Chronic childhood adversity, negative life events, and anxiogenic parenting behaviours have all been implicated in the development and maintenance of childhood anxiety disorders. However, few studies have addressed whether these factors are associated with particular types of childhood anxiety disorders.

The aims of this study were to investigate whether specific associations were obtained between specific types of childhood anxiety disorder – namely, social anxiety disorder (SOC), separation anxiety disorder (SEP) and generalized anxiety disorder (GAD) – and the nature of particular forms of psycho-social risk – namely, chronic childhood adversity, negative life events, and particular forms of parenting behaviours.

Two-hundred and ten children (aged 7–12 years) who met diagnostic criteria for SOC, SEP or GAD and their primary caregivers completed questionnaire measures on chronic childhood adversity and negative life events. In addition, dyads participated in two laboratory-based assessments of parent–child interactions.

We found little evidence for disorder specificity for chronic childhood adversity and negative life events, except in the case of separation anxiety disorder. Anxious children with separation anxiety were more likely than children with other forms of anxiety disorders to live with a single parent, experience more frequent parent arguments, and more negative life events. No group differences in observed parenting behaviours were found.

Childhood SEP may be particularly associated with family challenges which may need specific consideration to optimize prevention and/or treatment. Beyond this, there is limited evidence of specific associations between family and environmental factors and specific types of childhood anxiety disorders.

Perfectionism is a transdiagnostic risk factor across psychopathology. The Clinical Perfectionism Questionnaire (CPQ) was developed to assess change in order to provide clinical utility, but currently the psychometric properties of the CPQ with adolescents is unknown.

To assess the factor structure and construct validity of the CPQ in female adolescents.

The CPQ was administered to 267 females aged 14–19 years of age. Confirmatory factor analysis (CFA) was used to examine the validity of the two-factor model and a second-order factor model. Pearson correlations were used to evaluate the relationships between the CPQ and a wide range of measures of perfectionism, psychopathology and personality traits.

The study demonstrated internal consistency, construct validity and incremental validity of the CPQ in a sample of female adolescents. The CFA in the present study confirmed the two-factor model of the CPQ with Factor 1 relating to perfectionistic strivings and Factor 2 representing perfectionistic concerns. The second-order two factor model indicated no deterioration in fit.

The two-factor model of the CPQ fits with the theoretical definition of clinical perfectionism where the over-dependence of self-worth on achievement and concern over mistakes are key elements. The CPQ is suitable for use with female adolescents in future research that seeks to better understand the role of perfectionism in the range of mental illnesses that impact youth.

Cognitive models of psychopathology suggest that negatively biased thinking styles are involved in the development and maintenance of emotional disturbances.

The present study examined the relationships between negative cognitive errors and indices of mental health status (i.e. anxiety and depression) in New Zealand adolescents.

A community sample of 490 youth aged 16–18 years completed an anonymous online survey consisting of the Children’s Negative Cognitive Error Questionnaire (CNCEQ), the Trait subscale of the State-Trait Anxiety Inventory (STAI-T) and the Center for Epidemiologic Studies Depression Scale (CES-D).

Negative cognitive errors correlated positively with greater levels of anxious and depressive symptoms. Hierarchical regression analyses indicated that overall cognitive error score was a strong predictor of adolescents’ self-reported anxious symptoms and, to a lesser extent, depressive symptoms. Moreover, cognitive errors significantly differentiated between adolescents with high scores from adolescents with low scores on both the anxiety (STAI-T) and the depression (CES-D) scales.

These findings lend support to the generalizability of Beck’s cognitive theory to a New Zealand adolescent population and highlight the importance of focusing on prevention and early intervention programmes that directly target these faulty or biased ways of thinking in adolescents with anxious and/or depressive symptoms before meeting diagnostic criteria.

Although internet-based cognitive behaviour therapy (ICBT) is an effective treatment for social anxiety disorder (SAD), a substantial proportion of patients do not achieve clinically significant improvement. More research is needed to identify which factors predict treatment adherence and outcomes.

The aims of this study were to (1) identify demographic and clinical factors associated with treatment adherence and outcomes in ICBT for social anxiety in China, and (2) explore whether low-intensity therapist support results in improved treatment adherence or outcomes.

Participants were assigned to either therapist-guided (N = 183) or self-guided ICBT (N = 72). Level of social anxiety was measured at both pre- and post-treatment. Treatment adherence and outcomes were analysed using a two-step linear and logistic regression approach. Clinical and demographic characteristics were examined.

No significant group differences were found for treatment adherence or outcomes between the therapist-guided and self-guided conditions. Participants diagnosed with SAD were significantly less likely to drop out (OR 0.531, p = .03) compared with subclinical participants with social anxiety symptoms. Older participants (B = 0.17, SE = 0.04, p = .008) and participants with a diagnosis of SAD (B = 0.16, SE = 0.44, p = .01) tended to complete more modules. Participants who completed more modules (B = 0.24, SE = 0.03, p = .01) and participants who identified as female (B = –0.20, SE = 0.18, p = .04) reported greater reductions in SAD symptoms.

