Although insomnia disorder and social anxiety disorder are among the most prevalent psychiatric disorders, no studies have yet evaluated the use of sequential evidence-based treatment protocols in the population with co-morbid social anxiety disorder and insomnia disorder.

This study aimed to investigate the effects of sequential treatments on co-morbid insomnia disorder and social anxiety disorder. As depression is a common co-morbid syndrome for both insomnia and social anxiety, a secondary aim was to examine depressive symptoms.

A single-case repeated crossover AB design was used. Ten participants between 18 and 59 years of age with co-morbid DSM-5 diagnoses of insomnia disorder and social anxiety disorder received sequential treatments with cognitive behavioural therapy (CBT). Seven participants completed the treatment course. The primary outcomes were symptoms of insomnia and social anxiety, and the secondary outcome was symptoms of depression.

The effects of CBT on people with co-morbid social anxiety disorder and insomnia disorder were mixed. The majority of participants improved their sleep quality and lessened symptoms of social anxiety and depression. However, participants differed in their degree of improvement concerning all three disorders.

Sequential CBT treatments are potentially effective at decreasing symptoms of social anxiety and insomnia for people with co-morbid social anxiety disorder and insomnia disorder. The variation in outcome across participants makes firm conclusions about the treatment efficacy difficult to draw.

Despite the vast majority of evidence indicating the efficacy of traditional and recent cognitive behaviour therapy (CBT) therapies in treating social anxiety disorder (SAD), some individuals with SAD do not improve by these interventions, particularly when co-morbidity is present.

It is not clear how emotion regulation therapy (ERT) can improve SAD co-morbid with symptoms of generalized anxiety disorder (GAD) and depression. This study investigated this gap.

Treatment efficacy was assessed using a single case series methodology. Four clients with SAD co-occurring with GAD and depression symptoms received a 16-session version of ERT in weekly individual sessions. During the treatment, self-report measures and clinician ratings were used to assess the symptom intensity, model-related variables, and quality of life, work and social adjustment of participants every other week throughout the treatment. Follow-up was also conducted at 1, 2 and 3 months after treatment. Data were analysed using visual analysis, effect size (Cohen’s d) and percentage of improvement.

SAD clients with depression and GAD symptoms demonstrated statistically and clinically significant improvements in symptom severity, quality of life, work, social adjustment and model-related measures (i.e. negative emotionality/safety motivation, emotion regulation strategies). The improvements were largely maintained during the follow-up period and increased for some variables.

These findings showed preliminary evidence for the role of emotion dysregulation and motivational factors in the aetiology and maintenance of SAD and the efficacy of ERT in the treatment of co-morbid SAD.

The unified protocol (UP) is indicated when patients present with co-morbidity, but no studies have previously investigated the effectiveness of the UP with co-morbid health anxiety and depression.

An A/B single case design evaluated outcomes for a 27-year-old male presenting with health anxiety and co-morbid depression. Following a 21-day assessment-baseline period containing three sessions, the manualised UP was delivered across a 42-day period containing seven intervention sessions. Four idiographic measures (occurrence and duration of health checking, sleep duration and food intake satisfaction) were collected daily throughout, and two nomothetic measures were collected at four time points.

All sessions were attended. Number of health checking episodes reduced from four per day to two per day. A 59 minute per day reduction in time spent health checking occurred, and sleep increased by 100 minutes per night. There was little apparent change in terms of food intake satisfaction. There was a reliable and clinically significant reduction in depression.

Further testing of the effectiveness of the UP with co-morbid health anxiety and depression in true single case experimental designs is now indicated.

One reason that motivational interviewing (MI) is thought to translate well to a variety of treatment domains is due to the focus on client ambivalence.

Therefore, the current study aimed to explore the construct of ambivalence in the context of MI and cognitive behavioural therapy (CBT) for social anxiety disorder (SAD).

Participants were 147 individuals diagnosed with SAD who were randomised to receive either MI or supportive counselling prior to receiving group CBT for SAD.

The results suggested that MI was not related to decreases in general ambivalence or treatment ambivalence, although an indicator of treatment ambivalence was found to predict worse treatment outcome.

The findings suggest that three sessions of MI prior to CBT may not decrease ambivalence in participants with SAD, which may underscore the potential importance of tackling ambivalence as it arises during CBT.

Due to the COVID-19 pandemic, mental health services have had to offer psychological therapy via video with little time to prepare or mitigate potential problems. Identifying the barriers, benefits and training needs highlighted by clinicians may support the effective delivery of care.

Changes in the mode therapy sessions were delivered in during 2020 were assessed in two high-volume psychological therapies services. Sixty-six therapists completed a survey about their experiences of delivering therapy via video.

The lockdown in March 2020 precipitated a dramatic shift from face-to-face to telephone and video-delivered sessions. Most clinicians (89%) found video-based sessions acceptable. Barriers to effective delivery included technological issues, problems with online platforms, and feeling more tired after sessions. Benefits included generalised learning from behavioural work, improvements in efficiency and in the therapeutic relationship, particularly in comparison with telephone-based sessions. Tutorials and support guides were recommended to maximise use of sessions via video.

Video-delivered therapy was liked by clinicians and preferred to telephone-based sessions. Issues with platforms, internet connections and access for patients need addressing, local troubleshooting guides, video-based tutorials and greater support for low-intensity therapists to maximise uptake of video sessions where appropriate, may be beneficial.

Effective monitoring of cognitive behaviour therapy (CBT) competence depends on psychometrically robust assessment methods. While the UK Cognitive Therapy Scale – Revised (CTS-R; Blackburn et al., 2001) has become a widely used competence measure in CBT training, practice and research, its underlying factor structure has never been investigated.

