Empirical research demonstrates the short- to medium-term efficacy and effectiveness of cognitive behavioural group therapy (CBGT) for social anxiety disorder (SAD). Little is known about the durability of gains beyond 1 year following treatment in real-life clinical settings. Literature regarding the impact of aftercare programs as an adjunct to CBGT treatment on SAD is scarce.

To evaluate the long-term effectiveness of CBGT for SAD in a community sample and to explore the relationship between long-term treatment outcomes and aftercare support group attendance.

A longitudinal cohort design evaluated changes in standardized psychological measures assessing aspects of SAD, anxiety and depression. Questionnaires were completed before the program (time 1, N = 457), after the program (time 2, n = 369) and at an average of 4.6 years follow-up (time 3, n = 138).

Large treatment effect sizes at post-intervention were maintained at long-term follow-up on measures of SAD, anxiety and depression. There was no statistically significant relationship between frequency of attendance at an aftercare support group and degree of improvement from post-treatment severity on any measure.

CBGT is an effective intervention in the long-term in a routine clinical setting and should be considered a viable treatment option for SAD. Recommendations for future research, treatment implications and study limitations are considered.

Cognitive behavioural therapy (CBT) is an effective psychological treatment for major depressive disorder, although some patients experience a return of symptoms after finishing therapy. The ability to predict which individuals are more vulnerable to deterioration would allow for targeted interventions to prevent short-term relapse and longer-term recurrence.

This systematic review and meta-analysis aimed to identify factors associated with an increased risk of relapse and/or recurrence (RR) after CBT for depression.

We reviewed 13 relevant papers, of which a small set of unique samples were eligible for meta-analysis (k = 5, N = 369). Twenty-six predictor variables were identified and grouped into seven categories: residual depressive symptoms; prior episodes of depression; cognitive reactivity; stressful life events; personality factors; clinical and diagnostic factors; demographics.

Meta-analyses indicated that residual depressive symptoms (r = 0.34 [0.10, 0.54], p = .01) and prior episodes (r = 0.19 [0.07, 0.30], p = .002) were statistically significant predictors of RR, but cognitive reactivity was not (r = 0.18 [−0.02, 0.36], p = .08). Other variables lacked replicated findings. On average, 33.4% of patients experienced RR after CBT.

Patients with the above risk factors could be offered evidence-based continuation-phase interventions to enhance the longer-term effectiveness of CBT.

The principles of the Armed Forces Covenant state that Armed Forces Veterans should be at no disadvantage resulting from their service compared with a general adult population. However, despite being at increased risk of experiencing common mental health difficulties, evidence indicates that 82% of Armed Forces Veterans receive no treatment, compared with 63% of the general adult population.

To gain a better appreciation of factors that inform the type of adaptations to cognitive behavioural therapy (CBT) interventions for depression and mainstream service promotion materials to enhance acceptability for Armed Forces Veterans.

This is a qualitative study employing a focus group of 12 participants to examine the main impacts of depression on Armed Forces Veterans alongside attitudes towards terminology and visual imagery. Thematic analysis was used to identify themes and sub-themes with rigour established through two researchers independently developing thematic maps to inform a final agreed thematic map.

A behavioural activation intervention supporting re-engagement with activities to overcome depression had good levels of acceptability when adapted to reflect an Armed Forces culture. Preferences regarding terminology commonly used within CBT adapted for Armed Forces Veterans were identified. Concerns were expressed with respect to using imagery that emphasized physical rather than mental health difficulties.

There is the need to consider the Armed Forces community as a specific institutional culture when developing CBT approaches with potential to enhance engagement, completion and recovery rates. Results have potential to inform the practice of CBT with Armed Forces Veterans and future research.

Cognitive processing therapy (CPT) is an effective treatment for posttraumatic stress disorder (PTSD), including for veterans with military sexual trauma (MST)-related PTSD. Most CPT research to date has focused on pre- to post-treatment change in total PTSD symptoms; however, PTSD symptom criteria may not change equivalently over the course of treatment. For example, changes in re-experiencing symptoms have been shown to precede changes in other PTSD criteria during other PTSD treatments (i.e. virtual reality exposure therapy, venlafaxine ER). An improved understanding of the mechanism of change in PTSD symptoms during CPT may assist in optimizing treatment.

The purpose of this study was to identify the pattern and temporal precedence of change in PTSD symptom criteria during and after CPT using cross-lagged panel analyses.

Data from veterans (n = 32) enrolled in a randomized clinical trial investigating the effectiveness of CPT for MST-related PTSD were utilized for this secondary analysis. Using hierarchical linear modelling, each symptom criterion was entered as a predictor of subsequent change in the other PTSD symptom criteria.

All symptom criteria followed a logarithmic pattern of change. Hyperarousal symptoms were found to both predict and temporally precede change in avoidance symptoms, but not re-experiencing symptoms. Re-experiencing and avoidance symptoms did not predict change in other PTSD symptom criteria.

