This is going to be an interesting year for CBT. The National Institute of Clinical Excellence (NICE) unveils a series of treatment guidelines this year. These guidelines are intended to support good practice in clinical settings; implicitly, they also seek to discourage ineffective or bad practice. It is becoming evident that CBT is likely to be judged as a first line treatment (or the first line treatment) in a range of anxiety disorders, depression and eating disorders. Other issues which will be tackled include the lack of evidence for just about all other psychological treatment approaches, that CBT should be readily and rapidly available where it is needed and the need for quality control linked with (but not confined to) proper training and supervision of therapists. Early identification of clinical difficulties and a better research understanding of the extent and limitations of current psychological and pharmacological treatments are also likely to be advocated. These are all issues which greatly concern the Association and this journal, and as editor I look forward to receiving empirically based submissions addressing these topics.

Although cognitive behavior therapy (CBT) has been shown to be generally effective in the treatment of social anxiety disorder (SAD), not all individuals respond to treatment, and among those who do respond the degree of improvement is sometimes far from optimal. Little research has examined the impact of variations in the format of treatment delivery in this area. Participants were randomly assigned to either a standard, 12-session CBT program for generalized SAD in which treatment was delivered in successive weekly sessions (standard treatment) or a similar program in which the 12 sessions were delivered over 18 weeks (extended treatment). Intent-to-treat analyses revealed that the standard treatment program resulted in superior outcome in terms of self-rated symptom and impairment levels, categorical ratings of responder status, and lower dropout rates. Analyses of treatment completers only revealed comparable gains between the two conditions by post-treatment. However, the standard treatment condition revealed a more rapid improvement in magnitude initially. These findings suggest no benefit from extending the course of CBT treatment over a greater length of time, and suggest that such extension may in fact substantially increase the likelihood of premature termination.

The current study explored whether, consistent with Wegner's (1994) theory of ironic process of mental control, instructions to suppress rape-related thoughts would lead to paradoxical increases in the accessibility and distress associated with these thoughts. In order to minimize experimental artifacts, instructions and assessments were designed to be unobtrusive. Although no effects of suppression instructions on rape-related distress emerged, directed suppression was associated with a concurrent increase in heart rate. In addition, directed suppression led to a medium-sized effect of increased accessibility, although this effect was nonsignificant due to small sample size. Finally, individual differences in the tendency to suppress thoughts were associated with increased accessibility in the suppression condition, suggesting that thought control strategies may be particularly problematic when they are chronically employed.

Emotional images may be viewed as propositional structures (Lang, 1977), and involve a range of modalities, including cognitive processes. Early memories, however, are often experienced non-verbally (Pillemer, 1998). Self-generated and spontaneous images were investigated in a spider anxious group (N=29) and a non spider anxious group (N=30). Participants completed self-report measures and a detailed semi-structured interview. The spider anxious, compared to the control group, reported more modalities, particularly skin and internal body sensations, in a self-generated spider image than in a control image. Their spider image was also associated with more anxiety, greater intent and vividness, and skin and body sensations that lasted longer. It was also associated with more negative self and other related core beliefs. Themes in core beliefs included loss of control, negative self-evaluation and vulnerability. Most of the spider anxious group reported spontaneous, recurrent images associated with their fear of spiders. Visual, body, skin and auditory sensations were noted. These images were linked to negative self and other related beliefs. Over half identified an associated early memory containing content, emotional meaning and modalities similar to that identified in the initial image. Implications for the treatment and cognitive theory of phobias are considered.

The purpose of this study was to evaluate a new brief training programme in Cognitive Behavioural Therapy (CBT) within a waiting list control group design. A consecutive sample of 90 mental health professionals were allocated routinely by their managers to be trained in CBT. Over 12 week training periods, these 90 professionals received a total of 48 hours of shared learning, covering core CBT theory and techniques for depression and anxiety. An experiential workshop format was utilized throughout and a comprehensive outcome evaluation was conducted, using multiple measures and methods. The findings indicated that the training was effective in terms of the favourable reactions of the participants, the knowledge and skills they gained, and the generalization of this learning to their work environment. It is concluded that brief shared training in CBT can be successful, in line with current NHS priorities.

