Background: Mindfulness-based therapy (MBT) has been demonstrated to be effective for reducing chronic pain symptoms; however, the use of MBT for Chronic Tension-Type Headache (CTH) exclusively has to date not been examined. Typically, MBT for chronic pain has involved an 8-week program based on Mindfulness Based Stress Reduction. Recent research suggests briefer mindfulness-based treatments may be effective for chronic pain. Aims: To conduct a pilot study into the efficacy of brief MBT for CTH. Method: We conducted a randomized controlled trial of a brief (6-session, 3-week) MBT for CTH. Results: Results indicated a significant decrease in headache frequency and an increase in the mindfulness facet of Observe in the treatment but not wait-list control group. Conclusion: Brief MBT may be an effective intervention for CTH.

Background: The current study examined whether yoga would increase levels of mindfulness in a healthy population. Method: Forty-six participants were randomly assigned to an 8-week yoga intervention group or a wait-list control group. Mindfulness was assessed pre and post yoga, using the Freiburg Mindfulness Inventory (FMI). Results: Results indicate that the yoga group experienced a significant increase in Overall mindfulness, and in three mindfulness subscales; Attention to the present moment, Accepting and open attitudes toward experience, and Insightful understanding (p < .01). The control group experienced a significant increase in overall mindfulness (p < .02) and insightful understanding (p < .01). Findings suggest that a yoga intervention may be a viable method for increasing levels of trait mindfulness in a healthy population, potentially implicating yoga as a preventive method for the later development of negative emotional mood states (i.e. anxiety and depression). The control group also experienced moderate elevations of mindfulness at the second assessment.

Background: There is sufficient research evidence in favour of cognitive therapy in western world. However, only limited research has been carried out on its effectiveness in other countries. It is suggested that adaptations in content, format and delivery are needed before CBT can be employed in non-western cultures. We describe a preliminary evaluation of culturally adapted CBT for depression in Pakistan. Aims: We aimed to evaluate the efficacy of this culturally adapted CBT using a therapist manual. Method: In a randomized controlled trial we compared combination of CBT and antidepressants with antidepressants alone (treatment as usual) in primary care. Referred patients with ICD-10 diagnosis of depression were invited to participate and randomized to the intervention and control groups. Hospital Anxiety and Depression Scale (HADS) and Bradford Somatic Inventory (BSI) were used to measure changes in depression, anxiety and somatic symptoms. Results: Seventeen patients each were randomized to each arms of the trial. Except for financial status there were no differences between the two groups on various demographic variables. Patients receiving CBT showed statistically significant improvement on measures of depression (p < .001), anxiety (p < .001) and somatic symptoms (p < .000) as compared to antidepressant alone group. 82% patients attended six or more sessions of therapy. Conclusions: A culturally sensitive manualized CBT was effective in reducing symptoms of depression and anxiety in Pakistan.

The present study had two purposes: 1) to examine the relationship between tendency to experience obsessional intrusive thoughts and tendency to worry; 2) to replicate and extend earlier findings (Purdon and Clark, 1993, 1994) on appraisal and thought suppression strategies in the persistence and control of obsessional intrusive thoughts. A sample of 160 college students were administered the Revised Obsessional Intrusions Inventory (ROII), the Penn State Worry Questionnaire (PSWQ), the Beck Depression Inventory (BDI), and the White Bear Suppression Inventory (WBSI). The ROII total score had minimal association with worry, trait thought suppression, or depressive symptoms, thereby supporting the distinctiveness of obsessional intrusive thoughts. Hierarchical multiple regression analyses revealed that cognitive appraisal, especially worries that the intrusion might come true in real life, accounted for a significant amount of variance in thought frequency and controllability. Thought suppression strategies accounted for substantially less variance in both frequency and control of intrusive thoughts. The results are discussed in terms of their support for Rachman's (1993) and Salkovskis' (1985, 1989) theories regarding the role of personal responsibility in the persistence of obsession-like intrusive thoughts.

