Controlled efficacy/effectiveness trials throughout the world have reached a high standard from a methodological stance, but what do we regard as the ideal or elegant intervention in clinical psychology? This paper presents six key points as the gold standards of psychosocial interventions by which treatment efficacy/effectiveness research with children, adolescents and adults might be evaluated: (1) Theoretical rationale and conceptualization of clinical dysfunction; (2) Clear problem identification and target client group; (3) Program features such as realistic goal setting, flexibility, and time limited interventions; (4) Manual based treatments; (5) Research support including clinically significant outcomes; and (6) Acceptability/social validation of clients and society. Sound case formulation and therapeutic alliance are crucial to assessment-treatment interface. Finally, we discuss the usefulness of such a framework for mental health professionals and clinical-researchers.

This paper describes a cognitive model for first/second onset depression that has been precipitated by major life stress, entrenched for several months and is unresponsive to pharmacotherapy. These conditions create high risks for recurrent/chronic depression and early intervention is proposed to identify, treat and protect against relapse/recurrence. Severe life stress interacts with an individual's core self-representations and personal values, identity is disrupted and depression is maintained by dysfunctional goal engagement and disengagement. Treatment aims to restore functional self-regulation by increasing self-diversification and creating balanced goal investments. Outcome and follow-up data are reported in a case series of five consecutive patients. There was good therapist adherence to the prescribed targets and pre-post effect sizes were comparable or larger than published outcome studies. At the 12 month follow-up, three of the four treatment completers (75%) had made reliable and clinically significant changes and were in full remission. This provides encouraging preliminary evidence for the model's validity and the therapy's efficacy.

Despite being a core characteristic of anxiety disorders, little data have been reported on somatic symptoms (SSs) in youth with obsessive-compulsive disorder (OCD). Eighty-five children and adolescents with OCD were administered the Children's Yale Brown Obsessive-Compulsive Scale and completed the Children's Depression Inventory and Multidimensional Anxiety Scale for Children. Their parents completed the Child Behavior Checklist and Children's Obsessive-Compulsive Impact Scale. A subset of youth (n = 62) completed a trial of cognitive-behavioral therapy. The frequency of specific SSs was examined in relation to age, gender, OCD symptom severity, child-rated symptoms of depression and anxiety, parent-proxy ratings of internalizing and externalizing problems, and functional impairment. Ninety-six percent of youth experienced at least one SS, with 67% reporting five or more SSs. Child-rated SSs were positively associated with parent-ratings of child SSs, child-rated anxiety and depression, and parent ratings of the children's internalizing problems. Parent-rated SSs were positively related to parent-proxy ratings of internalizing problems and OCD-related impairment, clinician-rated OCD symptom severity, and child-rated generalized anxiety. Total and several specific SSs were reduced following cognitive-behavioral treatment. These results suggest that SSs are prevalent in youth with OCD, are associated with symptom severity, are reduced after participation in cognitive-behavioral therapy, and warrant attention during assessment and treatment.

Although the emotion of anger has, in recent years, been the subject of increasing theoretical analysis, there are relatively few accounts of how interventions designed to reduce problematic anger might be related to cognitively oriented theories of emotion. In this review of the literature we describe how a cognitive-behavioural approach to the treatment of those with anger-related problems might be understood in relation to conceptualizations of anger from a cognitive perspective. Three additional interventions (visual feedback, chair-work, forgiveness therapy) are identified that aim to improve the perspective-taking skills of angry clients. It is concluded that such interventions might be considered for use within the context of cognitive-behavioural treatment.

To date, little research has endeavoured to discriminate between cognitive and somatic dimensions of trait anxiety and, consequently, it remains uncertain whether these anxiety dimensions can be reliably distinguished at the trait level. The four studies presented here support the validity of the distinction between cognitive and somatic anxiety at both state and trait levels. The research involved the development and validation of a self-report questionnaire, the State-Trait Inventory for cognitive and somatic anxiety (STICSA). The nature of the anxiety dimensions assessed by this new measure was then investigated. The results indicate that the state scales of this new measure assess the degree of cognitive and somatic anxiety experienced at a particular point in time. The trait scales of the STICSA predict the situations in which different individuals will display elevations in cognitive and somatic state anxiety. Trait cognitive and somatic anxiety are indeed distinct constructs that can be reliably and validly assessed. Theoretical and applied implications of this finding are discussed.

