The journal would be nothing without our strong editorial team; so, thanks and farewell to Craig Steel as Book Review Editor (and to Tracy Johnson who has ably assisted him). Fortunately, we retain Craig as Associate Editor specializing in Psychosis. Also fortunately, we are able to welcome a new book review team: Victoria Oldfield and Fiona Challacombe. I would like to take this opportunity to thank our wonderful team of Specialist Associate Editors for the excellent work they do. Also a big welcome to Manuela Herrera, our new editorial assistant, who has ably taken up her duties and is making everyone's life better and easier!

This study investigated whether brief training in cognitive therapy for panic disorder (Clark et al., 1994) can improve the outcomes that primary care therapists obtain with their patients. Seven primary care therapists treated 36 patients meeting DSM-IV (APA, 1994) criteria for panic disorder with or without agoraphobia in general practice surgeries. Outcomes for the cohort of patients whom the therapists treated with their usual methods (treatment-as-usual) before the training (N = 12) were compared with those obtained with similar patients treated by the same therapists after brief training and ongoing supervision in cognitive therapy (CT) for panic disorder (N = 24). Treatment-as-usual led to significant improvements in panic severity, general anxiety, and depression. However, only a small proportion (17% of the intent-to-treat sample) became panic free and there was no improvement in agoraphobic avoidance. Patients treated with CT achieved significantly better outcomes on all measures of panic attacks, including panic-free rate (54%, intent-to-treat), and showed significantly greater improvements in agoraphobic avoidance and patient-rated general anxiety. In conclusion, cognitive therapy for panic disorder can be successfully disseminated in primary care with a brief therapist training and supervision programme that leads to significant improvements in patient outcomes.

Clinical significance analyses of controlled studies comparing Exposure and Response Prevention (ERP) and Cognitive Therapy (CT) in the treatment of Obsessive-Compulsive Disorder (OCD) are scarce. The objective of this study is to compare the clinical efficacy of ERP and CT for OCD patients, and the usefulness of each in changing dysfunctional beliefs and thought control strategies at post-treatment and at a one-year follow-up. The two treatments were delivered on the basis of a routine clinical practice in a public-mental health service. Thirty-three OCD patients were randomly assigned to ERP or CT, and 29 completed the treatments (13 in ERP and 16 in CT). The ERP applied was in vivo, gradual and therapist-guided. The CT was designed to challenge all the cognitive domains considered relevant for OCD, using cognitive techniques. The improvement and recovery rates (YBOCS) were slightly superior for CT than for ERP (ERP: 69.23% and 61.53%, respectively; CT: 81.25% and 68.75%, respectively). These therapeutic outcomes were maintained after the two treatments: at the one-year follow-up, 53.85% of the treated patients remained free of symptoms in ERP, and 65.5% in CT. Finally, the two treatments were equally effective in modifying dysfunctional beliefs, and the outcomes at the end of the treatments were maintained, or even increased, one year later.

This study was a controlled clinical trial in which patients were offered a brief low cost, low intensity self-help intervention while waiting for psychological therapy. A CBT based self-help pack was given to patients with significant anxiety problems and no attempt was made to exclude patients on the basis of severity or co-morbidity. The treatment group received the intervention immediately following assessment and the control group after a delay of 8 weeks so comparisons between the two groups were made over 8 weeks. Although there was some support for the effectiveness of the self help intervention, with a significant time x group interaction for CORE-OM scores, this was not significant with the intention to treat analysis, nor for HADS anxiety and depression scores and the effect size was low. A follow up evaluation suggested some patients attributed significant goal attainment to the intervention. The findings suggest the routine use of self-help interventions in psychological therapies services should be considered although further more adequately powered research is required to identify the type of patients and problems that most benefit, possible adverse effects and the effect on subsequent uptake of and engagement in therapy.

Mindfulness training has been proposed as a potentially important new approach for the treatment of generalized anxiety disorder (GAD). However, to date only a few studies have investigated mindfulness training for GAD. The aim of this study was to further investigate symptom change and recovery in pathological worry after mindfulness-based cognitive therapy (MBCT) using an uncontrolled pre-post design. Twenty-three adults with a primary diagnosis of GAD participated in the study. The MBCT program involved 9 weekly 2-hour group sessions, a post-treatment assessment session, and 6-week and 3-month follow-up sessions. Intent-to-treat analysis revealed significant improvements in pathological worry, stress, quality of life, and a number of other symptoms at post-treatment, which were maintained at follow-up. Attrition was also low, and MBCT was perceived as a credible and acceptable intervention. However, when applying standardized recovery criteria to pathological worry scores, the rate of recovery at post-treatment was very small, although improved at follow-up. Overall, the findings suggest MBCT is definitely worthy of further investigation as a treatment option for GAD, but falls well short of outcomes achieved by past research. Possible reasons for the poor rate of recovery, implications, and limitations are briefly outlined.

