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Objective: To determine if cues help young children discriminate among thoughts, feelings and behaviours. Participants: Ninety-six children aged 4–7 years from three schools in Norwich, UK. Design: Within each age band (4, 5, 6, 7), children were randomised to the cue or the no cue condition on a stratified basis ensuring that equal numbers of boys and girls from each school were in each of the eight cells (cue condition × age). Cues were glove puppets and post boxes. The effect of IQ was controlled. Measures: A discrimination task, in which children were asked to identify a thought, a feeling and a behaviour from each of six brief stories, and a brief IQ assessment were administered to children individually. Results: There was a significant effect of age and cue condition on performance; older children and those who were presented with the cue performed better. There were no gender differences and no interaction between cue condition and age. Conclusion: Many young children discriminated among thoughts, feelings and behaviours suggesting that they may be able to engage in this aspect of cognitive behaviour therapy. Simple cues (puppets and posting boxes) improved children’s performance and these may be useful therapeutic tools with young children.

This paper discusses the work on thought-starting, a clinical technique developed by Durac, over many years. Much clinical work has taken place in using and further developing this approach, and some research has also been carried out. This paper attempts a review of these developments. A selective account of some of the major developments is given. The implications of these developments are also briefly discussed.

The current study examined the role of thought suppression in spider phobia. Spider phobic (n = 41) and non-phobic (n = 40) subjects were asked to monitor their thoughts for three 5 min periods. During the first period, all subjects were instructed to ''think about anything''. During the second period, half of the subjects received suppression instructions (i.e., subjects were explicitly asked ''not to think of spiders''), whereas the other half once again received instructions to ''think about anything''. During the third period, all subjects were instructed to ''think about anything''. Spider-related thoughts were monitored on-line. Also, subjects retrospectively estimated the amount of time they had spent thinking about spiders. Overall, spider phobics reported higher levels of spider-related thoughts than non-phobic subjects. Furthermore, phobic subjects tried harder to suppress spider-related thoughts than non-phobic subjects. Finally, although some evidence was found for the counterproductive effects of thought suppression, its contribution to the frequency of spider-related thoughts was minimal.

Characteristics of social phobics were examined to determine their effect on treatment acceptance, drop-out rate and amount of improvement at post-treatment. The rate of treatment non-acceptance was low and those who entered treatment differed from those who did not only on ratings of social phobia severity. The drop-out rate also was relatively low, and there were no differences between those who dropped out and those who completed treatment. When patients were divided on the specific versus generalized subtype dichotomy, a number of interesting findings emerged. Response to treatment was similar, but the specific subtype was significantly more improved at post-treatment than the generalized subtype. When compared on composite indexes of overall improvement and endstate functioning, there was no difference between the number of specific and generalized social phobics achieving significant or moderate improvement. However, a greater number of the specific subtype were judged to have high or moderate endstate status than the generalized subtype. A similar outcome was found when social phobics with comorbid disorders were compared with those who were non-comorbid. The results are discussed in terms of factors affecting outcome in social phobia treatment.

The aim of this study was to compare two forms of outpatient treatment, educational behavioural treatment and cognitive analytical therapy for adult anorexia nervosa. Thirty patients were randomly allocated to the two treatments. At one year, the group had gained 6.8 kg, 19 30 (63%) had a good or intermediate recovery in terms of nutritional outcome. The group given cognitive analytical treatment reported significantly greater subjective improvement but there were no differences in other outcome parameters. In conclusion outpatient treatment of adult onset anorexia nervosa leads to an improvement in two thirds of cases. Larger studies will be needed to determine the most effective form of treatment in this group.

Deliberate suppression of intrusive thoughts has previously been shown to be associated with higher levels of intrusion compared to monitoring without suppression. In an attempt to apply this paradigm to people attempting smoking reduction and cessation, it was demonstrated that intrusive thoughts about smoking occur frequently. Subjects reported difficulty in controlling smoking related intrusions, and ratings indicated that all subjects made attempts to suppress them. In an experimental study, instructions to suppress were associated with increased frequency of intrusion compared to the control (mention) condition. A simple distracting task was highly effective in reducing intrusion frequency to below the levels obtained in the control condition, and intrusions remained significantly lower during the second (non-suppression) period.