The delivery of cognitive behaviour therapy (CBT) in the UK has moved through two phases. In the first phase specialist practitioners delivered bespoke CBT to individuals often experiencing complex and longer-lasting problems. This phase has been characterized by waiting lists and a high quality service delivered to a few. In the second phase of service delivery CBT has begun to be delivered in all sorts of different formats, including CBT self-help/guided CBT, behavioural activation, computerized CBT and group based CBT that aim to increase access to CBT delivered in these ways. It remains unclear how these varying models – “high intensity” (phase 1) and “low intensity” (phase 2) should relate – and even who does best with each. There are implicit assumptions by practitioners reflected in language such as “stepping up/down” that assumes high intensity working is superior in some way to low intensity. Few studies have however examined this in depth and what studies there are suggest these beliefs may be incorrect for many. How these new ways of working will be introduced, evaluated and integrated into existing services currently remains a challenge. A helpful way of resolving some of these issues is to view CBT using a learning/teaching paradigm. In this the focus is primarily on how the client wishes to learn to tackle their problems. This provides a helpful way for both introducing different and new ways of working, and also maintaining a focus on the client's needs at the centre of service development. Crucially, phase two CBT working does not replace phase one. How the two approaches complement each other and compare will be two of the interesting questions to be addressed over the next few years.

People with sleep-onset insomnia commonly attribute their difficulty falling asleep to intrusive thoughts, worries, or “a racing mind”. Previous research has implicated strategies of thought control in the maintenance of symptoms in a number of psychological disorders. The purpose of the present study was to compare individuals diagnosed with insomnia (n = 30) and good sleepers (n = 29) for the strategies employed to manage cognitive activity during the pre-sleep period. Reappraisal, worry, and suppression were employed more by participants with insomnia than by good sleepers. Good sleepers employed social control, replacement, suppression, and reappraisal strategies most frequently, whereas the strategies most frequently employed by insomniacs were suppression and reappraisal. The results are discussed in terms of the role of strategies employed to manage pre-sleep cognitive activity in the maintenance and reversal of insomnia.

Background: Psychiatric staff play a key role in the lives of people with psychosis and the quality of staff and service user relationships is associated with relapse and recovery. One factor that might determine the capacity of staff to form positive therapeutic relationships is their appraisals of service users' mental health problems. Method: A pilot intervention was implemented with psychiatric staff that involved helping them develop psychological formulations for individual service users. Staff perceptions of service users' mental health problems were measured before and after the intervention using Likert scales. Data at the two time points were collated for 30 staff. Results: There was a significant increase in staff perceptions of the degree of control service users and themselves had over problems, an increase in the degree of effort they felt service users were making in coping, reductions in blame, and more optimism about treatment. Staff also reported an increase in understanding of service users' problems, more positive feelings towards service users, and an increase in confidence in their work. Conclusions: Results from this pilot are promising, but findings warrant replication in controlled studies. It is also important to establish whether changes in staff perceptions influence the actual nature of staff-service user relationships.

Five patients suffering from chronic and distressing psychotic symptoms were treated with a cognitive-behavioural approach designed to modify their beliefs that their auditory hallucinations were real, and to enhance their ability to control psychotic experiences. Four of the patients reported an increase in their ability to control hallucinations, but only one of these also reported a decreased frequency of hallucinating and a reduced belief in the reality of hallucinations. The discussion focusses on the implications for future interventions in this area.

The reformulated balanced states of mind (BSOM) model (Schwartz, 1997) proposed new cognitive-affective set-point ratios based on a mathematical model of consciousness (Lefebvre, 1990) to differentiate among pathological, normal and optimal balances. Using data derived from the Affects Balance Scale (Derogatis, 1975), the reformulated set-points were empirically evaluated by tracking changes in affect balance SOM (ratio of positive to total affect) in 66 depressed male outpatients undergoing cognitive-behavior therapy (n = 45) or pharmacotherapy (n = 21). Confidence interval estimations indicated that across treatments both remitted (SOM = .35) and unremitted (SOM = .35) patients had pathological pretreatment affect balances near the predicted set-point (.38). At post-treatment, affect balance for remitted patients (SOM = .74) progressed to a normal dialogue near the predicted set-point (.72), whereas unremitted patients maintained a negative balance (SOM = .41). Using Hamilton and Global Assessment Scale ratings, remitted patients were classified into average and optimal responders. At post-treatment, average responders achieved an affect balance (SOM = .70) near the normal dialogue set-point (.72), whereas optimal responders progressed to an affect balance (SOM = .81) at the optimal dialogue set-point (.81), supporting the theoretical distinction between normal and optimal balance. A mathematically generated measure that distinguishes normality and optimality permits increased quantitative precision in comparative psychotherapy outcome research.

