self-verification theory in samples of socially anxious individuals.

Six clients in cognitive behaviour therapy (CBT) or metacognitive therapy (MCT) were interviewed about their experiences of therapy with a focus on helpful elements. Clients in both CBT and MCT mentioned the positive and informal relationship with the therapist as helpful. However, while clients in both therapies emphasized insight into the causes of depression and modification of negative maintenance patterns as helpful, the understanding of depression and the remedies for the condition differed. Clients in CBT focused on previous negative experiences as the cause of present maintenance patterns and mentioned changing negative thought patterns as helpful. Clients in MCT stated that the realization that rumination was their key problem and that they could choose not to engage in negative thinking had been crucial. Furthermore, clients in CBT tended to describe increased personal strength and self-confidence as the main gain from therapy, whereas MCT clients mentioned improved ways of coping with thoughts or problems. The importance attributed by the clients to technical factors differs from previous qualitative studies conducted across various therapeutic approaches, which have typically concluded that common therapeutic factors are more important than specific factors. It does, however, correspond with conclusions from other qualitative studies focusing explicitly on CBT.

While the benefits of routine outcome measurement have been extolled and to some degree researched, it is surprising that service user opinions on this common therapy practice have largely not been investigated. This study aimed to assess service users’ experiences of completing measures during psychological therapy, with a view to exploring how therapists can maximize how helpful measures are in therapy. Fifteen participants completed surveys about the use of measures in their current episode of care. Ten clinicians also completed a survey about their use of, and views about, measures. Results showed that despite mixed experiences in how measures were explained and used, service users showed generally favourable attitudes towards their use in therapy, with them being perceived as most helpful when well integrated into sessions by their therapists. Clinicians reported using a wide range of measures, and generally endorsed positive beliefs about measures more strongly than negative ones. Implications for clinical practice, service development, and further research are discussed.

Attention to client metaphors has been asserted as a way of enhancing cognitive behaviour therapy. Metaphors can be part of the shared language that is co-constructed between clients and therapists. Recent advances in cognitive linguistics have provided the most clearly operationalized method yet to identify metaphors in conversations, allowing analysis of how shared language develops. This study aims to explore how metaphoric shared language develops in early cognitive behaviour therapy sessions. Based on 12 transcripts of early cognitive behaviour therapy sessions, an iterative process led to the identification of a range of therapist and client responses to each other's metaphors, and identification of whether therapists or clients initiated metaphoric exchanges. Types of responses to therapist or client metaphors within three speaking turns were found to be: repetition, rephrasing, exploration, elaboration/extension, or agreement. Bursts of metaphoric exchange were initiated and taken up by therapists and clients at a similar rate. To conclude, therapists need to attend to the occurrence of metaphors and be aware of the range of potential responses that can engage the client in the ‘metaphoric dance’ (co-construction of shared metaphors). This has the potential to enhance engagement and outcomes though more salient reformulating of the problem for the client.

Formulation is widely considered a critical component of psychological therapies, and is thought to have a number of benefits both for the therapeutic process and the client directly. However, the evidence base supporting formulation and its possible interventive capacity is limited, and there is little empirical evidence exploring how clients perceive formulation as part of therapy. Work with the client described in this single case report provided an opportunity to explore the use of formulation as intervention and evaluate ways in which it may or may not prove helpful by interviewing the client directly about her experience of the process. Implications for further research on the use and outcomes of formulation are discussed.

The Children and Young People's Improving Access to Psychological Therapies (CYP IAPT) programme emphasizes the meaningful contribution session-by-session routine outcome monitoring (ROM) can make to clinical practice and its importance in highlighting services’ effectiveness. Two studies on issues related to the implementation of ROM in children's services were conducted. Study 1 was qualitative; 12 Child and Adolescent Mental Health Services (CAMHS) professionals participated in focus groups. Themes identified included the idea that ROM could provide objectivity, could be collaborative and empowering. Concerns included how measures may adversely influence therapeutic sessions and how the information may be used by the service. These themes were used to develop a questionnaire about professionals’ experience of and views on session-by-session ROM. In Study 2, 59 professionals from four CAMHS teams completed the questionnaire. It was found that only 6.8% reported ‘almost always’ utilizing session-by-session ROM. Detailed analysis of questionnaire responses suggested two subscales reflecting the perceived negative and positive impact of session-by-session ROM. It was found that clinicians who currently use session-by-session ROM hold stronger positive and negative beliefs than clinicians who do not. This study suggests that session-by-session ROM is not currently routine practice within CAMHS and highlights the importance of considering how this practice can be best implemented within this setting with reference to clinician attitudes.