These findings provide initial support that targeting and reducing hyperarousal symptoms may be a key component of PTSD intervention with CPT. Additional research is needed to identify factors that predict change in PTSD-related re-experiencing symptoms.

Cognitive behavioural therapy (CBT) is an evidence-based treatment for chronic fatigue syndrome (CFS). Stepped care for CFS, consisting of a minimal intervention followed by face-to-face CBT, was found efficacious when tested in a CFS specialist centre. Stepped care implemented in a community-based mental health centre (MHC) has not yet been evaluated.

(1) To test the effectiveness of stepped care for CFS implemented in a MHC at post-treatment and at long-term follow-up; and (2) compare post-treatment outcomes of implemented stepped care with treatment outcomes of a CFS specialist centre.

An uncontrolled study was used to test effectiveness of stepped care implemented in a MHC (n = 123). The outcomes of implemented care were compared with the outcomes of specialist care reported in previous studies (n = 583). Data on outcomes from implemented stepped care were gathered at post-treatment and at long-term follow-up. Mixed models were used as method of analysis.

Fatigue decreased and physical functioning increased significantly following implemented stepped care (both p < .001). The follow-up was completed by 94 patients (78%) within 1–6 years after treatment. Treatment effects were sustained to follow-up. Patients in the MHC showed less improvement directly following stepped care compared with patients in a CFS specialist centre (p < .01).

Implemented stepped care for CFS is effective with sustained treatment gains at long-term follow-up. There is room for improvement when compared with outcomes of a CFS specialist centre. Some suggestions are made on how to improve stepped care.

Psychological treatments provide many benefits for patients with psychiatric disorders, but research also suggests that negative effects might occur from the interventions involved. The Negative Effects Questionnaire (NEQ) has previously been developed as a way of determining the occurrence and characteristics of such incidents, consisting of 32 items and six factors. However, the NEQ has yet to be examined using modern test theory, which could help to improve the understanding of how well the instrument works psychometrically.

The current study investigated the reliability and validity of the NEQ from both a person and item perspective, establishing goodness-of-fit, item bias, and scale precision.

The NEQ was distributed to 564 patients in five clinical trials at post-treatment. Data were analysed using Rasch analysis, i.e. a modern test theory application.

(1) the NEQ exhibits fairness in testing across sociodemographics, (2) shows comparable validity for a final and condensed scale of 20 instead of 32 items, (3) uses a rating scale that advances monotonically in steps of 0 to 4, and (4) is suitable for monitoring negative effects on an item-level.

The NEQ is proposed as a useful instrument for investigating negative effects in psychological treatments, and its newer shorter format could facilitate its use in clinical and research settings. However, further research is needed to explore the relationship between negative effects and treatment outcome, as well as to test it in more diverse patient populations.

Research indicates that people suffering from obsessive compulsive disorder (OCD) possess several cognitive biases, including a tendency to over-estimate threat and avoid risk. Studies have suggested that people with OCD not only over-estimate the severity of negative events, but also under-estimate their ability to cope with such occurrences. What is less clear is if they also miscalculate the extent to which they will be emotionally impacted by a given experience.

The aim of the current study was twofold. First, we examined if people with OCD are especially poor at predicting their emotional responses to future events (i.e. affective forecasting). Second, we analysed the relationship between affective forecasting accuracy and risk assessment across a broad domain of behaviours.

Forty-one OCD, 42 non-anxious, and 40 socially anxious subjects completed an affective forecasting task and a self-report measure of risk-taking.

Findings revealed that affective forecasting accuracy did not differ among the groups. In addition, there was little evidence that affective forecasting errors are related to how people assess risk in a variety of situations.

The results of our study suggest that affective forecasting is unlikely to contribute to the phenomenology of OCD or social anxiety disorder. However, that people over-estimate the hedonic impact of negative events might have interesting implications for the treatment of OCD and other disorders treated with exposure therapy.

Individuals with generalized anxiety disorder (GAD) have elevated intolerance of uncertainty (IU) and anger, and IU mediates the relationship between GAD symptoms and anger.

The current pilot study examined whether group cognitive behavioural therapy (CBT) improves anger in people with GAD, and the degree to which change in IU mediates improved anger.

Individuals diagnosed with GAD completed measures of worry, IU, and facets of anger, before and at the end of group CBT for GAD.

Worry, IU, and internally felt and outwardly expressed anger, reduced significantly over treatment, but anger control (inwardly and outwardly) did not. CBT for GAD led to improvement in both internally felt and outwardly expressed anger, even though anger is not directly targeted in this treatment. Improvement in IU significantly mediated improvement in internally felt and outwardly expressed anger.

This preliminary study contributes to the literature on the importance of IU in understanding worry and other symptoms such as elevated anger, experienced by people with excessive worry.

Models of social anxiety suggest that intrusive images/memories are common in social anxiety and contribute to the maintenance of social anxiety.

We examined the context and phenomenological features of intrusive social images using quantitative and qualitative measures across various levels of social anxiety.