Background: Previous research suggests that the distress experienced by clinical voice hearers is associated with the perceived relationship between voice and hearer, independent of beliefs about voices and depression. Aims: This study aimed to replicate these findings and generate further hypotheses by comparing the voice hearing experiences of clinical and non-clinical hearers. Method: A cross-sectional, quantitative design was employed and used between-subjects and correlational methods. Thirty-two clinical voice hearers and 18 non-clinical voice hearers were assessed using the PSYRATS, the Voice and You questionnaire, the Beliefs About Voices Questionnaire – Revised, and the Beck Depression Inventory-II. Results: For clinical voice hearers, distress was significantly associated with perceptions of the voice as dominating and intrusive, and hearers distancing themselves from the voice. However, these associations were not independent of beliefs about voices’ omnipotence or malevolence. Non-clinical voice hearers were significantly less distressed than clinical voice hearers and voices were perceived as less dominant, intrusive, malevolent and omnipotent. Non-clinical hearers were found to relate from a position of less distance to voices perceived as benevolent. Conclusions: Findings from previous research were only partially replicated. Clinically, the development of less maladaptive relationships between voice and voice hearer may reduce distress.

The manner in which parents adapt to the experience of caring for a child with an intellectual disability is generally thought to depend upon a range of variables typically conceptualized within multi-dimensional models. This review briefly describes three such models that share significant common features, incorporating child variables, environmental characteristics, and parental cognitive processes as contributors to parental coping styles or parenting stress. The effects of child and environmental characteristics on parenting stress and coping in parents of children with disabilities have been well documented. It is argued, however, that some aspects of cognitive processes in parents of these children have received less attention from researchers. In particular, there has been a large amount of research into parenting self-esteem, parental attributions, and parental locus of control with parents of other groups of children. This research is reviewed, and it is argued that further research into similar cognitions in parents of children with intellectual disabilities is warranted. Finally, the potential clinical implications of such research are examined in relation to behavioural interventions for children's behavioural difficulties. It is suggested that parental cognitions may influence the acceptability of such interventions and also be associated with their effectiveness.

Background: Clinical perfectionism is a risk and maintaining factor for anxiety disorders, depression and eating disorders. Aims: The aim was to examine the psychometric properties of the 12-item Clinical Perfectionism Questionnaire (CPQ). Method: The research involved two samples. Study 1 comprised a nonclinical sample (n = 206) recruited via the internet. Study 2 comprised individuals in treatment for an eating disorder (n = 129) and a community sample (n = 80). Results: Study 1 factor analysis results indicated a two-factor structure. The CPQ had strong correlations with measures of perfectionism and psychopathology, acceptable internal consistency, and discriminative and incremental validity. The results of Study 2 suggested the same two-factor structure, acceptable internal consistency, and construct validity, with the CPQ discriminating between the eating disorder and control groups. Readability was assessed as a US grade 4 reading level (student age range 9–10 years). Conclusions: The findings provide evidence for the reliability and validity of the CPQ in a clinical eating disorder and two separate community samples. Although further research is required the CPQ has promising evidence as a reliable and valid measure of clinical perfectionism.

Thirty-one children, aged 7 to 11 years, were selected on the basis of depressive symptomatology over a two week period, as assessed by self-report questionnaires and a diagnostic interview. Subjects were randomly assigned to one of three groups, namely Social Competence Training (SCT), Attention Placebo Control (APC) and No Treatment Control (NTC). Intervention was conducted on a group basis for eight, weekly sessions. The results indicated a decline in depression scores during the treatment period for subjects in all conditions, and this continued during the two month follow-up period to within the normal range. The SCT programme did not produce significantly greater reductions in depression than either the APC or NTC conditions and was not effective in producing improvements on measures of social competence.