In this pilot study the influences of the media on suicidal ideation and behaviour were investigated through interviews with patients who had recently engaged in an episode of self-harm. They were asked about the impact of individual media stories, how they had first learned about suicide and the role of the media in the formation of images related to self-harm. Twelve patients between the ages of 17 and 25 were interviewed using a semi-structured interview. Most of the patients reported being affected by a story presented in the media; four reported that a story had prompted them to self-harm. Some also reported beneficial effects of the media on self-harming behaviour, either in terms of preventing an act or encouraging help seeking. This study has shown that in-depth interviews using qualitative and quantitative methods can provide new information about influences of the media on suicidal behaviour.

Cognitive behavioural treatment manuals have increased in frequency, purpose and impact over the last 40 years. Despite numerous papers on the topic, few empirical studies regarding the constitution of treatment manuals have been conducted. A Delphi study examining the factors that constitute a good cognitive behavioural treatment manual is presented. This study generated a consensus of opinion of factors that therapists and researchers should consider when developing and appraising treatment manuals for cognitive behavioural interventions. Limitations of the study and the potential relevance of the research are discussed.

This paper summarizes the best available information on the nature and prevalence of drug-facilitated sexual assault (DFSA) in the UK. Characteristics of the assault itself and the drugs used are described. The minimal available data on the psychological consequences of DFSA are considered. Our clinical experience suggests that DFSA has some psychological consequences that are distinct from those seen in sexual assault without drug involvement. The survivor's response to a fragmented or absent traumatic memory appears important. We suspect that specific characteristics of the assault (for example, obvious premeditation) may affect adjustment. Also, the involvement of alcohol, drugs and an incomplete memory in the survivor's account may affect the levels of validation and social support received. We review the model of post-trauma reactions that seems most useful in treating the consequences of DFSA and suggest additional treatment strategies that address the specific nature of this trauma.

The present study aimed to test the hypothesis that women with high shape concern would differ in their use of mirrors from women with low levels of shape concern. The “Mirror Questionnaire” was completed by 150 women, half of whom had high levels of shape concern. The findings support the notion that women with high shape concern differ from those with low concern in their use of mirrors, and argue for further investigation of the role of mirror cognitions and behaviours in the maintenance of body image disturbance.

Within Primary Care, clients presenting with mental health problems are most likely to report the presence of an anxiety disorder. Referrals to mental health services can result in waiting lists due to the prevalence of individual models of intervention. A service delivery innovation to this organizational impasse has been White's group-based “Stresspac” approach. The current project attempted to increase the effectiveness of such service delivery via the application of practice-based evidence (PBE) guidelines. Clients completed a battery of psychometric tests prior to engaging in and on completion of a six-session group cognitive-behavioural intervention. A satisfaction survey was completed on termination of the group. Two groups were completed, the second of which was conducted using a PBE derived selection criterion. The application of the PBE selection criterion appeared to increase the effectiveness of the intervention provided, with clients in both groups being widely satisfied with the group approach. The active employment of PBE in the design and implementation of services appears to offer the opportunity for increasing the range, format and effectiveness of psychological interventions offered.

A number of studies have shown that patients with obsessive-compulsive disorder do not universally regard their obsessions as either senseless or unlikely to happen. This is of particular significance for the current cognitive-behavioural model of OCD, which is based on the notion that obsessions are ego-dystonic. This study examined the appraisal of obsessions by a group of OCD patients (n=63). Participants completed a paper and pencil task in which they had to appraise a range of intrusive thoughts and contamination fears on two variables: senselessness and likelihood to happen. The results suggest that the appraisals may vary according to the content of the obsessive thought. Contamination obsessions were judged less senseless and more likely to happen than obsessions concerning aggressive and sexual themes. A number of variables, which may play a role in these appraisals, are discussed and the methodological limitations of the study are examined.

Trauma within psychosis is often undiagnosed or untreated. There is a wide body of literature on the efficacy of cognitive behaviour therapy (CBT) for post-traumatic stress disorder (PTSD), but there has been no report of combining CBT for psychosis and CBT for PTSD in modular form. The authors discuss a combined treatment for two patients with psychosis and a history of trauma. The clinical features, process of therapy, and outcome are all described in relation to cognitive therapy models developed for use in PTSD. The implications for therapy, service development, and training are discussed.

We assessed the use of a microswitch cluster to improve assisted ambulation in a man with multiple disabilities. The cluster included two optic microswitches at the man's heels to detect his steps and a pressure microswitch under his right arm to detect his body posture (i.e. whether he had an upright, appropriate posture or was leaning forward). The man received 2.5 seconds of favourite stimulation at each step provided that his posture was appropriate. The results showed that there was a large increase in the man's appropriate posture during walking throughout the intervention phases and the 3-month follow-up.