Background: Irritable bowel syndrome (IBS) is a common co-morbid condition with anxiety disorders, and patients often report a fear of incontinence in public places. This type of bowel control anxiety (BCA) can be conceptualized as a phobic syndrome. Yet little evidence exists on the prevalence or outcomes of these co-morbidities in routine primary care psychological therapy (Improving Access to Psychological Therapies, IAPT) services. Aims: To examine the prevalence and outcomes of IBS and BCA patients treated with cognitive behavioural therapy (CBT) for anxiety disorders within a routine IAPT service. Method: An observational cohort study screened 2322 referrals to an IAPT service over 12 months for the presence of IBS. Patients with co-morbid anxiety disorders and IBS were grouped into those with, and without BCA. Patients completed the IBS symptom severity scale and the IAPT minimum data set. Diagnoses and outcomes were examined for all groups up to 6 months follow-up. Results: A greater proportion of BCA patients had a primary diagnosis of phobic disorder. After receiving CBT, patients made clinically significant improvement in both anxiety and IBS symptoms at 6 months follow-up. Patients with BCA made greater improvement in phobia scales and IBS symptoms than non-BCA patients. Conclusions: Anxiety disorders with co-morbid IBS improved significantly in a routine IAPT service. A significant proportion of co-morbid IBS sufferers had a fear of incontinence in public places (BCA). Directly addressing and modifying these fears with CBT appeared to enhance improvement in both phobic anxiety and IBS symptoms.

Background: Previous research suggests that minimal interventions such as self-help guidance can improve outcomes in patients with fatigue or chronic fatigue syndrome (CFS). Aims: The aim of the current study was to investigate whether self-help guidance could improve physical functioning, social adjustment and fatigue in a group of patients with CFS who were awaiting CBT at a clinic in secondary care. Method: Patients completed questionnaires at their initial assessment (baseline), immediately before beginning CBT (pre-treatment), and after their last session of CBT (end of treatment). The primary outcome was physical functioning, and the secondary outcomes were social adjustment and fatigue. Multi-level linear models were used to assess change over time after adjustment for gender and age. Results: Multi-level models revealed that from baseline to pre-treatment, patients showed statistically significant improvements in physical functioning, but there were no statistically significant improvements in fatigue or social adjustment. However, all the primary and secondary outcomes showed statistically significant changes after CBT. Conclusions: The findings of this study indicate that self-help guidance may be beneficial for patients with CFS who are awaiting CBT treatment or those who are unable to access specialist treatment in their local area.

Background: Therapists in Improving Access to Psychological Therapies (IAPT) services are often expected to treat complex presentations of post-traumatic stress disorder (PTSD), such as individuals with multiple, prolonged or early life trauma histories and significant co-morbidity, for which they have received minimal training. Although high recovery rates for PTSD have been demonstrated in randomized controlled trials, these are not always replicated in routine practice, suggesting that training interventions are required to fill the research–practice gap. Aims: This study investigated the outcomes of a therapist training programme on treating PTSD with trauma-focused cognitive behavioural therapy (TF-CBT). Method: Twenty therapists from ten IAPT services participated in the training, which consisted of workshops, webinars and consultation sessions over a 6-month period. Results: Feedback indicated that participants found the training highly acceptable. PTSD knowledge and self- and supervisor-rated competence on TF-CBT measures improved following the training and improvements were maintained a year later. Client outcomes on a PTSD measure improved following the training. Participants reported attempts to disseminate learning from the course back to their teams. Conclusions: The findings indicate that the training programme was successful in improving TF-CBT knowledge, skills and outcomes for IAPT therapists. Tentative support for training ‘trauma experts’ within IAPT services was found, although institutional constraints and staff turnover may limit the sustainability of the model.

Background: The integrative cognitive model of mood swings proposes that mood symptoms are driven by extreme, self-referent appraisals. For example, if activated mood is appraised positively, this prompts selection of mood regulation strategies that act to up-regulate mood. Appraisals are driven by fast and automatic Type 1 cognitive processes, which, left unchecked, can cause activated mood to escalate. Aims: It was hypothesized that greater propensity to override these automatic processes by engaging in reflective (Type 2) thinking would be negatively associated with extreme appraisals of activation and activation. Method: Study 1 (n = 150) was a cross-sectional survey consisting of measures of activation, extreme appraisals, and an objective performance-based measure of the propensity to engage in reflective thought (cognitive reflection test; CRT). In Study 2 (n = 241) participants completed these measures plus three alternative measures of effortful cognitive engagement (CRT-2, Need for Cognition and Actively Open-Minded Thinking). Results: In Study 1, propensity to engage in reflective thought (higher CRT scores) was not significantly associated with activated mood or extreme appraisals, but activated mood and extreme appraisals were positively correlated. In study 2, the association between activation and extreme appraisals was replicated. Predicted associations between alternative measures of reflective thinking, activated mood, and extreme appraisals were not found. Conclusions: Extreme appraisals of internal states may be a psychological mechanism underlying activated mood. Propensity to reflect on and override default cognitions was unrelated to these extreme appraisals and activated mood. Further research in a clinical sample using mood-relevant measures of reflective thinking is warranted.

