There is a paucity of research exploring the validity, reliability and impact on clinical outcome of Cognitive Behavioural Psychotherapy (CBP) case formulations. This review considers a variety of literature that relates to formulations and their use, it also draws on other types of psychotherapy where there appears to be a more established and robust research base. The literature review explores the research that has taken place within CBP and considers the themes that emerge from this research. Several themes were identified and these relate to decision-making and experience, specific guidelines to aid quality of formulations and a significant lack of understanding of clients' views on the formulation process and its outcome. It is unclear whether formulations do influence the successfulness of therapy. Recommendations are made as to what further research is needed and the form this should take.

A range of clinicians (n = 72) were asked to provide a definition of a schema. The participants were selected from different parts of the broad church of the CBT community, with all having received some training in CBT – although only 26.4% had a formal CBT qualification. Fourteen themes were identified, suggesting that the concept is perceived to be complex. However, the mean number of themes identified per clinician's definition was small: 2.86 (mode = 2). We consider this finding reflects a problem concerning a lack of clarity with respect to the use of one of the key concepts in CBT.

This editorial introduces the special issue of The Cognitive Behaviour Therapist on Control Theory and CBT. The various routes through which Perceptual Control Theory (PCT) can inform CBT are explained and a range of theory, research and practice articles are introduced. Each focuses on encouraging and validating a Control Theory perspective to the clinical practice of cognitive behavioural therapies.

The aim of this pilot study was to test whether a future-oriented expressive writing intervention is able to reduce post-traumatic stress disorder (PTSD) severity and associated symptoms such as depression and unhelpful trauma-related beliefs. In an uncontrolled pre-/ post-design participants attended 8 weeks of manualized therapy. Assessment was undertaken pre- and post-treatment, and participants also completed a 3-month follow-up assessment. Of the 17 participants who began therapy, 13 were treatment completers. Results indicated a significant decrease in PTSD severity, depression and unhelpful trauma-related cognitions from pre- to post-treatment and at 3-month follow-up. Clinically meaningful change was more modest; however, three participants reported PTSD remission at 3-month follow-up. It is concluded that expressive writing with a focus on achieving future goals and personal change may have some utility in reducing post-traumatic stress but future research will need to investigate this with greater methodological rigour before firm conclusions can be made.

I have been asked to describe how Perceptual Control Theory (PCT) and Method of Levels (MOL) came into being, and as I approach the age of 82 that seems a prudent request. Some parts of the following should probably be taken more as a reconstruction than a verifiable record of the past, but I will strive for realism.

Cognitive behavioural interventions specifically for older people have been described and researched for the last 30 years. However, despite a robust evidence base to support the use of CBT in the treatment of mental disorders in younger adults, trials with older people have generally been of poor methodological quality. Therefore, the potential of CBT to improve the outcome of late-life mental illness has not yet been adequately tested and demonstrated. The priorities, if this is to happen, are to develop standardized, reproducible CBT interventions and to evaluate these in large trials alongside medication or as part of case-management interventions.

Using 16 non-clinical adults from the community, this study examined the effects on well-being of a group intervention consisting of a 4-week behavioural activation component followed by a 3-week mindfulness component, finishing with an integrating closure session. Results from intention-to-treat analyses showed moderate and significant improvements in psychological distress and several indices of well-being after the behavioural activation component. These improvements continued through the mindfulness component of the intervention such that effects were greater after participants had received the complete intervention. Half of the participants reported reliable and clinically significant improvement in the amount of time they felt happy after the intervention and a quarter of participants reported improvement at follow-up. Behavioural activation and mindfulness interventions may provide a useful framework for further research with non-clinical populations who wish to enhance their well-being and learn skills that may protect them against depression and other mental health problems.

CBT treatment programmes for children and adolescents with anxiety disorders are promising as indicated by efficacy research. Replicating this research in ordinary clinical care is crucial in order to establish the validity of these results and disseminate empirically based treatments to practitioners. This paper presents the first experiences of using a structured programme, the Friends for Life manual, in ordinary clinical care in Norway targeting anxiety problems in children aged between 7 and 12 years. The effects of the treatment are presented as multiple single-case studies. Clinical meaningful change is considered from two perspectives; diagnostic change and changes in self-report measures. At a statistical significance level the treatment effect can be characterized as modest. Independent of the symptom reduction, the children, families and therapist are in the main satisfied with the structured approach indicating the acceptability of the programme.