It has been hypothesized that personally relevant negative intrusive thoughts may be the direct precursors of obsessional thinking. Efforts made to suppress or neutralize are said to be involved in the transition between 'normal' and 'abnormal' intrusive thoughts. In order to test this hypothesis, naturally occurring intrusive thoughts were identified in non-clinical subjects, some of whom were asked to suppress these thoughts during an experimental period. The occurrence and characteristics of the target intrusive thoughts during suppression and a subsequent non-suppression period were assessed. The results indicate that (i) suppression can result in increased intrusion; and (ii) that distraction can play an important moderating role. It is suggested that, in suppression experiments, the effects of self-monitoring per se may have been underestimated. Motivated and intrusion-focussed monitoring of consciousness may be as important as suppression, given that obsessional patients tend to be constantly vigilant for the occurrence of obsessional thinking.

The presence of a diagnosable Axis I psychiatric disorder predicted significantly (P less than 0.001) lower likelihood of significant improvement among 90 irritable bowel syndrome patients given cognitive and behavioral treatments to help the disorder. Other psychological tests, including the MMPI, BDI, STAI, as well as demographic variables, failed to yield significant prediction.

Gaudiano's criticism of one part of my review of ACT outcome research (Ost, 2008) is refuted on all issues but one. It is clear that the average amount of grant support for the ACT-studies was smaller than that of CBT-studies, even if the proportion of studies having grant support was not lower. However, that fact should only influence 25% (2 out of 8) of the methodology variables on which ACT-studies had lower mean scores than CBT-studies. It is not acceptable that a relatively new treatment, such as ACT, should be evaluated by more lenient criteria than already established therapies like CBT. If proponents of a new treatment wish to claim that their therapy is empirically supported then they have to accept to be evaluated by the APA Task Force criteria. It is time that ACT researchers start using the current psychotherapy research methodology.

There is ample evidence that the use of safety behaviour can interfere with the progress of therapy, particularly if exposure is involved. As a result, it is widely asserted that safety behaviour is anti-therapeutic. However, an unqualified rejection of safety behaviour should be reconsidered because we now have theoretical justification, experimental evidence and clinical observations showing that the judicious use of safety behaviour, especially in the early stages of treatment, can be facilitative. Experiments in which escape behaviour facilitated fear reduction, and others in which the use of safety gear facilitated fear reduction, are reviewed. It also appears that safety behaviour does not necessarily prevent disconfirmatory experiences. We propose that additional investigations of the judicious use of safety behaviour will help to elucidate therapeutic uses of safety behaviour in the treatment of anxious and related types of psychopathology.

Although overgeneral retrieval of autobiographical memories has been repeatedly demonstrated in posttraumatic stress disorder (PTSD), no studies have indexed overgeneral retrieval before and after treatment of PTSD. Autobiographical memory was assessed in PTSD participants (n=20) prior to commencing cognitive behaviour therapy and 6 months after therapy completion. Fifteen participants completed both assessments. Improvement in PTSD symptoms was significantly associated with improved retrieval of specific memories and decreased retrieval of categoric memories in response to positive cues. These data suggest that symptom reduction during treatment of PTSD leads to greater access to specific memories of positive experiences.

The present study investigates the effectiveness of a 3-h cognitive behavioral workshop for individuals, ages 18-22, with subclinical obsessions and compulsions. It was hypothesized that, compared to individuals in an assessment-only waitlist group (n = 42), individuals assigned to the workshop group (n = 43) would experience a significant decrease in obsessive-compulsive (OC) symptomatology, comorbidity, and thought action fusion endorsement at 1-month and 5-month follow-up assessments. An additional outcome of interest was the number of incident cases of obsessive-compulsive disorder (OCD) over the course of the study. The results indicated that the workshop group reported a significantly fewer number of OC symptoms at 5-month follow-up and endorsed significantly less thought action fusion at both follow-up points. However, there were no differences between groups in severity of OC symptoms and number of comorbid diagnoses endorsed. Only one incident case of OCD was observed during the study, from a participant in the waitlist group. These results are discussed in reference to treatment of subclinical anxiety symptoms.

