Background: Childhood worry is common, and yet little is known about why some children develop pathological worry and others do not. Two theories of adult worry that are particularly relevant to children are Davey's problem-solving model in which perseverative worry occurs as a result of thwarted problem-solving attempts, and Wells’ metacognitive model, in which positive and negative beliefs about worry interact to produce pathological worry. Aims: The present study aimed to test hypotheses that levels of worry in young children are associated with poor or avoidant solution generation for social problems, and poor problem-solving confidence. It also aimed to explore beliefs about worry in this age group, and to examine their relationships with worry, anxiety and age. Method: Fifty-seven young children (6–10 years) responded to open ended questions about social problem-solving situations and beliefs about worry, and completed measures of worry, anxiety and problem-solving confidence. Results: Children with higher levels of worry and anxiety reported using more avoidant solutions in social problem situations and children's low confidence in problem solving was associated with high levels of worry. Children as young as 6 years old reported both positive and negative beliefs about worry, but neither were associated with age, gender, or level of anxiety or worry. Conclusions: Results indicate similarities between adults and children in the relationships between problem-solving variables and worry, but not in relationships between beliefs about worry and worry. This may be due to developmental factors, or may be the result of measurement issues.

Background: There is a dearth of information about imagery in pain sufferers. Aim: The aim of this study was to collect data on the characteristics, prevalence, and potency of imagery associated with pain. Method: The images of 59 pain sufferers were assessed by means of a semi-structured interview. The emotional, cognitive, behavioural, and pain-inducing properties (potency) of their index images were assessed by an image induction procedure and self-report scales of anxiety, depression and trauma symptoms. Results: The results showed a remarkably high incidence of images in pain sufferers, with 78% of participants reporting one or more repetitive images when in pain. Exposure to their most powerful/distressing image (Index image) resulted in significant increases in negative emotions, negative cognitive appraisals, and in pain levels. In a sub-group of sufferers with significant levels of trauma symptoms, the index images elicited significantly higher levels of emotion and pain increment than did those respondents in a low/no trauma group. Conclusion: It was concluded that imagery is a prevalent, often “unobserved” but potent cognition in pain sufferers. The implications for CBT approaches to chronic pain, including image rescripting, are considered.

Background: Motivational Interviewing (MI) and Acceptance and Commitment Therapy (ACT) are two emerging therapies that focus on commitment to behavior change. Aim: The aim was to provide the first systematic comparison of MI with ACT. Method: A systematic comparison was undertaken of MI and ACT at the conceptual level, with a focus on their philosophical and theoretical bases, and at the clinical level, with a focus on the therapeutic relationship, use of language in therapy, and use of values in therapy. Results: Conceptually, MI and ACT have distinct philosophical bases. MI's theoretical basis focuses on language content, whereas ACT's theoretical basis focuses on language process. Clinically, ACT and MI have distinct approaches to the therapeutic relationship, fundamentally different foci on client language, and different uses of client values to motivate behavior change. ACT, but not MI, directly targets the willingness to experience thoughts, feelings, and sensations. Conclusions: Despite their conceptual and clinical differences, MI and ACT are complementary interventions. Collaborations between MI and ACT researchers may yield fruitful cross-fertilization research on core processes and clinical outcomes.

Background: The Vancouver Obsessive Compulsive Inventory (VOCI) is a self-report measure of the severity of obsessive-compulsive problems such as contamination, checking, obsessions, hoarding, needing things to be just right, and indecisiveness. In the seminal paper a six-correlated-factor structure was found in a sample of OC patients, but the issue of the factor structure of the VOCI in non-clinical populations was not addressed. Aim: This study assesses the psychometric properties and the factor structure of the Italian version of the VOCI in a non-clinical sample. Method: The VOCI was administered to a large community sample (n = 445). Some participants also completed a battery including measures of OC behaviour, worry, anxiety and depression (n = 89) and were administered the VOCI twice at an 8-week interval (n = 46). Results: Confirmatory factor analyses replicated the six-correlated-factor structure originally found in a patient sample, but a more parsimonious, second-order-factor model showed a statistically higher fit, suggesting that VOCI subscales can be considered as facets of a higher-order OCD factor. The whole item pool and each of the subscales showed good internal consistency, unidimensionality, test-retest reliability and convergent construct validity. As in the original version, limited support for discriminant validity was found. Scores were weakly associated with age, gender and education. Conclusions: Although some key issues still need to be investigated (e.g. sensitivity to change), the VOCI seems to be a psychometrically sound instrument for the assessment of OCD-related behaviours and thoughts and can be used in cultural contexts different from the original.