Cognitive models have linked individual differences in the appraisal of traumatic events and their sequelae to the persistence of post-traumatic stress disorder (PTSD). A pilot study investigated this proposal with victims of assault. Eleven assault victims suffering from persistent PTSD and 9 victims who had recovered from PTSD were interviewed retrospectively and compared on potentially relevant cognitive factors. Groups were comparable in terms of characteristics of the assault, gender, age, and initial PTSD severity. Participants with persistent PTSD were less likely than those who had recovered to have engaged in mental planning during the assault and more likely to have experienced mental defeat, and to indicate negative appraisals of their actions during the assault, of others' reactions after the assault, and of their initial PTSD symptoms. They were also more likely to indicate global negative beliefs concerning their perception of themselves, their world or their future. These cognitive factors may maintain PTSD symptoms either directly or by motivating the individual to engage in behaviour that prevents change.

Background: Mindfulness-based Cognitive Therapy (MBCT) is a relapse prevention treatment for major depressive disorder. Method: An observational clinical audit of 39 participants explored the long-term effects of MBCT using standardized measures of depression (BDI-II), rumination (RSS), and mindfulness (MAAS). Results: MBCT was associated with statistically significant reductions in depression from pre to post treatment. Gains were maintained over time (Group 1, 1–12 months, p = .002; Group 2, 13–24 months, p = .001; Group 3, 25–34 months, p = .04). Depression scores in Group 3 did begin to worsen, yet were still within the mild range of the BDI-II. Treatment variables such as attendance at “booster” sessions and ongoing mindfulness practice correlated with better depression outcomes (p = .003 and p = .03 respectively). There was a strong negative correlation between rumination and mindful attention (p < .001), consistent with a proposed mechanism of metacognition in the efficacy of MBCT. Conclusion: It is suggested that ongoing MBCT skills and practice may be important for relapse prevention over the longer term. Larger randomized studies of the mechanisms of MBCT with longer follow-up periods are recommended.

Background: Manualized cognitive-behavioural therapy (MCBT) approaches to treating adolescent anxiety and depression have been shown to be effective in recent years, as have MCBT for adult self-harm (SH). Aims: This paper describes the rationale for, development and pilot evaluation of the efficacy of a novel manualized CBT package for adolescent self-harm (SH). It also addresses the acceptability of this treatment package to therapists and patients. Method: Twenty-five adolescents (aged 12–18 years) presenting to a Community Child and Adolescent Mental Health Service (CAMHS) in Greater London with SH behaviour began the “Cutting Down” programme and 16 (64%) completed the treatment. Outcomes were assessed at baseline, at the end of treatment and at 3 month follow up. Results: Significant reductions in self-harm behaviour, depression symptoms and trait anxiety were reported. There was no change in state anxiety or in levels of parental expressed emotion as perceived by the adolescent. Conclusion: These pilot findings provide preliminary support for the efficacy and acceptability of this time-limited CBT package for adolescents who self-harm.

