A number of studies have demonstrated that patients suffering from PTSD show differences from appropriate controls in psychophysiological responding. This study aimed to investigate whether there were differences in habitu ation and psychophysiological reactivity between PTSD patients and normals, and between patient subgroups depending on their symptoms and whether psychophysiological variables were associated with clinical outcome from a treatment trial. Participants were tested by measuring electrodermal activity to two sets of 15 auditory stimuli of different intensity, and to six vignettes, four neutral, one of general stress and one trauma related. Psychophysiological variables were entered into a multiple regression with clinical outcome as the dependent variable. There were no differences between patients and controls or within patients on the habituation paradigms. Patients differed from controls only on their response to the trauma related vignette. There were no differences on any within patient compar isons. There was no association with these measures and later clinical outcome. Psychophysiological differences between PTSD patients and normal controls are very specifically related to trauma related stimuli. Patients with startle or high arousal symptoms do not show differences from those without. These measures were not related to treatment response.

It has been noted that obsessional patients appear to be equally sensitive to ideas regarding the possibility that they may cause harm by both their actions and by their failure to act (i.e., omission). This observation is discrepant with findings in non-clinical populations. The cognitive theory of obsessive-compulsive disorder suggests that it is the very occurrence of intrusive thoughts about potential harm that mediates this effect. In this study, 22 obsessional patients and 30 non-clinical participants were provided with details of ambiguous situations and either a negative or neutral intrusive thought pertaining to this situation. Behavioural and emotional responses to these situations were rated using self-reported measures. It was found that situations including an intrusive thought about harm were associated with higher intensity behavioural and emotional responses compared with the same situation when the intrusion was neutral. Obsessional participants scored higher overall; only on the rating of perceived responsibility was there an interaction between group and item type. These results are consistent with the idea that the occurrence of an intrusion about harm modifies both obsessional and non-clinical participants' reactions in ways that suggest obsessionality, and support cognitive theories that emphasize that obsessional experiences arise from normal processes.

Studies of in-service training demonstrate repeatedly the difficulty of transferring training to the routine work of the staff. One of the likely explanations for this difficulty is the recurring absence of an educational and organizational needs assessment to guide the training. Such assessments can play a critical role in defining management support, goal setting, the selection of the trainee group and in analysing the readiness of staff in an organization for a training intervention. The present study summarizes and extends prior research in the field of mental health by conducting a comprehensive educational and organizational needs analysis. Six assessment methods were administered to N = 72 staff and 20 clients in a psychiatric hospital, including questionnaires, interviews, direct observations and an audit. The study design was based on a series of naturalistic, cross sectional comparisons between four wards. Significant differences were obtained between the four participating wards, which served to define training needs and to validate the needs assessment procedure. Implications are drawn for needs assessment within a more systematic approach to staff training.

Activation of a depressogenic schema by a negative life event is said to be more likely when the life event corresponds to the same domain of vulnerability (congruency hypothesis). Specifically, this refers to a negative interpersonal event for the sociotropy/dependency schema, and an obstacle or a failure in achieving a goal for the autonomy/accomplishment or self-criticism schema. This study examines the congruency hypothesis for the prediction of relapse. Older patients were followed for 6 months after remission from major depression. Life events were rated as interpersonal or autonomous in nature. Their subjective impact on social relations and on autonomous functioning was also assessed. Congruency between dependency schema and interpersonal events, but only when the subjective impact of event was taken into consideration, predicted relapse. Non-congruency between an autonomous schema and an event rated as impacting the social domain also predicted relapse. However, in both analyses of dependency and autonomy schemas, impact of event on social relations on its own predicted relapse. These findings support the cognitive vulnerability theory of depressive relapse, underlining the importance of considering how the person views the influence of life events and the determining impact of stressful life events on social relations.

Cognitive therapy has traditionally assumed that the therapy relationship provides a necessary context for intervention but is insufficient alone to produce therapeutic change. This assumption is reviewed in the light of up-to-date evidence from research studies of cognitive therapy and recommendations are made for further research. Mechanisms by which the therapy relationship may influence outcome and factors influencing the quality of the relationship are briefly discussed and the need for further research highlighted. Implications for the practice of cognitive therapy are suggested.

Self-help materials can be offered to clients/patients either for use alone (unsupported self-help) or to support work with a health care practitioner (supported self-help). Structured self-help materials that use a Cognitive Behaviour Therapy (CBT) treatment approach have been shown to be clinically effective. We report a national survey of all 500 cognitive and behavioural psychotherapists registered with the British Association for Behavioural and Cognitive Psychotherapies, the lead organisation for CBT in the United Kingdom. A total of 265 therapists responded (53%). Self-help materials were used by 88.7% of therapists and were mostly provided as a supplement to individual therapy. Self-help was most frequently used to help patients experiencing depression, anxiety and obsessive compulsive disorder and was largely delivered using paper-based formats. The majority of self-help materials used a CBT approach. Only 36.2% of therapists had been trained in how to use self-help treatments, and those who had received training recommended self-help treatments to more clients/patients per week and rated self-help approaches as being significantly more helpful than those who had not received training.