This study investigated the role of metacognitions in high-dependency smokers, low-dependency smokers and non-smokers. A sample of high-dependency smokers (n = 27), low-dependency smokers (n = 33), and non-smokers (n = 43) completed self-report measures of negative emotion, metacognitions and smoking dependence. Results indicated that high-dependency smokers scored higher than non-smokers on Positive Beliefs about Worry. Furthermore on Beliefs about the Need to Control Thoughts high and low-dependency smokers scored higher than non-smokers. A logistic regression analysis indicated that Beliefs about the Need to Control Thoughts were the only predictor of classification as a dependent smoker when controlling for negative emotion. These results are consistent with a metacognitive conceptualization of smoking dependence.

Mental health work is now core to primary care practice, and CBT shows promise as a guiding approach. However, dissemination to primary care practitioners has not yet been demonstrated. A training intervention (a brief CPD workshop of 3–4 hours) plus four case discussion groups lasting 1.5 hours each, plus manual, was evaluated with a convenience sample of N = 25 primary care practitioners. Five adapted self-report questionnaires measured their reactions, learning, and transfer, within a pre-post research design. The participants regarded the training and materials as acceptable. Their performance on declarative and procedural quizzes improved significantly by the post-test, as did their reported transfer of CBT to their primary care work. These positive findings indicate that the training package may be able to produce transferable impacts on primary care practitioners' use of CBT. But the reliance on self-report and the simple design preclude definitive conclusions. Suggestions for an improved research design are offered, together with suggestions on dissemination.

The concept of safety (seeking) behaviours has been very important in cognitive behavioural models of anxiety disorders. Morrison (1998) considered how a similar process may be involved in the development and maintenance of auditory hallucinations; however there has been no research that specifically explores safety behaviours in people who hear voices. The S-REF model (Wells and Matthews, 1994) proposed that compensatory beliefs mediate the choice of coping mechanism. The aim of this study was to explore whether people who hear voices have interpretations about the experience of hearing voices and if this interpretation threatens their physiological or psychological wellbeing, do they engage in safety behaviours to prevent this feared outcome. The study also considered whether the choice of behaviour was cognitively mediated. Twelve participants who had heard voices in the previous 2 weeks completed the study; 11 participants reported catastrophic interpretations and 12 reported using safety behaviours. The theoretical and clinical implications are discussed.

Procrastination can have deleterious effects on well-being. Despite this, little is known about cognitive-attentional processes involved in procrastination. In this study, 12 individuals self-reporting problematic procrastination were assessed using a semi-structured interview to investigate: (1) whether they held positive and/or negative metacognitive beliefs about procrastination; (2) what was their main goal in procrastinating, and how they knew if they had achieved their goal; (3) how they directed their focus of attention when procrastinating; and (4) what they perceived the advantages and disadvantages of these attentional strategies to be. Results indicated that participants endorsed both positive and negative metacognitive beliefs about procrastination, and that the goal of procrastination was to regulate cognition and negative affect. Participants reported that they either did not know how to determine if they had achieved their goal or that an improvement in mood would signal the goal was achieved. Participants also reported that the principal object of their attentional focus when procrastinating was their emotional state. All participants were able to identify disadvantages to their attentional strategies, whilst nine participants described perceived advantages. The implications of the findings are discussed.

Obsessive-compulsive symptoms (OCS) have been observed in a substantial proportion of patients with schizophrenia. Although several studies have investigated the comorbidity associated with OCS in schizophrenia, few case studies are available regarding cognitive behavioural therapy (CBT) for the treatment of OCS of patients within this group. This paper describes a case report in which OCS emerged gradually after the remission of positive symptoms of schizophrenia. The CBT involved psycho education and case formulation, cognitive restructuring, exposure and response prevention (EPR), and behavioural experiments. Improvement in the compulsive behaviours led to a greater insight regarding the relationship between OCS and past experience of positive symptoms (e.g. hallucinations). The cognitive characteristics of the patient were discussed in light of current cognitive models of OCD.