Post traumatic stress disorder (PTSD) and other reactions including driving phobias and depression have in recent years been clearly identified as common motor vehicle accident (MVA) sequelae. To date, no treatment outcome data exist for PTSD following MVA beyond case study reports and one pilot investigation. The present study reports on the first randomized control trial for PTSD following MVA. Twenty volunteer participants who had motor vehicle accidents resulting in physical injury requiring medical attention and PTSD were recruited through rehabilitation service providers, other psychologists, community physicians, and lawyers. Assessments included a structured interview for diagnosis of post traumatic stress disorder (Clinician Administered PTSD Scale) by an independent rater, a range of self-report symptom questionnaires and a behavioural test wherein they had their heart rate and subjective distress measured in reaction to idiosyncratic audio descriptions of their accident. Participants were randomly assigned to eight to ten hours of individual cognitive-behavioural therapy (n=10) or to a wait list control group (n=10). Treatment included education about post-trauma reactions, relaxation training, exposure therapy with cognitive restructuring and instruction for self-directed graduated behaviour practice. Results demonstrated statistically and clinically significant treatment effects across structured interviews, self-report questionnaires and the behavioural test. Treatment gains were maintained over a 6 month follow-up using self-report questionnaires.

We report a subgroup analysis of 24 out of 42 subjects who were hospitalized for non-psychotic major depressive disorder and who agreed to participate in interviews at admission and 2 years afterwards (as reported previously by Domken, Scott, & Kelly, 1994; Bothwell & Scott, 1997). At 2 year follow-up, these 24 subjects were categorized according to established criteria into clients meeting criteria for full remission (FR; n=9) and those meeting criteria for partial remission (PR; n=15). The most striking findings were that, over time, PR subjects showed significant loss of self-esteem and showed greater divergence in self-ratings compared to observer ratings of their depressive symptoms, whilst the same ratings in the FR group changed in the opposite direction. We suggest that the persistence of depression in PR subjects may provide evidence to support Teasdale’s (1988) hypothesis that some individuals “get depressed about being depressed”. The research and clinical implications of the results are noted.

The role of appraisal of negative events in social anxiety of adolescents was studied. One-hundred and sixty-eight Icelandic pupils between the ages of 13 and 15 years completed the Social Phobia and Anxiety Inventory for Children (SPAI-C), Children’s Depression Inventory (CDI), and measures of situational appraisal. Social anxiety was found to be specifically related to the appraisal as threatening of negative social events happening to the self. These relationships remained when depression was partialized out, whereas the reverse was not true. On the whole, the results support the notion of judgmental specificity in relation to social anxiety in adolescents.

This study compares the effectiveness of a standard cognitive-behavioural treatment for panic disorder with a reduced therapist contact program supported by self-help materials. This program shortens the total therapy length (from 10 to 5 weeks) and the contact time with the therapist (from 10 to 5 sessions). The sample was mostly referred from a public mental health unit, and it had a low level of education (average of 9.7 years). The subjects were assessed according to several variables related with panic disorder at pre- and post-test, and at 12-month follow-up. The results demonstrated that both programs produced significant improvements for all variables at post-test, the benefits were maintained at follow-up assessment, and even heightened for some of the measures. Also, both treatment programs obtained comparable improvements for most measures. These results suggest that the programs that reduce the contact with the therapist, supported by self-help materials, and shorten the time that the patient suffers from this problem (Margraf, Barlow, Clark, & Telch, 1993) may be a good intervention for the treatment of panic disorder. These programs can help to overcome some of the cost-benefit therapeutic limitations of standard cognitive-behavioural programs.

Chronic fatigue syndrome is a disabling condition characterized by persistent mental and physical fatigue. Its aetiology is controversial, and it has been attributed to both physical and psychological causes. Previous controlled trials with ambulatory patients have shown that a proportion of CFS patients respond to cognitive-behaviour therapy. In this paper, we report two case studies of patients who are wheelchair-bound, who have been treated by a pragmatic intervention designed to increase activity and challenge dysfunctional illness beliefs. The patients received 60 and 55 contacts with the therapist, some of which were face-to-face and some of which were by telephone. At the end of treatment, the patients experienced clinically significant reductions in fatigue, were not using wheelchairs, showed an increase in occupational and social functioning and were leading relatively independent existences.

A strategy involving urine-triggered alarm signals and prompts combined with positive reinforcement for appropriate urination was employed for promoting daytime urinary continence in a boy with severe intellectual disability. The strategy, which was applied only in the day centre the boy attended, seemed effective for promoting self-initiated toileting actions and for eliminating almost totally large urinary accidents. Some small urinary accidents (consisting of wetting small areas of the underpants) remained. Implications of the findings are discussed.

Training in cognitive therapy includes a grounding in relevant empirical research, and the development of a range of clinical skills. It is recognized that this training will need to be continually updated in line with new developments. Several postgraduate training courses in cognitive therapy or cognitive behaviour therapy exist in the United Kingdom. Such courses are expensive in terms of both direct and indirect costs. A postal survey was employed to investigate the effects of the one-year post-qualification course in cognitive therapy at the Newcastle Cognitive Therapy Centre on trainees who had attended the course. The questionnaire examined trainees’ views about the course, of their current clinical skills in cognitive therapy and their use of cognitive therapy since leaving the course. Finally, continuing professional development, on-going supervision and further training in cognitive therapy were examined.

This single case study describes the successful application of pelvic floor exercise to the treatment of childhood encopresis. A 10-year-old boy with lifelong incontinence of faeces and anal sphincter hypotonia practised daily pelvic floor contractions by interrupting his urine flow mid-stream, the rationale for the regime being strengthening of the sphincter muscle and improvement of its voluntary operation. Benefits to bowel control were immediate and complete cleanliness was achieved in 9 weeks. Being non-intrusive, the exercise procedure may be more acceptable to some patients with anal sphincter flaccidity than balloon biofeedback. The likely mechanism underlying the method is simultaneous contraction of the anorectal sphincter when the bladder sphincter is tensed.

Empirical evidence for the efficacy of Cognitive Therapy (CT) treatments for older adults, when compared with other psychotherapies, is inconclusive (Davies & Collerton, 1997). The current authors suggest that one reason for the equivocal findings lies in the failure to adapt the cognitive rationale sufficiently to cater for the different presentation of depression in older people; particularly for those experiencing first-episode late onset-depression. It is argued that existing models tend to focus on the negative aspects of self-appraisal, and fail to fully conceptualize the functional role of positive beliefs (i.e. functional beliefs that have maintained the self-esteem over many years). The work presents an alternative conceptualization of depression for older people, along with implications for therapy. This framework does not represent a brand new approach, but emphasizes specific aspects of existing psychological conceptualizations.