Cognitive therapy, based on the Clark and Wells (1995) model, is a first-line treatment for adults with social anxiety disorder (SAD), and findings from research settings suggest it has promise for use with adolescents (Cognitive Therapy for Social Anxiety Disorder in Adolescents; CT-SAD-A). However, for the treatment to be suitable for delivery in routine clinical care, two questions need to be addressed.

Can therapists be trained to achieve good outcomes in routine Child and Adolescent Mental Health Services (CAMHS), and what are the costs associated with training and treatment?

CAMHS therapists working in two NHS trusts received training in CT-SAD-A. They delivered the treatment to adolescents with SAD during a period of supervised practice. We examined the clinical outcomes for the 12 patients treated during this period, and estimated costs associated with treatment and training.

Treatment produced significant improvements in social anxiety symptoms, general anxiety and depression symptoms, and reductions in putative process measures. Seventy-five per cent (9 out of 12) patients showed a reliable and clinically significant improvement in social anxiety symptoms, and 64% (7/11) lost their primary diagnosis of SAD. The total cost to the NHS of the CT-SAD-A treatment was £4047 (SD = £1003) per adolescent treated, of which £1861 (SD = £358) referred to the specific estimated cost of face-to-face delivery; the remaining cost was for training and supervising therapists who were not previously familiar with the treatment.

This study provides preliminary evidence that clinicians can deliver good patient outcomes for adolescents with SAD in routine CAMHS during a period of supervised practice after receiving a 2-day training workshop. Furthermore, the cost of delivering CT-SAD-A with adolescents appeared to be no more than the cost of delivering CT-SAD with adults.

Social anxiety disorder (SAD) is common. It usually starts in adolescence, and without treatment can disrupt key developmental milestones. Existing generic treatments are less effective for young people with SAD than with other anxiety disorders, but an adaptation of an effective adult therapy (CT-SAD-A) has shown promising results for adolescents.

The aim of this study was to conduct a qualitative exploration to contribute towards the evaluation of CT-SAD-A for adoption into Child and Adolescent Mental Health Services (CAMHS).

We used interpretative phenomenological analysis (IPA) to analyse the transcripts of interviews with a sample of six young people, six parents and seven clinicians who were learning the treatment.

Three cross-cutting themes were identified: (i) endorsing the treatment; (ii) finding therapy to be collaborative and active; challenging but helpful; and (iii) navigating change in a complex setting. Young people and parents found the treatment to be useful and acceptable, although simultaneously challenging. This was echoed by the clinicians, with particular reference to integrating CT-SAD-A within community CAMHS settings.

The acceptability of the treatment with young people, their parents and clinicians suggests further work is warranted in order to support its development and implementation within CAMHS settings.

Motivational factors are generally regarded as an important ingredient for change in therapy. However, there is currently a lack of available instruments that can measure clients’ readiness for change in therapy.

The objective of this paper was to create an instrument, the Readiness for Therapy Questionnaire (RTQ), which could measure clients’ readiness for change.

The RTQ was created by researchers following analysis of themes drawn from a review of the literature and interviews with patients at the end of therapy. This included both people who completed therapy and those who dropped out. As part of the standard assessment process, the RTQ was administered to 349 participants (69.6% female and 30.4% male; mean age 37.1 years; 90.5% Caucasian) who were patients at a psychological therapy service for common mental health difficulties.

An initial 12-item scale was reduced to 6 items. This scale significantly correlated with post-therapy PHQ-9 and GAD-7 scores and changes in these scores across therapy. After controlling for baseline scores and demographic variables, a logistic regression showed that scores on this 6-item measure pre-therapy significantly predicted three outcome variables: completing therapy, being recovered on both PHQ-9 and GAD-7 post-therapy, and having a reliable change in both the PHQ-9 and GAD-7 post-therapy. However, receiver operating characteristic (ROC) curve analysis showed the measure had poor sensitivity and specificity. Symptom severity did not have a significant impact on motivation to change.

The RTQ is potentially a valid measure with useful clinical applications in treatment of common mental health difficulties.

