This special issue is the culmination of an ESRC seminar series grant awarded to the authors of this editorial. We named the seminar series CATTS (Child Anxiety, Theory and Treatment Seminars) and it took the form of six highly stimulating, one-day seminars on the subject of child anxiety, with participants from clinical and academic backgrounds and from Great Britain, Europe, the USA and Australia. Most of the authors in this publication, and a sister special issue in Cognitions and Emotion (2008), participated in the CATTS series.

Following a great deal of careful and thoughtful work by a number of key individuals and organizations, including the BABCP, the initiative to increase access to psychological therapies (IAPT) has become a reality. As the readers of this journal will now know, this is not an exercise in redistributing resources but rather the creation of an entirely new high quality way of delivering evidence-based psychological therapies to the maximum number of people possible, and doing so in their local area.

The journal would be nothing without our strong editorial team; so, thanks and farewell to Craig Steel as Book Review Editor (and to Tracy Johnson who has ably assisted him). Fortunately, we retain Craig as Associate Editor specializing in Psychosis. Also fortunately, we are able to welcome a new book review team: Victoria Oldfield and Fiona Challacombe. I would like to take this opportunity to thank our wonderful team of Specialist Associate Editors for the excellent work they do. Also a big welcome to Manuela Herrera, our new editorial assistant, who has ably taken up her duties and is making everyone's life better and easier!

Controlled efficacy/effectiveness trials throughout the world have reached a high standard from a methodological stance, but what do we regard as the ideal or elegant intervention in clinical psychology? This paper presents six key points as the gold standards of psychosocial interventions by which treatment efficacy/effectiveness research with children, adolescents and adults might be evaluated: (1) Theoretical rationale and conceptualization of clinical dysfunction; (2) Clear problem identification and target client group; (3) Program features such as realistic goal setting, flexibility, and time limited interventions; (4) Manual based treatments; (5) Research support including clinically significant outcomes; and (6) Acceptability/social validation of clients and society. Sound case formulation and therapeutic alliance are crucial to assessment-treatment interface. Finally, we discuss the usefulness of such a framework for mental health professionals and clinical-researchers.

A number of developments make the formal specification of competences in CBT both timely and relevant, in particular the Improving Access to Psychological Therapies (IAPT) programme, the increasing focus on process and therapist variables in determining outcome, and the increasing diversity of CBT. This paper outlines the development of an evidence-based methodology for determining both a model and a framework for CBT competences, and considers issues related to the implementation of the framework.

In 1993 Behavioural and Cognitive Psychotherapy published a supplement edited by Ann Hackmann with the title “Behavioural and Cognitive Psychotherapies: Past History, Current Applications and Future Registration Issues”. This was the journal's first ever supplement and it provided an overview of the state of behavioural and cognitive psychotherapies at that time. It was intended to provide a context for discussions concerning the future of the field, and as Paul Salkovskis said in his editorial, “[the supplement]. . .will be an important reference source for years to come.”

This paper describes the nature of the difficulties faced by asylum seekers and refugees who present with traumatic stress symptoms and uses existing cognitive models to better understand theoretical issues in these cases. The focus is on those people for whom traumatic stress symptoms are their main problem/pre-occupation. It is acknowledged that these people may only form a small proportion of those who have experienced such events. This paper does not focus on the important multicultural issues integral to this work. A possible clinical pathway is presented, including the role of exposure/reliving, and how it may be adapted where necessary for people who have experienced multiple traumatic events, often of prolonged duration. Discussion of possible psychosocial understandings of torture and mass violence may be important in this work. A case example is presented that demonstrates how this clinical pathway might unfold in practice.