This study reports an evaluation of a 10-day training course in cognitive behaviour therapy (CBT). The course comprised both formal CBT workshops and clinical case supervision, and was evaluated on measures of trainee satisfaction, trainee- and assessor-rated measures of CBT skill, and clinical outcomes for a subgroup of trainees' patients. The course was well received by trainees and their post-training therapy tapes were rated significantly higher on both trainee- and assessor-rated measures of CBT skills. In addition, trainees achieved significantly better outcomes with their patients after the training course than before, suggesting that the training impacted not only on their skills but also on their effectiveness in routine clinical practice. The limitations of the study and implications for future research in training are discussed.

The quality control of therapy in routine clinical practice depends to a large degree on the ability of therapists to evaluate accurately their own performance in administering therapy. However, the literature in many fields casts doubt on the accuracy of people's self-evaluations. This study aimed to examine the accuracy of therapists' judgments about their own competence in cognitive therapy. Twenty-two therapists rated a tape of one of their cognitive therapy sessions from the middle of therapy using the Cognitive Therapy Scale (CTS) and provided information about their profession and their training in cognitive therapy. An independent expert rater, blind to all information about the therapist, also rated these tapes on the CTS. Therapists were coded as Competent or Less Competent on the basis of the observer-rated CTS score. Whilst there was a significant correlation between self-ratings and expert ratings of competence, therapists significantly over-rated their competence relative to the expert rater. Less competent therapists over-rated their own competence to a greater degree than therapists who met criteria for competence. The finding that therapists, especially less competent therapists, over-rate their competence in cognitive therapy has serious implications for ensuring effective practice of cognitive therapy in routine clinical situations.

Relationships between trauma symptoms and delusional ideation were explored in a forensic sample. A between-subjects design compared low and high trauma scoring patients on measures of delusional ideation and paranoia. A within-subjects design examined associations between trauma-related cognitions, delusional ideation and paranoia. Thirty-four participants were recruited from a number of secure units. Participants' “worst trauma” was identified using a self-report analogue scale. Self-report measures of trauma symptoms, trauma-related beliefs, delusions and paranoia were completed. Thirteen patients scored above the cut-off on the trauma measure, indicating a high rate of trauma symptoms. The most frequently cited worst traumas were committing an offence and the experience of psychosis. Correlational analyses revealed positive associations between traumatization and intensity of delusional ideation and paranoia. Trauma-related negative cognitions about the self were positively associated with level of delusional ideation, associated distress, and preoccupation. Negative cognitions about the world were associated with paranoia. Findings provide some evidence for associations between traumatization and delusional ideation and paranoia in this population. Future research should aim to replicate and extend the study, using a larger sample size and diagnostic measures of post-traumatic stress disorder (PTSD).

According to the cognitive model, an inflated sense of responsibility is an important cognitive mediator both in the development and maintenance of obsessive-compulsive disorder (OCD). Empirical findings assign differential roles to responsibility in different kinds of obsessive-compulsive (OC) symptoms. However, findings that suggested a different function for responsibility revealed the need for an operational definition of responsibility and its multi-factorial structure. Few studies have examined the role of responsibility in OC symptoms in adolescents. The present study therefore aimed to explore responsibility concerns and to evaluate the relationship between responsibility dimensions and obsessive-compulsive symptom subgroups in two samples of adolescents and university students in a developing non-Western country. The findings suggested that the Responsibility Attitude Scale had a bifactorial structure, responsibility being based on self-dangerousness and prevention. Adolescents reported more responsibility in prevention and self-dangerousness than university students. The results appear to contribute to the symptom differentiation of OC behaviour by highlighting the importance of both dimensions of responsibility for checking symptoms, responsibility based on danger prevention for cleaning and, finally, responsibility based on self-dangerousness for obsessive thinking. Replication with clinical samples and different methodologies are encouraged.

Clinical supervision is of growing importance professionally, but instruments to measure its effectiveness are scarce. Based on the observational instrument Teachers' PETS, two complementary levels of outcome measurement were used to analyse supervisory effectiveness, namely momentary time sampling (i.e. a micro-analysis of frequencies) and the more molar “change episodes”. Ten audio-taped sessions of routine (baseline; N = 5) and CBT supervision (N = 5; i.e. the intervention phase) were coded with both measures, to assess their relative sensitivity to this manipulation. Improved supervisee learning was detected during the intervention phase by both measures. However, a retrospective comparison between the data within these change episodes and the accompanying non-episode data indicated that the micro level of analysis provided a more sensitive measure of supervisory effectiveness. Technical and conceptual issues arise.

Anxiety symptoms and panic disorder are common sequelae of chronic obstructive pulmonary disease, an illness that primarily affects older adults. The aim of this paper is to describe the application of cognitive behavioural treatment for two patients with chronic obstructive pulmonary disease and co-morbid panic disorder. The patients attended for eight to twelve sessions of cognitive behaviour therapy. Both improved on a range of indices of anxiety and quality of life. Neither patient met criteria for panic disorder at the end of treatment or over the following year. These two cases provide evidence that interventions of proven efficacy for treating panic disorder in healthy individuals can be adapted to treat patients with chronic obstructive pulmonary disease.