Undergraduate students (n = 191) completed measures of social anxiety (i.e. Social Interaction Anxiety Scale and Social Phobia Scale) and wrote a description of an intrusive social image. Individuals who reported an intrusive social image (n = 77) rated the frequency, interference and phenomenological (e.g. vividness, emotional intensity) characteristics of the image. A content analysis of the intrusive image narratives was completed by independent raters.

High social anxiety (HSA) increased the likelihood and frequency of experiencing intrusive images, and to some extent the interference caused by these images. However, the characteristics of these images with regard to their content and quality were similar across levels of social anxiety. Among participants who provided narratives, HSA individuals (n = 34) did not differ from low socially anxious (LSA) individuals (n = 28) in themes that reflect concerns about their own thoughts, actions and behaviours. However, HSA individuals reported greater concerns about how other individuals would react, and their intrusive images were often from an observer perspective when compared with LSA individuals.

These results are interpreted in relation to cognitive models of emotion, memory and cognitive behavioural models of social anxiety.

Cognitive behavioural therapy (CBT) for panic disorder encourages patients to learn about and make changes to thoughts and behaviour patterns that maintain symptoms of the disorder. Instruments to assess whether or not patients understand therapy content do not currently exist.

The aim of this study was to examine if increases within specific knowledge domains of panic disorder were related to improvement in panic symptoms following an intensive 2-day panic treatment.

Thirty-nine Veterans enrolled in an intensive weekend panic disorder treatment completed knowledge measures immediately before the first session of therapy and at the end of the last day of therapy. Four panic disorder experts evaluated items and reached consensus on subscales. Subscales were reduced further to create psychometrically sound subscales of catastrophic misinterpretation (CM), behaviours (BE), and self-efficacy (SE). A simple regression analysis was conducted to determine whether increased knowledge predicted symptom change at a 3-month follow-up assessment.

The overall knowledge scale was reduced to three subscales BE (n = 7), CM (n = 13) and SE (n = 8) with good internal consistency. Veterans’ knowledge of panic disorder improved from pre- to post-treatment. Greater increase in scores on the knowledge assessment predicted lower panic severity scores at a 3-month follow-up. A follow-up analysis using the three subscales as predictors showed that only changes in CM significantly contributed to the prediction.

In an intensive therapy format, reduction in panic severity was related to improved knowledge overall, but particularly as a result of fewer catastrophic misinterpretations.

Veterans are at high risk for suicide; emotion dysregulation may confer additional risk. Dialectical behaviour therapy (DBT) is a well-supported intervention for suicide attempt reduction in individuals with emotion dysregulation, but is complex and multi-component. The skills group component of DBT (DBT-SG) has been associated with reduced suicidal ideation and emotion dysregulation. DBT-SG for Veterans at risk for suicide has not been studied.

This study sought to evaluate the feasibility and acceptability of DBT-SG in Veterans and to gather preliminary evidence for its efficacy in reducing suicidal ideation and emotion dysregulation and increasing coping skills.

Veterans with suicidal ideation and emotion dysregulation (N = 17) enrolled in an uncontrolled pilot study of a 26-week DBT-SG as an adjunct to mental health care-as-usual.

Veterans attended an average 66% of DBT-SG sessions. Both Veterans and their primary mental health providers believed DBT-SG promoted Veterans’ use of coping skills to reduce suicide risk, and they were satisfied with the treatment. Paired sample t-tests comparing baseline scores with later scores indicated suicidal ideation and emotion dysregulation decreased at post-treatment (d = 1.88, 2.75, respectively) and stayed reduced at 3-month follow-up (d = 2.08, 2.59, respectively). Likewise, skillful coping increased at post-treatment (d = 0.85) and was maintained at follow-up (d = 0.91).

An uncontrolled pilot study indicated DBT-SG was feasible, acceptable, and demonstrated potential efficacy in reducing suicidal ideation and emotion dysregulation among Veterans. A randomized controlled study of DBT-SG with Veterans at risk for suicide is warranted.

Kleptomania is a disease that shares features with obsessive compulsive spectrum disorders (OCD) and with substance abuse disorders (SAD). This is underlined by therapeutic approaches in kleptomania ranging from cognitive behavioural therapy and selective serotonin reuptake inhibitors that are effective in OCD, and opioid antagonists that are currently being used in SAD. However, almost no literature exists about exposure and response prevention (ERP) therapy in kleptomania. Furthermore, there is a clear lack of objective markers that would allow a therapeutic monitoring.

To show the effectiveness of ERP therapy in kleptomania in a single case report.

An ERP therapy under real-world conditions and later augmentation with the opioid antagonist naltrexone is described. Continuous measurements of galvanic skin response (GSR) before, during and after therapy sessions are reported in association with changes of the Kleptomania Symptom Assessment Scale (KSAS) self-questionnaire.

While KSAS scores showed a clear treatment response to ERP sessions, the GSR was significantly lower during ERP treatment in comparison with baseline measures. However, during augmentation with naltrexone, GSR measures increased again and clinical severity did not further improve.

This case shows the possible usefulness of ERP-like approaches and therapy monitoring using electrophysiological markers of arousal for individualized treatment in kleptomania.