Background: In contrast to a wealth of research on the treatment of Obsessive Compulsive Disorder (OCD), there is a relative paucity of work examining how OCD begins. Available data suggest that there is often a slow progression from the onset of symptoms to meeting criteria for a diagnosis of OCD. Aims: The current study sought to add to existing data documenting the slow-development of OCD, and to extend previous findings by examining potential moderators of this symptom phase and to examine patients’ explanations for the transition from symptoms to disorder. Method: One hundred and ninety-nine individuals with OCD reported on the start of their symptoms and the disorder via an internet-based survey. Results: Over two-thirds of respondents reported that the development of their OCD was gradual. Further, participants reported having experienced obsessions and/or compulsions for an average of 5 years before experiencing full-blown OCD. This extended symptom phase was observed in individuals with early- and late-onset OCD, with an even more protracted symptom phase in the later group. Female gender and onset of compulsions prior to obsessions were also associated with slower progression to full-blown OCD. Finally, explanations for the transition from symptoms to disorder suggest that changes in daily routines and general stress may be particularly important in this transition for individuals that develop clinical OCD at age 18 or later. Conclusions: Existence of a protracted symptom phase may present opportunities for elucidating risk factors for OCD disease progression and a window of opportunity for indicated prevention programs.

Background: Eating disturbances and poor body image are maintained by body-related safety behaviours and their associated cognitions. These include body checking, avoidance, comparison and display, which can be seen as safety behaviours, maintaining eating pathology and poor body image. It is not clear from the existing literature whether these behavioural and cognitive patterns are independently related to eating psychopathology. Method: This study of a non-clinical group of women and men (N = 250) explored the association of eating attitudes and behaviours with these four elements of body-related behaviours and cognitions. Results: It was found that each of the four elements had independent associations with eating attitudes and behaviours. Those associations were not explained by anxiety or depression levels. Discussion: Whilst these findings require study within a clinical group, they suggest that all four elements of body-related behaviours and cognitions need to be considered as potential maintaining factors when formulating eating psychopathology and body image disturbance.

Background: A self-verification model of social anxiety views negative social self-esteem as a core feature of social anxiety. This core feature is proposed to be maintained through self-verification processes, such as by leading individuals with negative social self-esteem to prefer negative social feedback. This model is tested in two studies. Methods: In Study 1, questionnaires were administered to a college sample (N = 317). In Study 2, questionnaires were administered to anxiety disordered patients (N = 62) before and after treatment. Results: Study 1 developed measures of preference for negative social feedback and social self-esteem, and provided evidence of their incremental validity in a college sample. Study 2 found that these two variables are not strongly related to fears of evaluation, are relatively unaffected by a treatment that targets such fears, and predict residual social anxiety following treatment. Conclusions: Overall, these studies provide preliminary evidence for a self-verification model of social anxiety.

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: A premise of cognitive behavioural treatment is that individuals make cognitive, behavioural and situational changes prompted by interventions and that these changes bring about improvements in targeted outcomes. Aims: The present project set out to provide reliability and validity information for a brief measure of therapeutically induced change. Methods: A total of 281 participants, comprising three samples who took part in three different intervention studies, completed items relating to cognitive, behavioural and situational changes and completed measures relating to the intervention in which they participated. Results: The internal consistency of the scale assessing therapeutically induced change was high in the three samples. The scale showed evidence of validity through association with (1) more involvement in an intervention (2) reporting that an intervention was meaningful (3) being instructed to incorporate insights gained from an intervention into one's daily life (4) greater decreases in psychological distress and negative affect from pre-intervention to post-intervention, and (5) greater increases in positive affect from pre-intervention to post-intervention. Conclusions: The therapeutically-induced change scale may have utility as a process measure in various interventions.