Dismantling studies are used in psychotherapy in order to understand the important components of treatment. Typically, this has occurred so that people could understand the unique contributions provided by cognitive versus behavioural techniques. Recently, mindfulness-based approaches have apparently added a third dimension to the dismantling enterprise. Dismantling is seen as an important way of understanding the change process in psychotherapy and, therefore, clarifying how we might most effectively promote change. The way in which an entity is dismantled, however, exposes assumptions about the nature of the entity and its organization. In this paper we argue that dismantling studies in psychotherapy have perhaps generated more confusion than consensus and have provided little practical benefit for clinicians. We suggest that the phenomenon of control might provide a unifying perspective from which to approach the integration of behavioural, cognitive, and mindfulness approaches. In one sense all these seemingly different approaches are doing the same thing and it is this ‘thing’ we highlight in this paper.

Depressive disorders are relatively common in adolescents although less so in younger children. They accrue significant morbidity and frequent long-term sequelae as well as increased suicide risk in sufferers. Evidence-based treatment of depression in children and adolescents is the subject of intense investigation and debate. This article reviews the current evidence base for cognitive behaviour therapy in this group and makes recommendations for further areas of research.

We describe the results of a randomized controlled trial to assess effectiveness of an anger management group programme, employing a cognitive behavioural framework that was run by the Psychology Service. The treatment group was compared with a control group on a waiting list. The trial was performed at the Southampton CBT Service. The treatment group received a cognitive behavioural anger management programme, initially based on Novaco's approach, but with further development of the motivational components. The control group received no treatment and was on a waiting list. The Novaco Anger Assessment Scale (NAS), State-Trait Anger Expression Inventory (STAXI), Evaluative Beliefs Scale (EBS), Hospital Anxiety and Depression Scale (HAD) and the Clinical Outcomes in Routine Evaluations (CORE) were used to measure anger, belief about self and others, anxiety and depression, and physical and psychological wellbeing. Clients in the anger management group showed statistically significant changes on STAXI, NAS, CORE and EBS subscales at the end of the therapy. The change in depression and anxiety on HAD (depression and anxiety) was not statistically significant. It was not possible to carry out analyses at follow-up due to high dropout rates. We concluded that an anger management programme using CBT was helpful in reducing anger and overall psychopathology.

This article summarizes the current knowledge and treatment for a specific phobia of vomiting (SPOV). It is relatively uncommon compared to other specific phobias but may have been misdiagnosed in catchment-area surveys. The differential diagnosis of SPOV includes obsessive–compulsive disorder, hypochondriacal disorder and anorexia nervosa. I discuss the following: a model that is linked to past aversive experiences of vomiting; conducting a clinical assessment; making a formulation; psycho-education, engagement and therapy. The strategies employed depend on the formulation but are likely to include: exposure in vivo to cues of vomiting, exposure in imagination and role-plays of vomiting, imagery re-scripting, behavioural experiments; and dropping of safety-seeking behaviours.

Individually focused CBT for road traffic accident (RTA)-related post-traumatic stress disorder (PTSD) involving exposure and cognitive restructuring has been shown to be effective. Group CBT interventions provide an opportunity for treatment to be delivered in a cost-effective fashion and may also be ‘normalizing’ for patients, but few evaluations have been published. Many elements of CBT lend themselves well to group presentation, although implementing exposure presents a specific problem. The development and preliminary evaluation of a group (n = 6) targeting RTA-related PTSD is described here. Pre- and post-questionnaire evaluation is accompanied by assessment of patient satisfaction. Four of the group no longer met diagnostic criteria and the remaining two showed clinically significant change in both the number and severity of symptoms. In addition symptoms of depression decreased from the severe to the mild range within the group and there were high levels of participant satisfaction reported. Further research is required to evaluate this and similar packages before group treatment can be advocated as an alternative to individual CBT for PTSD.

Recently, autobiographical memory theorists proposed that intrusive imagery contains important information about goals. This study examined thematic links between approach and avoidance goals in two groups: a clinical group (n = 22) and a non-clinical group (n = 24). Participants completed the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), Goals Task and an imagery interview. In the total sample, almost 90% of reported imagery matched at least one goal. Eighty-five percent of clinical participants reported imagery that matched avoidance goals, whereas only half of non-clinical participants' imagery matched an avoidance goal. The majority of imagery was found to be associated with a particular memory or a collection of memories for similar events. These findings support proposals that intrusive imagery contains important information about goals, and in particular states of the world to be avoided. Clinical implications and directions for future research are discussed.