This study prospectively examined the effect of hopelessness on outcome in cognitive therapy. Hopelessness has a central role in cognitive theories of depression, and consistently predicts suicide attempts and suicide completion. Furthermore, there is indirect evidence that hopelessness predicts cognitive therapy outcome, in terms of early termination of therapy, perhaps in part because theories of therapy change suggest that “remoralization” is a critical first phase of change. It was hypothesized that hopelessness non-responsiveness early in therapy would be predictive of eventual outcome, over and above hopelessness severity at intake. In a naturalistic study of 122 patients diagnosed with unipolar depression, it was found that non-responsive hopelessness predicted outcome in cognitive therapy, and this effect is over and above any effect of initial severity of hopelessness or depression. These findings suggest that patients whose level of hope is responsive to early interventions make more rapid and pronounced improvements during “real world” cognitive therapy.

It has been suggested that disgust plays a prominent role in the fear of spiders. Participants (N=27) displaying marked spider fear were provided 30 min of self-directed in vivo exposure to an actual tarantula, during which time their fear and disgust levels were assessed repeatedly. Growth curve analyses were then conducted to examine the decay slopes in both fear and disgust and their relationship. Consistent with prediction, exposure led to significant declines in both spider fear and spider-specific disgust but not in global disgust sensitivity. However, the decay slope observed for fear was significantly greater than that for disgust. Further analyses revealed that the reduction in disgust during treatment remained significant even after controlling for change in fear; and similarly, change in fear remained significant even after controlling for change in disgust. Contrary to prediction, disgust levels at pretreatment did not moderate the level of fear activation or fear reduction during treatment. Theoretical and clinical implications of the findings are discussed.

Attempted suppression of pain-related thoughts was investigated in consecutive referrals for pain management (N = 39). Participants monitored their pain-related thoughts for three 5-min periods. In period 1, all participants were instructed to think about anything. For period 2, participants were instructed to either suppress pain-related thoughts, attend to pain-related thoughts, or to continue to think about anything. In period 3, all participants were again instructed to think about anything. Participants instructed to attend to their pain reported more pain-related thoughts than suppressors and controls in both periods 2 and 3. Suppressors experienced reduced pain-related thoughts during period 2. There was no immediate enhancement or delayed increase.

Little is known about the relationship between health anxiety and chronic pain. The present study explored whether individual differences in health anxiety would influence the response of chronic pain patients to physical therapy. Furthermore, the interaction of health anxiety with coping strategy usage (distraction versus attention) was studied. Participants were 81 chronic pain patients who were interviewed and completed measures of pain, anxiety and cognition following an active physiotherapy session in which they either: (1) attended to physical sensations; (2) distracted from physical sensations or (3) completed the session as usual. Health anxious, compared to non-health anxious, individuals worried more about their health and injury during the session and attended to and catastrophically misinterpreted sensations more frequently. A complex interaction between health anxiety and coping strategy emerged. Among health anxious patients, attention to sensations resulted in lower anxiety and pain than did distraction. It appears as though attention had a short-term anxiety reducing effect for health anxious patients. Among non-health anxious patients, attention resulted in greater worry about health than distraction. Clinical and theoretical implications are discussed.