Background: Behavioural parent training is effective in improving child disruptive behavioural problems in preschool children by increasing parenting competence. The indicated Prevention Programme for Externalizing Problem behaviour (PEP) is a group training programme for parents and kindergarten teachers of children aged 3–6 years with externalizing behavioural problems. Aims: To evaluate the effects of PEP on child problem behaviour, parenting practices, parent-child interactions, and parental quality of life. Method: Parents and kindergarten teachers of 155 children were randomly assigned to an intervention group (n = 91) and a nontreated control group (n = 64). They rated children's problem behaviour before and after PEP training; parents also reported on their parenting practices and quality of life. Standardized play situations were video-taped and rated for parent-child interactions, e.g. parental warmth. Results: In the intention to treat analysis, mothers of the intervention group described less disruptive child behaviour and better parenting strategies, and showed more parental warmth during a standardized parent-child interaction. Dosage analyses confirmed these results for parents who attended at least five training sessions. Children were also rated to show less behaviour problems by their kindergarten teachers. Conclusions: Training effects were especially positive for parents who attended at least half of the training sessions. Abbreviations: CBCL: Child Behaviour Checklist; CII: Coder Impressions Inventory; DASS: Depression anxiety Stress Scale; HSQ: Home-situation Questionnaire; LSS: Life Satisfaction Scale; OBDT: observed behaviour during the test; PCL: Problem Checklist; PEP: prevention programme for externalizing problem behaviour; PPC: Parent Problem Checklist; PPS: Parent Practices Scale; PS: Parenting Scale; PSBC: Problem Setting and Behaviour checklist; QJPS: Questionnaire on Judging Parental Strains; SEFS: Self-Efficacy Scale; SSC: Social Support Scale; TRF: Caregiver-Teacher Report Form

Research has shown an important link between depression and rumination. This study set out to explore depression-focused rumination and anger-focused rumination in relation to shame and entrapment, and depression. 166 undergraduate students completed a battery of self-report questionnaires measuring current depression, rumination on depressive symptoms, rumination on anger, and the frequency of shame-focused and entrapment-focused thoughts. Both depression-focused and anger-focused rumination were related to depression, and to the frequency of shame and entrapment thoughts. In a mediational model, the link between depression-focused rumination and depression was partially mediated by feeling trapped by, and wanting to escape from, one's thoughts and feelings. Thus the link between rumination and depression is complex. Although rumination may contribute to depression by generating a spiral of negative thinking and negative feeling, feeling trapped and unable to control one's rumination, and being flight motivated, may add a further dimension to the depressogenic qualities of rumination.

Background: Reassurance seeking is particularly prominent in obsessive-compulsive disorder (OCD) and may be important in OCD maintenance. Aims: This study used a new self-report questionnaire to measure the range of manifestations of reassurance-seeking behaviours, describing their sources from which they seek, frequency, process (how they seek), and consequences (as opposed to triggers and motivations). This study also attempts to identify the degree to which reassurance is specific to OCD as opposed to panic disorder. Method: Reassurance Seeking Questionnaire (ReSQ) was administered to 153 individuals with OCD, 50 individuals with panic disorder with/without agoraphobia, and 52 healthy controls. The reliability and validity of the measure was evaluated and found to be satisfactory. Results: Reassurance seeking was found to be more frequent in both anxiety disorders relative to healthy controls. Individuals diagnosed with OCD were found to seek reassurance more intensely and carefully, and were more likely to employ “self-reassurance” than the other two groups. Conclusions: Further investigation of reassurance will enable better understanding of its role in the maintenance of anxiety disorders in general and OCD in particular.

Depression, anxiety disorders and phobias are common mental health problems associated with considerable occupational and interpersonal impairment. Although there is substantial evidence to support the use of cognitive behaviour therapy (CBT) in the treatment of these disorders, access is limited. Computerized cognitive behaviour therapy (CCBT) is one of a variety of aids to self-management that offer patients the potential benefits of CBT with less therapist involvement than therapist led CBT (TCBT). In this systematic review of the efficacy of CCBT, 16 studies were identified. Of these 11 were RCTS and the remaining 5 were pilot or cohort studies. The quality of studies ranged from poor to moderate (although the criteria used precluded the highest rating). In the studies comparing CCBT with TCBT, five studies showed CCBT have equivalent outcomes to TCBT. One study of depressed inpatients found TCBT to be significantly more effective than CCBT. Four studies found CCBT to be more effective than treatment as usual (TAU). Two studies found CCBT to be no more effective than TAU. Two studies compared CCBT with bibliotherapy. Of these, one study found CCBT to be as effective as bibliotherapy and one found bibliotherapy to be significantly more effective than CCBT on some outcome measures. Although the results of this review are not conclusive, CCBT is potentially useful in the treatment of anxiety disorders, depression and phobias. From the results of this review, we make three recommendations to improve the quality of research in this field, and suggest four areas requiring further research.