This study aimed to present the first investigation into the factor structure of the CTS-R based on a large sample of postgraduate CBT trainee recordings.

Trainees (n = 382) provided 746 mid-treatment audio recordings for depression (n = 373) and anxiety (n = 373) cases scored on the CTS-R by expert markers. Tapes were split into two equal samples counterbalanced by diagnosis and with one tape per trainee. Exploratory factor analysis was conducted. The suggested factor structure and a widely used theoretical two-factor model were tested with confirmatory factor analysis. Measurement invariance was assessed by diagnostic group (depression versus anxiety).

Exploratory factor analysis suggested a single-factor solution (98.68% explained variance), which was supported by confirmatory factor analysis. All 12 CTS-R items were found to contribute to this single factor. The univariate model demonstrated full metric invariance and partial scalar invariance by diagnosis, with one item (item 10 – Conceptual Integration) demonstrating scalar non-invariance.

Findings indicate that the CTS-R is a robust homogenous measure and do not support division into the widely used theoretical generic versus CBT-specific competency subscales. Investigation into the CTS-R factor structure in other populations is warranted.

Whilst the delivery of low-intensity group psychoeducation is a key feature of the early steps of the Improving Access to Psychological Therapies (IAPT) programme, there is little consensus regarding the skills and competencies demanded.

To identify the competencies involved in facilitating CBT-based group psychoeducation in order to inform future measure development.

A Delphi study in which participants (n = 36) were relevant IAPT stakeholders and then an expert panel (n = 8) review of the competencies identified within the Delphi study to create a shortened, more practical list of competencies.

After three consultation rounds, consensus was reached on 36 competencies. These competencies were assigned to four main categories: group set-up, content, process and closure. A further expert review produced a shortened 16-item set of psychoeducation group facilitation competencies.

The current study has produced a promising framework for assessing facilitator competency in delivering CBT-based group psychoeducational interventions. Weaknesses in the Delphi approach are noted and directions for future measure development research are identified.

There has been increased research interest into the concept of treatment integrity within psychotherapy research. The Competence and Adherence Scale for Cognitive Behavioural Therapy (CAS-CBT) was developed to measure therapists’ competence and adherence in cognitive behavioural therapy (CBT), when delivered to children and youth with anxiety disorders.

The aim of this study was to evaluate the psychometric properties of the CAS-CBT in a naturalistic treatment setting.

Ratings of 212 randomly selected sessions from a clinical effectiveness trial for children with anxiety disorders (n = 165, mean age = 10.46 years, SD = 1.49) were analysed to assess the psychometric properties of CAS-CBT. Therapy format included both individual sessions and group sessions.

Internal consistency for the CAS-CBT was excellent (Cronbach’s alpha = .88). Factor analysis suggested a two-factor solution for the total sample, where the first factor was related to CBT structure and session goals, and the second factor was associated with process and relational skills. The individual CBT treatment condition (ICBT) and group CBT treatment condition (GCBT) showed the same factor solution.

The CAS-CBT is a feasible and reliable measure for assessing competence and adherence to CBT in the treatment of anxious children. Future research is needed to further assess the generalizability of this scale, its psychometric properties in different treatment populations and with other treatment approaches, and ideally with larger sample sizes.

To cope with the rising demand for psychological treatment, evidence-based low-intensity cognitive behavioural therapy (LiCBT) delivered by trained para-professionals was introduced internationally.

This pilot study aimed at examining the effectiveness of LiCBT in Hong Kong.

This study was of an uncontrolled pre- and post-treatment design, testing LiCBT at a local community mental health centre in Hong Kong. Two hundred and eighty-five Chinese adult help-seekers to the centre attended two or more sessions of LiCBT delivered by trained para-professionals. These participants also rated their depression and anxiety on the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Scale-7 (GAD-7), respectively, at pre- and post-treatment.

Comparison of the pre- and post-treatment PHQ-9 and GAD-7 scores of 285 participants indicated significant improvements in depression and anxiety with large effect sizes (depression: d = 0.87; anxiety: d = 0.95). For those participants reaching the clinical level of either depression and/or anxiety at pre-treatment (n = 229, 80.4%), they reported even larger effect sizes (depression: d = 1.00; anxiety: d = 1.15). The recovery rate was 55.9% with a reliable improvement rate of 63.9%. An average of 5.6 sessions was offered to the participants with each session spanning a mean of 42 minutes. The baseline clinical conditions and participants’ educational level were predictive of post-treatment recovery.

The results supported the effectiveness and cost-efficiency of LiCBT for depression and anxiety at a Hong Kong community mental health centre. The effect sizes and the recovery and reliable improvement rates achieved were comparable to those reported from countries such as the UK and Australia.

The Work and Social Adjustment Scale (WSAS) is an instrument that can be easily applied for routine evaluation of the impact of mental disorders on patient functioning. In spite of the interest in its use, there is very little information available on its psychometric characteristics and even less in Spanish.

The objective of this study was to analyse its psychometric characteristics.

The sample consisted of 441 patients treated in a community mental health unit. They filled out the WSAS and two psychopathology measures, one for anxiety and the other for depression. Fifty-five of them, chosen at random, were asked to fill out the scale again a second time to explore its temporal reliability.

The scale showed high internal consistency, a single factor that explained 60.4% of the variance, and temporal reliability of .78 for the total score. Significant correlations were found between the WSAS scores and the psychopathological measures, as well as significant differences between those working and those on leave.

The results confirm the validity and reliability of the scale and support its possible use for routine evaluation of the functional impact of mental disorders.