Evidence indicates that workshop training, personalized feedback, and individual consultation can increase competence in motivational interviewing (MI) among highly motivated and skilled substance abuse counselors. Little is known, however, about the translational value of these training strategies for counselors with fewer counseling skills and less stated motivation to learn MI. This study presents evidence from a randomized, controlled trial of 129 behavioral health providers assigned to receive workshop training and enrichments to learn MI. A diverse group of Air Force behavioral health providers working in substance abuse treatment programs were trained in MI and subsequently observed in clinical sessions at 4, 8 and 12 months after training. Results indicate that training was effective in increasing the skill level of these clinicians; however, these gains had decreased by the 4-month follow-up point. Training enrichments in the form of personalized feedback and consultation phone calls did not have an expected, additive effect on clinician skill level. The results of this study lend support to the hypothesis that a greater investment of resources and incentives may be necessary to achieve gains in MI skills for counselors with relatively lower baseline skills than those commonly participating in research studies.

CBT is now considered to be a “family” of related therapies. Seven future challenges for CBT are defined and their relationships with one another considered. They are: clarity (shared definitions of CBT and its terminology), coherence (shared therapeutic principles and theory), cohesion (integration of individuals and subgroups using CBT), competence (assessing standards during training and personal development), convenience (accessibility and public awareness), comprehensiveness (applicability to a wide range of problems) and connectivity (links to other disciplines). Key issues concerning the fragmentation of the discipline and difficulties in judging competence are discussed. It is proposed that through improving the clarity, coherence and cohesion of CBT, there would be improvements in the remaining four domains, which would enhance its overarching efficacy and influence on improving public health.

This study investigated whether brief training in cognitive therapy for panic disorder (Clark et al., 1994) can improve the outcomes that primary care therapists obtain with their patients. Seven primary care therapists treated 36 patients meeting DSM-IV (APA, 1994) criteria for panic disorder with or without agoraphobia in general practice surgeries. Outcomes for the cohort of patients whom the therapists treated with their usual methods (treatment-as-usual) before the training (N = 12) were compared with those obtained with similar patients treated by the same therapists after brief training and ongoing supervision in cognitive therapy (CT) for panic disorder (N = 24). Treatment-as-usual led to significant improvements in panic severity, general anxiety, and depression. However, only a small proportion (17% of the intent-to-treat sample) became panic free and there was no improvement in agoraphobic avoidance. Patients treated with CT achieved significantly better outcomes on all measures of panic attacks, including panic-free rate (54%, intent-to-treat), and showed significantly greater improvements in agoraphobic avoidance and patient-rated general anxiety. In conclusion, cognitive therapy for panic disorder can be successfully disseminated in primary care with a brief therapist training and supervision programme that leads to significant improvements in patient outcomes.

This paper describes a cognitive model for first/second onset depression that has been precipitated by major life stress, entrenched for several months and is unresponsive to pharmacotherapy. These conditions create high risks for recurrent/chronic depression and early intervention is proposed to identify, treat and protect against relapse/recurrence. Severe life stress interacts with an individual's core self-representations and personal values, identity is disrupted and depression is maintained by dysfunctional goal engagement and disengagement. Treatment aims to restore functional self-regulation by increasing self-diversification and creating balanced goal investments. Outcome and follow-up data are reported in a case series of five consecutive patients. There was good therapist adherence to the prescribed targets and pre-post effect sizes were comparable or larger than published outcome studies. At the 12 month follow-up, three of the four treatment completers (75%) had made reliable and clinically significant changes and were in full remission. This provides encouraging preliminary evidence for the model's validity and the therapy's efficacy.

Social phobia (SP) is characterized by a fear of one or more social or performance situations. Studies of comorbidity in SP youth find anxiety and affective disorders co-occurring. The present study examined children with primary SP and compared them to children with primary Separation Anxiety Disorder (SAD) or Generalized Anxiety Disorder (GAD) prior to treatment and in response to treatment. The groups differed significantly on self-, parent- and teacher-rated pretreatment measures. Additionally, the two groups showed differential treatment outcomes. When the SP youth with comorbid Affective Disorder were excluded in treatment outcome analyses, there were non significant differences, indicating that comorbid affective disorders likely contributed to differential treatment outcome. Results are discussed in terms of treatment recommendations for socially phobic youth.

