This article argues for the benefits of a revision of cognitive therapy for depression around two main points. First, compared to recently developeded models for other disorders, our knowledge of cognitive content in depression is out of date and attracting little research, as if there is no more to be learned about what depressed people think and feel. Recent trends to challenge cognitive processes, without addressing the relevant content, might therefore meet with limited success, depending on how the content and processes are linked. Second, re-reading Beck et al. (1979) suggests the importance of exploring the meanings attached to precipitating events, a cognitive strategy that has fallen into the background, is probably used in an ad hoc fashion, and needs to be used more systematically to improve clinical effectiveness.

The present study evaluated the relative importance of different cognitive factors (anxiety sensitivity and trauma-related beliefs) in predicting PTSD symptom severity and treatment-related changes in these symptoms. Eighty-one victims of motor vehicle accidents (MVAs) completed self-report measures of PTSD symptoms, anxiety sensitivity (AS), MVA-related beliefs and control variables (e.g., medication use, pain severity). A subsample of patients (n=28), who received cognitive-behavioural treatment for PTSD, completed these measures pre- and post-treatment. For the combined sample (n=81), regression analyses indicated that AS and pain severity were significant predictors of PTSD symptoms, whereas MVA-related beliefs were not. For patients completing treatment, regression analyses indicated that reductions in AS and pain severity were significant predictors of reductions in PTSD symptoms. MVA-related beliefs did not significantly predict symptom reduction once AS, pain severity and medication status was controlled for. These findings suggest that AS is a significant cognitive risk factor for exacerbating and maintaining PTSD symptoms. Treatment implications are discussed.

Motivational interviewing is a client centred behavioural therapy for addictive behaviours. It is an intervention designed to help all addicts, not just those ready to change. It is therefore suitable for use as an opportunistic intervention for clients whose main reason for contact may not be their addiction. A pilot randomized controlled trial of home-based motivational interviewing by a specially trained midwife to help pregnant smokers reduce their habit was performed in Glasgow from February 1997 to January 1998. Did motivational interviewing take place? All 171 counselling interviews from 48 intervention clients were audio-taped. Forty-nine interviews from 13 randomly selected clients were transcribed for content analysis. A rating scale established for feedback to trainee psychologists was used by three experienced analysts. Thirty-two interviews were scored independently to validate the rating scale in this setting. More than 75% of interviews showed satisfactory motivational interviewing. Therapist utterances were motivational, and client responses included many self-motivational statements. Few episodes of client resistance were recorded. Rating took 160 mins per half hour interview. This instrument provided a valid measure of intervention quality for a randomized controlled trial. It would not be practical to document process outside a research environment.

Rational Emotive Behaviour Therapy (REBT) hypothesizes that the functionality of inferences is primarily affected by the preferential and demanding nature of rational and irrational beliefs, respectively. It is then, secondarily, influenced by the functional and dysfunctional contents to which rational and irrational beliefs, respectively, refer. This hypothesis was tested by asking 96 participants to imagine themselves holding one of four specific beliefs: a rational belief with a preference and a functional content, an irrational belief with a demand and a dysfunctional content, a rational belief with a functional content and no preference, and an irrational belief with a dysfunctional content and no demand. Participants imagined themselves holding their belief in an imaginary context, whilst rating the extent of their agreement to 14 functional and dysfunctional inferences. Contrary to REBT theory, results indicated that rational and irrational beliefs had the same magnitude of effect on the functionality of inferences, whether they referred to a preference/demand+contents, or only contents. The discussion maintains that preferences and demands may not constitute the principal mechanism through which rational and irrational beliefs affect the functionality of inferences. Instead, consistent with Beck's cognitive therapy, belief contents may constitute this primary mechanism.

Some studies suggest that self-focus contributes to the onset of depression. A new cogitive model of depression, the three-phase model of self-focus and depression, is presented here to explain the mechanism of the onset and maintenance of depression. In this model, the relationship between self-focus and the course of depression is divided into three phases: (1) initiation, (2) operation, and (3) maintenance. Previous studies examining the relationship between self-focus and depression are reviewed, within the framework of the model: (1) studies investigating situations that will initiate self-focus; (2) studies examining the effects of self-focus on behaviour, cognition, and affect; and (3) studies examining the duration of self-focusing. The model is then presented and propositions derived from it are outlined. Finally, suggestions are made for preventing depression, for recovery from it and for the scope of application of the model.

This study uses semi-structured interviews with obsessionals and nonclinical controls to investigate the frequency with which these individuals experience intrusions about possible harm and the frequency with which they then act to prevent that possible harm. The findings suggest that obsessionals do not generally experience more frequent intrusions about possible harm than do nonobsessionals, but that obsessionals more frequently experience intrusions in specific situations: obsession-relevant situations and situations they find most problematic. There was found to be a generalized difference between obsessionals and nonobsessionals in terms of frequency of actions taken to prevent potential harm following intrusions in situations that are obsession-relevant and obsession-irrelevant. The findings suggest that the occurrence of intrusions is just one factor influencing obsessional behaviour.

Longitudinal evaluations were conducted on 61 adults who were referred to a Mood Disorders Unit with a history of depression (all index episodes reached criteria for DSM-III-R major depression or dysthymia) and who had completed a cognitive behavioural therapy group either on its own or in combination with an assertion training group. Assessment of personality was made using DSM-III-R Axis II personality disorder categories. These categories were aggregated to form three groups: (i) no personality disorder; (ii) Cluster B (dramatic-erratic); and (iii) Cluster C (anxious-fearful), and were used to identify responsiveness to treatment and outcome at long-term follow-up. A battery of self-report measures were administered pretreatment, posttreatment and at long-term follow-up (1–3 years later). Both groups showed significant improvements in mean scores during treatment and these gains were maintained over the follow-up period. However, improvement in those patients without personality disorders was greater at posttreatment and at long-term follow-up, both in level of depressive symptomatology and proportion of cases meeting criteria for recovery. The treatment implications of these results are discussed.

Whilst there is substantial evidence of the efficacy of exposure and response prevention in Obsessive-Compulsive Disorder (OCD), little research has focused on delivering treatment in a more cost-effective way. This study investigated the use of brief treatment of a single 45-minute face-to-face treatment session, followed by eight weekly 15-minute telephone therapy sessions, and a final face-to-face session of 30 minutes. Of the four patients included in this small pilot study, of whom all completed treatment, three clients improved and one client made slight improvement. Given these promising results, further investigation of exposure and response prevention delivered in this way is warranted.