The recent cognitive theory of obsessions suggests that catastrophic misinterpretations of the significance of one's unwanted intrusive thoughts gives rise to, and maintains, obsessions (Rachman, Behaviour Research and Therapy, 1997). It follows from this that provision of benign interpretations of the significance of intrusions is likely to challenge and weaken the catastrophic appraisals. This article describes the application of this theory to two adolescents with obsessive-compulsive disorder (OCD). The adolescents were provided with an alternative, benign interpretation of the significance of intrusive thoughts and images using a thought suppression paradigm. It is concluded that a personal demonstration using the thought suppression paradigm is a helpful clinical tool for the cognitive treatment of obsessions in adolescent OCD.

Subjects were shown a short film fragment. Following this, one group of subjects (n = 26) was instructed to suppress their thoughts about the film, while the other group (n = 24) received no instructions. After 5 hrs subjects returned to the laboratory and completed a questionnaire testing their memory about the film. Results showed that suppression subjects reported a higher frequency of thoughts about the film than control subjects. No evidence was obtained for Wegner, Quillian, and Houston's (1996; Journal of Personality and Social Psychology, 71, 680-691) claim that suppression has an undermining effect on memory for chronology. Possible causes for the differences between the results as obtained by Wegner et al., and those found in the present study are discussed. These causes may pertain to the experimental design, but also to differences in emotional impact of the stimulus material that was used in both studies.

The functional connection between unwanted intrusive hair growth and negative automatic cognitions is described and illustrated by case-material. Treatment by cognitive-behavioural therapy (CBT) is recommended as generally successful except when certain facts are denied.

This study evaluates the efficacy of a cognitive treatment for obsessive-compulsive disorder (OCD). Four patients with OCD whose major complaints were checking rituals were treated in a multiple baseline across subjects design. Cognitive correction targeted inflated responsibility, without any exposure or response prevention. All subjects reported a clinically significant decrease in interference caused by rituals, a 52-100% reduction in Y-BOCS scores, and a decrease in perceived responsibility. Therapeutic gains were maintained at follow-up (6 and 12 months) for three patients. Results suggest that cognitive therapy targeting inflated responsibility is a promising alternative to exposure-based treatment.

Thirty-four social phobic patients were treated with either exposure in vivo or an integrated treatment, consisting of rational emotive therapy, social skills training and exposure in viva. Comparison with a waiting-list control group showed the effectiveness of both treatments. Contrary to expectations, the integrated approach was not superior over exposure in vivo alone. Also, the long-term effectiveness of both treatments was equally good.

High and low worriers were primed by a short period of worry, suppression of worry, or the same period of non-worrying thought. Analysis of thoughts during the period following showed that worriers had more than twice as many unpleasant thoughts as did controls, across all prior conditions. Priming condition had little effect on this difference, although worry suppression was associated with a slight increase in the frequency of neutral or pleasant thoughts in high worriers, and a slight decrease in controls. These results are taken as evidence against the hypothesis that suppression of upsetting thoughts increases their intrusive quality, and thereby contributes to anxiety disorders.

It has often been suggested that attempts to suppress a thought will lead to an immediate and/or delayed increase in its occurrence. In a recent experiment (Clark, Ball & Pape, Behaviour Research and Therapy, 29, 253–257, 1991) we obtained a delayed (rebound) effect but failed to demonstrate an immediate enhancement effect. Lavey and van den Hout ( Behavioural Psychotherapy, 18 , 251–258, 1991) have suggested immediate enhancement might be observed only if subjects are instructed not to use distraction while suppressing. The present experiment tested this hypothesis. An immediate enhancement effect was not obtained but the delayed (rebound) effect was twice replicated and an artifactual explanation of this effect was discounted.

Four traditional formats of treatment for writing blocks (automaticity, regimen, self-control, and social skills training) proved insufficient to maintain unblocking in professorial writers for periods of an academic year. A combined application of the four historically prominent interventions was clearly more effective in terms of stable productivity, manuscripts finished and submitted, and manuscripts accepted for publication. Because writing blocks are too often conceptualized and treated by way of lore, a theory of blocking is proposed that clarifies the fundamental steps in effecting lasting unblocking.