The present study investigated the relations between youth anxiety sensitivity and perceived anxiety control over Internal Reactions and perceived anxiety control over External Threats within the context of a (partially) mediated model in the prediction of anxiety symptoms. Youth sex also was investigated as a moderator of the conceptual model. The sample consisted of 333 children and adolescents (51.4% boys; M = 10.27 years old) referred to a youth anxiety disorders specialty research clinic. Findings showed that high anxiety sensitivity predicted high levels of anxiety symptoms for both boys and girls. Findings also showed that for both boys and girls, high anxiety sensitivity predicted low perceived anxiety control over Internal Reactions, as well as low perceived anxiety control over External Threats. Interestingly, perceived anxiety control over Internal Reactions was a partial mediator of the relation between anxiety sensitivity and anxiety for boys, but not girls. In contrast, perceived anxiety control over External Threats was a partial mediator of the relation between anxiety sensitivity and anxiety for girls, but not boys. The results are discussed within the context of the study's conceptual model as well as potential clinical implications.

No randomized controlled trials (RCTs) have been conducted of cognitive behavioural therapy (CBT) for depressed patients who have not responded to antidepressants, yet CBT is often reserved for this group. We conducted a pilot study for a pragmatic RCT of the clinical effectiveness of CBT as an adjunct to pharmacotherapy in primary care based patients with treatment resistant depression (TRD). Patients on antidepressants for at least 6 weeks were mailed a study invitation by their GP. Those who consented to contact were mailed a questionnaire. TRD was defined as compliance with medication (self-report) and Beck Depression Inventory (BDI) ≥ 15. Those who met ICD-10 depression criteria were eligible for randomization and followed after 4 months. Of 440 patients mailed, 65% responded and 72% consented to contact. Ninety-four percent completed the questionnaire and 82 patients (42%) had TRD. Thirty were subsequently identified as ineligible and 10 did not participate further. Twenty-six of the remaining 42 patients met ICD-10 depression criteria and 25 agreed to being randomized. Twenty-three patients completed the 4-month follow-up questionnaire. Recruitment into a RCT to examine the effectiveness of CBT as an adjunct to pharmacotherapy in primary care based patients with TRD appears feasible and should now be conducted.

This paper reports the psychometric properties of a CBT for psychosis adherence scale, the Revised Cognitive Therapy for Psychosis Adherence Scale (R-CTPAS). The scale's factor structure, inter-rater reliability and concurrent validity were analysed in a sample of 67 audiotaped sessions of CBT for psychosis. The concurrent validity of the scale was examined through comparison with the Cognitive Therapy Scale (CTS, Young and Beck, 1980). Principal components analysis of the trial data suggested three factors: “engagement/assessment work”, “relapse prevention work” and “formulation/schema work”. Satisfactory levels of inter-rater reliability were established between rater dyads. Moderate correlations with the CTS provided an indication of concurrent validity. The R-CTPAS is concluded to be a reliable and useful instrument that can assess adherence to CBT for psychosis using the Fowler, Garety and Kuipers (1995) therapy model.

Clinical significance analyses of controlled studies comparing Exposure and Response Prevention (ERP) and Cognitive Therapy (CT) in the treatment of Obsessive-Compulsive Disorder (OCD) are scarce. The objective of this study is to compare the clinical efficacy of ERP and CT for OCD patients, and the usefulness of each in changing dysfunctional beliefs and thought control strategies at post-treatment and at a one-year follow-up. The two treatments were delivered on the basis of a routine clinical practice in a public-mental health service. Thirty-three OCD patients were randomly assigned to ERP or CT, and 29 completed the treatments (13 in ERP and 16 in CT). The ERP applied was in vivo, gradual and therapist-guided. The CT was designed to challenge all the cognitive domains considered relevant for OCD, using cognitive techniques. The improvement and recovery rates (YBOCS) were slightly superior for CT than for ERP (ERP: 69.23% and 61.53%, respectively; CT: 81.25% and 68.75%, respectively). These therapeutic outcomes were maintained after the two treatments: at the one-year follow-up, 53.85% of the treated patients remained free of symptoms in ERP, and 65.5% in CT. Finally, the two treatments were equally effective in modifying dysfunctional beliefs, and the outcomes at the end of the treatments were maintained, or even increased, one year later.