Previous research has indicated that nightmares might be a common problem for people with psychotic symptoms. Furthermore, more distressing nightmares have been associated with higher levels of delusional severity, depression, anxiety, stress and working memory. However no known research has investigated the use of nightmare treatments in those with symptoms of psychosis. This study aimed to assess the acceptability and feasibility of using imagery rehearsal (IR) therapy as a treatment of nightmares for those presenting with co-morbid psychotic symptoms. Six participants presenting with frequent distressing nightmares and psychotic symptoms were recruited. Five participants attended 4–6 sessions of IR. Measures of nightmares, sleep quality, psychotic and affective symptoms were completed at baseline and immediately following the intervention. It was feasible to adapt IR for those experiencing psychotic symptoms. Descriptive improvements were noted on measures of nightmare-related distress, vividness and intensity. Positive post-session feedback endorsed the acceptability of IR. Nightmare frequency did not reduce following IR; however, participants described a change in emotional response. IR was an acceptable and feasible intervention for this small sample. A larger study powered to detect group changes, with an additional control is warranted to test the efficacy of the intervention for those with psychosis.

Returning to the scene of the trauma is often recommended as part of trauma-focused cognitive-behavioural therapies for post-traumatic stress disorder (PTSD). Many clinicians avoid site visits due to lack of confidence or practical constraints; however, recent research suggests this is a valuable part of treatment. This article summarizes a rationale for including the site visit as part of cognitive therapy for PTSD, as well as the main considerations about when to carry it out in treatment. A practical framework for planning and implementing site visits is described.

According to interpersonal theory of personality, interpersonal behaviours can be causal and maintaining factors in emotional disorders. However, interpersonal styles have not yet been investigated in the treatment of obsessive compulsive disorder (OCD). The aim of the study was to investigate interpersonal style in OCD. The Inventory of Interpersonal Problems – Circumplex was used to assess the interpersonal styles of 101 outpatients with OCD treated with cognitive behavioural therapy (CBT). Patients with OCD had more interpersonal problems than the healthy control group. However, the OCD group presented with slightly fewer interpersonal problems than a further comparison group of psychiatric outpatients. Interpersonal style did not predict improvement in OCD symptoms. Following CBT for OCD, there were small to moderate improvements in interpersonal problems. These changes remained stable at 12-month follow-up. Although the OCD group reported reduced interpersonal problems post-treatment, the group still experienced more submissiveness compared to healthy controls. Interpersonal problems in OCD appeared to be more attributable to comorbid conditions than to OCD-specific symptoms. Although patients with OCD were found to have interpersonal styles that might cause some problems, these were minimal at baseline and did not significantly affect OCD treatment outcomes. Interpersonal problems in this population might be more strongly related to depressive symptoms than to OCD-specific symptoms. CBT was associated with slight improvements in interpersonal problems.

Within the field of adult mental health, self-help is now a pivotal treatment modality. However, earlier research indicates that some individuals react negatively to this. Through three, small-scale studies, this paper explores both clinicians’ experience of harm in patients as a response to self-help materials as well as patients’ own reports. In Study 1, a postal survey was administrated to clinicians; in Study 2, semi-structured interviews were conducted with clinicians; and in Study 3, patients were sent a postal survey. Over 18% of clinicians indicated that they had experienced self-help materials resulting in harm to patients. The interviews uncovered four main themes: the patients’ clinical presentation, how the materials were presented within the therapeutic contact, certain personality characteristics in patients, and the characteristics of some materials. Between 12% and 24% of patients reported experience of negative effects (depending upon how this is defined), although the latter finding is limited by a small sample size. Proposals are made that are linked to best practice and it is suggested that there is a generic training need for clinicians in materials’ use.

Thank you very much to all of you who participated in the peer-review process for the Cognitive Behaviour Therapist during 2014. Your expert opinion has been very much appreciated. Many of you have already contributed to the reviewing process in 2015 for which we are also very grateful.