Understanding of factors related to adherence and outcome is necessary to prevent drop-out and optimize outcome.

There is evidence that individuals with high levels of social anxiety utilize more safety behaviours and experience more post-event processing than those with lower levels of social anxiety. There are also data to suggest that the relationship between safety behaviour use and social anxiety symptoms is mediated by perceived control of one’s anxiety. Furthermore, it has been suggested that post-event processing influences anticipatory anxiety for a future social situation.

A direct link between the perpetuating factors of social anxiety described above has not been established in the literature. The aim of the current study was to test a model examining the relationship between these constructs.

Participants first completed a battery of questionnaires. They then participated in an impromptu, 3-minute speech and were informed they would be videotaped. Following the speech, participants completed measures of anxiety and were instructed to return the following week. During the second session, they were informed they would deliver an additional speech and provided ratings of their anxiety in anticipation of delivering the second speech.

The results of a serial mediation support that greater levels of social anxiety lead to less perceived control over one’s anxiety, leading to increased safety behaviour use. The increase in safety behaviours led to an increase of post-event processing which resulted in greater anticipatory anxiety for a future speech task.

This study provides novel evidence for the importance of perceived control in the genesis of social anxiety, which has implications for treatment.

Cognitive behavioural models of hypochondriasis assume that dysfunctional illness-related beliefs are involved in the genesis and maintenance of the disorder. The role that other more general dysfunctional beliefs about thoughts play in this disorder has also been highlighted. Internal triggers such as illness-related intrusive thoughts could activate these beliefs.

The present paper examines whether general dysfunctional beliefs about distressing thoughts, such as intolerance of uncertainty, over-estimation of threat, and thought-action fusion-likelihood, mediate between illness-related intrusive thoughts and health anxiety symptoms.

A group of participants composed of individuals with hypochondriasis (n = 31; 51.5% women; mean age = 32.74 years, SD = 9.96) and community individuals (n = 219; 54.3% women; mean age = 39.56 years, SD = 15.20) completed a series of questionnaires to assess illness-related intrusive thoughts (INPIE), dysfunctional beliefs about thoughts (OBSI-R), and health anxiety symptoms (SHAI).

Results from a multiple parallel mediation analysis indicate that over-estimation of threat partially mediated the relationship between illness-related intrusive thoughts and health anxiety symptoms.

The results support the importance of the tendency to over-estimate the threat in the relationship between intrusive thoughts related to illness contents and health anxiety. Conceptual and clinical implications of these results are discussed.

The Salkovskis (1999) model of obsessive compulsive disorder (OCD), which emphasizes the role of inflated responsibility, has proven highly influential in both the understanding and treatment of OCD.

This study aimed to empirically test several core processes of this model.

The individual components of the model were measured using multiple indicators in a sample of undergraduate students (n = 170), and confirmatory factor analyses were used to ascertain the most reliable, valid and theoretically consistent latent variables. Structural equation modelling was used to test proposed relations between latent constructs in the model.

The inflated responsibility model was a good fit for the data in the present sample. As predicted by the model, misinterpretations of intrusive thoughts as indicating personal responsibility fully mediated the relationships between responsibility beliefs and counterproductive safety strategies, neutralizing actions and mood changes.

The Salkovksis (1999) inflated responsibility model of OCD is empirically supported in the present sample of undergraduate students, lending support to the proposed mechanisms in the model and supporting prior evidence.

The relevance of schema theory to psychopathology, in particular personality disorder, in younger adults is established. Investigations into the relevance of schema theory to older adults, however, is highly limited.

To consider the relationship of schema modes to psychopathology in older adults and establish whether maladaptive schema modes are associated with unmet needs and that this relationship is mediated by the healthy adult mode of responding in this population.

One hundred and four older adults were recruited from an established database. Participants completed questionnaires assessing psychopathology, schema modes (YAMI: Young-Atkinson Mode Inventory) and basic psychological needs (BPNS: Basic Psychological Needs Scale – autonomy, competence and relatedness). Ninety-four responses were included after applying exclusion criteria.

The healthy adult schema mode was found to be associated with reduced psychopathology, and maladaptive child modes (angry and vulnerable child) to increased psychopathology. The healthy adult schema mode mediated the relationship between maladaptive child modes and needs satisfaction.

As predicted by schema theory, the presence of one of the maladaptive child modes makes it difficult for an older individual to have their needs met, but the presence of healthy adult mode works to support this process.

Lowering the cost of assessing clinicians’ competence could promote the scalability of evidence-based treatments such as cognitive behavioral therapy (CBT).