Hearing about trauma can leave a mark on an individual, leading to a significant change in worldview that shatters their existing beliefs and is pervasive across view of self, other and the world. Individuals present with a range of symptoms that mimic post-traumatic stress disorder although the symptoms are less severe. Despite this, some individuals can experience growth through an enriched understanding of self and other. This altered perspective enables individuals to respond in ways that promote growth and positivity in their own lives.

The aim of this review was to synthesise existing qualitative literature exploring how therapists experience working with trauma survivors.

A systematic literature search found 16 studies which were selected for review following the application of inclusion/exclusion criteria and quality appraisal. Noblit and Hare’s (1988) approach to meta-ethnography was followed.

The themes identified outline a cognitive model of vicarious trauma whereby therapists presented with cognitive, emotional, physiological and behavioural ‘symptoms’ due to marked changes in schemata following repeated exposure to trauma. The literature suggests that therapists experience growth and development alongside vicarious trauma through witnessing clients’ resilience and growth.

This meta-ethnographic review suggests that the impact of working with trauma is profound and complex for therapists bearing witness to their client’s pain and concurrently, their growth.

Trait boredom is associated with several internalizing and externalizing problems. Addressing existing research gaps in the field, the present study investigated the map of cognitive processes for boredom, based on the rational emotive behaviour therapy model (REBT).

The general aim of the study was to investigate the organization of irrational and rational evaluative cognitions related to boredom, and the association between boredom and depression symptoms and state/trait anxiety.

The 233 participants (84% women) completed online scales of evaluative cognitions, trait boredom, trait/state anxiety and depression. Multiple mediation models via the SPSS extension PROCESS were employed.

The REBT psychopathology and psychological health models were partially confirmed, as the evaluative primary cognitions predicted positively and significantly the secondary ones in both cases. Low frustration tolerance (LFT) and global evaluations (GE), and frustration tolerance (FT), respectively, had significant effects. We found a positive significant association between boredom proneness and the negative dysfunctional emotions investigated.

Both results offer further support for the hierarchy of cognitions and the distinction between the level of irrationality and rationality in REBT. This is the first attempt to assess a cognitive map of boredom, underlining the importance of (L)FT in relation to boredom. The significance of GE in boredom suggests that people might see themselves responsible, or even blame themselves, others or life itself while bored. The associations of boredom with anxiety and depression are relevant, as its role in those contexts is not yet fully understood.

There is considerable evidence indicating that similar aetiological and maintenance processes underlie depressive and anxious psychopathology. According to the literature, perfectionism and emotion regulation are two transdiagnostic constructs associated with symptoms of emotional disorders.

This study is the first randomized controlled trial comparing the efficacy of cognitive behavioural therapy for perfectionism (CBT-P) and the unified protocol for the transdiagnostic treatment of emotional disorders (UP).

Seventy-five participants with a range of depressive and anxiety disorders and elevated perfectionism were randomized to three conditions: CBT-P, UP or a waitlist control (WL).

Repeated measures ANOVA indicated that the treatment groups reported a significantly greater pre–post reduction in the severity of symptoms of disorders, as well as a significantly greater pre–post increase in quality of life, all with moderate to large effect sizes compared with the WL group. Treatment gains were maintained at 6-month follow-up. The CBT-P group reported a significantly greater pre–post reduction in perfectionism compared with UP, and the UP group reported a significantly greater pre–post improvement in emotion regulation compared with CBT-P.

Findings support CBT for perfectionism and regard UP as efficacious treatments for individuals with depression and anxiety disorders who also have dysfunctional perfectionism. It appears that perfectionism cannot be a serious obstacle to UP. As this is a preliminary study and has some limitations, it is recommended that further research be conducted.

Catastrophic cognitive appraisals, similar to those in anxiety disorders, are implicated in depersonalisation, a form of dissociation. No scales exist to measure appraisals of dissociative experiences. Dissociation is common in psychosis. Misinterpretations of dissociative experiences may maintain psychotic symptoms. Therefore, assessing appraisals in this context may be valuable.

The primary aim was to develop a measure of key appraisals of dissociation in psychosis. Secondary aims were to test the relationship between appraisals and psychotic experiences (paranoia and hallucinations), and determine whether appraisals explain additional variance in psychotic symptoms above dissociative symptoms.