We applied Narrative Exposure Treatment (NET) to a severely traumatized Kosovar refugee living in a Macedonian refugee camp during the Balkan War. NET is a pragmatic short-term approach that integrates effective therapeutic components deriving from Cognitive Behaviour Therapy and Testimony Therapy. Outcome was evaluated by clinical examination and the Posttraumatic Stress Diagnostic Scale (PDS). Three sessions of NET were enough to afford considerable relief, although some PTSD symptoms remained. Our experience indicates that Narrative Exposure is a promising and realistic approach for the treatment of even severely traumatized refugees living in camps. In addition, it can prove valid testimonies about human rights violations without humiliating the witness.

Empirical findings and theoretical models posit a central role for an inhibited temperament in the development of anxiety. In turn, this suggests that reduction of withdrawn and inhibited characteristics in very young children may prevent the later development of anxiety disorders. To date, no programs have targeted inhibited temperament as a focus of treatment and it is often assumed that temperament is an immutable phenomenon. The current study piloted a brief education program for the mothers of seven temperamentally withdrawn 4-year-old boys. Results showed marked changes in mothers' perceptions of withdrawn temperament and anxious symptoms that continued over the following 6 months. These data encourage a larger-scale investigation of parent education for the reduction of inhibited temperament in pre-school children.

The psychometric properties of the Stages of Change scales (McConnaughy, Prochaska, & Velicer, 1983) were examined in a clinical sample of clients referred for psychotherapy. Sixty clients completed the Stages of Change scales and the Brief Symptoms Inventory before their first session of psychotherapy. The scales means, standard deviations and high internal consistency (all coefficients exceeding 0.7) compared favourably with previous research conducted by McConnaughy et al. (1983, 1989). The study investigates two methods of interpreting the Stages of Change scales. It discusses the methodological limitations in interpreting the highest scale score, and recommends instead the interpretation of the samples mean scores for the scales. It further assesses the theoretical underpinnings of the scales intercorrelations and argues in support of the “states” of change model proposed by Sutton (1996).

The unusual case of a young mathematics student is described. While studying and at other times he was troubled by intrusive thoughts about the logical foundations of mathematics. A treatment package involving the use of thought stopping, emotional processing and training in study skills is described and some ideas about the treatment of intrusive thought are considered.

Past research has demonstrated that anxiety disorders represent a significant mental health concern. A review of the literature in the area indicates that there is limited information regarding gender differences on the basis of cognitions in clinical or nonclinical samples. The current investigation sought to determine whether any observable gender differences existed in the expression of symptoms, cognitions, and anxiety sensitivity for a nonclinical sample of 48 males and 49 females. Multivariate analyses of variance revealed support for gender differences in the expression of physiological hyperarousal, catastrophic cognitions and a general level of anxiety sensitivity in a nonclinical population. The strengths, limitations, and directions for future research are discussed.

Meta-cognitive observation is a kind of cognitive activity that may serve to interrupt worry, rumination, and other kinds of sleep-interfering cognitive processes. In a pilot study, 40 individuals recorded their sleep on a sleep diary during one week (the baseline week) and were then administered a meta-cognitive observation task to use at bed-time during a second week (“the treatment week”). Consistent with the hypothesis, the participants showed a decreased sleep latency during the treatment week compared to the baseline week, and also an increased total sleep time and an improved sleep efficiency. The lack of a control group (i.e., a group who kept a sleep diary for both weeks, without any meta-cognitive observation task), however, precludes any definite conclusion with regard to the effects of the meta-cognitive observation task. It is suggested that meta-cognitive observation tasks should be tested in controlled studies.

Selecting a convenient response, and a microswitch suitable to it, is critical to successfully introduce students with multiple disabilities to a microswitch-aided programme. This study evaluated the use of a hand-tap response with a vibration microswitch with two students. Both students increased the frequency of the hand-tap response during treatment and maintained such an increase at 3-month follow-up. Procedural issues, practical implications of the findings, and measures for promoting long-term response maintenance/extensions were discussed.

Self-help approaches are popular with patients and can be effective treatments for common mental disorders such as anxiety and depression (Gould & Clum, 1993; Marrs, 1995; Scogin, Bynum, Stephens, & Calhoon, 1990; and Cuijpers, 1997). In spite of this, it is clear that a number of factors should also influence us in how we choose and use self-help materials with our patients.