This study examined the concordance between clinicians’, supervisors’ and independent observers’ session-specific ratings of clinician competence in school-based CBT and treatment as usual (TAU). It also investigated the association between clinician competence and supervisory session observation and rater agreement.

Fifty-nine school-based clinicians (90% female, 73% Caucasian) were randomly assigned to implement TAU or modular CBT for youth anxiety. Clinicians rated their confidence after each therapy session (n = 1898), and supervisors rated clinicians’ competence after each supervision session (n = 613). Independent observers rated clinicians’ competence from audio recordings (n = 395).

Patterns of rater discrepancies differed between the TAU and CBT groups. Correlations with independent raters were low across groups. Clinician competence and session observation were associated with higher agreement among TAU, but not CBT, supervisors and clinicians.

These results support the gold standard practice of obtaining independent ratings of adherence and competence in implementation contexts. Further development of measures and/or rater training methods for clinicians and supervisors is needed.

It has been proposed that both positive and negative metacognitive beliefs sustain engagement in post-event processing (PEP). However, it is unknown: (1) whether individuals with social anxiety disorder (SAD) actually derive the benefits from PEP that they expect; (2) if this is not the case, how their positive beliefs are maintained; and (3) if they are aware of the counterproductive effects of PEP, why they still perform PEP.

To explore the phenomenology of the processes involved in PEP from the perspective of SADs, in order to address the research questions above.

Twenty-one participants suffering from SAD received individual semi-structured interviews. Transcripts were analysed using thematic analysis.

Analysis revealed three main themes: (1) ‘Only, safe and useful way to improve myself’: SADs feel the need to improve their social performance, and they believe that PEP is the only, safe, and private way to do so, which is an underlying motive for them to do PEP; (2) ‘It hurts more than helps me’: however, through PEP, they do not seem to obtain the benefit that they expect, or only find a variety of counterproductive outcomes; (3) ‘Better safe than sorry’: they sometimes find makeshift solutions to improve their social performance during PEP, which may maintain their PEP as a form of intermittent reinforcement. They weigh up such costs and benefits, and choose to perform PEP while feeling conflicted about PEP.

The results suggest that: (1) SADs rarely obtain the benefits from PEP that they expect; (2) their positive metacognitive beliefs are maintained by solutions they sometimes find during PEP; and (3) SADs choose to perform PEP while feeling conflicted; while PEP ironically maintains and exacerbates negative self-beliefs/images, it is the only safe and useful way to improve their social performance. These findings support and expand on the theories of PEP.

Tendencies to attend to threatening cues in the environment and to interpret ambiguous situations with negative/hostile intent maintain and may even precipitate internalizing and externalizing problems in young people with a history of maltreatment. Challenging maladaptive information-processing styles using cognitive bias modification (CBM) training may reduce symptoms.

To investigate the acceptability of CBM training in nine young people attending alternate education provision units in the UK, and 10 young people living in out-of-home care institutions in Nepal with a history of maltreatment.

CBM training consisted of five sessions of training over a 2-week period; each training session consisted of one module targeting attention biases and one module targeting interpretation biases for threat. A feedback form administered after training measured acceptability. Pre- and post-intervention measures of internalizing and externalizing symptoms were also taken.

Most young people (89%) found the training helpful and 84% found the training materials realistic. There were reductions in many symptom domains, but with individual variation. Although limited by the lack of a control condition, we established generalizability of acceptability across participants from two cultural settings.

Replication of these findings in larger feasibility randomized controlled trials with measures of attention and interpretation bias before and after intervention, are needed to assess the potential of CBM in reducing anxiety symptoms and its capacity to engage targeted mechanisms.

One-third of patients with depression do not respond satisfactorily to treatment, and approximately 20% of all patients treated for depression develop a chronic depression. One approach to more effective treatment of chronic and treatment-resistant depression is to target rumination – an underlying mechanism implicated in the development and maintenance of depression.

The purpose of this uncontrolled group study was to investigate the feasibility of individual rumination-focused cognitive behavioural therapy (RfCBT) for patients with chronic and treatment-resistant depression.

A total of 10 patients with chronic and treatment-resistant depression were offered 12–16 individual sessions of RfCBT. The primary outcome was depressive symptoms as measured by Hamilton Depression Scale at pre-, post- and 3-month follow-up. Secondary symptoms measured included self-reported rumination and worry.

There was a significant reduction in depressive symptoms (p < 0.05), rumination (p < 0.01) and worry (p < 0.5) from pre- to post-treatment. Half of the participants (n = 5) showed significant reliable change on levels of depressive symptoms post-treatment. The reduction in depressive symptoms, rumination and worry were maintained at follow-up.

RfCBT was associated with significant reductions in depressive symptoms in a small sample with chronic and treatment-resistant depression. Despite limitations of being a small uncontrolled study with limited follow-up, these results are promising in a difficult to treat population. RfCBT warrants further systematic evaluation.