Fifty items were generated from transcripts of interviews with patients. The measure was developed and psychometrically validated via factor analysis of data from 9902 general population participants and 1026 patients with psychosis. Convergent validity, test–re-test reliability, and internal reliability were assessed. Regression analyses tested relationships with psychotic symptoms.

A 13-item single-factor measure was developed. Factor analysis indicated good model fit [χ2(65) = 247.173, comparative fit index (CFI) = 0.960, root mean square error of approximation (RMSEA) = 0.052]. The scale had good convergent validity with a rumination (non-clinical: r = 0.71; clinical: r = 0.73) and dissociation measure (r = 0.81; r = 0.80), high internal consistency (α = 0.93; α = 0.93), and excellent 1-week test–re-test reliability [intraclass correlation (ICC) = 0.90]. It explained variance in psychotic symptoms (paranoia: 36.4%; hallucinations: 35.0%), including additional variance compared with dissociation alone (paranoia: 5.3%; hallucinations: 2.3%).

The Cognitive Appraisals of Dissociation in Psychosis (CAD-P) measure is a psychometrically robust scale identifying appraisals of dissociative experiences in psychosis and is associated with the presence of psychotic experiences. It is likely to prove useful for clinical assessment and research.

Self-esteem is a common factor in many mental health problems, including anxiety and depression. A cognitive behavioural therapy (CBT)-based protocol called ‘Overcoming Low Self-Esteem’ is available; the use of this protocol in a group format has been associated with improvements in self-esteem. However, it is unclear whether improvements persist after the end of a group-based version of this programme.

We aimed to assess whether changes in self-esteem, anxiety and depression persist 3 months after the end of a group version of the Overcoming Low Self-Esteem programme.

Using data from the National Health Service in Fife, Scotland, we analysed whether there were improvements on self-report measures of self-esteem, anxiety and depression from the beginning of the group to the end of the group and at a follow-up session 3 months later.

Significant improvements in self-esteem, anxiety and depression are maintained at 3 months follow-up.

The Overcoming Low Self-Esteem group seems to be associated with improved self-esteem, anxiety and depression. However, further research from randomised controlled trials is needed to establish a causal link between the programme and improved psychological outcomes.

This was a multi-site evaluation of psycho-educational transdiagnostic seminars (TDS) as a pre-treatment intervention to enhance the effectiveness and utilisation of high-intensity cognitive behavioural therapy (CBT).

To evaluate the effectiveness of TDS combined with high-intensity CBT (TDS+CBT) versus a matched sample receiving CBT only. Second, to determine the consistency of results across participating services which employed CBT+TDS. Finally, to determine the acceptability of TDS across patients with different psychological disorders.

106 patients across three services voluntarily attended TDS while on a waiting list for CBT (TDS+CBT). Individual and pooled service pre–post treatment effect sizes were calculated using measures of depression, anxiety and functional impairment. Effectiveness and completion rates for TDS+CBT were compared with a propensity score matched sample from an archival dataset of cases who received high-intensity CBT only.

Pre–post treatment effect sizes for TDS+CBT were comparable to the matched sample. Recovery rates were greater for the group receiving TDS; however, this was not statistically significant. Greater improvements were observed during the waiting-list period for patients who had received TDS for depression (d = 0.49 compared with d = 0.07) and anxiety (d = 0.36 compared with d = 0.04).

Overall, this new evidence found a trend for TDS improving symptoms while awaiting CBT across three separate IAPT services. The effectiveness of TDS now warrants further exploration through an appropriately sized randomised control trial.

Late-life depression issues in developing countries are challenging because of understaffing in mental health. Cognitive behavioural therapy (CBT) is effective for treating depression.

This pilot trial examined the adherence and effectiveness of an eight-session adapted CBT delivered by trained lay health workers for older adults with depressive symptoms living in rural areas of China, compared with the usual care.

Fifty with screen-positive depression were randomly assigned to the CBT arm or the care as usual (CAU) arm. The primary outcomes were the session completion of older adults and changes in depressive symptoms, assessed using the Geriatric Depression Scale (GDS).

The majority (19/24) of participants in the CBT arm completed all sessions. Mixed-effect linear regression showed that the CBT reduced more GDS scores over time compared with CAU.

Lay-delivered culturally adapted CBT is potentially effective for screen-positive late-life depression.