Background: Therapist self-practice, in its various forms, is common across therapeutic modalities, but a measure of its impact on participants does not yet exist. Aims: This paper describes the development and reliability testing of the ‘Self-focused Practice Questionnaire’ (SfPQ), a measure of self-perceived impact of one's self-focused practice. Method: Exploratory factor analysis (EFA), internal consistency and reliability were assessed in a convenience sample of 112 trainee therapists. Results: Five factors, rating impacts on therapist Personal-self (Awareness of Developmental experiences, Experience of Personal Change and Felt-sense/Self-awareness), and Therapist-self (Internalization of the Model, and Development of Empathy) were identified, with good internal consistency and acceptable to good test–retest reliability. Conclusions: Though more work is needed, these preliminary results support the SfPQ's reliability and validity. The SfPQ is an important measure, which may enhance routine rating of self-focused practice in training institutions.

Background: Self-critical thinking is common across psychological disorders. This study hypothesized that it may play an important role in ‘overgeneralization’, the process of drawing general implications from an isolated negative experience. Aims: To explore the impact of two experimental tasks designed to elicit self-critical thoughts on the endorsement of general negative self-views of clinical and non-clinical populations. Method: Three groups (depression, eating disorders and non-clinical controls), completed standardized questionnaires and the two tasks. Participants rated their self-critical thinking and general negative self-beliefs before and after each task. Results: Following a failure experience, both clinical groups showed a greater increase in general negative self-views compared with controls, indicating greater overgeneralization. Both habitual and increases in state self-critical thinking were associated with overgeneralization while negative perfectionism was not. Overgeneralization was more strongly associated with post-task reduced mood than self-criticism. Conclusions: Self-critical thinking may be an important factor in the process of overgeneralization, and the increase in general negative self-views may be particularly crucial for lowering of mood.

Background: The evidence regarding whether co-morbid obsessive compulsive personality disorder (OCPD) is associated with treatment outcomes in obsessive compulsive disorder (OCD) is mixed, with some research indicating that OCPD is associated with poorer response, and some showing that it is associated with improved response. Aims: We sought to explore the role of OCPD diagnosis and the personality domain of conscientiousness on treatment outcomes for exposure and response prevention for OCD. Method: The impact of co-morbid OCPD and conscientiousness on treatment outcomes was examined in a clinical sample of 46 participants with OCD. Results: OCPD diagnosis and scores on conscientiousness were not associated with poorer post-treatment OCD severity, as indexed by Yale-Brown Obsessive Compulsive Scale (YBOCS) scores, although the relative sample size of OCPD was small and thus generalizability is limited. Conclusion: This study found no evidence that OCPD or conscientiousness were associated with treatment outcomes for OCD. Further research with larger clinical samples is required.

Background: In a previous effectiveness study (Havnen et al., 2014), 35 obsessive compulsive disorder (OCD) patients underwent Concentrated Exposure Treatment (cET), which is a newly developed group treatment format delivered over four consecutive days. Aims: The primary aims of the present study were to evaluate the treatment results for a new sample of OCD patients receiving the cET treatment approach and to replicate the effectiveness study described in Havnen et al. (2014). Method: Forty-two OCD patients underwent cET treatment. Treatment was delivered by different therapists than in Havnen et al. (2014), except for two groups led by the developers of the treatment. Assessments of OCD symptom severity, treatment satisfaction, and occupational impairment were included. Results: The results showed a significant reduction in Yale-Brown Obsessive Compulsive Scale scores from pre-treatment to post-treatment, which was maintained at 6-month follow-up. At post-treatment, 74% of the sample was remitted; at 6-month follow-up, 60% were recovered. The sample showed a very high degree of overall treatment satisfaction. The results from the present study were statistically compared with those obtained in the previous study. The analyses showed that the study samples had comparable demographic data and equal application of treatment. The outcome of the present and original study did not differ significantly on primary and secondary outcome measures. Conclusions: This study shows that cET was successfully replicated in a new patient sample treated by different therapists than the original study. The results indicate that cET is well accepted by the patients, and the potential for dissemination is discussed.

Background: Researchers focused on developing therapeutic strategies for perfectionism given its well-established link to the onset and maintenance of several mental disorders. Meta-analytical findings provided support for the efficacy of cognitive behavioural (CB) approaches. However, most studies have focused on the efficacy of interventions, without analysing their efficiency. Aims: To explore the feasibility of a brief (five weekly sessions) CB group intervention focused on reducing perfectionistic concerns in Argentine students. We also aimed to identify participants who benefited from the intervention and to explore their differences with non-respondents. A third aim was to explore the potential merits of the intervention in a different cultural context as this is the first attempt to adapt an English-spoken protocol to the Spanish language. Method: A quasi-experimental design with two time points was used. Twenty-four out of 84 participants (mean age = 27.75 years, SD = 8.3) were classified as maladaptive perfectionists. Results: Paired t-tests and reliable change index comparisons revealed that most students (75%) statistically and clinically reduced their levels of perfectionistic concerns as well as their perfectionistic strivings. General distress, operationalized as anxious and depressive symptoms, was also decreased. Students who completed and responded to the intervention were more dysfunctional in academic and psychological measures at baseline than non-completers and non-improvers. Conclusions: Findings support the feasibility, preliminary efficacy and efficiency of this five weekly session intervention when applied to a sample of Argentine university students.