The construct of cognitive errors is clinically relevant for cognitive therapy of mood disorders. Beck's universality hypothesis postulates the relevance of negative cognitions in all subtypes of mood disorders, as well as positive cognitions for manic states. This hypothesis has rarely been empirically addressed for patients presenting bipolar affective disorder (BD). In-patients (n = 30) presenting with BD were interviewed, as were 30 participants of a matched control group. Valid and reliable observer-rater methodology for cognitive errors was applied to the session transcripts. Overall, patients make more cognitive errors than controls. When manic and depressive patients were compared, parts of the universality hypothesis were confirmed. Manic symptoms are related to positive and negative cognitive errors. These results are discussed with regard to the main assumptions of the cognitive model for depression; thus adding an argument for extending it to the BD diagnostic group, taking into consideration specificities in terms of cognitive errors. Clinical implications for cognitive therapy of BD are suggested.

Interpersonal dynamics are a recurring impediment to effective clinical supervision and can lead to phenomena like collusion between the supervisor and supervisee. Collusion involves both supervisor and supervisee engaging in safety behaviours that serve to conveniently avoid and escape from difficult topics and challenging methods. Whilst minimizing the short-term threat to supervisor and supervisee, collusion will tend to undermine the effectiveness of supervision and limit significantly its long-term value to patients. In order to consider how best to address collusion, we review the cognitive-behavioural therapy (CBT) and related literature on collusion, focusing on how it has been formulated and managed. We then provide a case study featuring a supervisor who was colluding with the supervisee's avoidance behaviours (i.e. filling supervision sessions with superficial reflections on his casework) by not challenging these reflections or moving to another learning mode (e.g. experimenting). We develop a CBT formulation of this pattern of supervision as part of the self-reflection process, led by a consultant. Self-reflection appeared to be a useful tool for improving the supervisor's understanding of this dysfunctional process, and strengthened the supervisor's confidence in utilizing relevant skills in the future.

The Oracle of Delphi's admonition to ‘know thyself’ may be more difficult than it seems, when it comes to self-assessment of competence in cognitive behaviour therapy (CBT). This paper investigates the accuracy of self-rating of competence in relation to other measures such as ‘direct’ assessment of videotaped sessions or supervisor ratings. Self-assessment of competence is something most of us do and arguably has an important role in professional development, but it may also be biased and unreliable. Two measures were developed, based on the Cognitive Therapy Scale – Revised, to assess student and supervisor assessments of competence at the start and end of a CBT training course. Competence data across a range of measures from a 5-year audit of a postgraduate CBT course is presented and the relationship between self-rated and other-rated measures explored. Results are discussed and it is suggested that trainee self-assessment, while not found in this study to be correlated with other measure of competence, may provide important information about confidence development, and areas where a trainee perceives they have strengths and weaknesses.

Method of Levels (MOL) is a form of cognitive therapy based on Perceptual Control Theory (PCT). This paper presents the initial steps towards four methods of establishing the validity of MOL. First, the session was rated by two independent experts for its adherence to MOL using a newly developed 6-item scale based on the Cognitive Therapy Rating Scale. Second, each therapist utterance within a session of MOL was coded and categorized in terms of the therapist's goal to test for adherence to the two specified goals of MOL. Third, a macroanalysis of a MOL session utilizing interpretative phenomenological analysis hypothesized the control hierarchies involved in a client's presenting problem and their zones of conflict. Fourth, a microanalysis of a brief interchange between the therapist and client explored its adherence to PCT. These methods of establishing validity are introduced and explored for later use in larger scale studies. The limitations of the present study and suggestions for future research are discussed.

Exposure therapy is a widely used and well-evidenced treatment for a variety of avoidance behaviours. This paper offers a modest proposal for an improvement in how it is carried out (‘dynamic hierarchies’). The theoretical and practical context is set out, including some thoughts on the role of appraisals and cognitive dissonance, and some advantages of the method are suggested.

The Method of Levels (MOL) shares many similarities with other therapeutic approaches and is perhaps most distinguishable by what it does not include rather than what it does use in sessions. MOL has two basic steps which are followed in an iterative procedure until the patient/client experiences a change or shift in their understanding and experience of a problem. This article explains the steps and uses examples and suggestions for practice to promote understanding.