Nineteen of 27 patients suffering from Irritable Bowel Syndrome (IBS) who had completed a multicomponent treatment involving progressive muscle relaxation, thermal biofeedback, cognitive therapy and IBS education were located and evaluated 4 yr posttreatment. Seventeen of 19 (89.5, or 63% of the total original sample) rated themselves as more than 50% improved. Six of the 12 patients (50%) who submitted symptom monitoring diaries met our criteria for clinical improvement, i.e. achieving at least a 50% reduction in primary IBS symptom scores. The means on all measures at long-term follow-up were lower than those obtained prior to treatment. When follow-up symptom means were compared with pretreatment means, significant (P less than 0.05) reductions were obtained on abdominal pain/tenderness, diarrhea, nausea, and flatulence.

There is good evidence that psychological treatments can be effective in reducing depression. However, effective treatments often differ considerably in the procedures they include and in their underlying rationales. Thus, the nature of their central effective therapeutic processes is unclear. It is proposed that ‘depression about depression’, arising from a reciprocal relationship between cognitive processing and the depressed state, is frequently an important factor maintaining depression. It is suggested that effective treatments operate, at least in part, by modifying this factor. Evidence from a trial of cognitive therapy consistent with this hypothesis is presented.

A replication of previous work on the incidence and characteristics of intrusive cognitions in non-clinical populations was carried out. The results closely reflected those obtained previously, and further relationships between variables were found. The importance of distinguishing between- and within- S data is stressed.

One reason why exposure to a feared stimulus does not result in a reduction in anxiety involves patients' cognitions as to the typicality of the encounter. This possibility was tested by relating the discrepancy between the discomfort dental patients expect to feel and their actual experience to their views of the typicality of the appointment and any change in dental anxiety reported 3 months later. As predicted, a large discrepancy between expected and experienced pain was associated with a change in anxiety only when the patients were confident that the discrepancy was a typical one. Implications for the design of therapeutic programmes are discussed.

Salkovskis (Behav. Res. Ther.23, 571–583. 1985) offers of cognitive-behavioural analysis of obsessional-compulsive disorder and the treatment implications of the analysis are discussed by Salkovskis (1985) and Salkovskis and Warwick (Behav. Psychother.13, 243–255, 1985). A number of criticisms and objections to this work are set out.

The concept of ‘hypochondriasis’ is examined and an alternative cognitive-behavioural approach to health preoccupation is proposed. Avoidance behaviour (reassurance seeking and checking bodily status) is suggested as an important maintaining factor. In two single case experiments, short-and long-term effects of medical reassurance are assessed in ‘hypochondriacal’ patients; results are fully consistent with the model. Treatment designed to eliminate reassurance and hence to facilitate self-directed exposure and cognitive change proved rapidly effective.

Jakes' critique fails to consider (i) the importance of appraisal of responsibility in initiating neutralising activity, and that (ii) obsessional patients negatively evaluate the occurrence as well as the content of intrusive thoughts. These factors are crucial because neutralising is presumed to be central to the development and maintenance of obsessional disorders. The current form of the hypothesis is outlined and recent data reviewed. Possible experimental investigations on the focus of therapeutic interventions are considered.

Two studies on patients with Chronic, Daily, High Intensity Headache (CDHIHA) are presented. In the first, their response to various self-regulatory (biofeedback, relaxation) treatments was compared to that of case controls matched for age, duration and Ad Hoc Committee diagnoses who had 1–2 headache-free days per week (Group II) and 3–5 headache-free days per week (Group III). The CDHIHA patients had a significantly poorer response to treatment (12.7 vs 49.8% improvement for Groups II and III combined). In the second study, the psychological profiles of an enlarged sample of CDHIHA patients were compared to matched case controls from Group II and Group III. The CDHIHA patients tended to be more anxious, more hysterical and to have more non-headache somatic complaints than Groups II and III combined.

Salkovskis (Behav Res. Ther.27, 677–682, 1989) presents a development of his 1985 account, together with empirical findings. A number of criticisms of this work are presented.