The theory and principles of Metacognitive therapy (MCT) are described and data supporting its effects are summarized. MCT does not advocate challenging of negative automatic thoughts or traditional schemas. It proposes the existence of a universal maladaptive thinking style that causes disorder and focuses on helping patients regulate their cognition more adaptively. It aims to reduce worry and rumination and alter problematic patterns of attention and coping. In doing so it targets underlying metacognition that controls thinking and helps patients develop new ways of consciously experiencing inner events. Data from treatment studies suggest that individual MCT techniques and full treatment are highly effective. Further randomized trials are clearly warranted.

Despite being a core characteristic of anxiety disorders, little data have been reported on somatic symptoms (SSs) in youth with obsessive-compulsive disorder (OCD). Eighty-five children and adolescents with OCD were administered the Children's Yale Brown Obsessive-Compulsive Scale and completed the Children's Depression Inventory and Multidimensional Anxiety Scale for Children. Their parents completed the Child Behavior Checklist and Children's Obsessive-Compulsive Impact Scale. A subset of youth (n = 62) completed a trial of cognitive-behavioral therapy. The frequency of specific SSs was examined in relation to age, gender, OCD symptom severity, child-rated symptoms of depression and anxiety, parent-proxy ratings of internalizing and externalizing problems, and functional impairment. Ninety-six percent of youth experienced at least one SS, with 67% reporting five or more SSs. Child-rated SSs were positively associated with parent-ratings of child SSs, child-rated anxiety and depression, and parent ratings of the children's internalizing problems. Parent-rated SSs were positively related to parent-proxy ratings of internalizing problems and OCD-related impairment, clinician-rated OCD symptom severity, and child-rated generalized anxiety. Total and several specific SSs were reduced following cognitive-behavioral treatment. These results suggest that SSs are prevalent in youth with OCD, are associated with symptom severity, are reduced after participation in cognitive-behavioral therapy, and warrant attention during assessment and treatment.

Because anxiety and other concurrent psychological problems are common among children with high-functioning autism and Asperger syndrome, research initiatives have been devoted to the development of efficacious treatments to address the multifaceted needs of youth with this presentation. Emerging research indicates that when carefully adapted to accommodate for the unique needs of children with autism spectrum disorders (ASD), cognitive-behavioural therapy (CBT) may be a viable treatment modality. Because inherent features of ASD may compromise the efficacy of traditional CBT, our preliminary work suggests that it may be important to gear intervention efforts towards directly addressing core autism symptoms to promote optimal treatment response. This article describes an evidence-based CBT treatment manual modified and expanded to address core ASD features above and beyond anxiety symptomatology. A case example of a 10-year-old boy with Asperger syndrome is presented with supporting data to illustrate the treatment modifications and their rationale. The positive treatment response attained in this case suggests that an enhanced variant of a standard CBT programme may be an efficacious treatment approach for children with ASD and concurrent anxiety.

Cognitive-behavioral models of obsessive compulsive disorder (OCD) assert that negative appraisals of obsessional thoughts lead to distress over the thoughts and drive ameliorative actions such as thought suppression and compulsions. These responses in turn play a role in the persistence of the disorder. However, past research has not examined (a) what factors lead individuals to suppress obsessional thoughts; (b) whether certain predictors and consequences relate to suppression uniquely or can be explained by general factors such as negative mood and neuroticism; or (c) individuals' natural active suppression of obsessions. The current study addresses these limitations by examining the roles of natural suppression and distress over thought intrusions in the thought-appraisal/OC symptoms relationship while controlling for general factors. Ninety-one nonclinical participants completed a variety of measures assessing theoretically relevant constructs. After their obsessional thought was primed, they recorded their thoughts for 6 minutes and then rated their suppression effort. Four hours later, longer-term outcomes were assessed. Path analyses supported most components of cognitive-behavioral models.